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Safe Drug Dispensing
Vivien GamBSc Pharm, PharmD, RPh
Medication Error• Human beings are prone to errors• Number of reported medical errors is rising• Increase awareness by consumers, the
media and regulators• Patients expect the practice of health care
in an environment free from accidental injury and risk
• Health care workers expect to work within systems that support safe and effective care
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HUMAN ERRORS ARE SYMPTOMS OF
DEEPER TROUBLE
Sidney Dekker (2002); The Field Guide to Human Error Investigations
Why do errors occur ?• Deficit in
• Deficit in
• Or
knowledge
performance (practices)performance (practices)
both of the aboveboth of the above
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Training of Pharmacy Technicians
• Pharmacy technician training programs– US ~ 1100 hours– Canada ~ 2 years– UK ~ 2 years
“..who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions”
~Pharmacy Technician Certification Board~
Training of Dispensers
• HK – 3 years (post secondary 5)– Higher Diploma in Pharmaceutical Technology 配藥及製藥高級文憑 (IVE/CW)Hong Kong Institute of Vocational Education (Chai Wan) 香港專業教育學院
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Training of Dispensers
• Higher Diploma in Pharmaceutical Technology– Year 1 – foundation modules
(chemistry, physiology, data processing, introduction to dispensing, pharmaceutics, etc.)Summer Placement
– Year 2 – basic pharmaceutical modules(drug actions, basic dispensing and pharmacy practice, manufacturing and GMP, management, etc.)Summer Placement
– Year 3 – application modules(dispensing and pharmacy practice, therapeutics, toxicology, quality assurance, etc.)
Good Practices
• A good checking and tracking system• Continuous quality improvement • Focus on the whole process• Total involvement (frontline and
management)
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Three C’s
• Concentration 專心
• Caution 小心
• Conscientiousness 責任心
Concentration
• Human beings are not made to be multi-taskers• Interruptions and distractions increase error
rates• Drivers on cell phones have 50% more
accidents, 25% of traffic accidents are “distracted drivers”
Michael Leonard, Safer Healthcare Now Presentation, 2005
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Concentration
• Work environment• Minimize distractions• Focus on one task at a time• Work on one drug item at a time• Fatigue and stress can reduce our
concentration
Caution
• Things to watch out – Drug names– Strengths– Dosage forms– Routes of administration
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Drug Names
• Brand names ( beware of multiple brand names for the same generic drug)
• Always use generic names • Use the complete drug name (drug names
can have more than one word)• Note the complete spelling of the drug
name (look alike/ sound alike names)
Use the Complete Drug Name
• Modified release dosage form
Adalatcap10mg
Adalat GITS tab 60mg
Adalat Retard tab 20mg
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Use the Complete Drug Name
• Modified release dosage form
TegretolCR divitab200mg
Tegretol tab 200mg
Use the Complete Drug Name
• Modified release dosage form
– Elantan tab 20mg– Elantan Long cap
50mg
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Use the Complete Drug Name
• Modified release
– Sinemet 25/100 tab – Sinemet 25/250 tab – Sinemet CR 50/200
tab
Use the Complete Drug Name
• Modified release dosage form
Timoptol 0.5% ophthalmic solution
Timoptol-XE 0.25% ophthamicsolution
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Use the Complete Drug Name
• Combination products– Betnovate Cream– Betnovate
Ointment – Betnovate-N
Ointment
Complete spelling of drug namesLook-alikes and Sound-alikes
www.wiseregional.com/ Pharmacy.asp
www.artthrob.co.za/ 99feb/news.htm
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Look-alikes and Sound-alikes
• Clozaril (Brand; Anti-psychotic drug)
• Clinoril (Brand; NSAID)
Look-alikes and Sound-alikes
• Daonil(Brand; Hypoglycemic drug)
• Lodine (Brand; NSAID)
• Isordil(Brand; Vasodilator)
• Codeine (Generic; Narcotic)
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Look-alikes and Sound-alikes
• Lasix (Brand; Diuretic) • Losec (Brand; H+ pump inhibitor)
Look-alikes and Sound-alikes
• Pulmicort Turbuhaler100 mcg/dose (powder oral inhalation)
• Rhinocort Turbuhaler100 mcg/dose (powder nasal inhalation)
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Look-alikes and Sound-alikes
• Norvasc (B) Ca channel blocker
• Prozac (B) Antidepressant
• Ventolin (B) Bronchodilator
• Chlorpromazine (G)Anti-psychotic drug
• Dimethicone (G) antiflatulent
• Navane (B)Major tranquilizer
• Proscar (B) BPH
• Benylin (B) cold & cough
• Chlorpropamide (G) Hypoglycemic drug
• Diamicron (B) Hypoglycemic drug
Beware of different strengths
• Strengths– Most drugs have the strengths listed in “mg”
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Beware of different strengths
Betaloc ZOK
Betaloc
These are also of different salts
Beware of different strengths
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Beware of different strengths
• Some exceptions :-– Many eye preparations and topical products in %
• (Timolol eye drop 0.25%, 0.5%)– Transdermal patch
• release rate mg/hr (Nitro-Dur 0.2, 0.4 mg/hr,)• release rate ug/24 hr (Estraderm TTS-25, 50, 100)• surface area cm2 (Nicotinell TTS-10, 20, 30)
Beware of different strengths
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Dosage forms/ routes of administration
– Tablet (oral, SL)– Capsule– Liquid (suspension, solution,
oral/otic/ophthalmic/nasal)– Inhaler (propellant, powder)– Transdermal patch– Topical (ointment, cream, lotion)– Others such as vaginal tablet, injection
Isosorbide dinitrate10mg oral tablet
Beware of different dosage forms
Isosorbide dinitrate5mg sublingual tablet
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Oral Inhalers –different dosage forms
Tarivid Ophthalmicsolution
Tarivid OticSolution
Beware of different routes of administration
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Conscientiousness
Checking• Check against the original• Check as if you were the 1st and the last
person to handle the script• Check before signing• Make no assumption (always ask when in
doubt)
Ask when in doubt
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Ask when in doubt
Conscientiousness
• Continual improvement• All errors reviewed and discussed• Dispensing procedures reviewed• Staff kept current on new drug additions• Continual education and training
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The point of an investigation is not to find where people went wrong.
It is to understand why their assessments and actions made sense at the time.
Human Error
Sidney Dekker (2002); The Field Guide to Human Error Investigations
• “…there are some patients we cannot help, there are none we cannot harm...”
Arthur Bloomfield, M.D. Quality of Healthcare in America Project 2003
