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Appropriate Implementation of

Medication Review

By: Adeline Saliba, PharmD, MBA

Acting Pharmacy Manager

Corniche Hospital

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DisclosureAdeline Saliba declares no conflicts of interest, andno financial interests in any company, product orservice mentioned in this presentation. She is an

employee of the Corniche Hospital.

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Outline1) Define JCI medication management and use

standard 5: preparation and dispensing

2) Implement strategies to prevent errors at time ofmedication review

3) Discuss innovative technologies for safermedication review

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Corniche Hospital

235 bed maternity hospital

with 50 neonatal intensive care cots

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Medication Management and Use

Preparation

and

Dispensing

Administering

Selection

and

Procurement

Storage

Prescribing

and

Transcribing

Monitoring

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Preventing Prescribing ErrorsAlthough the root causes of medication errorsreside in systems, each individual health care

professional beginning with the prescriber must

take every possible precaution to prevent errors.

Michael CohenPresident, Institute for Safe Medication Practices (ISMP)

Cohen, M. Medication Errors. 2ndedition: 2007

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Safe Prescribing Practices1) Legible handwriting

2) Complete and accurate prescriptions

3) No unapproved abbreviations4) Medication reconciliation

Computerized Prescriber Order Entry (CPOE)

Clinical decision support

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Error Trajectory

Actual

error

Potential

error

Latent

error

James Reason 1991

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Medication Order Review

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Medication Order Review1) Allergy

2) Height and weight

3) Drug components4) PRN indications

5) Duplications

6) Interactions7) Contraindications

8) Clinical guidelines

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Medication Order Review1) Standardized concentrations for IV admixtures

2) Standardized recipes for extemporaneous oralpreparations

3) Standardized labeling incorporating tall menlettering for look alike sound alike medications

DOPamine DOBUTamine

hydrALAZINE hydrOXYzine

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Medication DispensingPre-Automation Post-Automation

Blister pack Unit dose packaging

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Medication DispensingPre-Automation Post-Automation

Bulk bottle Individualized oral syringes

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Medication DistributionPre-Automation Post-Automation

Locked cabinets Decentralized automated dispensing

cabinets

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Integrated Systems

Cerner EMR

Patient Registration

and Admission

Cerner PowerChartDoctor prescribes

medications for

patients

Cerner PharmNet

Pharmacy verifiesmedication orders

Pyxis Medstation

Nurse removes

ordered medications

to administer

Cerner Supply

Chain Management

Pyxis ServerInterface Engine

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Medication Use Process Errors

Leape, Bates and colleagues 1995

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Closing the Loop

Prescribing &

Transcribing

Preparation &Dispensing

Administration

Scan patients wristband

Scan medication barcode

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Scan for Safety

5 Rs:

Right patient Right drug

Right dose

Right route Right time

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Health Information Technologies

1) Health information system

2) Unit dose packaging

3) Automated dispensing solutions4) Bar code scanning

5) Robotic dispensing

Enhance both workflow and thesafety of medication management

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Lessons Learned

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Thank You