Safe Use Of Medications
Safe Use Of Medications
(Hospital Pharmacy Chapter# 10)
(Doctor of Pharmacy)
Contents
❖ Introduction
❖ Categories of Medication Errors
❖ Factors Contributing Towards Medication Error
❖ Safe Drug Use Program
❖ Role of Pharmacist In Medication Error
Prepared By
• Junaid Khan
• Doctor of Pharmacy
• University of Malakand, KPK, Pakistan
• Phone (WhatsApp): +92 3239692385
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Safe Use Of Medications
Safe Use Of Medications
Introduction
Pharmacist has a moral, legal and professional duty for safe drug use in hospital or institution.
Any sort of deviation from the pre-set standards specified by the manufacturer or given by
the physician at the time of prescribing, instructions given at the time of dispensing by
pharmacist which may lead to failure or ineffective therapeutic responses is called medication
error.
Categories of Medication Errors
Occurrence of medication errors is a daily matter in hospitals and health care institutions.
Following are the categories of medication errors:
1. Omission Error
2. Unauthorized Drug Error
3. Wrong Dose Error
4. Wrong Route Error
5. Wrong Site Error
6. Wrong Rate Error
7. Wrong Dosage Form Error
8. Wrong Time Error
9. Wrong Preparation of a Dose
10. Incorrect Administration Technique
1. Omission Error
When nurse fails to administer physician dose to the patient is known as omissions error.
These errors includes: patients less intake of medication as prescribed by physician,
discontinuation of drug before prescribed time and omission of dose as prescribed by
physician. Omission error may lead to sub-therapeutic level of the prescribed drugs,
Medication omission is not regarded as an error if a patient refuses to take medication or
if dose is not administered because of any recognized contraindications.
2. Unauthorized Drug Error
Unauthorized drug error is the administration of drug to the wrong patient, use of
duplication doses of medication and use of un-prescribed medication to the patient. The
uses of medication outside clinical parameters are also unauthorized drug error. These
errors may lead to unpredictable blood levels of the drugs in patient.
3. Wrong Dose Error
A wrong dose error is the administration of wrong quantity of medication, it may be
above (2 tablets instead of 1) or below (1 tablet instead of 2) than the prescribed doses.
It may be giving same drug from 2 different bottles or taking less or more than the
prescribed dose per day.
4. Wrong Route Error
The administration of drug by a route other than the prescribed route is known as wrong
route error e.g., a drug prescribed for administration via I/M route is administered via I/V
route is known as wrong route error.
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Safe Use Of Medications
5. Wrong Site Error
It is medication error in which a dose is given at a wrong site via correct route of
administration. e.g., administration of drug into left ear is administered to right ear. This
error leads to no therapeutic response.
6. Wrong Rate Error
The administration of a drug at a rate not specified in patient’s prescription e.g.,
administration of I/V infusion without specifying rate of administration.
7. Wrong Dosage Form Error
Intake of wrong dosage form than that of the specified in physician’s prescription e.g., use
of an ophthalmic ointment when a solution was prescribed by physician is the example of
this type of error.
8. Wrong Time Error
The wrong dose error is an administration of a dose of drug greater or lesser than its
scheduled medication time. A hospital sets a policy for limitation of such type of errors
during administration of drugs.
9. Wrong Preparation of a Dose
This type of error is an incorrect preparation of a dose not complied with physician or
manufacturer instructions. The examples of this type of error are use of incorrect
reconstitution volume, wrong dilution, not shaking a suspension, not keeping a light sensitive
drug protected from light and mixing drugs that are physically / chemically incompatible.
The use of an expired drug is also included under this error category.
10. Incorrect Administration Technique
The administration of drug by using an improper technique or a technical not consistent
with the instructions of the physician, examples are not using a Z- track injection technique
when indicated for a drug. Z-track is an intramuscular injection technique used for
medication that stain upper tissue or irritate tissues. In this technique, skin is displaced
laterally prior to injection, needle is inserted and syringe aspirated and the injection is
performed the needle is then withdrawn and the skin released. This creates a Z-pattern
that blocks the infiltration of the medication into subcutaneous tissues.
Factors Contributing Towards Medication Error
1. Hospital Administration Related Factors
a) Inadequate policies regarding safe use of drugs.
b) Inadequate policies regarding reporting of incidence.
c) Inadequate policies concerning performance.
2. Personnel Related Factors
a) No hospital pharmacist employed.
b) No administered nurse employed.
c) Over burden personnel.
3. Techniques Related Factors
a) Use of non-professional staff in areas requiring professional judgment.
b) Inadequate labeling of drugs and allied materials.
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Safe Use Of Medications
4. Facilities Related Factors
a) Inadequate storage and equipment facilities.
b) Inadequate drug stations on patient care.
Safe Drug Use Program
A program for insuring safety in handling and administration of drugs is responsibility of
pharmacy and therapeutic committee (PTC).
1. Medication Error Detection and Reporting System
Hospital must be having a system for reporting of medication error. If this system is not
developed then life threatening consequences may occur. Medication error must be
reported on a standard medication error form typically containing:
a) Patient’s Identification.
b) Name, strength and dosage form of drug.
c) Route of administration.
d) Type of error reported.
e) Physician comments in the error.
f) Corrective measures taken against the error.
g) Name of the nursing staff or nurse reporting the error.
2. Monitoring Adverse Drug Reactions (ADR’s)
Adverse drug reaction is any response to a drug which is noxious (harmful or poisonous)
and which occurs at doses used for prophylaxis (treatment given or action taken to prevent
disease), diagnosis or therapy leading to pathological conditions. Adverse drug reaction
includes toxicity caused by overdose, hypersensitivity or allergy for any medication error.
In the hospital or health care institution, pharmacy and therapeutic committee (PTC)
assumes responsibility of adverse drug reaction, monitoring and to formulate effective
prevention system and treatment. It is the responsibility of the nurse to complete an
adverse drug reaction form and send to chairman of committee.
3. Drug Utilization Review
Drug utilization review is ongoing system for improving quality of drug used within hospital
in which, pharmacy and medical staff are involved. Drug utilization review requires
development of an evaluation process for prescribing, dispensing, administering and
ingesting of prescription drugs. Drug utilization review helps in identifying problems in
drug use.
4. Drug Interaction Surveillance
Safe use of medication in the hospital requires drug interaction monitoring. Drug
interaction surveillance is a program which is used for the identification of drug-drug
interaction. Drug interaction surveillance can be accomplished by devising a program of
working from a direct copy of the physician’s original order sheet, preparing a patient
drug profile and drug interaction reporting form. Now-a-days computer software are
used in the hospital. The computer of physician is connected with pharmacist and nurse. The
physician enters the medication in his computer that is displayed in the computer of
pharmacy. The pharmacist checks accuracy of the physician prescription and will check
drug- drug interaction possibilities.
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Safe Use Of Medications
5. Drug product Defect Reporting System
The medication dispensed and supplied from pharmacy should meet high standards of
quality to assure safety and efficacy when used properly. Sometimes, an error or accident
happens with a finished product during its distribution. The pharmacy committee sets down
a system for drug defect reporting program whereby, physicians or hospital pharmacists
report any defect in a drug observed during its distribution. The reportable defects may
include,
a) Inadequate packaging
b) Inadequate labels
c) Changed taste, color
d) Inaccurate fill or count of drug product.
The pharmacist plays an important role in detection and reporting of product defects
through participation in defect reporting program. The information provided through this
program helps to hospital, manufacturing, and drug authority in maintaining quality
standards of drug. These reports may result in changes in product labeling, warning letters
to health care professionals regarding safe conditions of use, requirement for further
clinical studies.
6. Therapeutic Drug Monitoring (TDM)
Therapeutic drug monitoring is a routine estimation of plasma concentration of a drug, the
pharmacologic or toxic effect of which has a direct correlation with its concentration in
blood. The advancement in drug assay technology has made it possible to measure the
plasma concentration of the majority of drugs used in clinical practice. A clinical
pharmacist should ideally supervise the TDM services. TDM program provides clinician with
valuable information towards maximizing safety and efficacy of drug therapy. The
patients benefited from the TDM program includes that with impaired renal failure without
TDM, a large number of patient populations would have to receive dosages having
concentrations outside the therapeutic range.
7. Patient Care Audits
Audit means a comparison of actual practice with best practice to judge its quality.
Numbers of services are provided from hospital pharmacy and these have an impact on
patients, either directly or indirectly. Patient care audits are needed for safe drug
administration. Patient care audits uses the clear-cut measurable process and outcome
criteria applied to a sufficiently large number of patients records to evaluate quality of
care being provided. The patient care audits requires the following profiling of
a. Choice of therapeutic agent.
b. Choice of dosage form
c. Choice of route of administration
d. Drug allergy
e. Effect of therapy upon utilization of hospital facilities.
f. Follow-up and discharge medication.
Role of Pharmacist In Medication Error
We know that any sort of medication error can lead to inappropriate error of the therapy
suggested for particular patient. Pharmacist must assume the responsibility concerning the
matter of medication error. Pharmacist can play effective role in term of:
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Safe Use Of Medications
1. Identification and Documentation
The adverse drug reaction and drug interactions may be checked on daily basis by
screening prescriptions vigilantly (watch alertly to avoid danger). After identification of
suspected adverse reaction or any drug interaction, the pharmacist is in position to prevent
their recurrence. These reactions can be recorded in the medical notes, the patient
medication records, or entered into computer for study purpose. The hospital pharmacist
has a direct contact with outpatients and is able to obtain relevant details from them to
allow assessment of potential adverse drug reactions and their prevention subsequently.
2. Participation in Monitoring and Reporting
A pharmacist can report any event of drug interaction, adverse drug reaction or drug
defect. A pharmacist can also act as a facilitator by encouraging physicians to report
these events. The pharmacists are involved in setting up and running of reporting systems
of the unusual responses of drugs in a hospital. The pharmacists working in drug
information center may prepare information for distribution to medical staff and
pharmacists. This will prevent the future occurrence of the unwanted reactions.
3. Prevention
Most of the adverse drug interactions are preventable thus the major role of pharmacist is
to reduce such problems. Pharmacists can be involved in improving the use of drugs in
patients through:
a) Identifying potential side effects of drug therapy and advising the patients.
b) Checking for a history of allergy or previous reactions to a drug.
c) Avoiding unnecessary several drugs for the treatment of any ailment by
encouraging and carrying out review of therapy already prescribed.
d) Avoiding unnecessary several drugs treatment.
e) Using the least toxic drugs where possible.
f) Careful consideration of dosage requirements for individual patients.
g) Assuring therapeutic drug monitoring and for taking of appropriate laboratory test.
h) Checking for possible drug-drug interaction
i) To educate the patient on drug regimen particularly when new treatment is initiated.
j) Encouraging patient to complete courses of medication and disposal off unused
drugs to prevent accumulation, mixing of drugs and poising incidents.
k) Encouraging patient to report any sort of new symptoms appear on him/her.
l) Advising on simplifying dose and drug.
m) Routine sharing of information between various medical staff personnel.
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