Medication Safety

1
Medication Safety

• James Morris R.Ph.
• Director of Pharmacy
• Greenview Regional Hospital

2
The Institute of Medicine

• 4 of hospitalized patients suffer an adverse
  event
• As many as 98,000 patient may die annually due to
  medical mistakes
• Medical mistakes are the 5th leading cause of
  death, ahead of auto accidents, suicide, breast
  cancer, diabetes, and AIDS.

3
Cost of Medical Errors

• 2 of admissions to American hospitals have a
  preventable drug event resulting in
• Increased length of stay by 4.6 days
• Increased hospital cost of 4,700 per admission

4
Medication Errors

• 50 of all prescriptions filled are used
  inappropriately
• 10 of all admission to hospitals are related to
  the use of prescription drugs
• The most common mistake in a hospital involves
  the use of medication.

5
Prescription Errors

• 46 year old man went to his Doctor for chronic
  back and leg pain. The Doctor changed his
  medication to a different narcotic pain reliever.
• Within 36 hours, the patient was found dead on
  the shower floor.
• The medication instructions on the bottle were
  wrong and did not reflect the MDs orders.

6
28.5 Million Verdict

• 42 year old mother undergoing chemotherapy for
  breast cancer.
• Pharmacy dispensed a blood thinner medication ten
  times stronger than prescribed.
• The patient suffered a stroke that left her an
  invalid and forced a stop in her chemotherapy.
• The patient ultimately died.

7
6 Million Mistake

• 31 year old high school teacher died of a toxic
  drug reaction.
• The patient was taking 2 drugs and was not warned
  about the danger of taking them together.
• Two different doctors prescribed the medications.

8
31 Million Mistake

• 79 year old man has his prescription filled for
  his gout.
• The wrong medication was dispensed.
• The patient went into kidney failure, started
  dialysis, and went into a fatal health slide.

9
Pharmacists

• Pharm D is the entry level into Pharmacy today
• 6 years of education 2 years pre-pharmacy, 4
  years of Pharmacy School
• Experiential Rotations begin the 1st year of
  Pharmacy School working in Pharmacies,
  Hospital, etc.

10
Pharmacist Shortage

• 30 increase in prescription volumes from 1992 to
  1999
• Growth in population 65 years of age or older
  which uses a disproportionately high share of
  prescription drugs
• High requirements for administrative requirements
  for handling 3rd party payments.

11
Pharmacist Shortage

• By 2020, the annual volume of prescriptions is
  expected to rise from 3 billion to 7.2 billion
• Vacancy rates for pharmacists nationwide reported
  in 2005 5971 open positions

12
General Drug Safety Tips

• Keep a record of your current medicines,
  including the names regimens (dose/time)
• Write down any problems you have with medicines
  so you can discuss with your doctor or pharmacist
• Read labels carefully before taking the medicine

13
Tips continued

• Ask the doctor or pharmacist before crushing or
  splitting tablets, some should be only be
  swallowed whole.
• Contact the doctor or pharmacist if new or
  unexpected symptoms or other problems appear.
  Some reactions are delayed.
• Never stop taking the medicine the doctor has
  told you to finish just because symptoms
  disappear.

14
Tips - Continued

• Ask the doctor to periodically reevaluate long
  term treatments.
• If you have questions, talk to the doctor or
  pharmacist before using an OTC medicine the first
  time, especially if you use other medicine
• Carefully read OTC medicine labels for
  ingredients, proper uses, directions, warnings,
  precautions, and expiration dates.

15
Tips Continued

• Discard outdated medicine (carefully)
• Store medicine in the original container, where
  the label identifies it and gives direction for
  use. If you choose to use a convenience
  container, ask the pharmacist whether the
  container will affect the stability of the
  medication.

16
Tips - Continued

• Never store medicine in the bathroom. Unless
  otherwise instructed, keep it away from heat,
  light and moisture.
• Never store medicine near a dangerous substance
  which could be taken by mistake.
• Never take someone elses medicine

17
Tips - Continued

• Tell you health professional if you
• Are breast feeding or may be pregnant
• Are allergic to drugs or food
• Have diabetes, kidney, or liver disease
• Take other prescription or OTC medicines
• Follow a special diet or take dietary supplements
• Use alcohol or tobacco.

18
Tips last one

• Use one pharmacy only for all of your
  prescription needs.

19
FDA 101

• Since 2000, the FDA has received more than 95,000
  reports of medication errors through a voluntary
  reporting system called MedWatch.
• In reviewing errors reported, the FDA has seen
  its role evolve to protect consumers

20
FDAs Role

• Drug name review to minimize confusion, the FDA
  reviews about 4000 drug names that companies
  submit as proposed names. The agency rejects
  about one-third of the names that drug companies
  propose.

21
FDAs Role

• Drug labels FDA requires that all over the
  counter drug products (more than 100,000) have a
  standardized drug facts label. The FDA has also
  improved prescription drug package inserts for
  health care professionals, including BLACK BOX
  warnings.

22
FDAs Role

• Drug labeling and packaging. FDA works with drug
  companies to reduce the risk of errors that may
  result from similar-looking labeling and
  packaging, or from poor product design.

23
FDAs Role

• Bar Code Label Rule. In accordance with an FDA
  rule that went into effect, bar codes are
  required on product labels for certain drugs and
  biologics such as blood. When used with bar code
  scanner and computerized patient information
  systems, bar code technology can help ensure that
  the right dose of the right drug is given to the
  right patient at the right time.

24
FDAs Role

• Error analysis FDA reviews about 1400 reports
  of medication errors per month and analyzes them
  to determine the cause and type of error.

25
FDAs Role

• Guidance for Industry. FDA is working on three
  new guidances one on complete submission
  requirements for analysis of trade names, one
  about the pitfalls of drug labeling, and another
  on best practices for naming drugs.

26
FDAs Role

• Public Education. FDA spreads the message about
  medication errors through public health
  advisories, medication guides, and outreach
  partnerships with other organizations.

27
Counterfeit Medication

• Drugs sold under a product name without proper
  authorization. May include products without the
  active ingredient, insufficient or excessive
  quantity of the active ingredient, with the wrong
  active ingredient, or with fake packaging

28
Counterfeit Medication

• Risk unexpected side effects, allergic
  reactions, or worsening of their medical
  condition. A number of counterfeit medications
  have been found to contain no active ingredient
  and contain only inert substances or hazardous
  substances

29
Counterfeit Medication

• Prevalence Unknown, Difficult to detect or
  investigate. More prevalent in developing
  countries. The World Health Organization (WHO)
  estimates that counterfeit drugs range from less
  than 1 in developed countries to over 30 in
  some developing countries.

30
Counterfeit Medications

• Counterfeit drugs in the US. Less than most
  countries due to the strict regulatory framework
  that governs the production, distribution, and
  enforcement against violators.
• Two highly publicized examples
• Lipitor
• Procrit

31
Counterfeit Medications

• Safety do not use unverified internet
  distributors. Look for the web site to have the
  Verified Internet Pharmacy Practice Site Seal
• (VIPPS). These are licensed by the state in
  which they reside.

32
Summary

• Patient need to take an active role in their own
  care, read labels, ask questions, ask questions,
  ask questions.
• Keep you medication list with you and up to date.
• Bring the list to each healthcare provider you
  see.