The document discusses the role of pharmacists in patient safety. It notes that patient safety is a serious global issue and errors in healthcare harm many patients worldwide each year. It then provides examples of different types of medication errors like prescription errors, transcription errors, and administration errors that pharmacists can help prevent. The role that pharmacists play in areas like proper medication management, avoiding look- and sound-alike drug names, and ensuring the safe use of high-alert medicines is emphasized.

1. WORLD PHARMACIST DAY
“Role of pharmacist
in
patient safety”
SOURABH KOSEY
ASSOCIATE PROFESSOR
DEPT. OF PHARMACY PRACTICE
ISF COLLEGE OF PHARMACY, MOGA, PUNJAB
95013-05664
sourabhkosey@gmail.com

2. PATIENT SAFETY

3. WHO facts on Patient Safety
Fact 1- Patient safety is a serious global public
health issue. In 2002, WHO Member States agreed on
a World Health Assembly resolution on patient safety.
Fact 2- Estimates show that in developed countries
as many as one in 10 patients is harmed while receiving
hospital care. The harm can be caused by a range of
errors or adverse events.
Fact 3- In developing countries, the probability of patients
being harmed in hospitals is higher than in industrialized
nations. The risk of health care-associated infection in some
developing countries is as much as
20 times higher than in developed countries.

5. "It may be part of human nature to err, but it
is also part of human nature to create
solutions, find better alternatives and meet
challenges ahead".

6. Quality
State of excellence
Free from defects and deficiencies
Doing things right first time and doing it better
everytime

7. IPSG-3
MEDICATION SAFETY

8. Medication Management

10. MEDICATION ERRORS
• Prescription Errors
• Transcription Errors
• Administration Errors
• Dispensing Errors
• Storage Errors

11. • All orders in Capitals
• Drug Name (trade/ generic)
• Dose, Route, Frequency
• Directions (Dilutions, Admin./ infusion time etc)
• Signature, Date
• e.g.
• Inj. KCl 10 mg IV OD
• Inj. KCl 10 meq IV OD in 500 ml IVF over 3 hrs
PRESCRIPTION WRITING

12. • No Dose or Wrong Dose mentioned
• No Route or Wrong Route mentioned
• Overwriting of drug orders
• Dilution not mentioned
• Duplication of orders
• Writing revised drug on same order
• Illegible Drug Orders
PRESCRIPTION ERRORS

13. NO DOSE OR WRONG DOSE MENTIONED
• Tab. ECOSPRIN 180 mg PO OD - Tab. ECOSPRIN 150 mg PO OD
• Tab. DEPLATT-A OD - Tab. DEPLATT-A(75/150 mg) PO OD
• Inj. ACTAMASE 1 g IV - Inj. ACTAMASE 1.125 g IV BD
• Inj. REFLIN IV TDS - Inj. REFLIN 1 gm IV TDS
• Inj. RABLET BD - Inj. RABLET 20 mg IV BD
• Tab. GANATON TDS - Tab. GANATON 50 mg PO TDS
• Inj. VANCOMYCIN IV BD - Inj. VANCOMYCIN 1 GM IV BD
• Inj. KCl 40 mg IV OD - Inj. KCl 40 Meq IV OD in 500 mL
IVF

14. NO ROUTE OR WRONG ROUTE MENTIONED
• Inj. RABLET BD - Inj. RABLET 20 mg IV BD
• Inj. VIT-K IV 1 amp OD - Inj. VIT-K IM 1 amp OD
• Inj. IMIPENEM 500 mg BD - Inj. IMIPENEM 500 mg IV BD
• Inj. TARGOCID 400 mg OD - Inj. TARGOCID 400 mg IV OD
• Inj. CLEXANE 40 mg PO OD - Inj. CLEXANE 40 mg S/C OD
• INJ. LASIX 40 mg P/ORAL - INJ. LASIX 40 mg IV OD
• Inj. MVI OD - Inj. MVI 1 amp. IV OD in 500
mL IVF over 3 hours

15. OVERWRITING OF DRUG ORDERS
• Tab. AVAS (20/40) mg PO HS - Tab. AVAS 20 mg PO HS
• Inj. to Tab. PANTOP/ DYTOR
• Inj. TAZACT 4.5 gm to 2.25 gm IV BD
• Tab. AMLONG 5 mg to Tab. AMLONG 10 mg
• Inj. GRAMOCEF 1 gm to Tab. GRAMOCEF 200 mg
• Tab. URSOCOL 300 mg PO BD to PO TDS

16. DILUTION NOT MENTIONED
• Inj. POLY-B 7.5 lac units IV BD - Inj. POLY-B 7.5 lac units
IV BD diluted in 250 ml 5%
Dextrose
• Inj. KCl 20 mEq IV OD - Inj. KCl 20 mEq IV OD in
500 ml IVF
• Inj. KCl 20 mEq slow IV - Inj. KCl 20 mEq IV OD
diluted in 500 ml IVF
• Inj. AMPHOTERICIN-B 50 mg STAT (no brand, no dilution)
• Inj. AMPHOTERICIN-B (lyophilized/ liposomal) 50 mg IV

17. DUPLICATION OF ORDERS
• Tab. ZANOCIN 400 mg OD - discontinue previous
(double order) orders and prescribe new one
• Discontinue Pre-operative orders to start with post-operative orders

18. • Inj. TARGOCID 400 mg IV OD in 100 mL NS over 30 min
• Inj. POLY-B 5.0 Lac Units IV BD in 500 mL 5% Dextrose
• Inj. MVI 1ampoule IV OD in 500mL IVF over 3 hours
• Tab. DROTIN DS PO BD
• Tab. DEPLATT-A (75/150) mg PO OD
EXAMPLES OF GOOD PRESCRIPTION

19. • Abbreviations those can be used
• SOS, IV, IM, PO, S/C
• Abbreviations those shouldn’t be used
• OD, BD, TID/ TDS, QID, HS, CST
• 1-0-1 to indicate BD
• cc for mL, g for Gram,
• Decimals
• Leading zero must be written (0.25 mg and not .25 mg)
• Trailing zero NOT to be written
ABBREVIATIONS

20. MEDICATION SAFETY
• Look Alike Sound Alike (LASA)
• High Risk Medicines
• Narcotics
• Crash Carts
• Buffer stocks

21. NARCOTICS
• Define
• Narcotic Drugs
– Morphine
– Fentanyl
– Pathidine
– Naloxone
• Storage
– Double lock
– Keys with 2 different individuals
– Environmental control

22. NARCOTICS
• Register
– Daily inventory
– Prescription
– Receipt
– Empty container

23. NARCOTICS
• Narcotics policy states
– No Cutting
– No overwriting
– No pasting/ withering of pages
– No whitener allowed

24. LOOK ALIKE SOUND ALIKE
• LASA medicines
– Look alike
– Sound alike
• May lead to error while
– Prescription
– Transcription
– Dispensing
– Administration

25. LOOK ALIKE SOUND ALIKE
• LASA medicines
– List of LASA to be displayed at all stations
– Available medicines to be highlighted
– LASA medicines to be kept segregated
• Pharmacy to put distinguishing label on LASA
• LASA medicines should be rechecked/
reconfirmed before dispensing

26. Sr. No LOOK ALIKE MEDICINES
1 AMARYL 1 MG AMARYL 2 MG
2 AMARYL M1 AMARYL M2
3 CARCA 3.125 CARCA 6.25
4 CARLOC 3.125 CARLOC 6.25
5 CARDACE 2.5 CARDACE 5
6 CARDACE H 2.5 CARDACE H 5
7 CARDACE AM 2.5 CARDACE AM 5,10
8 DEPLATT A 75 DEPLATT A 150
9 DYTOR PLUS 10 DYTOR PLUS 20
10 DYTOR 10 DYTOR 20
11 GLUCONORM G1 GLUCONORM G 2
12 GLYCOMET GP 1 FORTE GLYCOMET GP 2 FORTE
13 MAGNEX FORETE 1.5 GM MAGNEX FORTE 3GM
14 CREMAFFIN PLAIN CREMAFFIN PLUS
15 THYRONORM 25,50 THYRONORM 75, 100,150
16 STALOPAM 5 STALOPAM 10
17 CEFTUM 250 CEFTUM 500
18 CLOPITAB A 75 CLOPITAB A 150
19 ECOSPRIN AV 75 ECOSPRIN AV 150
20 ECOSPRIN GOLD 10 ECOSPRIN 20 FORTE
21 MAGNAMYCIN MAGNEX FORTE
22 VIATRAN 1.5 GM VIATRAN 3GM
23 PERINORM CALMPOSE
24 HOPACE 1.25,2.5 HOPACE 5
25 ZYTANIX 2.5 ZYTANIX 5
26 ENVAS 2.5 ENVAS 5
27 MEZOLAM 5ML MEZOLAM 10ML
28 NITROCIN INJ TRANEMIC INJ
29 HEPARIN 5000 HEPARIN 25000
30 ERYKINE 4000 NEUKINE 3000
31 INJ. METOLAR INJ. MYOPYROLATE
32. INJ. ATROPINE INJ. PYROLATE
Sr.
No
SOUND ALIKE MEDICINES
1 DIAPRIDE FORTE DIAPRIDE FORTE 1 GM
2 DIAPRIDE PLUS DIAPRIDE PLUS 1 GM
3 TRIPRIDE 1 TRIPRIDE 2
4 AVAS EBAST
5 STROCIT STROLIN
6 LORNICA ZORNICA
7 MYOSPAZ THIOSPAS
8 METALOC BETALOC
9 CIPLORIC ZYLORIC
10 T. LANOXIN T. LINOX
11 Inj. DEXEM Inj. DIXIN
LASA MEDICINES

27. HIGH ALERT MEDICINES
• Define
• Dispensing protocol
• Prescription by Doctor
• No verbal orders
• Replacement in name of the patient

28. • Insulin's
• Opiates
• Concentrated Electrolytes
– KCl
– NaCl (> 0.9%)
– Mg SO4
• IV Anticoagulants
• Psychoactive drugs
• Chemotherapeutic Drugs
HIGH ALERT MEDICINE

29. HIGH ALERT MEDICINES
1) Opioids and Narcotics
i. Morphine
ii. Pethidine
iii. Fentanyl
iv. Pentazocin
v. Buprenorphine
vi. Dextropropoxyphene
vii. Tramadol
viii. Codeine
2) Sedatives and Hypnotics
i. Chlordiazepoxide
ii. Diazepam
iii. Lorazepam
iv. Alprazolam
v. Midazolam
vi. Nitrazepam
vii. Flurazepam
viii.Clonazepam
ix. Clobazam
x. Zolpidem
xi. Zaleplon
xii. Phenobarbitone
3) Injectable Concentrated
Electrolytes
i. Conc. Potassium
Chloride
ii. Conc. Sodium
Chloride (>3%),
iii. Magnesium Sulphate
(25%/ 50%)
iv. Calcium Gluconate
4) Neuro Muscular Blocking
agents
i. Vecuronium
ii. Pancuronium
iii. Atracurium
iv. Succinyl Choline
5) Chemotherapeutic (Anti
Cancer) Drugs
6) Insulin’s
7) Intravenous Anticoagulants
i. Heparin 25000 I.U.
ii. Enoxaparin
iii. fondaparinux
8) Haloperidol (Antipsychotic
Drug)

30. • AMI
• Pain assessment and management
• Prescription audit
• Antibiotic prescription
• DVT
• Pharmacological management of Heart Failure
• Step up analysis
• CPR
Clinical Audits

31. • Assessment (Pain Score)
– Visual Analogue Scale
– Numerical Rating Scale
– Faces Rating Scale
– Behavioral Rating Scale
– Functional Activity Scale
• Hourly assessment post-op (6 hrs)
• If pain score <4, 8th hourly
• If pain score > 4, 6th hourly
PAIN- Assessment & Management

32. Visual Analogue Scale

33. Numerical Rating Scale

34. Faces Rating Scale

35. Functional activity
score#
(Cough/movement)
A – No limitation
B – Mild limitation
C – Severe limitation
#Relative to baseline
Face 0
Face muscles
relaxed
1
Facial muscle
tension, frown,
grimace
2
Frequent to constant
frown, clenched jaw
Face score:
Restlessness 0
Quiet, relaxed
appearance,
normal movement
1
Occasional
restless
movement,
shifting position
2
Frequent restless
movement may include
extremities or head
Restlessness
score:
Muscle tone* 0
Normal muscle
tone
1
Increased tone,
flexion of fingers
and toes
2
Rigid tone
Muscle tone
score:
Vocalisation** 0
No abnormal
sounds
1
Occasional
moans, cries,
whimpers and
grunts
2
Frequent or continuous
moans, cries, whimpers
or grunts
Vocalisation
score:
Consol ability 0
Content, relaxed
1
Reassured by
touch, distractible
2
Difficult to comfort by
touch or talk
Consol ability
score:
Behavioural pain assessment scale total (0–10) /10
Behavioral Rating Score

36. Functional Activity Scale
• Activity-related score
• Ask your patient to perform an activity related to
their painful area (deep breathe/ cough for thoracic
injury/ move affected leg for lower limb pain).
• Observe during the chosen activity and score A, B or
C.
– A – No limitation (activity is unrestricted by pain)
– B – Mild limitation (activity is mild to moderately restricted
by pain)
– C - Severe limitation (ability to perform the activity is
severely limited by pain)

37. • Management
– Doctor
– Nurse
• If pain score >5, inform primary consultant
• Inform the consultant in all conditions

38. WHO Pain Management
Ladder

39. Date Time Pain Score Management Remarks
PAIN ASSESSMENT/ MANAGEMENT AUDIT TOOL
Patient’s labelPatient’s name: _____________
UHID: __________ IPID: _______________
Consultant: ____________________________
Diagnosis/ Procedure: ___________________

40. Medication Error Categorization
Category Description Example
A No error, capacity to cause error NA
B Error that did not reach the patient NA
C Error that reached patient but unlikely to cause harm (omissions
considered to reach patient)
Multivitamin was not ordered on
admission
D Error that reached the patient and could have necessitated
monitoring and/or intervention to preclude harm
Regular release metoprolol was ordered
for patient instead of extended-release
E Error that could have caused temporary harm Blood pressure medication was
inadvertently omitted from the orders
F Error that could have caused temporary harm requiring initial or
prolonged hospitalization
Anticoagulant, such as warfarin, was
ordered daily when the patient takes it
every other day
G Error that could have resulted in permanent harm Immunosuppressant medication was
unintentionally ordered at one-fourth the
dose
H Error that could have necessitated intervention to sustain life Anticonvulsant therapy was inadvertently
omitted
I Error that could have resulted in death Beta-blocker was not reordered post-
operatively

42. Reporting Any Error