1. Wrong patientPharmacists carry out a whole spectrum of duties. We order medications, verify them, pick, pack, check, deliver and dispense them to patients. Regardless of the nature of the illness, the first step of these processes often involves identifying the correct patient. Pharmacists who are new to the job often run into trouble of verifying medications or filling medications for the wrong patient. This is especially common as patients in the local setting often have similar names or surnames, which further confuse pharmacists.
In order to prevent this problem from occurring, it is important to always get into the habit of looking at both the patient's name and one more identifier such as the identification number or birth date. Do not rely solely on just the surname or initials, prescription number, or bed number because these are non-specific cues to identify a patient. If a prescription has multiple pages, make sure to run through all the pages to ensure that they belong to the same patient before processing the order. Lastly, ensure that the total number of items also tally against those on the Rx.
2. Wrong medicationLoose tablets that are similar could be mixed up within the same bottle during the return process. Examples are codeine and theophylline tablets (both white and round), gabapentin and phenytoin capsules (both white capsules).
Additionally, medications with multiple strengths but slight differences in appearance are look-alike medications that new pharmacists may pick wrongly. For example, EPO-beta (Recormon) 2000iu and 4000iu vial (orange and red wordings for strength respectively) and salmeterol/fluticasone (Seretide) evohaler 125 and 25.
Medications with multiple strengths are common medications that new pharmacists may fail to pick up during checking and dispensing. For example, metformin comes in 250mg, 500mg, 500mg XR, 850mg per tablet, bisoprolol comes in 2.5mg and 5mg per tablet. Confusing names for variation in insulin preparations are also common mistakes to which newbie pharmacists must pay special attention to, for example NovoMIX and NovoRAPID .
In order to lessen the chances of prescribing the wrong medication, always check all contents within a packaging before dispensing it to a patient. Also remember to counter check this to the item on the prescription as well.
3. Wrong pack sizeDifferent pharmacies keep different pack sizes for prepack medications, for example, paracetamol may come in 20 tablets or 50 tablets per zip lock. Also, manufacturers produce medications in different pack sizes, for example hydroxyzine can come in 25 tablets per strip and omeprazole can come in 7 tablets per strip. Loose tablets may also come in different pack sizes, for example, lorazepam can come in 500 tablets per bottle 1000 tablets per bottle, depending on the brand the pharmacy carries.
Pharmacists must be familiar with the stock bottle and pack size variances of medications in their own pharmacy. Try circling the quantity on the packaging as a visual cue to help yourself during picking, packing, checking or dispensing.
4. Confusing ear drops with eye drops, or vice versaAs a rule, eye drops are sterile, and can be used for the eye or ear. Ear drops are not sterile, and should not be used in the eye. Pharmacists who are new to the job may confuse otic (by ear) and optic (by eye).
To prevent the confusion, always check the route of administration when an ear or eye drop is prescribed. If in doubt, always contact the prescriber.
5. Step order, skip dose order, day/night orderDose tapering is common. For example, high dose of steroids need to be tapered off to prevent suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Medications with dose related side effects such as amiodarone, dipyridamole and varenicline, need to be tapered upwards slowly to retard the scale of side effects. Certain hormonal pills such as dydrogesterone/estradiol (Femoston), will require patients to follow strictly a 28-days cycle of drug consumption in which the first 14 days and the following 14 days, the patient should consume different medications.
Never rush: Always slow down and triple check against the prescription before dispensing it to the patient. Do not be afraid to tell the patient to wait and be sure you have a clear understanding of the regime before explaining it to the patient. MIMS
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