•what is 6th leading cause of death?
•7000 fatalities/year from adverse drug reactions.
The FDA, in a compilation of reports from 1998 to 2005, found that dangerous side effects and deaths from prescription and over-the-counter medications almost tripled to nearly 90,000 incidents
•100000(in 1999) fatalities/year from medical errors(400,000?now)
•celebrities who have been killed by pharmaceutical mistakes, overdoses, etc?
most common?---insulin, narcotics, opiates, methotrexate, warfarin, kcl injection drug use kills more people than MVA now.
ADE=adverse drug event
ADR=adverse drug reaction

Medication errors handwriting, wrong patient, language, wrong strength, wrong calculation, wrong sig,overworked, sound alike, look alike names, pt noncompliance, ect errors have categories--show chart tell pharm stories--medication reconciliation---process to find the most current meds of a patient--show form pg 354

• A. Personal safety
• 1. Safety from physical harm
• a. substances
• b. supplies (chemicals, poisons, etc.)
• c. equipment
• d. improper body mechanics
• 2. Employee responsibilities
• a. maintain a safe work place
• b. apply principles of proper body mechanics
• c. wear appropriate PPE (Personal Protection Equipment)
• d. follow proper procedures in handling pharmaceutical agents that may pose a hazard to the practitioner
• e. know where to locate the material safety data sheets (MSDS)
• f. know and apply policies and procedures in case of
• emergency

• i. fire safety
• ii. chemical spills and other hazardous materials
• iii. body fluids
• iv. standard precautions
• v. equipment maintenance and failure
• vi. internal disasters (fire, robbery, bomb threat, etc.)
• vii. external disaster (weather related, traffic disaster, etc.)
• Environmental Safety
• 1. Clean work place
• 2. Proper ventilation
• 3. Proper lighting
• 4. Adequate set-up and layout of work place
• 5. Properly functioning equipment
• 6. Well trained employees aware of potential hazards

• Occupational Safety and Health Administration (OSHA)
• 1. Workplaces may be inspected by OSHA officers without prior
• announcement in order to accomplish intent to decrease hazards
• in the workplace and maintain a reporting system for monitoring
• job-related injuries and illness
• 2. They develop mandatory job safety and health standards
• Joint Commission on Accreditation of Healthcare Organizations
• (JCAHO)
• 1. Pharmacy standards of JCAHO provide quasi-legal standard of practice for the profession
• 2. In court of law practice standards define accepted professional practice and assume quasi-legal status
• 3. Pharmacies must meet strict standards in order to be accredited by JCAHO
• 4. Accreditation is voluntary but important if business is interested in dealing with third party payers who require certification through accreditation process, e.g. Medicaid, etc.

• Pharmacy must ensure
• 1. Right drug – always double check the label on bulk bottle for
• strength and correctness
• 2. Right patient
• 3. Right dosage
• 4. Right route
• 5. Right time
• 6. Right attitude

• Practitioner must be familiar with
• 1. Common side effects
• 2. Contraindications
• 3. Drug or food reactions with medications
• 4. Generic drugs that may be substituted
• D. Practitioner should know at minimum the following information for the drugs most used in individual practice setting or geographical location
• 1. Adverse drug reactions
• 2. Side effects
• 3. Contraindications
• 4. Drug/food interactions
• 5. Safe/effective dosage range
• 6. Common dosage regimens
• 7. Dosage forms
• 8. Route of administration
• E. Reviewing Refills
• 1. Number of refills
• 2. Correct drug selection
• 3. Significantly early or late requests for refills may indicate
• medication misuse

• Beware of dispensing errors
. Proper storage of pharmaceuticals
• 1. Store in original container until dispensed
• 2. Follow manufacturer’s directions for proper storage
• 3. Follow proper disposal of expired drugs
• a. deteriorated drugs are ineffective
• b. deteriorated drugs may be a hazard if a condition not treated appropriately
• c. deterioration may cause chemical changes leading to dangerous reactions
• All schedule II drugs must be kept under lock and key.
With schedule III, IV, and V drugs, lock and key storage is optional but suggested

manufacturing label has a bar code somewhere----bottle comes to pharmacy with many pills inside. label gives generic and brand name, how many, strength,NDC code, lot#, expiration, instructions.
prescription label has bar code somewhere---bottle to patient. has pt name, dr name, drug name, refills,sig, pharmacy name accuracy scanner--- a quick scan tells if the rx label and manufacture label have same drug.
medication counter---quickly counts pills that are not see through.
not to be used for sulfa drugs and amoxicllin due to residue.
or use spatula and counting tray. count 3 or 5 at a time.
put into bottle…child safety cap?
pharmacist does verification of the drug.