Do Your Staff Know How to Check for Tampering?
All across the country, pharmacy staff are picking up returned controlled substances and placing them back into pharmacy stock. They are removing them from automated dispensing machine return bins and placing them back into the dispensing pockets. Prior to placing the medication back into stock for dispensing, are they checking the item to confirm there […]
Read MoreIncluding the Infection Prevention Department
Do you have a solid drug diversion monitoring program? If you said yes, that’s great! For those of you that do have a monitoring program, how many of you have participation from the Infection Preventionist (IP) during a suspected case involving injectable medication? Any time there is diversion that involves injectable medications, we need to […]
Read MoreEducation Surrounding a Facility’s Diversion Program
An important component to a comprehensive diversion program is educating staff on the elements of the program. Education surrounding what diversion looks like, why prevention measures need to be put in place, why monitoring for diversion is important, and the expectations of staff. Additional education is needed for supervisors and managers that will be reviewing […]
Read MoreMedication Error Experience Update
Some of you may recall my previous blog telling of a medication error that happened to someone close to me. I sat in the car (couldn’t go in because of COVID-19 precautions) while they were in the urgent care where they received an IM injection of ceftriaxone in a volume of 10 ml. A recap […]
Read MoreSolid Process for Receiving Recall Alerts and Taking Action
In the last few days, I have seen two potentially serious recall alerts from the FDA; a mix up in labeling between Amiodarone HCl Injection and Tranexamic Acid Injection as well as a Class I recall due to hardware issues for BD Alaris System infusion pumps. How solid is your process regarding being informed of […]
Read MoreVoluntary Error Reporting
How well is your facility doing when it comes to staff voluntarily reporting adverse events and medication errors? Voluntary reporting should not be the sole means by which we identify areas for improvement, but it is a valuable avenue, and reporting should be the expectation. At one point, I was part of a regulatory prep […]
Read MorePatients are Real People with Real Stories
Nurses and physicians are reminded every day that patients are real people, just like them, with real stories. Pharmacy staff, however, may need a little more reminding. Unless a pharmacist or technician has a role that brings them into regular contact with patients, we may need the reminder that on the other side of the […]
Read MoreHow Well Have You Explained the Expectations?
I am a firm believer in explaining the big picture and the root of why people do certain things. I think that is especially important when it comes to medication safety initiatives and processes that have been put in place to improve safety. If we don’t explain the big picture of why, we risk staff […]
Read MoreAn Excerpt From CMS Regarding Medication Errors
Medication errors are a substantial source of morbidity and mortality risk in the hospitalized setting. Therefore, hospitals must take steps to prevent, identify, and minimize these errors. These steps must be based on accepted professional principles. This includes not only ensuring that the pharmacy processes conform to accepted standards of pharmacy practice, but also proactively […]
Read MorePatient Safety & Quality Improvement Act Provides Protection
The Patient Safety and Quality Improvement Act of 2005, among other things, was designed to increase the reporting of all medication errors and sharing of quality information. This Act protects healthcare workers from litigation while establishing a culture of reporting, encouraging analysis and sharing of error events, and ultimately increasing patient safety. In order to […]
Read More