Buletin Farmasi HRPZ

If you have any queries with regards to drugs / health, feel free to con-

tact us at

Drug Information Service (DIS), Pharmacy Department HRPZ II

09-7452000 Ext: 2478 (Office hours) , [email protected]

We source the answers from:

Micromedex, Internet and our References

Medication safety Strive to enSure patient’S Safety

Edisi Mei 2013 Terbitan Jabatan Farmasi 2013

MOH/P/KEL/90.13 BUL)

HIGH ALERT MEDICATION :

PREVENTING ERRORS

Buletin Farmasi HRPZ II Edisi Jan—Mac 2013

Supervisor : Pn Fatimah

Chief Editor : Pn Sudarwaty

Cik Zaimawati

Pn Wan Najwa

Pn Wan Mahani

Cik Tg. Norfarhah Cik Balqis

Cik Suhaine

Cik Siti Noratiqah

Pn Sharina

Editor :


trol of the healthcare pro-

fessional, patient or con-

sumer.

Types of medication error:

Prescribing error

Wrong time error

Dose error

Dosage form error

Drug preparation error

Omission error

Unauthorized drug error

Route of administration

Medication safety is one

of the major components

in patient safety but unfor-

tunately medication errors

do occur and often go

undetected.

Medication error is any

preventable event that may

cause or lead to inappro-

priate medication use or

patient harm while the

medication is in the con-

error

Administration tech-

nique error

Deteriorated drug error

With guidance and cooper-

ation of the Medication

Safety Technical Advisory

Committee, the Pharma-

ceutical Services Division

has embarked on a report-

ing system called the Med-

ication Error Reporting

One of the important missions of the healthcare providers is to help patients make the best use of

medications and very importantly, strive to ensure patient safety.

Medication Error Reporting System (MERS)

In Malaysia, medication

error reporting is at the

moment on a voluntary

basis.

Objectives of MERS:

To obtain information

on the occurrence of

medication errors

Maintain a database of

medication errors

Analyse reports

Propose remedial ac-

tions

Monitor the situations in

an effort to minimize

MEDICATION SAFETY Look alike drug

Example of error

http://mers.moh.gov.my/MERS/


The consequences of an error associated with

use of these medications can result in significant

patient injury and special precautions must be

employed with their overall management.

CATEGORIES OF HIGH ALERT

MEDICATIONS

1. ADRENERGIC AGONISTS–

Adrenaline, Noradrenaline.

2. ADRENERGIC ANTAGONISTS–

Propanolol, Labetalol

3. ANESTHETIC AGENTS–

Propofol, Ketamine

4. ANTIARRYTHMIC—

Lignocaine, Amiodarone

5. ANTIFIBRINOLYTICS

6. ANTITHROMBOTIC AGENTS–

Warfarin, Heparin, Streptokinase

7. ANTIVENOM–

Sea snake, cobra, pit viper

8. CHEMOTHERAPEUTIC AGENTS

9. DEXTROSE, HYPERTONIC-

10. EPIDURAL & INTRATHECAL MEDICATIONS

11. GTN INJECTION

12. INOTROPIC MEDICATIONS–

Digoxin, Dobutamine, Dopamine

13. INSULIN

14. MAGNESIUM SULPHATE INJECTION

15. MODERATE SEDATION AGENTS

16. NEUROMUSCULAR BLOCKING AGENTS–

Pancuronium, Atracurium, Rocuronium

17. OPIATES & NARCOTICS

18. PARENTERAL NUTRITION PREPARATION

19. POTASSIUM SALT INJECTIONS

Institute for Safe Medication Practices (ISMP) in the United States has termed medications that have the highest risk of

causing injury when misused as ‘High-Alert Medications’. These are more likely to be associated with harm compared

to other medications, and the harm are likely to be more severe.

CONCLUSION High Alert Medications require a heightened

vigilance and a joint effort from all health-care

practitioners to improve patient safety with respect

to minimizing the errors and their consequences.

KEKUCHA AS SYURA JOHANAN FUTSAL

ANAN FUTSAL ANTARA JABATAN

COMMON RISK

FACTORS

1. Poor handwriting.

2. Incorrect dilution

procedure.

3. Confusion between route

of administration (IM, IV,

Intrathecal, epidural).

4. Confusion between differ-

ent strengths.

5. ‘Look-alike’ product.

6. ‘Sound-alike’ product.

STRATEGIES IN

PREVENTING ERRORS

1. Limit the drug’s strengths

available in the formulary.

2. Avoid frequent changes of

brand.

3. All HAM should be kept

in individual labeled-

containers. Avoid look-alike

and sound-alike drugs or

different strengths of the

same drug from being stored

side by side.

4. Use TALL-man letter to

emphasize differences in

medication names (ex: DO-

Pamine

and DOBUtamine).

5. Label all containers used

for storing HAM in red as

"HIGH ALERT".

6. All HAM must be coun-

ter-checked before dispens-

ing.

http://www.bing.com/images/search?q=warfarin&view=detail&id=2E6DC52362C644D2B7C29444415BDF4ED144A9C6&FORM=IDFRIR

http://www.bing.com/images/search?q=noradrenaline&view=detail&id=215340E957D7FAC3074A68EA9200F1760EFBD7DC&FORM=IDFRIR


An appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product. –WHO-

website to refer :

www.pharmacy.gov.my

www.farmasiklt.moh.gov.my

www.bpfk.gov.my


NO GENERIC NAME PRESCRIBER

CATEGORY

DETAILS

1. Amoxicillin 500 B As Amoxicillin 250 mg Capsule

2. Cloxacillin 500

mg Capsule

B As Cloxacillin 250 mg Capsule

3. Memantine HCl A* As Memantine HCL 10 mg Tablet

4. Quetiapine

Fumarate 100 mg

Immediate Re-

A* Indication

i) Schizophrenia, ii) Short term treatment of acute

manic episodes associated with bipolar I disorder,

either monotherapy or adjunct to lithium or divalpro-

ex, iii) Treatment of depressive episodes associated

with bipolar disorder

5. Quetiapine

Fumarate 200 mg

Immediate Re-

A*

6. Metformin HCl

750 mg Extended

A/KK As Metformin Hydrochloride 500 mg Extended Re-

lease Tablet

7. Benzydamine Hy-

drochloride 3.0

mg/ml throat

spray

A* Temporary relief of painful conditions of the mouth

and throat including tonsillitis, sore throat, radiation

mucositis, aphthous ulcers, pharyngitis, swelling,

redness, inflammatory conditions, post-orosurgical

and periodontal procedures. (For pediatric and oto-

rhinolaringology use. Restrict to patients who are not

8. Oxymetazoline

HCI 0.01% Nasal

A* Indication

i)Acute colds, ii)Paranasal sinusitis, iii)Otitis media

9. Calcipotriol mon-

ohydrate 50

mcg/g and Beta-

methasone di-

propionate 0.5

mg/g Gel

A* Indication

Topical treatment of scalp psoriasis

10

.

Ropinirole HCI 2

mg Extended Re-

lease Tablet

A* Indication

Treatment of idiopathic Parkinson?s disease. It may

be used as monotherapy or in combination with levo-

dopa 11 Ropinirole HCI 4

mg Extended Re-

lease Tablet

A*

NEW DRUGS IN MOH FORMULARY—3/2012


NO GENERIC PRESCRIBER DETAILS

1 Amoxicillin 500 B As Amoxicillin 250 mg Capsule

2 Cloxacillin 500 B As Cloxacillin 250 mg Capsule

3 Memantine HCl A* As Memantine HCL 10 mg Tablet

4 Quetiapine

Fumarate 100

mg Immediate

A* Indication

i) Schizophrenia, ii) Short term treatment of

acute manic episodes associated with bipolar I

disorder, either monotherapy or adjunct to

lithium or divalproex, iii) Treatment of de-

pressive episodes associated with bipolar dis-

order

5 Quetiapine

Fumarate 200

mg Immediate

A*

6 Metformin HCl

750 mg Ex-

tended Release

Tablet

A/KK As Metformin Hydrochloride 500 mg Extended

Release Tablet

7 Benzydamine

Hydrochloride

3.0 mg/ml

throat spray

A* Temporary relief of painful conditions of the

mouth and throat including tonsillitis, sore

throat, radiation mucositis, aphthous ulcers,

pharyngitis, swelling, redness, inflammatory

conditions, post-orosurgical and periodontal

procedures. (For pediatric and otorhi-

nolaringology use. Restrict to patients who are

not able to gargle)

8 Oxymetazoline

HCI 0.01% Na-

sal Drops

A* Indication

i)Acute colds, ii)Paranasal sinusitis, iii)Otitis

media

9 Calcipotriol

monohydrate 50

mcg/g and Be-

tamethasone

dipropionate 0.5

A* Indication

Topical treatment of scalp psoriasis

10 Ropinirole HCI

2 mg Extended

A* Indication

Treatment of idiopathic Parkinson?s disease.

It may be used as monotherapy or in combina-

tion with levodopa 11 Ropinirole HCI

4 mg Extended

A*

ADD STRENGTH/ FORMULATION—3/2012


Indication

Long-acting β2-agonist indicated

for maintenance bronchodilator

treatment of airflow obstruction in

adult patients with chron-

ic obstructive pulmonary dis-

ease(COPD).

Dosage

Recommended Dosage: Once-daily

inhalation of one 150 mcg cap

Maximum Dose: 300 mcg once-daily.

Elderly: No dosage adjustment is

required in elderly patients.

Contraindications

Hypersensitivity to

indacaterol maleate, to

lactose or to any of the

other excipients of

Onbrez Breezhaler.

Mechanisme of

Action

Relaxes bronchial

smooth muscle by

selective action on β2-

receptors with little

effect on heart rate ;

acts locally in the lung

Storage

Store capsules at controlled

room temperature of 25°C ;

excursions permitted to 15°C

to 30°C.

Protect from direct sunlight

Administration

For inhalation using

Brezehaler. Do not swallow

capsules. Do not use remove

capsules from blister until

immediately before use. Use

at the same time everyday.

Do not wash mouthpiece.

How To Manage Missed Dose

If missed a dose, take the

dose as soon as possible as

long as it is 12 hours before

the next dose

If it is less than 12 hours to

the next dose, do not take the

dose that was missed

Do not take a double dose to

make up for the dose missed

Common Side Effect

Throat Irritation

Head pain

Cough


8. Before placing the mouthpiece in your mouth, breathe out fully.

12. Open the mouthpiece again, and remove the empty capsule.

10. As you breathe in through the inhaler, you should hear a whirring noise.

You will experience a sweet flavour as the medicine goes into your lungs.

7. Release the side

buttons fully.

11. Hold your breath for at least 5-10 seconds while taking the inhaler out

of your mouth.Then breathe out.

4.With dry hands, re-

move one capsule

from the blister.

5. Place the capsule

into the capsule

chamber. Close the in-

haler until you hear a

“click”.

1. Pull off the cap.

3.Hold the base of the

inhaler firmly and tilt

the mouthpiece.

2.Opens the inhaler

9. Hold the inhaler as shown in the picture. The side buttons should be fac-

ing left and right.Place the mouthpiece in your mouth and close your lips

firmly around it. Breathe in rapidly but steadily and as deeply as you can.

6. Pierce the capsule

by firmly pressing

together both side

buttons at the same

time. You should


Presenter Pn Nor Azura Mohd Noor giving a detailed ex-

planation & guide on the reporting of medication errors

through the Medication Error Reporting System (MERS)

MEMORY LANE 2012

Page 1

Tajuk Kajian:

“Meningkatkan Tahap Kepatuhan Ubat Di

Kalangan Pesakit Hipertensi di HRPZII”.

Pencapaian:

-Johan QAP Peringkat Hospital, HRPZII

-Naib Johan QAP Peringkat Negeri Kelantan

Fasilitator: Pn. Hasnah

Ahli: Pn. Nor Azura Mohd Nor

Pn Masnor Mat daud

Cik Fitriah Cahyani Che Will

En. Wan Mohd Khairul Wan Mahmud

QAP 2012

HARI KELUARGA JABATAN FARMASI HRPZII Date: 28-29 SEPTEMBER 2012 Venue: PCB BEACH RESORT


KEKUCHA AS SYURA

JOHANAN FUTSAL

ANAN FUTSAL ANTARA JABATAN

Misi Kemanusiaan ke Kg. Chhnang, Kemboja anjuran Persatuan Pekerja Islam, HRPZ II.

Bertarikh 24/10/2012 sehingga 29/10/2012.

Pada 13 Disember 2012 ‘Hari

Kucha As-Syura” peringkat

HRPZ II telah diadakan di

pe rka rangan Kuar t e r s

HRPZII. Jabatan Farmasi

telah muncul sebagai Johan

bagi kategori Kebersihan.

Perlawanan futsal peringkat Hospital telah diadakan di MASA Sport Centre , Panji Kota Bharu pada 10 November

2012. Pasukan futsal wanita telah menyertai pertandingan ini buat julung-julung kalinya dan berjaya muncul sebagai

Johan Peringkat Hospital dan mengharumkan nama Jabatan Farmasi.

NEWS FROM CAMBODIA

KUCHA AS SYURA

KEJOHANAN FUTSAL ANTARA JABATAN


Cik Ong Huey Chin Pharmacist U 41 Grad : International Medical University 2011 Date of report duty: 1/9/2013

Cik Siti Nurul Zuliana Bt Abdullah Pharmacist U 44 Grad : Universiti Islam Antarabangsa 2006 Date of report duty 17/2/2013

En Muhamad Tohiri Bin Mohd Zulkifli Pharmacist U 41 Grad : Universiti Islam Antarabangsa 2011 Date of report duty: 29/11/2012

Cik Hanan Hayati Bt Mamat Pharmacist U 41 Grad : Universiti Islam An-tarabangsa 2010 Date of report duty: 17/2/2013

Pn Nazmi Liyana Azmi Pharmacist U 48 Grad : Universiti kebangsaan Malaysia 2004 Date of report duty: 17/2/2013

En Shafei Ahmad Pharmacist Assistant U 36 Grad : Sekolah Latihan Pen.Pegawai Farmasi 1985 Date of report duty :03/09/2012

En Ahmad Nashriq Bin Setapa@Mustapha Pharmacist U41 Grad : UITM 2009 Date of report duty: 17/2/2013


Left : Pn Nor Sharina Bt Mohamed Nor Pharmacist U 41 Grad : UITM 2011

Right : Cik Wan Mastura Bt Wan Mohd Azlan Pharmacist U 41 Grad : UITM 2011

Middle : Pn Nur Husna Ibrahim Pharmacist U 41 Grad : UITM 2011 Date of report duty :20/11/2012

From Top Left : Tee Eng Chun, Liew Zhan Yit, Eddy Lim, K.Heygaajivan From Left : Chee Shu Wen, Wan Karen, Yusra, Nabilah, Ilmi Najwa, Yap Sze Yin, Shahratul Hafizan From Bottom Left : Chu Ee Wen, Tham Szhe Woon, Syuhidatun, Hidayah Awang, Hidayah Ghazali, Zulaikha, Azleen, Sarah Tan Not in the picture : Intisar, Hasanah, Khalifah, Tan Jing Rou, Wee Joo Lie, Syamimi, Qalif, Tg Norfarhah, Siti Noratiqah, Nadwanie,

Puan Nik Marahhan Nik Jaafar Pharmacist Assistant U 32 ( kup)

Pension Date : Januari 2013 Working experiences: 1979: petaling jaya makmal perubatan 1980: KK Pasir Putih 1981: Hosp Marchang 1982-2013: Hosp Raja Perempuan Zainab II ( 30th services)

SPECIAL THANKS TO:

Joke #2 Customers gets a topical cream. Direction : apply locally two times a day. Customer says to the pharmacist: "I can't apply locally, I'm going overseas."

Joke #1 (Just for laugh and not related to any real situation) Every morning during ward round, there will be a Specialist, a Medical Officer, a Houseman, a Nurse and a Pharmacist will see and discuss the patient in ward. One day when a pharmacist is not around during ward round : Specialist : Can anyone tell me what I wrote for PLAN on the case note yesterday? MO : Ermmm... I think is Pantoprazole 40mg stat, and....ermmmm...errr.... HO : Yesterday I gave Frusemide 40mg stat...So is frusemide!!! Nurse : I think you write KIV discharge if peak low improve 75%? Specialist: OMG!! You all don't simply guess my writing if you don't know!!! Please call the pharmacist to help us interpret what I write yesterday...

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