A Community Pharmacy Technician’s Role in Medication Error Reduction Strategies1
This column was prepared by the Institute for Safe Medication Practices (ISMP). ISMP is an independent nonprofit agency that works closely with United States Pharmacopeia (USP) and Food and Drug Administration (FDA) in analyzing medication errors, near misses, and potentially hazardous conditions as reported by pharmacists and other practitioners. ISMP then makes appropriate contacts with companies and regulators, gathers expert opinion about prevention measures, and publishes its recommendations. To read about the recommendations for prevention of reported errors that you can put into practice today, subscribe to ISMP Medication Safety Alert!® Community/Ambulatory Edition by visiting www.ismp.org. If you would like to report a problem confidentially to these organizations, go to the ISMP Web site (www.ismp.org) for links with USP, ISMP, and FDA. Or call 1-800/23-ERROR to report directly to the USP-ISMP Medication Errors Reporting Program. ISMP address: 200 Lakeside Dr, Horsham, PA 19044. Phone: 215/947-7797. E-mail: ismpinfo@ismp.org.
Pharmacy technicians play a major role in community pharmacy practice. The pharmacist relies on the technician to provide an extra layer of safety. It is important for technicians to follow system-based processes and inform the pharmacist when these processes do not work or are unmanageable.
Prescription Drop Off
The date of birth should be written on every hard copy prescription so the pharmacist has a second identifier readily available during verification. Allergy information should be questioned and updated at every patient encounter. Medical condition information, such as pregnancy, communicated to the technician at drop off should be updated in the computerized profile system to help the verification pharmacist determine counseling opportunities. Knowing a person’s medical conditions also helps the pharmacist determine if prescriptions are written incorrectly or for the wrong drug.
Data Entry
Medication safety is enhanced when technicians know the particular language of pharmacy when entering a prescription.
New drugs are at a particular risk because it is more likely that the technician is not aware of the new drug and a more familiar drug is selected. Pharmacists and technicians should work together to determine the best method of distributing information regarding availability of new drugs on the market.
It is important that the technician understands the safety features of the computer system and does not create work-arounds to improve efficiency at the risk of decreasing accuracy and safety. Drug alerts can be numerous, and the technician may be inclined to override the alert and not “bother” the pharmacist. A better way to resolve too many alerts would be to establish protocol between the technician and the pharmacist to determine which level and type of alert needs pharmacist intervention.
Production
Mix-ups occur primarily due to incorrectly reading the label. The problem is aggravated by what is referred to as confirmation bias. Often a technician chooses a medication container based on a mental picture of the item, whether it be a characteristic of the drug label, the shape and size or color of the container, or the location of the item on a shelf. Consequently the wrong product is picked. Physically separating drugs with look-alike labels and packaging helps to reduce this contributing factor.
Point of Sale
Correctly filled prescriptions sold to a patient for whom it was not intended is an error that can be avoided by consistent use of a second identifier at the point of sale. Ask the person picking up the prescription to verify the address or in the case of similar names, the date of birth, and compare the answer to the information on the prescription receipt.
Internal errors should be discussed among all staff for training purposes. In addition, it is important to read about and discuss errors and methods of prevention occurring and being employed at other pharmacies within a chain and in other pharmacies, nationwide. ISMP Medication Safety Alert! Community/Ambulatory Edition offers this information to both pharmacists and technicians.
1Reprinted from National Pharmacy Compliance News, July, 2008.