Medication Safety: The Role of the Pharmacy Technician

Transcription

1 Technician Education for Association Members Pharmacy By: Laura Hanson, PharmD PGY2 Pharmacy Practice Resident Midwestern University College of Pharmacy Glendale Dr. Hanson is currently a PGY2 pharmacy resident focusing on geriatrics + academia at Midwestern University College of Pharmacy-Glendale in Glendale, Arizona. She is interested in educating students and fellow healthcare professionals and promoting the health of geriatric patients within the long-term care, ambulatory and acute care settings. Medication safety is a particular passion due to the scope and impact of medication errors currently seen in various healthcare environments. Dr. Hanson reports no actual or potential conflicts of interest in relation to this continuing pharmacy education activity and reports off-label use will not be discussed. Medication Safety: The Role of the Pharmacy Technician A recent event, widely covered by news outlets, involved a medication error occurring while compounding chemotherapy for a 2-year-old pediatric cancer patient who was on the road to recovery. The Ohio pharmacy technician on duty prepared the child s parenteral chemotherapy using concentrated 23.4% sodium chloride in place of the ordered 0.9% saline. After the pharmacist then checked off on the preparation, the medication was administered as compounded. As a result of this medication error, the child died after three days of clinging to life while supported by machines. The pharmacist involved in the error was sentenced to six months in jail, six months home confinement, three years probation, 400 hours of community service, a $5,000 fine and payment of court costs. 1 The aforementioned story is just one example of how preventable medication errors harm patients in the United States on a daily CPE Information: Universal Activity Number: H05-T CPE/Hours: 1 contact hours (0.1 CEUs) Target Audience: Pharmacy Technicians Activity Type: Knowledge-based Initial release date: 1/1/2013 Planned expiration date: 12/31/2014 The Collaborative Education Institute is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Activity Goal: This activity provides pharmacy technicians with an awareness of the prevalence and consequences of various types of medication errors. The role of the pharmacy technician in promoting medication error reporting and prevention at both the personal and institutional level is also discussed. Learning Objectives: Upon successful completion of this knowledgebased CPE activity, pharmacy technicians should be able to: 1. Discuss the prevalence and consequences of medication errors 2. Compare and contrast various types of medication errors 3. Identify the role of just culture and voluntary reporting in medication error prevention 4. Describe the role of the pharmacy technician in preventing medication errors 5. Identify the role of the pharmacy technician in medication errors This activity has been developed specifically for pharmacy technicians and is one of 10 activities in the TEAM series.

2 basis. A 2006 report from the Institute of Medicine (IOM) estimated that 1.5 million Americans are harmed every year by medication errors, with the injury imparted ranging from mild to fatal. 2 Other statistics show an increase in medication errors leading to fatality, with 198,000 deaths reported in 1995 and 218,000 reported in From a financial standpoint, it is estimated that medication errors lead to an additional $3.5 billion in annual medical costs in the United States. 2 Observational studies have determined the rate of medication errors in the inpatient setting to be between 1.7% and 59.1%. 4 The wide range may be attributed to varied measurement tools and error underreporting. While these numbers seem staggering on their face, it is theorized that they actually represent only a small proportion of actual medication errors taking place today due to lack of awareness and underreporting. 4 This continuing education module is designed to educate the pharmacy technician about medication errors, from simple who, what and where definitions to practical approaches for error detection/prevention to the more complex nuances of developing and promoting a culture of safety. What is a medication error? Medication errors are broadly defined by the National Coordinating Council for Medication Error and Prevention (NC- CMEP) as...any preventable event that may cause or lead to inappropriate medication use or patient harm. 5 By this definition, medication errors must be preventable. An example of an event that would not be considered a medication error is a severe allergic reaction that had not been previously reported and could not be reasonably predicted based on patient and medication characteristics. In the same vein, an allergic reaction previously reported by the patient that was overlooked would be considered a medication error since it could have been prevented through proper use of available information. Another important point relating to this definition is that a medication error does not necessarily have to cause real patient harm, but rather may only potentially lead to patient harm or inappropriate medication use. This distinction is important because if effort is not made to address the root cause of near-misses (defined as medication-related events in which patient harm could have occurred but did not), the circumstances leading to the near miss may be repeated and lead to actual harm. When do medication errors occur? Medication errors can and do happen at any point within the medication use process. The medication use process consists of the following steps: prescribing, dispensing, administrating, monitoring and overseeing systems/management controls. 6 See Table 1: The Medication Use Process for examples of activities relating to each step (NOTE: listed examples do not comprise all potential activities). Where do medication errors occur? Medication errors can occur in any healthcare setting in which medication is manufactured, compounded, prepared, dispensed or administered. They can also be made in the patient s residence. These include but are not limited to manufacturers, community, hospital, compounding, mail-order and page 2 Medication errors are any preventable event that may cause or lead to inappropriate medication use or patient harm home infusion pharmacies. The potential for an error exists in every setting in which medications are utilized in any capacity. Who commits medication errors? The NCCMEP indicates that medication errors can occur while the medication is in the control of the health care professional, patient, or consumer. 5 Any healthcare professional whose role involves either direct (e.g. packaging/compounding) or indirect (e.g. prescribing) contact with medications has the potential to commit a medication error. Pharmacy personnel, including pharmacy technicians, are at high risk of committing a medication error simply due to the high volume of medication contact inherent in this setting. While patients are capable of committing a medication error themselves, healthcare practitioners need to ensure that patients have the proper tools to safely utilize their medication. How often do medication errors occur? As previously mentioned, medication error statistics only reflect reported errors. Therefore, the exact number of annual errors is impossible to determine. Pharmacy technicians are most likely to be involved in dispensing medication errors due to their primary roles. The rate of dispensing errors in community pharmacies range between 0%-3% with an average error rate of 1.7%. In the inpatient setting, dispensing error rate ranges from 0.04 to 2.9%. However, the statistics currently available underestimate the true incidence, and even these imperfect numbers are unacceptably high. What is the role of the pharmacy technician relating to medication errors? Pharmacy technicians are an integral part of the professional pharmacy team and can offer a unique perspective of the medication use process. As frontline staff, pharmacy technicians play a crucial role in identifying medication errors, whether potential or actual, and reporting these errors in an appropriate manner. Technicians can draw on their experiences to provide feedback and suggestions to promote medication safety among all involved, including pharmacy and non-pharmacy healthcare personnel and patients, in the prevention of medication errors. Additionally, pharmacy technicians are integral to the development and maintenance of a culture of safety in which error reporting and prevention strategies are freely discussed. Medication Error Classification Common types of medication errors are: prescribing, omission, wrong-time, unauthorized drug, improper dose, wrong dosage form, wrong drug preparation, wrong administration

3 technique, deteriorated drug, monitoring and adherence errors along with miscellaneous error not falling into any of these categories. 7 See Table 2. Examples of Medication Errors by Type. For each category, the error type will be defined, an example will be given and the potential role of the pharmacy technician in detecting and preventing the specific medication error type will be discussed. Medication errors are often multifactorial and a single error may fall into multiple categories. Prescribing Errors Prescribing errors are defined as errors relating to the initial prescribing of a medication and are relatively common, with a recent study citing a prescribing error incidence of 30.8 prescriptions out of 1000 prescriptions written. 4,7 Examples of prescribing errors include drug/allergy interactions, incorrect dosing, drug/drug interactions and illegible handwriting. The pharmacy technician can have a significant impact in preventing drug/allergy interactions by routinely verifying patient allergies at prescription drop-off. Additionally, pharmacy technicians involved in order entry can help prevent prescribing errors due to unclear written prescriptions. If a prescription is illegible, the pharmacy technician performing order entry should not try to discern questionable handwriting or guess at the correct medication prescribed. Rather, the situation should be reported to a pharmacist so clarification can be obtained from the prescriber. The same process should be followed when unclear abbreviations are used. Pharmacy technicians can help develop a list of banned abbreviations based on a list put forth by the Institute for Safe Medication Practices (ISMP). Technicians can help enforce this list by sharing with prescribers and requiring clarification before dispensing the medication when banned abbreviations are used. Some examples of inappropriate abbreviations include qd (preferred to write out daily) and cc (preferred to write ml). 8 page 3 pharmacy technicians can help prevent medication errors of omission by removing or minimizing all barriers to the patient receiving needed medication. This can be done by ensuring medications are stocked appropriately and any insurance delays in therapy are handled as quickly as possible. If the pharmacy technician recognizes issues beyond his/her control that may impact the patient s ability to obtain needed medication, it is his/her responsibility to communicate the issue through the appropriate channels in order to avoid an omission or wrong time error that may lead to patient harm. Unauthorized Drug Errors An unauthorized drug error is defined as a patient receiving a medication different than that prescribed. 7 A common cause of unauthorized drug error in the hospital setting is incorrect loading of ADMs. Pharmacy technicians can employ vigilance and suggest system factors to ensure ADM stocking accuracy to reduce this type of error. In the community setting, lack of patient counseling is a major contributor to unauthorized drug errors. When counseling is done, the patient is better informed as to the appropriate use of the medication and is less likely to commit administration or wrong time errors. Additionally, reviewing the medication name, strength, directions and indication with the patient ensures that patient understanding of these factors matches what was prescribed and dispensed. Any disconnect discovered through patient counseling can be clarified and, if necessary, remedied before the patient receives the product, thereby preventing potential patient harm. The pharmacy technician can help prevent this error by actively encouraging patients to accept pharmacist counseling. In all settings, medication names that look and sound alike can lead to unauthorized drug errors. The ISMP maintains a publicly available list of medications commonly mistaken due to look alike/sound alike errors and pharmacy technicians can be instrumental in developing and enforcing a system for verification of look alike/sound alike medication names. Omission/ Wrong-Time Errors Omission errors occur when a prescribed medication is not administered while wrong time errors involve the administration of a medication at the incorrect time. 7 A common example of these errors in the institutional setting occurs when a medication product is not available in the automated dispensing machine (ADM) and is therefore not administered. An example from the community pharmacy setting is delayed insurance authorization resulting in a patient not receiv- Improper Dose/ Wrong Dosage Form Errors Self-Reflection Exercise ing medication in a timely manner. To the best of their ability, An improper dose error is defined as a patient receiving a Think of 3 specific ways you medication could contribute dose different to preventing from medication that prescribed errors within while your a wrong organization: dosage form error involves an incorrect dosage form. 7 These A recent study cites prescribing 1. error incidence of 30.8 prescriptions 2. out of prescriptions written. Medica'on Safety: The Role of the Pharmacy Technician Look Alike/Sound Alike Medications Contribute to Errors Can you raed tihs? The hmaun biran is an aamizng tool capalbe of peorcsisng even sbcraemld infatoiromn wtih raelvteily litlte efofrt. Howveer, when wroikng wtih dgurs tihs aibtily can laed to doenarugs and even dleady cqsunecoeens. The above paragraph illustrates the ability of the human brain to process scrambled information into a recognizable and usable format. This ability contributes to errors associated with lookalike sound-alike medications and labeling. errors commonly occur when a prescription is filled incorrectly at the pharmacy level. An example of a wrong dose error is the dispensing of a 2 mg tablet when 5 mg was ordered. An example of a wrong dosage form error is the dispensing of a suppository when a capsule was prescribed. The pharmacy technician can help prevent these errors by determining high-risk drug products for these types of errors and working to ensure systems are in place to prevent their occurrence. Examples of

4 these system changes include physically separating suppositories and oral formulations on the pharmacy shelves and adding reminder signage so staff double checks commonly confused doses. Wrong Drug Preparation Errors Wrong drug preparation errors occur when a drug is compounded incorrectly. 7 This can involve addition of an incorrect diluent, neglecting to use aseptic technique or failing to combine ingredients in the prescribed ratio. The pharmacy technician with compounding tasks can ensure medications are correctly prepared by promoting safety in systems surrounding the drug compounding process. These opportunities include creating a distractionfree zone where compounding is done, manadating double check of components to be mixed before compounding high risk medications and facilitating access to medication compounding resources as appropriate per facility. Wrong Administration Technique Errors A wrong administration technique error occurs when a medication is administered incorrectly. 7 One example is a medication indicated to be given intramuscularly (IM) actually given intravenously (IV). While the pharmacy technician has minimal involvement with physical medication administration, he/she can contribute to the proper administration of medications by ensuring that all indicated auxiliary labels are properly affixed per pharmacist instructions/institutional policy. Medica'on Safety: The Role of the Pharmacy Technician Mini Quiz Which of the following is a medication error? A. A retail pharmacy technician forgets to record allergies and patient receives a medication to which he is allergic; patient harm occurs B. A hospital pharmacy technician notices the incorrect drug product in an automated dispensing machine drawer and replaces it with the correct product before patient receives medication; no patient harm occurs C. A & B Answer: C Remember! Medication Error = Real OR Potential Patient Harm. Mini Quiz his/her medication and satisfied with his/her relationship with healthcare providers is more likely to be adherent to recommended monitoring and dosing regimens. 9 Miscellaneous Errors While the types of medication errors listed cover most situations, it is impossible to create an exhaustive list. Healthcare practitioners, including pharmacy technicians, must be on alert for medication errors not falling into the traditional categories and work to improve systems to prevent recurrence of these errors. Part 1: (T/F) Different methods of error detection uncover different types of errors. Answer: True. Multiple methods should be utilized to detect as many medication errors as possible. Part 2: Which of the following is an appropriate mechanism for error detection? A. Trigger tools B. Voluntary Reporting C. Direct Observation D. All of the above Answer: D. All these are valid error detection methods. page 4 Deteriorated Drug Errors A deteriorated drug error occurs when a patient receives an expired or contaminated drug product. 7 For example, a patient purchasing an expired bottle of over-the-counter medication would be a victim of such an error. Additionally, pharmacy personnel can commit a deteriorated drug error by dispensing a product known to have been stored at inappropriate temperatures. The pharmacy technician can help prevent deteriorated drug errors by ensuring proper storage of drug products and vigilance with regards to expiration dates. Additionally, the pharmacy technician should perform a basic visual examination when compounding or packaging medications to determine whether the drug product has the appropriate appearance (e.g. correct color, texture, consistency). Monitoring Errors/Adherence Errors Both monitoring and adherence errors occur after a medication has been dispensed and administered to a patient. 7 While it is difficult for healthcare personnel to dictate what happens outside the healthcare environment, the pharmacy technician can play a role in promoting appropriate monitoring and adherence in the community pharmacy setting. Technicians can encourage patients to accept pharmacist counseling. Research shows that a patient who is educated as to the importance of Error Detection and Reporting The ability to obtain accurate information about medication errors is a cornerstone of the development of robust and effective medication safety systems. In order to make necessary improvements to the medication use process within an organization, the following information must be obtained: number of errors, type of errors, settings in which errors occur and type of personnel involved in errors. Many reporting methods are currently available, including but not limited to voluntary error reporting, direct observation, trigger tools (manual or electronic), database mining, evaluation of patient complaints and review of risk management records and/or medical malpractice suits. See Table 3. Error Detection Tools. Evidence has shown that different types of errors are discovered through the use of each of these tools. 10 For this reason, it is essential that a variety of error detection methods be utilized. The pharmacy technician can contribute to the development and maintenance of a robust error detection program by promoting the use of multiple error detection modalities in addition to voluntary reporting. While the majority of organizations rely heavily on voluntary reporting, the accuracy of this method depends on the willingness and participation of frontline staff to report. The cultural

5 model of blame and shame, in which the person committing a medication error is punished and judged to be incompetent regardless of circumstances, is a major cause of underreporting of medication errors. 4 In order to maximize the utility of information obtained via voluntary error reporting, an environment in which reporting is done freely without fear of negative repercussions must be cultivated. This type of environment Table 3. Error Detection Tools 10 Error Detection Tool Voluntary Reporting Direct Observation Trigger Tools Database Mining Patient Complaints Risk Management/Malpractice Suit Definition Medication errors are reported by staff as they occur Management staff observes workers for occurrence of medication errors Selected medications (e.g. antidotes) or words within the medical record (e.g. adverse effect act as a trigger designed to prompt investigation into whether a medication error was occurred Electronic review of medical records searching for common indicators of medication error Evaluation of patient complaints to determine if a medication error has occurred Review malpractice suits/ issues referred to risk management department to determine if a medication error has occurred requires an institutional culture of transparency, support, and commitment to improvement. 11 Transparency, defined as the free, uninhibited sharing of information, is essential to allow for a rich learning environment in which root causes of errors can be determined and ideas for improvements to medication safety systems can be shared. 11 Support and commitment to improvement should be demonstrated by visible and tangible system changes when appropriate and communication of these changes to frontline workers. As a frontline worker, the pharmacy technician must serve as a role model through personal transparency and dedication to reporting his/her own medication errors. Additionally, the pharmacy technician can serve to assess the organizational culture surrounding medication error reporting and frontline staff perception of system changes to improve medication safety. Just Culture One well-documented method of creating an environment of safety is through the promotion of a just culture. Just culture is defined as an atmosphere of trust in which people are encouraged (even rewarded) for providing essential safety-related information, but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior. 12 The just culture model accepts human error as a natural occurrence and encourages development of systems to prevent human error. Honest mistakes are not punished in this model; however, blame and remediation for errors resulting from careless or reckless behavior is encouraged. 12 The pharmacy technician can work both as an individual and as part of the interdisciplinary CASE QUIZ: Just Culture The following case illustrates the experience of a pharmacy technician involved in a medication error both in a setting of just culture and one in which blame and shame is the cultural norm. Which exemplifies Just Culture? Blame and Shame? Think about which setting would make you feel more comfortable self-reporting a medication error? Which environment is more conducive to medication error prevention? Background: Jim, a pharmacy technician, accidentally filled an automated dispensing machine with the incorrect medication. Jim was answering a nurse s work-related question and monitoring his work pager while he restocked the machine. He is a competent and caring professional and attributes the error to being distracted. INSTITUTION A: Upon discovery, Jim immediately reports the error to his supervisor because he feels confident he will not be humiliated or punished. He then utilizes his organization s medication error reporting system to formally report the error. Once the report is reviewed, senior management meets with Jim to determine the circumstances around the error. It is determined that Jim was not reckless and he is not punished for the error. Management personnel engage Jim in coming up with a system approach to ensure that other technicians do not encounter the same situation and potentially make the same error. INSTITUTION B: methods. A classic approach to prevention of medication errors is training individual healthcare staff members to always personally ensure that the 5 Rights are present at each step within the medication use process. These 5 Rights of safe medication use include right patient, right drug, right time, right dose and right way. It is considered the responsibility of the individual practitioner to ensure that these 5 Rights are in place. 4 This approach is common but.errors continue to occur in spite of its widespread use. One theory as to why this method is ineffective when used alone is that it relies heavily on individual responsibility and does not address the importance of system components that promote safe medication use. 4 The blame, shame and retrain model, in which personnel are punished and humiliated for making an error and individual competency training is viewed as the solution to prepage healthcare team to develop a just culture by promoting fair treatment in response to reported errors and commitment to a systems approach to safety improvements. Error Prevention Once information relating to medication errors is collected, the next step is to determine the cause of the error. When causative factors are identified, this information can be utilized to devise error prevention Jim is torn about reporting the error because he fears reprisal but ultimately decides it is the right thing to do. He reports the error and senior management scolds him for not being careful. It is implied that he is incompetent and he is assigned to 40 hours of remedial training. He is told that if he makes another medication error he will be fired.

6 venting medication errors, is commonly used. 4 However, this is an overly simplified approach to prevention of medication errors. While promotion of competency through training and education can impact medication errors to some degree, modifications must be made to systems in order to minimize the relatively unchangeable human factor involved in medication errors. 3 Human factors include confirmation bias (the human tendency to see what is expected as opposed to what is truly there), distraction (internal or environmental, memory lapses and the tendency to create and utilize shortcuts. 2,4 Examples of system changes to promote medication safety include the requirement of an independent double check on highrisk medications, enforcement of standardized medication concentrations, reduction in allowable consecutive working hours, encouragement of an atmosphere of open communication among colleagues and the appropriate implementation of technology. 4 The pharmacy technician can play a role in error prevention by maintaining his/her own professional competency, encouraging colleagues to do the same, helping to devise creative system-based solutions based on unique perspectives and working within interdisciplinary healthcare teams to implement these solutions. Conclusion Medication errors occur within all healthcare settings and affect all members of the interdisciplinary healthcare team, including the pharmacy technician and most importantly, the patient. Pharmacy technicians play a vital role in the detection and prevention of medication errors through their front line responsibilities of medication packaging and delivery and their unique perspective on the medication use process. On an individual basis, pharmacy technicians can identify both potential and actual errors and report such errors when they occur. On a broader level, the pharmacy technician can work with other healthcare practitioners to encourage a transparent culture of reporting of medication errors and a just culture model is practiced. These roles are universal among all pharmacy technicians regardless of practice setting. Through awareness and active advocacy, the pharmacy technician can have a major impact on reducing medication errors and thereby promote a safe and healing environment for optimal patient care. References: page 6 1. Cohen MR. An injustice has been done: Jail time given to pharmacist who made an error. Institute for Safe Medication Practices (ISMP) Newsroom. August 21, < Accessed September Institute of Medicine (IOM). Preventing Medication Errors. Report Brief. July 2006 < Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf> Accessed September Academy of Managed Care Pharmacy (AMCP). Medication Errors. June 2010 < aspx?id=9300> Accessed September Cohen MR. Medication errors 2nd ed. Washington, DC: American Pharmacists Association; Frequently Asked Questions (FAQ) Institute of Safe Medication Practices (ISMP). < Accessed September Ninno MA, Ninno SD. Chapter 14. Quality Improvement and the Medication Use Process. In: Kier KL, Malone PM, Stanovich JE, eds. Drug Information: A Guide for Pharmacists. 4th ed. New York: McGraw-Hill; Accessed September 19, Mark SM, Little JD, Geller S, et al. Chapter 5. Principles and Practices of Medication Safety. In: Talbert RL, DiPiro JT, Matzke GR, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; aspx?aid= Accessed September 19, ISMP Abbreviation List 9. Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine. 2000; 25(24): Shojania KG. The elephant of patient safety: What you see depends on how you look. Jt Comm J Qual Pat Saf 2010; 36(9): Leape L, Berwish D, Clancy C, et al. Transforming healthcare: a safety imperative. Qual Saf Health Care 2009; 18: Reason J. Human error: Models and management. BMJ 2000; 320:

7 Appendices Table 1. The Medication Use Process 6 page 7 Prescribing A prescriber selects the right medication for an individual patient based on comorbidities, allergies and current condition Pharmacist order/prescription clarification Dispensing Order/Prescription processing by a pharmacy technician Compounding of a medication product Labeling of a medication product Counseling the patient on name, strength, proper use of and what to expect from a medication Affixing proper warning labels to the medication product Administration Patient taking a capsule within his/her home Nurse administering a medication to an inpatient Home health personnel administering a parenteral medication Monitoring Ensuring proper laboratory test follow-up Identifying adverse reactions Making changes to medication regimen as appropriate Systems/Management Controls Interdisciplinary rounds to discuss proper medication utilization Required patient counseling on new prescriptions Automated computer-based warnings related to drug/allergy or drug/drug interactions

8 Appendices Table 2. Examples of Medication Errors by Type 7 page 8 Medication Error Type Prescribing Error Example(s) Provider prescribes a medication to which a patient has a severe allergy Prescription/medication order is illegible Dosing is incorrect for kidney function Nurse cannot locate drug product and patient misses entire dose Omission Error Medication requires a prior authorization from insurance and patient does not receive medication Nurse cannot locate drug product and drug administration is delayed Wrong Time Error Unauthorized Drug Error Improper Dose Error Wrong Dosage Form Error Wrong Drug Preparation Error Wrong Administration Technique Error Deteriorated Drug Error Monitoring Error Adherence Error Medication requires a prior authorization from insurance and patient experiences a delay in obtaining medication An automated dispensing machine is stocked with the incorrect drug product and patient receives the incorrect medication A prescription is filled with the incorrect medication but labeled for the prescribed drug An automated dispensing machine is stocked with the incorrect dose and patient receives the incorrect dose A prescription is filled with the incorrect dose but labeled for the prescribed dose A suppository is dispensed when a capsule was ordered A cream is dispensed in place of an ointment Incorrect diluent used in compounding parenteral product Incorrect ratio of ingredients added to compounded liquid medication A medication ordered to be given intramuscularly (IM) is given intravenously (IV) A patient purchases an expired bottle of over-the-counter medication A pharmacy dispenses tablets that have been stored at a temperature outside the appropriate range A medication requires lab monitoring but lab tests are not ordered Patient is not informed of adverse effects for which to monitor Patient does not take the full course of antibiotics because he/she is feeling better Patient takes daily blood pressure medications only every other day for cost saving

9 Assessment Questions 1) Which of the following is a medication error? A) A patient receives a capsule for rectal use when a suppository was ordered B) A nurse notices that a syringe is labeled to be administered intramuscularly when the order reads intravenous-she verifies the labeling with the pharmacist and the issue is corrected before the patient receives the medication C) A patient does not receive medication for 3 days due to insurance issues D) All of the above 2) When a Near Miss occurs, no further investigation is necessary because the potential issue was caught and no harm occurred. A) True B) False 3) Which of the following is an example of a drug preparation error? A) Lab tests are not ordered as appropriate to monitor with medication therapy B) A drug product is stored at the incorrect temperature and then dispensed to a patient C) Normal saline is used to compound a parenteral solution when sterile water was ordered D) A provider writes a prescription for a medication to which a patient has a known allergy 4) Which of the following is an example of a prescribing error? A) A drug product is stored at the incorrect temperature and then dispensed to a patient B) A drug product prescribed to be given intramuscularly is given intravenously C) Sterile technique is not used in D) The technician is unable to read a prescription and guesses which medication has been prescribed. The patient receives the incorrect drug. 5 Organizations should designate only one type of error detection method since use of multiple ethods can lead to confusion and inaccurate error rate measurement. A) True B) False 6) Which of the following is an effective approach to promote medication error detection and prevention? A) Punishment for personnel committing medication errors regardless of circumstances B) Emphasis on systems modifications to promote safety C) Discouragement of error reporting to maintain a seemingly low error incidence D) All of the above 7) Which of the following is an example of Just Culture? A) A staff member is punished for an medication error in which he/she exhibited reckless/careless behavior B) A staff member is punished for a medication error that occurred as the result of an honest mistake; no recklessness/carelessness was involved C) No punishment for medication errors is done regardless of whether the error was due to recklessness/carelessness or not 8) Voluntary error reporting gives an accurate measure of true error incidence A) True B) False 9) Which of the following is a way in which the pharmacy technician can help identify medication errors in his/her organization? A) Do not report medication errors so your organization appears to have a low error incidence B) Work with the interdisciplinary healthcare team to promote a just culture in which frontline staff feels free to report medication errors C) Encourage colleagues not to report errors committed by others and to focus on their own issues D)All of the above 10) Which of the following is a way in which the pharmacy technician can help prevent medication errors in his/her organization? A) Suggest ideas to improve a distraction-prone working environment B) Create a method to differentiate Look Alike Sound Alike products C) Create and enforce a list of error-prone abbreviations D) All of the above CPE Instructions: Pharmacy technicians must read this activity and successfully complete the exam (70% pass rate) and evaluation prior to December 31, 2014 using the following instructions: Login to MY PORTFOLIO on On the right of the title of this article, click on GO TO EXAM Upon successful completion of the exam, you will see a page with explanations to the exam questions. After reading through this feedback, scroll to the bottom of the page and click GO TO EVALUATION Complete the evaluation and click SUBMIT You can obtain your CPE Statement of Credit at within 45 days If you have any questions about this process, please contact Cindy Smith, [email protected],