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Department of Pharmacy Services: Medication Management

By: Miriam Klein, B.S., Pharm.D., RPh.Assistant Director of Pharmacy

Medication Safety

ConfidentialPHL 2805 J, K, L, MEd. Law6527

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Turning A Personal Tragedy Into Passion: Safe Medication Management

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Enhance Patient Safety: Best Practices� QuadraMed Computer Physician Order Entry (CPOE)

System

� On-Line Hospital Formulary

� Hospitals do not carry all medications approved by the FDA

� KCHC - Medication Formulary

� representation of each class.

� CPOE will warn if prescribed medication not on Formulary

(not listed in the QuadraMed) or if medication is restricted

� For Non-Formulary Medications:� First, try find formulary substitute if appropriate (ex: ACEI, Ca+ Blocker, PPI)

– convert dose – check online references or consult pharmacy if necessary

� If not, then make sure that the Non-Formulary Form is completed, with Chief or

Director of Service signature included

� Fax form to Pharmacy, call to coordinate and follow-up (may have to order

product).Fax:718-613-8047 ( pharmacy ext.7130)

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Enhance Patient Safety: Best Practices

� QuadraMed CPOE System:

� For Restricted Medications:

� Contact the appropriate specialist on call

� Get approval

� New automated Restricted Drug Approval Process

� This means approving Physicians are able to send restricted

drug approvals directly to Pharmacy

� Physicians using KCHC generic Group-Wise e-mail address

� Contact Pharmacy and ensure medication will be dispensed.

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Enhance Patient Safety: Best Practices

� QuadraMed CPOE System:

� Non-FDA Approved Usage Form

� Must complete Non-FDA Approved Usage Form

� Must provide literature showing safe and effective usage for

that indication.

� Fax/Deliver to Pharmacy and call to ensure dispensation

� Pre-made Typical Orders

� Building your own orders can potentially lead to errors

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Enhance Patient Safety: Best Practices

�QuadraMed CPOE System:

�Instruction/Comment Field in CPOE

�Free-text field

�Add helpful/additional comments to a medication order

(ex: take with juice, approved by Dr. Smith, etc.)

�CPOE system does not read info entered into this field

– will not be recognized!!

�Dose, Route, Frequency, and Number of Doses is Prohibited!!!! –

�When Field in CPOE

�Dose, Route, Frequency, and Number of Doses Should be entered

into the When field.

Example: High Alert Medication-Potassium Chloride Rider

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Medication Alert Info

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QuadraMed CPOE

Look-Alike/Sound-Alike List

Tall-Man’s lettering

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Enhance Patient Safety: Best Practice

� Anticoagulation Therapy Order Entry Module � In QuadraMed

� Features include weight based dosing suggestions based on pre-approved guidelines, protocols and automatic ordering of labs

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Enhance Patient Safety: Best Practices

� Electronic Medication Reconciliation� National Statistics show that this is one of the leading causes of

medication errors.

� Ensure continuing of care

� Identify discrepancies in medication therapy

� The process of comparing a patient's inpatient medication orders to all of the medications that the patient has been taking prior to admission.

� This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

� It should be done at every transition of care in which new medications are ordered or existing orders are rewritten.

� ADMISSION, TRANSFER AND DISCHARGE.

� Please ensure that for each medication the patient is taking prior to admission, that you enter whether you will: continue, discontinue or substitute.

� Then KCHC pharmacists can help check your intentions with the actual medication orders to look for and prevent/fix discrepancies/errors.

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Enhance Patient Safety: “Prevent Errors”� Unacceptable Abbreviations

�Errors� to eliminate the occurrence of unapproved abbreviations

in patients' charts� use of unapproved abbreviations compromises patient

safety� frequent focus by The Joint Commission surveys

�Deployed a new Word template in QuadraMed to all computers � This has the built in feature of "auto-correcting"

unapproved abbreviations into acceptable terms.� If you do type one of these abbreviations in Word

e.g. QD, it will automatically get converted to "daily".

iu, Mso4, Ms, Mgso4, qd, q.d., qod, q.o.d, u, a.s., ad, a.d., au, a.u., tiw, t.i.w., tid, t.i.d,

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Enhance Patient Safety: Best Practices� Hospital-Wide Bar-Code Medication Administration Project

� Helps ensure that the right medication, right concentration, right dose

� Given to the right patient at the right time

� Inpatient and Outpatient Dispensing Robots� Fills medications accurately and faster

� Automated Dispensing Cabinets� Interfaced with the QuadraMed’s medication orders

� Emergency Department, Clinics, Ambulatory Care and Inpatient Areas

� Lean Methodology, 6S Implementation in Medication Safety� KCHC channeled 6S theme into hospital-wide safe medication storage

� Create Medication Storage Label for LASA Drugs

� High-Risk/Alert Class of Drugs-Insulin Vials Storage

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THE JOINT COMMISSION FINDINGS

� July 2009 Unexpected Survey:�Saw how various insulin formulations,

categorized as high alert class of drugs, were stored uniformly hospital-wide� Storage reflects Medication Management

Standards and National Patient Safety Goals

�Will post on their web-site our label initiatives for safe medication storage � BEST PRACTICE in Medication Storage

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Enhance Patient Safety: Pharmacists� Listen:

� Will help you avoid problems and give solutions� call ext 7130 or 7131.

� Multidisciplinary Teamwork:

� Clinical guidance

� Help ensure that your patients receive their medications in a safe, effective and timely manner

� Guardian Angels:

� Not seen, but are checking every medication order to help prevent medication errors from reaching the patient.

� Good luck

� Look forward to working with you all!!!!

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THE END