Institute for Safe Medication

USP MEDICATION ERRORS REPORTING PROGRAM Presented in cooperation with the Institute for Safe Medication Practices The USP Practitioners Reporting Network is an FDA medWatch partner... 

A copy of this report is routinely sent to the Institute for Safe Medication Practices (ISMP), to the manufacturer.labeler, and to the Food and Drug Administration (FDA). USP may release my identity to (check boxes that apply)... 

EU (2001) EU directive 2001/83/EC. http //eur-lex.europa.eu/LexUriServ/site/en/consleg/2001/L/ 02001L0083-20070126-en.pdf. Cited 30 Dec 2008 EMEA (2008) European Medicines Agency. EPARs for authorised medicinal products for human use. http //www.emea.europa.eu/htms/human/epar/a.htm. Cited 30 Dec 2008 ICH (2008) The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). http //www.ich.org. Cited 30 Dec 2008 ISMP (2005) The Institute for Safe Medication Practices. List of confused drug names. http //www.ismp.org/Tools/confuseddrugnames.pdf. Cited 30 Dec 2008... 

American Association of Retired Persons American Health Care Association American Hospital Association American Medical Association American Nurses Association American Pharmaceutical Association American Society of Health-System Pharmaeists American Society for Healthcare Risk Management Department of Veterans Affairs Food and Drug Administration Generic Pharmaceutical Industry Association Institute for Safe Medication Practices... 

Error tracking and public education The FDA reviews medication error reports that come from drug manufacturers and through MedWatch, the agency s safety information and adverse event reporting program. The agency also receives reports from the Institute for Safe Medication Practices (ISMP) and the U.S. Pharmacopeia, or USP (see Who Tracks Medication Errors ). 

Computerized Physician Order Entry (CPOE) Studies have shown that CPOE is effective in reducing medication errors. It involves entering medication orders directly into a computer system rather than on paper or verbally. The Institute for Safe Medication Practices conducted a survey of... 

It was reported by the Institute for Safe Medication Practices (ISMP) in 2000 that fewer than 5 percent of physicians were writing prescriptions electronically. In a 2000 white paper entitled, A Call to Action Eliminate Handwritten Prescriptions within 3 Years, ISMP recommended the use of electronic prescribing by clinician order entry to reduce medication errors (ISMP, 2000). CPOE can help to reduce errors in the delivery and transcribing of orders to the pharmacy where the orders are filled. Order management can be used to control inventory and alert pharmacy staff (and even the patient) of the status of a prescription. For example, some national chain pharmacies have the capability of alerting the patient by phone or e-mail if a prescription is ready or if other action needs to be taken before the prescription can be picked up. The system should also be able to report results, such as the number of prescriptions filled, the revenue generated over a specified time, and medication error reports. 

Institute for Safe Medication Practices. 2000. White paper A call to action Eliminate handwritten prescriptions within 3 years. Minneapolis ISMP available at www. ismp.org accessed on May 19, 2007. 

Errors can result when ambiguous orders are interpreted in a manner other than what the prescriber intended. Proper expression of doses is vital in a drug order. Pharmacists should be able to recognize improper expressions of doses, and the potential for error, when they see them. When the order is not clear, the pharmacist must contact the prescriber for clarification. Pharmacists and technicians should avoid using dangerous expressions of doses as they process orders, type labels, and communicate with others. The following examples include several improperly expressed orders that were reported to the Institute for Safe Medication Practices (ISMP) ... 

Institute for Safe Medication Practices (ISMP). 1998. ISMP Medication Safety Alert p. 3. Washington, DC ISMP. 

President, Institute for Safe Medication Practices, Horsham, Pennsylvania Shane P. Desselle, PhD, RPh, FAPhA... 

Report any information relating to medication errors to the Medication Errors Reporting Program operated by USP convention [10] and the Institute for Safe Medication Practice (ISMP) or other corresponding institutions in the different countries. The program shares information on medication errors with health care professionals to prevent similar errors from recurring. 

Although it might be difficult to prevent adverse medication events attributable to idiosyncratic causes, there are systems to account for both the acts of commission and the acts of omission in the medication use process. For an excellent review of current and proposed actions to reduce medication errors from acts of commission, the reader is referred to the efforts and publications of the Institute for Safe Medication Practices. This chapter focuses on acts of omission, or developing and implementing systems for the accountability of patient medication use outcomes. 

The Institute for Safe Medication Practices, and the American Veterinary Medical Association cooperate in presenting the USP PRN. 

To better support the success of its members, ASHP works with other pharmacy organizations, such as the Joint Commission of Pharmacy Practitioners, the Pharmacy Technician Certification Board, the Board of Pharmaceutical Specialties, the Institute for Safe Medication Practices, and the International Pharmaceutical Federation. 

In facilities where samples are used, important first steps to bringing sample practices into compliance include consulting state and federal regulations and JCAHO standards (Table 1). Guidelines and recommendations from organizations such as the Society of Teachers of Family Medicine and the Institute for Safe Medication Practices (ISMP) can be consulted. 

Institute for Safe Medication Practices. A Call to Eliminate Handwritten Prescription Within 3 Years Institute for Safe Medication Practices 2000 1-12. 

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