WHAT YOU NEED TO KNOW

This month’s newsletter features research, reviews, interviews, and perspectives from a special issue of our award-winning journal, Patient Safety, dedicated to pharmacy education and practice. You will read about how sharing stories about medication errors helps prevent them from happening again, how to build a culture of safety in early training, ways to develop better habits in your life and work, and more.

In 1974, pharmacist Michael Cohen learned of a serious adverse event with insulin at a hospital and began sharing information about it with other pharmacists to prevent the error from happening again. Twenty years later, he founded the Institute for Safe Medication Practices (ISMP) with the same goal: collecting healthcare workers’ stories and reports about medication errors to improve patient safety. Cohen, president emeritus of ISMP, describes some of the organization’s ongoing initiatives and the biggest challenges in medication and vaccination safety facing pharmacists today:

“Education is part of every healthcare professional’s responsibility. One way to do that, and an especially important area, is sharing of information about medication errors. So as they go about their professional life, anything you become aware of that could really be important to others to know about from a safety standpoint should be considered as a report of a medication error. For example, if you experience a medication error or identify something that might be potentially harmful, even though there hasn’t actually been a problem yet—if that gets reported that can help not just your colleagues, but you as well.”

 

Antibiotic resistance—the process in which antibiotics lose their effectiveness in killing bacteria and other disease-causing germs—is one of the biggest health threats today. One way to address this ongoing challenge is antibiotic stewardship: prescribing and using antibiotics appropriately, when they are truly the best option to fight an infection. To gauge how antibiotics are being prescribed in a community hospital’s emergency department (ED), Bauman, et al. from St. Vincent’s Hospital evaluated the antibiotic regimen of 492 adult patients during four chosen weeks in 2019 who were discharged with oral antibiotics.

Among their findings: 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and 8% were not assessable. The infections most frequently treated inappropriately included skin and soft tissue infections, dental infections, and sinusitis. Medical residents prescribed the highest percentage of appropriate regimens, and the highest percentage of appropriate prescriptions were given in the 11 p.m. to 7 a.m. shift.

While the researchers determined that the prescribing habits of providers in the community hospital ED are appropriate overall, there also is room to improve antibiotic stewardship—which can be advanced with education and the clinical decision tools and guidance outlined in their study.

 

Caring for patients comes with the risk of errors that can potentially harm rather than help; however, these risks can be mitigated in a “culture of safety”: an environment in which everyone is encouraged to report errors or near misses, everyone works together to identify and solve patient safety issues, and leadership commits their support and resources to promoting safety. The earlier a safety mindset can be introduced and instilled, the better—for providers and patients alike. Fuentes, et al. from the University of Houston, College of Pharmacy offer a replicable model of how a health system and college can collaborate to create a strong foundation for safe practice.

They review best practices for medication safety training for pharmacy learners, as implemented by the University of Houston College of Pharmacy and Houston Methodist. This educational program encompasses didactic coursework, which provides training in understanding and preventing errors in the medication-use process, and tools and components in the quality improvement process; practical experiences through hospital rotations and internships that expand on these principles and promote teamwork; and postgraduate residencies to further hone their skills and engage in studying problems and developing strategies and solutions.

Another benefit of these efforts: opening up the discussion of how to care for caregivers in the pharmacy student and resident population, which includes treatment that is just, respect, understanding and compassion, supportive care, and the transparency and opportunity to contribute.

Pediatric and neonatal patients are a vulnerable population, presenting unique and complex challenges to delivering medications safely in the hospital. One study of more than 25,000 medication safety incidents in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) in England and Wales revealed that 48% of them occurred in babies less than 28 days old and 36.5% in babies 1 month to 1 year old. What puts our youngest patients so at risk? Another study suggests it relates to dosing errors resulting from rapid changes in weight and the use of specialized compounds in the NICU.

So what can be done? Elkeshawi, et al. from Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University review the potential risks to children and babies at every step of the medication-use system: medication procurement and formulary management; medication reconciliation, ordering, preparation and dispensing; administration; and monitoring.

They also share several innovations and tools to help make this population safer, such as bedside barcode scanning, infusion pumps and syringe pumps, computerized physician order entry systems, and more. But no matter the advances, patient care always benefits from close monitoring, communication, and collaboration among pediatric care teams and pediatric pharmacists, to identify the risks early and develop strategies and interventions to prevent harm.

 

Vaccination is the best way to prevent infection and serious illness from diseases like influenza and COVID-19, but some people are still nervous about getting that shot—those feelings of stress and anxiety alone may present as an adverse event.

Immunization stress-related response (ISRR), is associated with feelings of apprehension and increased heart and breathing rates. An experience like this could discourage people from receiving immunizations in the future, as well as contribute to public distrust of vaccines.

Mast and Li from the University of Pittsburgh School of Pharmacy discuss common symptoms of ISRR and share strategies that vaccination clinics and health systems can take to put patients at ease and keep them safe. These include screening for a history of allergies or other reactions, observing patients following their immunization, and preparing to respond to any patient needs or emergencies. One of their recommendations: “Following immunization, all patients should be observed in a dedicated area for approximately 15 minutes. If patients had a history of allergic reactions to vaccines, they are asked to wait for 30 minutes, as this increases their likelihood of having an allergic reaction to other vaccines.”

The benefits of taking precautions to ensure the patient’s safety go beyond their individual well-being, as the authors conclude, “In such an unprecedented time, combating vaccine hesitancy is key to ensuring a return to normalcy amidst a global pandemic and optimizing patient outcomes through disease prevention.”​

If you made a New Year’s resolution for 2022, by now you may be realizing how difficult it can be to improve habits and alter your daily routine. Now imagine the challenges organizations face in improving their work processes. However, in hospitals, pharmacies, and other healthcare facilities where patient safety may be on the line, it’s critically important to identify the risks for errors and make changes to prevent harm.

Daniel Degnan, PharmD, offers some insights into the science of habit formation and how it can be applied to pharmacy to reduce medication errors. Some tips: get a good night’s sleep, read the latest information on medication errors, and develop a list of safe practice habits based on your own individual practice. “Every practitioner should incorporate safety as a segment of their practice,” he says. “The safety principles a practitioner uses should be based on the science of safety rather than just professional opinion, just as with the adoption or use of any other clinical guideline when practicing.”

 

The study of pharmacy doesn’t stop in the classroom—it extends into community hospitals, clinics, and pharmacies, and for some practitioners it becomes a lifelong pursuit. Patrick McDonnell, PharmD, has spent nearly three decades of his professional career at Temple University School of Pharmacy: first as a student; then as a resident; and, since 1999, as a teacher. In his coursework he passes on the lessons and experiences learned over years as a practicing pharmacist—especially the thousands of stories he has been collecting about adverse drug reactions. Professor McDonnell shares what draws him to his work in both the hospital pharmacy and the classroom, and the unique and vital role pharmacists play in delivering safe, efficient patient care:

“Working with people that were my students that now are my colleagues, and that they’re exceptional pharmacists, and seeing them work in practice and utilizing some of the tools that we all taught them here—that’s one of my proudest moments, actually coming into work. They sometimes laugh, they call me ‘senior pool pharmacist,’ because I’ve been working there in the pool for 24 years. But it’s having that comradery with them, that type of respect with them as now working pharmacists.”