Community Pharmacies

Transcription

1 High-Alert Medication Modeling and Error-Reduction Scorecards (HAMMERS ) Workbook For Community Pharmacies Data Entry Errors (Patient) Data Entry Errors (Drug) Prescribing Errors Point of Sale Errors Drug Container Selection Errors A unique tool from the Institute for Safe Medication Practices designed to: Identify and quantify pharmacy dispensing system vulnerabilities Estimate the frequency of potentially harmful errors with high-alert medications Identify the most significant process steps and practices contributing to errors Determine how to reduce risks that have the highest probability of reaching patients Quantify the decrease or increase in risk after implementing new strategies This project was developed by the Institute for Safe Medication Practices in consultation with Outcome Engenuity, LLC. The project was supported by grant number R18HS from the Agency for Healthcare Research and Quality. This content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

2 Forward Invitation to Use HAMMERS Dear Community Pharmacy Professional: The Institute for Safe Medication Practices (ISMP) is pleased to provide the nation s community pharmacies with the High-Alert Medication Modeling and Error-Reduction Scorecards (HAMMERS ). This tool, which was funded by the Agency for Healthcare Quality and Research (AHRQ) and created in consultation with Outcome Engenuity, will help community pharmacies assess and improve medication safety and protect consumers from the adverse effects of medication errors. Based on published studies, we estimate that approximately four errors reach consumers for every 250 prescriptions dispensed from each pharmacy. HAMMERS will help you assess the risks of HIGH-ALERT MEDICATION errors reaching your patients, identify opportunities for improvement, and suggest specific strategies for reducing these risks. If you use this tool, you will be able to compare the baseline data you collect with your results after you implement various risk reduction strategies. HAMMERS becomes a tool to track system performance over time. HAMMERS offers community pharmacies a simple yet effective way to identify risks, estimate how often these risks result in potentially harmful errors that reach customers, rank which system features and behaviors most often contribute to these risks, and quantify how the frequency of these events will change if interventions are implemented. We applaud your desire to use this tool proactively to reduce errors in your pharmacy. We are confident that you will recognize the substantial value of HAMMERS the very first time you use it. It is truly a unique tool the first of its kind in healthcare. Regular use of HAMMERS will help make community pharmacies safer and more efficient. We welcome all community pharmacies to join us as we work together on this important endeavor. Sincerely, Michael R. Cohen Judy Smetzer Donna Horn President Vice President Director, Patient Safety INSTITUTE FOR SAFE MEDICATION PRACTICES About ISMP The Institute for Safe Medication Practices (ISMP) is the nation's only 501c (3) nonprofit organization devoted entirely to medication error prevention. The organization is known and respected worldwide as the premier resource for impartial, timely, and accurate medication safety information. The Institute's medication error prevention efforts began in 1975 with a groundbreaking and contin uing column in Hospital Pharmacy. Today, a continuously expanding core of knowledge in medication safety fuels the Institute's initiatives, which fall into six key areas: public and professional advocacy, consults and collaboratives, error-reporting and analysis, targeted publications, research and best practice development, and website/social media outlets. As an independent watchdog organization, ISMP receives no advertising revenue and depends entirely on charitable donations, educational grants, newsletter subscriptions, and volunteer efforts to pursue its lifesaving work. For more information, visit ISMP online at: Words or terminology in BLUE SMALL CAPS are defined in the Glossary. I 2012 ISMP

3 Table of Contents I. Description of HAMMERS II. Directions for Using HAMMERS Important Details for Using HAMMERS Directions for Pharmacy Organizations with Multiple Pharmacies General Directions for All Pharmacies Using the Results to Improve III. HAMMERS Scorecards Prescribing Errors Data Entry Errors (Patient) Data Entry Errors (Drug) Drug Container Selection Errors Point of Sale Errors IV. Frequently Asked Questions and Glossary Frequently Asked Questions Glossary Appendix A: High-Alert Medications Dispensed from Community Pharmacies.. Appendix B: Documented Rates of Errors and At-Risk Behaviors Table 1. Human Error Rates Table 2. Incidence of Outpatient Prescribing Errors Table 3. Incidence of Community Pharmacy Dispensing Errors Table 4. Incidence of Missed Opportunities to Capture Errors Table 5. Incidence of At-Risk Behaviors Appendix C: Risk-Reduction Strategies Preventing and Detecting Prescribing Errors Preventing and Detecting Data Entry Errors (Patient) Preventing and Detecting Data Entry Errors (Drug) Preventing and Detecting Drug Container Selection Errors Preventing and Detecting Point of Sale Errors Appendix D: Understanding Errors and At-Risk Behaviors Appendix E: How HAMMERS Works References ISMP

4 I. Description of HAMMERS Purpose The High-Alert Medication Modeling and Error-Reduction Scorecards (HAMMERS ) are designed to help community pharmacies: Identify their unique set of system and behavioral risks associated with dispensing certain HIGH-ALERT MEDICATIONS Estimate how often an error or adverse drug event reaches a patient The Scorecards identify risk factors within the dispensing process and provide estimates of the impact of each risk factor on the overall likelihood that an error will reach the patient. By using the tool, pharmacists can estimate how often prescribing and dispensing errors reach patients and how the frequency will change if certain interventions are implemented. The tool will identify the exact process steps, human behaviors, equipment and technology, and system components that, when combined together, lead to the greatest risk of an adverse outcome. The tool is also unique because an individual pharmacy will be able to quantify the safety benefits of a particular intervention as estimated by the HAMMERS tool. Five Scorecards are available with the HAMMERS tool, each representing different types of errors. 1 Prescribing Errors (wrong drug, dose, or directions) 2 Data Entry Errors (wrong patient) 3 Data Entry Errors (wrong drug, dose, or directions) 4 Drug Container Selection Errors (wrong drug or dose) 5 Point of Sale Errors (medication dispensed to the wrong customer) The Scorecards are described in more detail in Section II: Instructions for Using HAMMERS. With the exception of wrong patient errors, the Scorecards prompt users to choose a HIGH-ALERT MEDICATION or class of medications on which to focus. HIGH-ALERT MEDICATIONS bear a high risk of causing serious injury or death to a patient if they are misused. A complete list of HIGH-ALERT MEDICATIONS dispensed from community pharmacies can be found in Appendix A. The tool s intended focus on HIGH-ALERT MEDICATIONS heightens its ability to impact the health and safety of consumers because it helps prevent potentially serious errors. However, HAMMERS can be used to assess the risks associated with any medication or class/group of medications. The tool requires pharmacy staff to answer predetermined questions about how often certain process steps and practices occur, and how likely staff would be to detect an error given the circumstances described in the questions. Once the questions have been answered, HAMMERS will estimate how often specific types of medication errors with the chosen medication(s) could reach patients. The Scorecards will: Provide accurate estimates regarding the frequency of the medication errors under evaluation Identify the most frequent and significant process steps and practices contributing to these errors Guide the user to interventions that can reduce the risks identified by the tool Provide accurate estimates of the frequency of the medication errors after key interventions have been implemented, thus quantifying the decrease or increase in risk that is estimated to occur See Appendix D and E for additional information about how errors happen and how the HAMMERS tool was created using a SOCIO-TECHNICAL PROBABILISTIC RISK ASSESSMENT PROCESS (ST-PRA). Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

5 II. Directions for Using HAMMERS Important Details for Using HAMMERS HAMMERS has been designed for use in any community pharmacy practice, regardless of the number of staff employed or the number of pharmacies in the organization. However, the tool must be used at the individual pharmacy level and is not intended for centralized use by a single group at the corporate level. The tool requires data from individual pharmacies that can only be provided by pharmacy staff who work in the pharmacies. Corporate-level data invalidates the tool s accuracy. Independent pharmacies can follow the General Directions for All Pharmacies provided below. Directions for Pharmacy Organizations with Multiple Pharmacies Although pharmacy organizations with multiple stores may employ standard operating procedures, management practices, and technology, there are important differences in each individual pharmacy that may influence error rates, including but not limited to: prescription volume, environmental issues such as space and lighting, customer demographics (including ethnicity and native languages spoken), types of medications most frequently dispensed, practice habits of individuals, differences in application of operating procedures, and services available such as drive-through windows. Thus, to maximize the value and accuracy of HAMMERS, large pharmacy organizations should follow the directions below as well as the General Directions for All Pharmacies provided below Whenever possible, all pharmacies within a pharmacy organization should use the tool either independently (following the Directions for All Pharmacies) or as a group. If all pharmacies within the organization cannot participate, the pharmacy organization should select one or more groups of sample pharmacies to use the tool for a targeted HIGH- ALERT MEDICATION. Each sample of pharmacies should be similar in regards to prescription volumes, staffing patterns, and services provided (e.g., drive-through windows, hours of operation), and should include enough pharmacies to provide results that can be considered representative of all similar pharmacies in the pharmacy organization. Small pharmacy organizations should consider including all pharmacies in the samples (grouped by similar demographics, when appropriate). Midsize pharmacy organizations with more than 50 pharmacies but less than 1,000 pharmacies should include at least 25 pharmacies in each sample. Large pharmacy organizations with more than 1,000 pharmacies should include a minimum of 50 pharmacies in each sample. Ask the participating pharmacies to submit the completed Scorecards to a designated management or corporatelevel staff member. Anonymous submissions are highly suggested to promote staff willingness to answer questions in a forthright manner. Gather a team for each sample of pharmacies to review the Scorecards completed by the participating pharmacies to analyze the system vulnerabilities identified and corporate-wide interventions for improvement. General Directions for All Pharmacies 1 Download HAMMERS. Download the HAMMERS software onto your personal computer or server from: The following computer requirements are needed to install and run the software: Windows Installer 4.5 Microsoft.NET Framework 4 Client Profile (x86 and x64) SQL Server Compact 4.0 SQL Server Compact 3.5 SP2 If these components are not currently installed on your computer, you can load them while downloading the software. Once the software has been downloaded, all data entered into the software and results tabulated by the software are the sole Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

6 II. Directions for Using HAMMERS General Directions for All Pharmacies continued property of the HAMMERS user. The Institute for Safe Medication Practices will NOT have access to your data, nor can any data be accidentally entered into the software until it has been downloaded onto your computer or server. Before downloading the tool, you will be asked to provide very basic demographics, but no identifiable information will be requested or collected. There are no limitations on the frequency of downloading the software, which is copyright protected. 2 Establish a team. For each individual pharmacy, establish a team consisting of at least one pharmacist and one PHARMACY ASSOCIATE to answer the questions associated with HAMMERS. Depending on which Scorecard is used, the team can expect to spend about 1-2 hours to complete the assessment. The Scorecard for Prescribing Errors includes the most questions 38 in total. The Scorecard for Point of Sale Errors has the least questions 10 in total. 3 Prepare the team. Read the User s Workbook ( before using HAMMERS. 4 Select an area of focus. Narrow the focus of work by selecting a specific HIGH-ALERT MEDICATION or class of medications to evaluate. A complete list of HIGH-ALERT MEDICATIONS dispensed from community pharmacies can be found in Appendix A. The two Scorecards associated with wrong patient errors (Data Entry Errors-wrong patient, Point of Sale Errors) can include all dispensed medications. 5 Select the type of errors to evaluate and corresponding Scorecard. Select the type of error with the HIGH-ALERT MEDICATION(S) you want to evaluate from among the five Scorecards (Table 1). Table 1. HAMMERS Scorecards Prescribing Errors (wrong drug, dose, or directions) This Scorecard determines how often an error with the prescription gets through the dispensing system and reaches patients. Data Entry Errors (wrong patient) This Scorecard determines how often a prescription that has been entered into the wrong patient s profile gets through the dispensing system and reaches patients. Data Entry Errors (wrong drug, dose, or directions) This Scorecard determines how often mistakes get through the dispensing system and reach patients as a result of mistakes made while entering the drug, dosage form, dose, or directions into the pharmacy computer system. Drug Container Selection Errors (wrong drug or dose) This Scorecard determines how often mistakes get through the dispensing system and reach patients due to selecting the wrong drug product or container while filling the prescription. Point of Sale Errors (medication dispensed to the wrong customer) This Scorecard determines how often a customer leaves the pharmacy counter with the wrong patient s filled prescription at the time of purchase. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

7 II. Directions for Using HAMMERS General Directions for All Pharmacies continued 6 Gain access to the correct Scorecard. The Scorecards can be found in Section III of the workbook (or accessed electronically at: HAMMERS) and within the HAMMERS software on the Home Page. On the HAMMERS Home Page, click on the correct error type to gain access to the corresponding set of questions. 7 Gather dispensing information Gather information regarding how many prescriptions your pharmacy dispenses (weekly, monthly, quarterly, or yearly) for the selected HIGH-ALERT MEDICATION(S). The prescription volume of the medication is necessary as a denominator so HAMMERS can calculate estimates of risk and errors. 8 Discuss and answer each question in the tool. There are four types of questions in the Scorecards (Table 2 on next page). Consider each question in the Scorecard and evaluate the best answer. Always answer the questions based upon the specific HIGH-ALERT MEDICATION and type of error under evaluation. Many will find it helpful to answer the Scorecard questions on paper in the workbook (Section III) before entering data into the HAMMERS software. Helpful Hints Appendix B offers quick reference to research data, which can be used as a realistic starting point and then adjusted up or down according to your pharmacy s unique experiences when determining your pharmacyspecific rates. When estimating initial error rates, be sure to include all errors that are captured and corrected before the patient leaves the pharmacy counter or drive-through window. Many, but not all, questions are phrased negatively How many errors will be missed or processes skipped? for example so be sure to answer the questions as asked. 9 Access your saved Scorecard. Scorecards will be saved automatically as soon as you answer the first question, and then updated every time you answer a subsequent question. You can exit the Scorecard before completing each question and return to complete it at a later date without losing the information previously entered. As appropriate, the Scorecard name will include the medication type. A creation date will also be assigned and updated each time the Scorecard is changed. Saved Scorecards can be accessed via the tab along the right margin of the screen. To access a saved Scorecard, just doubleclick on the Scorecard name. To skip to the Scorecard results or to delete or copy a Scorecard, use the right click function. 10 Questions? If you have any questions while using HAMMERS, click on the Frequently Asked Question (FAQ) button which appears on most screens in the HAMMERS software. The most common Frequently Asked Questions can also be found in Section IV of the workbook. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

8 II. Directions for Using HAMMERS General Directions for All Pharmacies continued Table 2. Question Types in Scorecards Question Type Error frequency Exposure rates Missed CAPTURE OPPORTUNITIES AT-RISK BEHAVIORS Description You will be asked to estimate how often you observe or learn about the errors under evaluation. Support from studies that offer widely generalized data regarding error frequency can be found in Appendix B. However, you will be asked to estimate error rates with specific drugs, for which there are no error frequency data available. Thus, you will be asked to use your own experiences to estimate an error rate after referencing Appendix B and adjusting the rate up or down according to your pharmacy s experiences. You will be asked to estimate how often certain practices occur, or how often certain conditions exist. These data are often captured electronically. For instance, most pharmacies collect data on whether prescriptions are new or refills. When possible, HAMMERS calculates some exposure rates based on previous answers. For example, the tool asks only how often PHARMACY ASSOCIATES enter prescriptions, while the frequency of pharmacists entering prescriptions is calculated by the tool based on how often associates enter orders. You will be asked to estimate how often pharmacy staff or patients fail to capture an error that has been introduced into the dispensing system, given very specific conditions. For example, you may be asked how often a particular error would not be noticed when counseling occurs at the drive-through window, and the patient has not been asked for a second identifier (e.g., birth date) other than name. You will be asked to estimate how often staff engage in well-meaning but dangerous shortcuts, work-arounds, procedural violations, or other unsafe behaviors. AT-RISK BEHAVIORS are often employed and tacitly encouraged as a workaround for various system, technological, equipment, and environmental weaknesses or flaws. Using the Results to Improve Once all questions have been answered in the Scorecard, a report will be viewable on the screen to help guide your improvement activities. You can print each of the Results screens by clicking on the PRINT button in the upper left corner of the screen. When printing reports, the orientation of the page must be set to landscape. Your report will consist of four sections, each provided on a different screen in the software. Scorecard Results Screens Screen 1 (Scorecard Results) This screen provides an informed estimate regarding how many errors for the HIGH-ALERT MEDICATION and/or error type will reach patients from YOUR PHARMACY or PHARMACY ORGANIZATION within the specified timeframe. Screen 2 (Scorecard Metrics) This screen displays Table 1 and Bar Graph 1, which identify the events that most frequently and significantly contribute to the errors under evaluation. The Scorecard questions associated with these events are also provided. These events represent priority risks that should be reduced to improve safety. Screen 3 (Scorecard Metrics) This screen displays Table 2 and Bar Graph 2, which identify risk-reduction strategies and their contribution to the errors under evaluation. The Scorecard questions associated with these strategies are also provided. These strategies represent priorities that should be increased to improve safety. Screen 4 (Scorecard Metrics) This screen displays Table 3 and Bar Graph 3, which identify AT-RISK BEHAVIORS that most frequently and significantly contribute to the errors under evaluation. The Scorecard questions associated with these AT-RISK BEHAVIORS are also provided. These AT-RISK BEHAVIORS must be reduced in scope and frequency to further improve safety, which can only be accomplished after the underlying system-based causes of the behaviors have been addressed. See Appendix D for additional information about AT-RISK BEHAVIORS. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

9 II. Directions for Using HAMMERS Using the Results to Improve continued Additional risk-reduction strategies can be found in subsequent screens and Appendix C. HAMMERS users are strongly encouraged to implement any of the suggested strategies or a different strategy they feel might be effective. Helpful Hint Do not overestimate the scope of implementing a new strategy or its effects. New behaviors, technology, process steps, system changes, or environmental changes take time to be forged, and practitioners cannot expect 100% compliance because there will always be unexpected situations when the intervention will not be applicable or be able to be carried out. For example, if you plan to increase the frequency of patient counseling for a particular HIGH-ALERT MEDICATION, we suggest a 75% rate of compliance, even if the counseling is mandated, to account for conditions when counseling cannot be provided (e.g., the patient is in a hurry, the patient is in pain, the caregiver has a sick child, a patient surrogate picks up the prescription). Before and/or after implementation of risk-reduction strategies, the team that evaluated the initial risk should use the Scorecard to answer the questions again, this time anticipating or realizing the effects of the strategy. Even if you are only implementing a single strategy, be sure to review every question in the Scorecard to determine if the new strategy will have an impact on the answer. Once the questions have been answered, a new report will be generated, which can be used for comparison to the initial report, thus demonstrating the overall impact of the strategy. Please remember to copy and rename the Scorecard (using a right click function) before changing the answers to the questions so that the original risk and error rate data can be used for comparison. Helpful Hint To determine the percent of change between the initial error rate and the new error rate, use this formula: New Error Rate Old Error Rate x 100 Old Error Rate A negative percent of change means the error rate has been reduced by that percent. A positive percent of change means the error rate has been increased by that percent. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

10 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) # Question Answer Special Instructions or User Comments Drug Selection and Prescription Volume You have selected the Scorecard associated with prescribing errors (wrong drug, dose, or directions). Now you must specify which HIGH-ALERT MEDICATION(S) you want to evaluate, and how often your pharmacy fills prescriptions for these medications. While this tool can be used to evaluate prescribing errors with any drug, focusing on HIGH-ALERT MEDICATIONS helps to reduce the risk of errors that can cause harm to patients. 1a Please list the name(s) of the medication(s) or class of medications involved in the prescribing errors you want to evaluate. List Medication(s) See Appendix A for a list of HIGH-ALERT MEDICATIONS dispensed from community pharmacies. 1b Please provide the number of prescriptions (new prescriptions and refills combined) filled within the specified time interval for the medication(s) involved in these errors. # of Prescriptions Time Interval: Week, Month, Quarter, Year Include filled prescriptions that are picked up from the pharmacy or delivered to patients. Add all generics, brands, and strengths together. Error Frequency You will need to estimate how often you receive prescriptions for the specified medications with the wrong drug, dose, or directions. This may include a drug to which the patient is allergic or otherwise contraindicated, unsafe or ineffective directions for use, sub-therapeutic doses, doses that exceed safe limits, and doses that may not be appropriate for the specific patient (based on weight, lab monitoring values, condition being treated, etc.). Your answer should be provided as a percent of prescriptions with the wrong drug, dose, or directions per all prescriptions for the given medication(s) per week, month, quarter, or year. While prescribing error rates vary among different drugs, please consider the data from published research provided in Appendix B and adjust the rates up or down accordingly. Keep in mind that people tend to underestimate error rates, particularly forgetting to count errors that may not be easily captured. 2 In a normal week, month, quarter, or year, what percent of the time do you see prescriptions for this drug with the wrong dose, wrong directions, or wrong drug (not the intended drug)? 0.1% to 100% This includes errors that are detected before they reach the patient. For example, include prescribing errors that were corrected after you called the prescriber. Receipt of Prescription The next set of questions is associated with how prescriptions for the medication(s) are received in the pharmacy: hard-copies brought into the pharmacy, telephone prescriptions, FAXED PRESCRIPTIONS, or ELECTRONIC PRESCRIPTIONS. ELECTRONIC PRESCRIPTIONS include only those that are transmitted directly to the pharmacy computer and populate the required data entry fields. The sum of percentages for all forms of receiving prescriptions into the pharmacy (3a, 3b1, 3c, 3d) should equal 100%. 3a 3b1 3b2 What percent of prescriptions for this medication(s) are hard-copies brought into the pharmacy by either the patient or the patient s representative? What percent of prescriptions for this medication(s) are called into the pharmacy? Of the prescriptions for this medication(s) that are called into the pharmacy, what percent are left on voic ? 0% to 100% 0% to 100% Enter 0% if no prescriptions for the medication(s) are called into the pharmacy. 0% to 100% 3c 3d What percent of prescriptions for this medication(s) are faxed to the pharmacy? What percent of prescriptions for this medication(s) are ELECTRONIC PRESCRIPTIONS? 0% to 100% Please include prescriptions that are printed and entered after being faxed or transmitted by other electronic means as FAXED PRESCRIPTIONS. 0% to 100% ELECTRONIC PRESCRIPTIONS DO NOT require pharmacy staff to enter the drug name, dose/strength, and directions for use. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

11 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) continued # Question Answer Special Instructions or User Comments Receipt of Prescription (continued) For the next set of questions, you will need to estimate how often staff might detect the prescribing error while receiving the prescription into the pharmacy. One question also asks how often prescriptions are read back to the caller when taking DIRECT CALLS from physicians or office staff. READBACK involves transcribing the prescription on a prescription blank as it is being given, and then reading it back to the caller to verify accuracy. 4 What percent of these prescribing errors will be missed when pharmacy staff takes an oral (verbal) prescription on the phone? 5 Of the DIRECT CALLS (not voic ), what percent of the time are the prescriptions NOT read back to the prescriber or office staff to verify accuracy? 6 What percent of the prescribing errors will be missed despite READBACK of an oral (verbal) prescription? 0% to 100% This includes oral prescriptions left on voic and DIRECT CALLS, but it does not include the process of reading back the prescription to the caller. Detecting errors during READBACK is a separate step in the process, which is addressed later. Enter 0% if no oral prescriptions for the medication(s) are called into the pharmacy. 0% to 100% Forgetting to carry out the READBACK process, rather than skipping it, is already factored into the tool and should not be included in your answer. Common reasons for skipping the READBACK process may include: prescriber is in a hurry; the pharmacy is busy; the call is interrupted by a time-urgent task; prior experiences with READBACK have been poorly received; office staff who call in the prescription are unlikely to detect an error. Enter 0% if no oral prescriptions for the medication(s) are called into the pharmacy and/or if READBACK of prescriptions does not occur. 0% to 100% This includes READBACK of prescriptions to office staff, not just prescribers. Enter 0% if no oral prescriptions for the medication(s) are called into the pharmacy and/or if READBACK of prescriptions does not occur. Data Entry of Prescription The next set of questions explores how often pharmacists and PHARMACY ASSOCIATES enter prescriptions for these medications into the pharmacy computers, and how many prescriptions are for refills or for NEW PATIENTS (patients new to the pharmacy or new to the drug therapy). You will also be asked to estimate how often the prescribing errors are missed during data entry given specified conditions. These questions apply only to the data entry process. The data entry verification process and drug utilization review process are addressed later. 7 What percent of prescriptions for this medication(s) are entered into the pharmacy computer by a pharmacy associate? 8 What percent of prescriptions for this medication(s) are for NEW PATIENTS (new to therapy or new to the pharmacy/ chain)? 9 A PHARMACIST is entering a prescription into the profile of an EXISTING PATIENT who has previously taken the same drug or another drug within the same class. On average, what percent of the prescribing errors will be missed by a pharmacist during data entry without the help of a computer alert? 10 A PHARMACIST is entering a prescription into the profile of a NEW PATIENT (new to therapy or new to the pharmacy). On average, what percent of the prescribing errors will be missed by a pharmacist during data entry without the help of a computer alert? 0% to 100% Please be sure to consider daytime, nighttime, and weekend/holiday staffing when determining the percentage. 0% to 100% <1% to 100% Alerts are factored in during the pharmacists drug utilization review (DUR). Enter <1% if pharmacists never enter prescriptions into the pharmacy computer. <1% to 100% Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

12 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) continued # Question Answer Special Instructions or User Comments Data Entry Verification The next set of questions deals with the process of verifying the data entry of prescriptions. You will be asked whether your computer system requires data entry verification in order to continue the dispensing process. The questions that follow will ask you to estimate how often data entry verification is performed by the same pharmacist who entered the prescription, and how often the verification process occurs under less than ideal conditions. You will also be asked to estimate how often a pharmacist will miss the prescribing error during the verification process given specified conditions. 11 Does your computer system require some action by the operator (e.g., enter information, press a function key) during data entry verification in order to proceed with the dispensing process? Yes No 12 After a PHARMACIST has entered a prescription, how often is the data entry verification process rushed, inattentive, incomplete, or skipped? 5% to 100% Forgetting to carry out the data entry verification process, rather than skipping it or hurrying through it, has already been factored into the tool and should not be included in your answer. Sometimes data entry verification is rushed or skipped because an experienced pharmacist initially entered the prescription. Other times, multiple patients waiting for prescriptions and a hectic pace in the pharmacy can lead to rushed, incomplete, inattentive, or skipped data entry verification. Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter 5% (lowest score) if pharmacists never enter prescriptions into the pharmacy computer. 13 If data entry verification is required after a pharmacist has entered a prescription into the computer, how often do pharmacists have to verify their own data entry (self-check of data entry)? 14 After a PHARMACY ASSOCIATE has entered a prescription, how often is the data entry verification process rushed, inattentive, incomplete, or skipped? 15 For EXISTING PATIENTS who have been taking the same drug or a similar drug within the same class: What percent of the prescribing errors will be missed by a pharmacist verifying another pharmacist's data entry (INDEPENDENT CHECK)? 16 For NEW PATIENTS (new to the pharmacy or new to the drug therapy): What percent of the prescribing errors will be missed by a pharmacist verifying another pharmacist's data entry (INDEPENDENT CHECK)? 17 For EXISTING PATIENTS who have been taking the same drug or a similar drug within the same class: What percent of the prescribing errors will be missed by a pharmacist verifying a PHARMACY ASSOCIATE'S data entry? 0% to 100% Don t forget times when a pharmacist is working alone. Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter 0% if pharmacists never enter prescriptions into the pharmacy computer. 5% to 100% Forgetting to carry out the data entry verification process, rather than skipping it or hurrying through it, has already been factored into the tool and should not be included in your answer. Sometimes data entry verification is rushed or skipped because the checking pharmacist believes the PHARMACY ASSOCIATE S accuracy is very high. Other times, multiple patients waiting for prescriptions and a hectic pace in the pharmacy can lead to rushed, incomplete, inattentive, or skipped data entry verification. Enter 5% (lowest score) if PHARMACY ASSOCIATES never enter prescriptions into the pharmacy computer. <1% to 100% Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter <1% if pharmacists never enter prescriptions into the pharmacy computer. <1% to 100% <1% to 100% Enter <1% if PHARMACY ASSOCIATES never enter prescriptions into the pharmacy computer. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

13 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) continued # Question Answer Special Instructions or User Comments 18 For NEW PATIENTS (new to the pharmacy or new to the drug therapy): What percent of the prescribing errors will be missed by a pharmacist verifying a PHARMACY ASSOCI- ATE'S data entry? Data Entry Verification (continued) <1% to 100% Enter <1% if PHARMACY ASSOCIATES never enter prescriptions into the pharmacy computer. Drug Utilization Review (DUR) The next set of questions deals with the drug utilization review (DUR) process during which prescribed therapy is evaluated because initial concerns have surfaced. You will be asked about various computer alerts that may appear during data entry to which a pharmacist has access to during the DUR process. You will also be asked how often these alerts are ignored or not given the pharmacists full attention, and, if they are acknowledged by the pharmacist, how often the prescribing error will still be missed during the DUR process. 19 What percent of prescriptions with the prescribing error will cause a computer alert directly related to the type of prescribing error, which can be viewed by a pharmacist during DUR? 20 What percent of prescriptions with the prescribing error will cause a DUPLICATE THERAPY alert that can be viewed by a pharmacist during DUR? 0% to 100% Examples include an OUT-OF-RANGE DOSE alert for prescribing errors related to the dose or directions; or an allergy alert, a contraindication alert, or a look-alike drug name alert related to prescribing the wrong drug. Exclude prescriptions that cause an alert if the alert is not or cannot be viewed by the pharmacist or otherwise communicated to the pharmacist during DUR. 0% to 100% Exclude prescriptions that cause an alert if the alert is not or cannot be viewed by the pharmacist or otherwise communicated to the pharmacist during DUR. 21 What percent of prescriptions with the prescribing error will cause neither a DUPLICATE THERAPY alert nor an alert directly related to the type of prescribing error (e.g., OUT-OF- RANGE DOSE alert for prescribing errors related to the dose or directions; allergy alert; contraindication alert; look-alike drug name alert related to prescribing the wrong drug) during data entry and/or data entry verification? 22 What percent of these prescribing errors will a pharmacist miss when the computer issues an alert directly related to the type of prescribing error, the alert is available to the pharmacist conducting DUR, and the pharmacist acts on the alert? 23 What percent of these prescribing errors will a pharmacist miss when the COMPUTER FLAGS the prescription for DUPLI- CATE THERAPY, the alert is available to the pharmacist conducting DUR, and the pharmacist acts on the alert? 0% to 100% <1% to 100% Acting on the alert simply means that the pharmacist was aware of the alert and considered its importance. Action to correct an error may or may not occur. For example, a pharmacist may notice an alert, consider its importance, but still believe the order is acceptable. Or a pharmacist could call the prescriber s office, but the office nurse communicates that the prescription is correct so no further action is taken. Enter <1% if you previously indicated (Question 19) that no (0%) alerts related to the type of prescribing error would be issued or available to the pharmacist conducting DUR. <1% to 100% Acting on the alert simply means that the pharmacist was aware of the alert and considered its importance. Action to correct an error may or may not occur. For example, a pharmacist may notice an alert, consider its importance, but still believe the order is acceptable. Or a pharmacist could call the prescriber s office, but the office nurse communicates that the prescription is correct so no further action is taken. Enter <1% if you previously indicated (Question 20) that no (0%) DUPLICATE THERAPY alerts would be issued or available to the pharmacist conducting DUR. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

14 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) continued # Question Answer Special Instructions or User Comments 24 What percent of time does a pharmacist fail to give an alert directly related to the type of prescribing error his or her full attention or ignore the alert and quickly bypass it? 25 What percent of time does a pharmacist fail to give a DUPLICATE THERAPY alert for these medication(s) his or her full attention or ignore the alert and quickly bypass it? Drug Utilization Review (DUR) (continued) 5% to 100% Sometimes an alert is ignored or bypassed because the presenting issue appears to be inconsequential, is thought to have been addressed previously, or does not adequately capture the pharmacist s attention due to ALERT FATIGUE. Enter 5% (lowest score) if you previously indicated (Question 19) that no (0%) alert directly related to the prescribing error would be issued or available to the pharmacist conducting DUR. 5% to 100% Sometimes an alert is ignored or bypassed because the presenting issue appears to be inconsequential, is thought to have been addressed previously, or does not adequately capture the pharmacist s attention due to ALERT FATIGUE. Enter 5% (lowest score) if you previously indicated (Question 14) that no (0%) DUPLICATE THERAPY alerts would be issued or available to the pharmacist conducting DUR. Insurance Adjudication For the next question, you will need to know the percent of prescriptions typically adjudicated online for third-party payment. Because insurance prescription drug coverage is patient specific, not drug specific, this question applies broadly to all medications you dispense from the pharmacy. This is the only question in this Scorecard that you can answer broadly for all drugs, rather than for the specific medication(s) being evaluated with the prescribing errors. 26 What percent of prescriptions are adjudicated online for third-party payment? 0% to 100% Filling the Prescription The next set of questions deals with filling prescriptions for the medication(s) under evaluation, from selecting the drug off the shelf to applying the label on the product. You will be asked about automated and manual filling of the prescriptions and whether a pharmacist might detect the prescribing errors while filling a prescription. 27 What percent of prescriptions for the medication(s) involved in these prescribing errors are filled using AUTOMATED DIS- PENSING EQUIPMENT (e.g., robotics, dispensing machines)? 0% to 100% 28 For manually filled prescriptions for the medication(s) under evaluation, what percent are filled by PHARMACY ASSOCIATES? 29 What percent of these prescribing errors will be missed while a PHARMACIST is filling the prescription (e.g., counting tablets, filling vials, preparing cartons)? 0% to 100% <1% to 100% Final Product Verification The next few questions involve verification of the filled prescription before placing it in the will-call area and/or dispensing it. You will be asked to consider whether a pharmacist would detect the prescribing error during this step of the dispensing process. 30 What percent of prescriptions associated with this type of prescribing error might a pharmacist recognize as a potential problem without the aid of a computer alert? <1% to 100% 31 If the pharmacist recognizes a potential problem with these prescriptions, what percent of the errors will still be missed during final product verification? <1% to 100% Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

15 III. HAMMERS Scorecards Prescribing Errors (Wrong Drug, Dose, or Directions) continued # Question Answer Special Instructions or Rationale for Question 32 How often does a pharmacist rush through the final product verification process, or skip it in part or entirely, before filled prescriptions for the medication(s) are ready for pick-up or delivery? Final Product Verification (continued) <1% to 100% Reasons for rushing through or skipping the final product verification of the filled prescription may include the fact that another pharmacist (not a PHARMACY ASSOCIATE) filled the prescription, the same person who is supposed to conduct the final verification also filled the prescription, and over-reliance on PHARMACY ASSOCIATES during the pharmacy s busiest hours. Patient Counseling The final set of questions deals with counseling patients who pick up filled prescriptions or receive pharmacy deliveries for the medication(s) under evaluation. You will be asked how often this occurs at the counter or at the drive-through window, and whether you open the bag, prescription vial, or carton to view the product during the counseling session. You will also be asked how often you might miss these prescribing errors during counseling given specified conditions. 33 Considering both new prescriptions and refills of the medication(s) that are picked up from the pharmacy or delivered to patients, what percent of the time does patient counseling occur? 34 When patient counseling occurs, what percent of customers receiving the medication(s) are at the drivethrough window? 35 When patient counseling occurs at the counter, what percent of the time is the prescription vial or container opened to view the actual medication(s) under evaluation? 36 What percent of prescribing errors for this medication(s) would be missed when patient counseling occurs at the drive-through window? 37 While counseling a patient at the counter, a pharmacist HAS opened the prescription vial or container to show the patient the actual product. During the counseling session, what percent of the time would the pharmacist or patient fail to notice the prescribing error, and the patient leave the counter with the wrong medication, dose, or directions for use? 38 While counseling a patient at the counter, a pharmacist HAS NOT opened the prescription vial or container to show the patient the actual product. During the counseling session, what percent of the time would the pharmacist or patient fail to notice the prescribing error, and the patient leave the counter with the wrong medication, dose, or directions for use? 0% to 100% 0% to 100% If you do not offer drive-through services, enter a score of 0%. 0% to 100% <1% to 100% If you do not offer drive-through services, enter a score of <1%. <1% to 100% Enter <1% if you previously indicated (Question 35) that you never (0%) open the prescription vial or container while counseling the patient. <1% to 100% Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

16 III. HAMMERS Scorecards Data Entry Errors (Wrong Patient) # Question Answer Special Instructions or Rationale for Question Prescription Volume You have selected the Scorecard associated with data entry errors wrong patient. Because this type of error could involve any prescription filled in the pharmacy, you do not need to choose a specific medication or class of medications for evaluation all medications can be included. However, you will need to provide the volume of prescriptions filled in your pharmacy. Please provide a name for this Scorecard: 1 Please provide the number of prescriptions (new prescriptions and refills combined) filled within the specified time interval in your pharmacy. # of Prescriptions Time Interval: Week, Month, Quarter, Year Include filled prescriptions that are picked up from the pharmacy or delivered to patients. Add all generics, brands, and strengths together. Error Frequency You will need to estimate how often a prescription is initially entered into the wrong patient s profile. This includes errors that may be detected during the dispensing process. Your answer should be provided as a percent of data entry errors among all prescriptions per week, month, quarter, or year. Please consider the data from published research provided in Appendix B, and adjust the rates up or down accordingly. Keep in mind that people tend to underestimate error rates, particularly forgetting to count errors that may not be easily captured. 2 In a normal week, month, quarter, or year, what percent of the time is a prescription or group of prescriptions entered into the wrong patient s profile during data entry? 0.1% to 100% This includes errors that are detected before they reach the patient. For example, include data entry errors that are detected and corrected during order entry verification, final product verification, at the point of sale, or during patient counseling. Data Entry of Prescription The next set of questions explore how often pharmacists and PHARMACY ASSOCIATES enter prescriptions for these medications into the pharmacy computer, and how many prescriptions are for refills or for NEW PATIENTS (patients new to the pharmacy or new to the drug therapy). You will also be asked to estimate how often the data entry errors (wrong patient) are missed given specified conditions. These questions apply only to the data entry process. The data entry verification process and drug utilization review process are addressed later. 3 What percent of prescriptions are entered into the pharmacy computer by a PHARMACY ASSOCIATE? 0% to 100% Please be sure to consider daytime, nighttime, and weekend/holiday staffing when determining the percentage. 4 What percent of all prescriptions are for NEW PATIENTS (new to therapy or new to the pharmacy/chain)? 0% to 100% Data Entry Verification The next set of questions deals with the process of verifying the data entry of prescriptions. You will be asked whether your computer system requires data entry verification in order to continue the dispensing process. The questions that follow will ask you to estimate how often data entry verification is performed by the same pharmacist who entered the prescription, and how often the verification process occurs under less than ideal conditions. You will also be asked to estimate how often a pharmacist will miss the data entry error during the verification process given specified conditions. 5 Does your computer system require some action by the operator (e.g., enter information, press a function key) during data entry verification in order to proceed with the dispensing process? 6 If data entry verification is required after a pharmacist has entered a prescription into the computer, how often do pharmacists have to verify their own data entry (self-check of data entry)? Yes No 0% to 100% Don t forget times when a pharmacist is working alone. Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter 0% if pharmacists never enter prescriptions into the pharmacy computer. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

17 III. HAMMERS Scorecards Data Entry Errors (Wrong Patient) continued # Question Answer Special Instructions or Rationale for Question 7 For EXISTING PATIENTS (with an existing pharmacy profile): What percent of the wrong patient data entry errors will be missed by a pharmacist verifying another pharmacist s data entry (INDEPENDENT CHECK)? Data Entry Verification (continued) <1% to 100% Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter <1% if pharmacists never enter prescriptions into the pharmacy computer. 8 For NEW PATIENTS (new to the pharmacy): What percent of the wrong patient data entry errors will be missed by a pharmacist verifying another pharmacist s data entry (INDEPENDENT CHECK)? <1% to 100% 9 For EXISTING PATIENTS (with an existing pharmacy profile): What percent of wrong patient data entry errors will be missed by a pharmacist verifying a PHARMACY ASSOCIATE S data entry? 10 For NEW PATIENTS (new to the pharmacy): What percent of the wrong patient data entry errors will be missed by a pharmacist verifying a PHARMACY ASSOCIATE S data entry? 11 After a PHARMACY ASSOCIATE has entered a prescription, how often is the data entry verification process rushed, inattentive, incomplete, or skipped? 12 After a PHARMACIST has entered a prescription, how often is the data entry verification process rushed, inattentive, incomplete, or skipped? <1% to 100% Enter <1% if PHARMACY ASSOCIATES never enter prescriptions into the pharmacy computer. <1% to 100% 5% to 100% Forgetting to carry out the data entry verification process, rather than skipping it or hurrying through it, has already been factored into the tool and should not be included in your answer. Sometimes data entry verification is rushed or skipped because the checking pharmacist believes the PHARMACY ASSO- CIATE S accuracy is very high. Other times, multiple patients waiting for prescriptions and a hectic pace in the pharmacy can lead to rushed, incomplete, inattentive, or skipped data entry verification. Enter 5% (lowest answer) if PHARMACY ASSO- CIATES never enter prescriptions into the pharmacy computer. 5% to 100% Forgetting to carry out the data entry verification process, rather than skipping it or hurrying through it, has already been factored into the tool and should not be included in your answer. Sometimes data entry verification is rushed or skipped because an experienced pharmacist initially entered the prescription. Other times, multiple patients waiting for prescriptions and a hectic pace in the pharmacy can lead to rushed, incomplete, inattentive, or skipped data entry verification. Answer 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter 5% (lowest score) if PHARMACISTS never enter prescriptions into the pharmacy computer. Drug Utilization Review (DUR) The next set of questions deals with the drug utilization review (DUR) process during which prescribed therapy is evaluated because initial concerns have surfaced. You will be asked about various computer alerts that may appear during data entry to which a pharmacist has access during the DUR process. You will also be asked how often these alerts are ignored or not given the pharmacists full attention, and, if they are acknowledged by the pharmacist, how often the data entry error (wrong patient) will still be missed during the DUR process. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

18 III. HAMMERS Scorecards Data Entry Errors (Wrong Patient) continued # Question Answer Special Instructions or Rationale for Question 13 What percent of the data entry errors will a pharmacist miss if the COMPUTER FLAGS the prescription for an OUT-OF- RANGE DOSE, an allergy, or contraindication, the alert is available to the pharmacist conducting DUR, and the pharmacist acts on the alert? Drug Utilization Review (continued) <1% to 100% Acting on the alert means that the pharmacist was aware of the alert and considered its importance. Action to correct an error may or may not occur. For example, a pharmacist may notice an alert, consider its importance, but still believe the order is acceptable. Or a pharmacist could call the prescriber s office, but the office nurse communicates that the prescription is correct so no further action is taken. 14 On average, what percent of the time does a pharmacist ignore an alert for an OUT-OF-RANGE DOSE, allergy, or contraindication, or fail to give the alert his/her full attention? 15 What percent of the data entry errors will a pharmacist miss if the COMPUTER FLAGS the prescription for DUPLICATE THERAPY, the alert is available to the pharmacist conducting DUR, and the pharmacist acts on the alert? 16 On average, what percent of the time does a pharmacist ignore a DUPLICATE THERAPY alert or fail to give the alert his/her full attention? 5% to 100% Sometimes an alert is ignored or bypassed because the presenting issue appears to be inconsequential, is thought to have been addressed previously, or does not adequately capture the pharmacist s attention due to ALERT FATIGUE. <1% to 100% Acting on the alert simply means that the pharmacist was aware of the alert and considered its importance. Action to correct an error may or may not occur. For example, a pharmacist may notice an alert, consider its importance, but still believe the order is acceptable. Or a pharmacist could call the prescriber s office, but the office nurse communicates that the prescription is correct so no further action is taken. 5% to 100% Sometimes an alert is ignored or bypassed because the presenting issue appears to be inconsequential, is thought to have been addressed previously, or does not adequately capture the pharmacist s attention due to ALERT FATIGUE. Insurance Adjudication For the next question, you will need to know the percent of prescriptions typically adjudicated online for third-party payment. This question applies broadly to all medications you dispense from the pharmacy. 17 What percent of prescriptions are adjudicated online for third-party payment? 0% to 100% Filling the Prescription The next set of questions deals with filling prescriptions for the medication(s) under evaluation, from selecting the drug off the shelf to applying the label on the product. You will be asked about automated and manual filling of the prescriptions and whether a pharmacist might detect the data entry error while filling a prescription. 18 What percent of prescriptions are filled using AUTOMATED DISPENSING EQUIPMENT (e.g., robotics, dispensing machines)? 19 For manually filled prescriptions, what percent are filled by PHARMACY ASSOCIATES? 20 What percent of the data entry errors will be missed while a PHARMACY ASSOCIATE Is filling the prescription (e.g., counting tablets, filling vials, preparing cartons)? 0% to 100% 0% to 100% <1% to 100% 21 What percent of the data entry errors will be missed while a PHARMACIST is filling the prescription (e.g., counting tablets, filling vials, preparing cartons)? <1% to 100% Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

19 III. HAMMERS Scorecards Data Entry Errors (Wrong Patient) continued # Question Answer Special Instructions or Rationale for Question Final Product Verification The next few questions involve verification of the filled prescription before placing it in the will-call area and/or dispensing it. You will be asked to consider whether a pharmacist would detect the data entry error during this step of the dispensing process. 22 What percent of wrong patient data entry errors will be missed by pharmacists during final product verification? 23 How often does a pharmacist rush through the final product verification process, or skip it in part or entirely, before filled prescriptions are ready for pick-up or delivery? <1% to 100% If the original prescription, a scanned image, or ELECTRONIC PRESCRIPTION is not available to view and compare to the pharmacy label during the final product verification, do not enter a score lower than 90%. <1% to 100% Reasons for rushing through or skipping the final product verification of the filled prescription may include the fact that another pharmacist (not a PHARMACY ASSOCIATE) filled the prescription, the same person who is supposed to conduct the final verification also filled the prescription, or over-reliance on PHARMACY ASSOCIATES during the pharmacy s busiest hours. Patient Counseling The final set of questions deals with counseling patients who pick up medications or receive pharmacy deliveries of filled prescriptions. You will be asked how often this occurs at the counter or at a drive-through window, and whether you open the bag, prescription vial, or carton to view the actual product during the counseling session. You will also be asked how often you might miss the data entry errors (wrong patient) during counseling given specified conditions. 24 Considering both new prescriptions and refills of all medication(s) that are picked up from the pharmacy or delivered to patients, what percent of the time does patient counseling occur? 25 When patient counseling occurs, what percent of these customers are at the drive-through window? 26 What percent of the data entry errors (wrong patient) would be missed when patient counseling occurs at the drive-through window? 27 When patient counseling occurs at the counter, what percent of the time is the prescription vial or container opened to view the actual product? 28 While counseling a patient at the counter, a pharmacist HAS NOT opened the prescription vial or container to show the patient the actual product. During the counseling session, what percent of the time would the pharmacist or patient fail to notice the error, and the patient leave the counter with the wrong medication? 29 While counseling a patient at the counter, a pharmacist HAS opened the prescription vial or container to show the patient the actual product. During the counseling session, what percent of the time would the pharmacist or patient fail to notice the error, and the patient leave the counter with the wrong medication? 0% to 100% 0% to 100% If you do not offer drive-through services, enter a score of 0%. <1% to 100% If you do not offer drive-through services, enter a score of <1%. 0% to 100% <1% to 100% <1 to 100% If you never open the prescription vial or container while counseling the patient, enter a score of <1%. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP

20 III. HAMMERS Scorecards Data Entry Errors (Wrong Drug, Dose, or Directions) # Question Answer Special Instructions or Rationale for Question Drug Selection and Prescription Volume You have selected the Scorecard associated with data entry errors wrong drug, dose, or directions. Now you must specify which HIGH-ALERT MEDICATION(S) you want to evaluate, and how often your pharmacy fills prescriptions for these medications. While this Scorecard can be used to evaluate data entry errors with any drug, focusing on HIGH-ALERT MEDICATIONS helps to reduce the risk of errors that can cause harm to patients. 1a Please list the name(s) of the medication(s) or class of medications involved in the data entry errors (wrong drug, dose, directions) you want to evaluate. List Medication(s) 1b Please provide the number of prescriptions (new prescriptions and refills combined) filled within the specified time interval for the medication(s) involved in these errors. # of Prescriptions Time Interval: Week, Month, Quarter, Year Include filled prescriptions that are picked up from the pharmacy or delivered to patients. Add all generics, brands, and strengths together. Error Frequency You will need to estimate how often data entry errors (wrong drug, dose, directions) occur when entering prescriptions for the medication(s) being evaluated. This includes errors that may be detected and corrected during the dispensing process. Your answer should be provided as a percent of data entry errors among all prescriptions for the targeted medication(s) per week, month, quarter, or year. While the frequency of data entry errors (wrong drug, dose, directions) often varies based on the medication(s) under evaluation, please consider the data from published research provided in Appendix B, and adjust the rates up or down accordingly. Keep in mind that people tend to underestimate error rates, particularly forgetting to count errors that may not be easily captured. 2 In a normal week, month, quarter, or year, what percent of the time is the wrong drug, wrong dose, or wrong directions entered into the patient s profile during data entry? 0.1% to 100% Include errors that are detected before they reach the patient. For example, include data entry errors that are detected and corrected during data entry verification, final product verification, at the point of sale, or during patient counseling. Data Entry of Prescription The next set of questions explore how often pharmacists and PHARMACY ASSOCIATES enter prescriptions for these medications into the pharmacy computer, and how many prescriptions are for refills or for NEW PATIENTS (patients new to the pharmacy or new to the drug therapy). You will also be asked to estimate how often the data entry errors (wrong drug, dose, directions) will be missed given the specified conditions. These questions apply only to the data entry process. The data entry verification process and drug utilization review process are addressed later. 3 What percent of prescriptions for the medication(s) are entered into the pharmacy computer by a PHARMACY ASSOCIATE? 0% to 100% Please be sure to consider daytime, nighttime, and weekend/holiday staffing when determining the percentage. 4 What percent of prescriptions for the medication(s) are for NEW PATIENTS (new to therapy or new to the pharmacy/ chain)? 0% to 100% Data Entry Verification The next set of questions deals with the process of verifying the data entry of prescriptions. You will be asked whether your computer system requires data entry verification in order to continue the dispensing process. The questions that follow will ask you to estimate how often data entry verification is performed by the same pharmacist who entered the prescription, and how often the verification process occurs under less than ideal conditions. You will also be asked to estimate how often a pharmacist will miss the data entry error during the verification process given specified conditions. 5 Does your computer system require some action by the operator (e.g., enter information, press a function key) during data entry verification in order to proceed with the dispensing process? Yes No 6 If data entry verification is required after a pharmacist has entered a prescription into the computer, how often do pharmacists have to verify their own data entry (self-check of data entry)? 0% to 100% Don t forget times when a pharmacist is working alone. Enter 100% if your dispensing process does not require data entry verification after a PHARMACIST has entered a prescription. Enter 0% if pharmacists never enter prescriptions into the pharmacy computer. Words or terminology in BLUE SMALL CAPS are defined in the Glossary ISMP