Pharmacists should take leadership role on all medication issues-Marianne Ivey


PSHSP’s 3rd International conference
Pharmacists should take leadership role
on all medication issues-Marianne Ivey
Medication error is a major cause 
of preventable patient harm

KARACHI: Healthcare team expects that pharmacists should take the leadership role on all medication issues. Medication error is a major cause of preventable patient harm and identifying resources for expensive technology should be part of capital budget planning. This was stated by Dr. Marianne Ivey Prof. Emeritus Pharmacy Practice and Administrative Sciences at University of Cincinnati and former President of American Society of Health System Pharmacists. She was speaking at the 6th National and 3rd International conference organized by Pakistan Society of Health-System Pharmacists at Karachi on September 28th 2019.

Continuing Ms. Marianne pointed out that medications continue to be more targeted with increased risk. Targeted therapy increases Benefits as well as Risks. She was of the view that one should know the number of medication errors i.e. Error rate. Use process at different steps of medication and be mindful of factors which contribute to error. Ensure tracking low and high technologies that increase safety. She also highlighted the benefits of multidisciplinary approach.

 Ms. Marianne Ivey

Speaking about the current issues related to patient safety she mentioned medication shortages, lack of regulations i.e. dietary supplements, transition of care. Data producing technology analysis, she opined, is complex. She also referred to intra operative integration of technology and the importance of standardization. The activities which can improve mediation safety, she stated include use of generic names wherever appropriate, tailored prescribing for each patient, doing thorough medication histories, know the risk level of different medications and use precautions, educate yourself to know medications well, use both low and high memory technology aids, communicate clearly, do check of medication use steps, encourage the patients to become involved in their treatment and report and learn from medication errors.

It is also important to have Medication Safety Officers, ensure regulatory and accreditation compliance, use infusion pumps maintenance, do medication safety data analysis, help justify capital purchases for medication safety. Ensuring technology deployment and its maintenance, reporting, documentation and committee leadership were all extremely important. Hospital policy, she further stated, should exist based on the language of medication safety. It should be the Pharmacy and Therapeutics Committee which should set policies including side effects, adverse reactions, errors, adverse events. Some of these may or may not be preventable. Some may lead to harm. Some are near misses which neither does any harm nor have the potential. Different steps in medication use process include procurement, prescribing, preparing, dispensing and administration. Different steps most often associated with errors are dose, route, timing, documenting, communicating and educating. The prescription, she stated, can go wrong in case of inadequate knowledge about indications/contra indications, non-consideration of different patient factors like pregnancy, age, allergies, co-morbidities, wrong patient, wrong dose, wrong timing and wrong drug besides wrong route of administration. Other reasons include inadequate communication, illegible documentation, errors in math for dose calculation besides incorrect computer data entry i.e. duplication and omission etc. Look Alike, Sound Alike drugs and ambiguous nomenclature can also lead to errors. It is also important that one writes neatly or the order is printed if possible. Drug administration can go wrong with failure to administer besides inadequate documentation. Other causes include too fast administration of medications, failure to discontinue medication in case it is ineffective or course has been completed or discontinuation of medication before completing the full course. In addition if drug levels are not measured or not followed or there could be communication failure as well. Bar-coded medications, bar coded armbands, bar coded nurse’s badges and error-reducing infusion pumps are also quite useful. Inexperience of the pharmacists, rush to prescribe, doing too many things at a time, fatigue, boredom, lack of double checking, poor teamwork and dependence on memory can also lead to medication errors, she remarked. Absence of safety culture at work place can also be a contributory factor. Some drugs have narrow therapeutic window, be mindful of interaction with other drugs, complex dosage and monitoring schedule. Know the precautions to take in case of high risk medications. ASHP Summit held in 2008 had identified three main barriers which included lack of standardization and good process design for intravenous medication, lack of shared accountability for safety among different healthcare disciplines besides high volume, high demand environments in which safety may be sacrificed because of other priorities. Later Experts panels were formed consisting of physicians, nurses, pharmacists, spanning specialties including critical care, anaesthesia, emergency, trauma, and medication safety and information technology. They prepared guidelines and then published final standards. It was also emphasized to disseminate standards and promote their adoption. Some of the challenges which we face include drugs shortages, package size and dose mismatches in certain cases. Medication errors also occur due to improper medication reconciliation. She also highlighted the guiding principles for oral compounds and the challenges which are faced in this area.

Marianne Ivy concluded her presentation by suggesting that we should give pharmacy students rotation in medication safety and remember to take inter-professional approach including informatics team. Do hospital survey to assess medication safety culture and justify the appointment of Medication Safety Officer with clearly laid down responsibilities.

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