Medical problems

• Medication-related problems are undesirable events experienced by a patient that involve or are suspected to involve drug therapy and actually or potentially interfere with a desired patient outcome.
• Medication-related problems can be classified as psychological, physiological, social, or economic origin and may be the function of a patient.
• Medication-related problems can be caused by human errors such as need for additional drug, unnecessary drug, and inappropriate drug choice.
• Medication-related problems can be categorized as medication errors, which can be classified by level of severity and prevention.
• Documentation of pharmacist’s intervention is crucial in managing medication-related problems.
• Pharmacovigilance is the process of ADR monitoring or surveillance.
• Medication-related problems can be prevented by detecting, assessing and reporting suspected ADRs.
• Counseling the patients about ADR is also important.
• Prevention of rule-based errors can be improved by improving the rules/SOPs and always following the rules/SOPs.
• Classification of Medication Errors is also based on the stage of medication cycle, including point-of-entry errors (prescribing, ordering and transcription), dispensing errors, and administration errors.
• Dispensing errors occur at any stage of the dispensing process, from the receipt of the prescription in the pharmacy to the supply of a dispensed medicine to the patient.
• Prevention of dispensing errors can be helped by assuring the 5 R’s in medication: checking the clinical appropriateness of the prescription before dispensing, carrying out an accuracy check of the dispensed medicine, checking the patient’s or customer’s understanding of the medicine, managing workload and workplace, and maintaining environmental conditions in the dispensing area.
• Classification of Medication Errors is based on a psychological approach.
• Prevention of memory-based errors is best tackled by putting in place systems that detect such errors and allow remedial actions, such as check lists and computerized systems.
• Prescription errors may be defined as the incorrect format of writing the generic and brand name of the drug in the prescription or medication order.
• Memory-based errors are the most difficult to prevent and occur when something is forgotten, for example, giving penicillin to a patient knowing that the patient is allergic but forgetting.
• Action-based errors are defined as the performance of an action that was not intended, such as a slip of the pen or technical errors like addition to an infusion bottle of the wrong amount of drug.
• Prescribing errors may be defined as the incorrect drug selection for a patient, including the dose, quantity, indication, or prescribing of a contraindicated drug.
• Documentation outlines in a step-by-step process the care the patient received and serves as a form of communication among health care providers, so that each practitioner involved knows what evaluation has occurred, what the plan for the patient’s treatment is, and who will provide it.
• A Standard Operating Procedure (SOP) should be in place in the drugstore to introduce safe systematic procedures for dispensing medicines in the pharmacy.
• Severity Level of Medication Errors can be categorized into No Harm, No error, Error with Harm, and Error that resulted to Death.
• Critical incident techniques involve in-depth analysis of a large number of individual errors for the purpose of identifying a common cause.
• Anonymous self reports allow the person who commits the error or the person who discovers the error to report it without being associated with the error.
• Disguised observations involve an observer accompanying the person who will give the medication and witnessing the administration of each dose.
• Incident reports are the official written legal reports of a medication error as documented by the hospital staff, resulting to underreporting of the errors due to punitive action that might occur due to the report.
• Prevention of Dispensing Errors can be categorized into No error, capacity to cause error, Error that did not reach the patient, Error that reach the patient but unlikely to cause harm, Error that could have caused temporary harm, Error that could have caused temporary harm requiring initial prolonged hospitalization, Error that could have resulted into permanent harm, Error that could have resulted into permanent harm necessitating intervention to sustain life, and Error that resulted to death.
• RA 10918, RA3720, RA6675 and Philippine Practice Standards for Pharmacists are references.
• Documentation of Pharmacist’s Intervention serves three main purposes: Identifying potential and actual drug-related problems, Resolving actual drug-related problems, and Preventing potential drug-related problems.
• The SOAP Note is the most common and universally recognized format of documenting patient information.
• The pharmacist’s primary responsibility in the delivery of pharmaceutical care is to identify, prevent, and resolve medication problems.
• A (Assessment) includes the pharmacist’s evaluation of the current situation, delineating the thought process that led to the conclusion that a problem did or did not exist and that an active intervention either was or was not.
• The pharmacist should ensure that indicators are identified.
• P (Plan) involves the action that needs to be taken to resolve any problems that have been identified.
• Indicators can be measured to determine the impact of therapy and include reports of symptoms, laboratory values, and the results of quality-of-life assessments.
• The pharmacist should ensure that the patient is receiving appropriate pharmacotherapy for each definitively diagnosed disease.
• The pharmacist should ensure that the patient is receiving the appropriate dose of each medication at appropriate time intervals.
• The pharmacist should state the rationale for selecting the particular regimen(s).
• The pharmacist should identify feasible problem solutions and to evaluate results of the alternative that is ultimately chosen.
• R (Resolution) reflects the actions proposed (or already performed) to resolve the drug-related problem based upon the preceding analysis.
• Progress factors describe the degree of improvement in patient variables that can reasonably be expected to result from the pharmacotherapy.