1/21/2016 1 -Medication Errors -Prescription Opioid Overdose Epidemic -Pharmacy Safety -PMP -Forgeries Critical in preventing future medication errors NABP: most states require hospital & medical facilities (including pharmacies) to report med errors NMBOP requires adverse drug event reporting Incident - a drug that is dispensed in error, that is administered and results in harm, injury or death Harm - temporary or permanent impairment requiring intervention THE PHARMACIST IN CHARGE SHALL: A. Develop and implement written error prevention procedures as part of the Policy and Procedures Manual. B. Report incidents, including relevant status updates, to the Board on Board approved forms within fifteen (15) days of discovery. “Significant Adverse Drug Event Reporting Form” THE BOARD SHALL: A. Maintain confidentiality of information relating to the reporter and the patient identifiers. B. Compile and publish, in the newsletter and on the Board web site, report information and prevention recommendations. C. Assure reports are used in a constructive and non- punitive manner. BOP receives sworn Complaints Alleging Misfilled Prescriptions. Not generated from Adverse Event Reports. Most of these would not have occurred if the pharmacist complied with BOP requirements for: Prospective Drug Review Counseling All RPh’s presume the prescription is wrong until the pharmacist has satisfied him or herself it is correct.
Transcript
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-Medication Errors
-Prescription Opioid Overdose Epidemic
-Pharmacy Safety
-PMP
-Forgeries
Critical in preventing future medication errors
NABP: most states require hospital & medical facilities (including pharmacies) to report med errors
NMBOP requires adverse drug event reporting
Incident - a drug that is dispensed in error, that is administered
and results in harm, injury or death
Harm - temporary or permanent impairment requiring intervention
THE PHARMACIST IN CHARGE SHALL:
A. Develop and implement written error prevention procedures as part of the Policy and Procedures Manual.
B. Report incidents, including relevant status updates, to
the Board on Board approved forms within fifteen (15) days of
discovery.
“Significant Adverse Drug Event Reporting Form”
THE BOARD SHALL:
A. Maintain confidentiality of information relating to the
reporter and the patient identifiers.
B. Compile and publish, in the newsletter and on the Board
web site, report information and prevention recommendations.
C. Assure reports are used in a constructive and non-punitive manner.
Most of these would not have occurred if the pharmacist complied with BOP requirements for:
Prospective Drug Review
Counseling
All RPh’s presume the prescription is wrong until the pharmacist has satisfied him or herself it is correct.
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All clerks and technicians are taught that if there is a question regarding a prescription, the RPh (or intern) must take the question.
Patients provide a major safety check
Counseling
“Show and Tell”
Because of the prevalence of generics, patients often think nothing of a change in medication appearance. Patients need to be retrained. At the time the patient is shown the pill during counseling, the RPh says “This medication will never change unless I tell you. If it ever changes, do not take it. Call me.”
RPh starts with, “What did your doctor tell you this was for?” and refill Rx with, “Tell me again what you take this for.” While this may seem unnecessary to the patient, an explanation that it is used to verify what the patient already knows, and thus saves time, works well.
the majority of medical errors are caused by faulty systems, processes, and conditions that:
lead people to make mistakes
fail to prevent mistakes
When an error occurs, blaming an individual does little to make the system safer and prevent someone else from committing the same error.
Root cause analysis (RCA): Process for identifying the basic or causal
factors that underlie variation in performance, including the occurrence or risk of occurrence of a sentinel event.
Focus is on systems and processes, not individual performance
Identifying root causes illuminates significant, underlying, fundamental conditions that increase the risk of adverse consequences.
RCA facilitates system evaluation, analysis of need for corrective action, tracking and trending
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Source: National Pharmacy Compliance News www.nabp.net/system/redactor_assets/documents/.../1QNatNews2013.pdf
Resources:
http://www.ismp.org/communityRx/aroc/
Tools
ISMP Community Pharmacy Medication Safety Tools and Resources
Root Cause Analysis (RCA) Workbook for Community/Ambulatory Pharmacy
ISMP Medication Safety Self Assessment for Community/Ambulatory Pharmacy
CM Jones. Prescription Trends for Controlled Prescription Drugs. NIDA Webinar 9/21/2015. Based on IMS Health National Prescription Audit, Data Extracted 8/24/2015 http://www.drugabuse.gov/news-events/meetings-events/2015/09/latest-prescription-trends-controlled-prescription-drugs
Drug Overdose Death Rates: Leading States, U.S., 2010, 2012, and 2014
Rank State Deaths per 100,000 2010 2012 2014 1 (1) (1) West Virginia 28.9 32 35.5 2 (3) (2) New Mexico 23.8 24.7 27.3 3 (2) (4) Kentucky 23.6 25.0 24.7 4 (5) Nevada 20.7 21.0 5 Oklahoma 19.4 (4) Utah 23.1 (3) New Hampshire 26.2 (5) Ohio 24.6 US 12.3 13.1 Sources: CDC National Center for Health Statistics, NM Department of Health (DOH)
Source: NM Epidemiology Volume 2014, Number 7 August 22, 2014
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long-term use of opioids (over 90 days)
high doses of opioids (over 120 MME/day)
combining opioids and benzodiazepines
combining opioids, benzodiazepines and carisoprodol
multiple provider episodes (5 or more prescribers or 5 or more pharmacies in one year).
Source: NM Epidemiology Volume 2014, Number 7 August 22, 2014
Source: Michael Landen, NM Department of Health: A 50 state convening to prevent opioid overdose and addiction September 17-18, 2015
Age-specific rates per 100,000 population; drug overdose primary type categories are not mutually exclusive
Source: New Mexico Substance Abuse Epidemiology Profile August 2014
Estimated Costs of Prescription Opioid Abuse, Dependence, and Misuse, New Mexico, 2007
Note: New Mexico costs were estimated by multiplying estimated 2007 U.S. costs by the portion of 2007 U.S. prescription opioid overdose deaths that occurred in New Mexico (i.e., 231/14,408 = 0.016). Costs for the United States were derived in Birnbaum et al (2011) “Societal Costs of Opioid Abuse, Dependence, and Misuse in the United States,” Pain Medicine , April 12(4):657-67.
Source: 20130110 Costs for Mike (from Brad, 01-10-13).pptx – Note was modified from original
NOTE: Data include hospital discharges from in-state, non-federal hospitals (IHS not included) for both primary and secondary diagnoses.
SOURCE: New Mexico Department of Health, Hospital Inpatient Discharge Data
Source: New Mexico Substance Abuse Epidemiology Profile August 2014
Past 30-day Painkiller Use to Get High Grades 9-12, New Mexico, 2007-2013
Nonmedical Use of Pain Relievers in the Past Year among Youths Aged 12 to 17,
by State: Percentages, Annual Averages Based on 2012 and 2013 NSDUHs
• Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2012 and 2013.
POSTED: 8:38 am MST December 12, 2011
ALBUQUERQUE, N.M. -- Drug Enforcement Agents said prescription medications are the new gateway drug for teens, forming an expensive dependence that leads kids to look for cheaper ways to get high.
"It's really becoming the forefront of what is getting kids addicted to controlled substances, and the very obvious gateway from prescription narcotics and opioids to then, heroin," Chavez said.
When the habit becomes too expensive, the DEA said, teens turn to heroin, which is cheaper but offers a similar high.
"Those kids, they take a vicodin, oxycodone, and it becomes too expensive. And now, they're looking toward a bb of heroin," Chavez said.
expands upon the Administration’s National Drug Control Strategy and includes action in four major areas to reduce prescription drug abuse:
Education
Tracking and monitoring
Proper medication disposal
Enforcement Source: Epidemic: Responding to America’s Prescription Drug Abuse Crisis; Executive Office of the President of the United States; 2011; http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf
Source: Prescription Painkiller Overdoses in the US; CDC; Nov 2011
Source: Prescription Painkiller Overdoses in the US; CDC; Nov 2011
Laws Requiring a Physical Examination before Prescribing
Laws Requiring Tamper-Resistant Prescription Forms
Laws Regulating Pain Clinics
Laws Setting Prescription Drug Limits
Laws Prohibiting “Doctor Shopping”/Fraud**
Laws Requiring Patient Identification before Dispensing
Laws Providing Immunity from Prosecution/Mitigation at Sentencing for Individuals Seeking Assistance During an Overdose
Source: http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/laws/state/index.html **general language
Prescription Drug Abuse: Strategies to Stop the Epidemic
October 2013
Examined a set of 10 indicators of strategies being used in states to help curb the epidemic, including: - Rescue Drug Laws - Good Samaritan Laws - Medical Provider Education Laws - Support for Substance Abuse Treatment - ID Requirement - PMP
Score Summary: 10 out of 10: New Mexico and Vermont Key recommendations from the report include:
Educate the public to understand the risks of Rx drug use to avoid misuse in the first place;
Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
Increase understanding about safe storage of medication and proper disposal of unused medications, such as through "take back" programs;
Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs
Household medications may be properly disposed by taking them to the Metropolitan Forensic Science Center located at 5350 2nd ST NW (south of Montano Road on 2nd Street behind the Gerald Cline Memorial Police Substation).
Hours: Monday through Friday, 8 a.m. to 5 p.m.
Medications may also be disposed at any of the six area command substations, Monday through Friday from 8 a.m. to 5 p.m. Complete list is on the web page.
Only pills, no chemo or medical waste - web page has instructions and details.
http://www.cdc.gov/vitalsigns/heroin/infograp
hic.html#use
Rescue Drug Law: In 2001, NM became the first state to amend its laws to make it easier for medical professionals to provide naloxone, and for lay administrators to use it without fear of legal repercussions. (NMSA 24-23-1, 24-23-2; NMAC 7.32.7)
In 2007, NM became the first state to amend its laws to encourage Good Samaritans to summon aid in the event of an overdose. (NMSA 30-31-27.1)
Source: Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws; The Network for Public Health Law May 2013
Source: The Network for Public Health Law, last updated April 2015
