Medication safety

Advances in clinical therapeutics can result in major improvements in the health of patients. These benefits can become overshadowed by increased risks. An adverse drug event (ADE) is defined as harm experienced by a patient as a result of exposure to a medication, and ADEs account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year. ADEs affect nearly 5 percent of hospitalized patients, making than one of the most common types of inpatient errors ambulatory patients may experience ADEIs at even higher rates. 

---

The development and improvement of scientific-technical level of NDT and TD means for safety issues is connected with the necessity to find additional investments that must be taken into account at the stage of new technogenic objects designing, when solving new arising problems in social, economic, ecological and medical safety. It is not accidental, that the expenses for safe nuclear power plants operation cover 50% of total sum for construction work capital investments. That is why the investments for NDT and TD have to cover 10% of total amount for development and manufacturing of any product. 

In the Table 2 presented the actual conventional distribution of different physic diagnostic methods relative to the solution of this or that task of technogenic, social-economic, ecological and medical safety. In the table the relative average sales values of corresponding technique in the world is presented as well. 

The Japanese regulatory authority is the Ministry of Health and Welfare (MHW) and the Pharmaceutical and Medical Safety Bureau (PSMB) is responsible for the promulgation of national and international guidelines in the form of Notifications. Guidelines are available on the Internet web-site of the National Institute of Health and Science (http //www.nihs.go.jp). The MHW has not issued specific guidance on the development of chiral drugs, but has nonetheless responded to the enantiomer-versus-racemate scientific debate. The attitude of the MHW and its advisory body, the Central Pharmaceutical Affairs Council (CPAC) is discussed in two articles by Shindo and Caldwell published in 1991 and 1995 [17, 18]. The latter paper analyzes the results of a survey of the Japanese pharmaceutical industry which sought responses on chirality issues. 

ADEs and medication errors can be extracted from practice data, incidents reports from health professionals, and patient surveys. Practice data include charts, laboratory, prescription data, and administrative databases, and can be reviewed manually or screened by computer systems to identify signals. A method of ADE and medication error detection and classification has been presented that is feasible and has good reliability (Marimoto et al. 2004). It can be used in various clinical settings to measure and improve medication safety. 

The field test was conducted from May 2003, towards the end of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong, until January 2004. The students taking part in the field tests were properly trained and equipped with medical safety equipment. Air samples collected at the reception area was designated as control samples (Fig. 12.9-12b). The Prototype Unit was located in the doctor s consultation room (Fig. 12.9-12c) and was operated 10 h/day, 6 days/week during the six months test period. 

Koren G Medication Safety during Pregnancy and Breastfeeding A Clinician s Guide, 4th ed. McGraw-Hill, 2006. 

Strategies to Reduce Medication Errors Working to Improve Medication Safety... 

Kreek, M.J. Medical safety and side effects of methadone in tolerant individuals, J. Am. Med. Assoc. 1973, 223, 665-668. 

As previously mentioned, the nickel—titanium alloys have been the most widely used shape memory alloys. This family of nickel—titanium alloys is known as Nitinol (Nickel Titanium Naval Ordnance Laboratory in honor of the place where this material behavior was first observed). Nitinol have been used for military, medical, safety, and robotics applications. Specific usages include hydraulic lines capable of F-14 fighter planes, medical tweezers, anchors for attaching tendons to bones, eyeglass frames, underwire brassieres, and antiscalding valves used in water faucets and shower heads (38,39). Nitinol can be used in robotics actuators and micromanipulators that simulate human muscle motion. The ability of Nitinol to exert a smooth, controlled force when activated is a mass advantage of this material family (5). 

Anonymous. 2003d. The virtues of independent double checks They really are worth your time. ISMP Medical Safety Alert available at www.ismp.org/msarticle/ timeprint.html accessed on March 02, 2003. 

Dr. Butler believes that medication safety has recently become a more visible issue in her community. That is, more people are thinking about how medi-... 

You can find out more about medication safety and ADEs by visiting the Web site of the Institute of Medicine at www.iom.edu. 

Describe what changes are needed at the risk management level to better address medication safety issues, including the use of failure mode and effects analysis to reduce the... 

Pharmacists and technicians play a major role in medication safety in modern pharmacy practice. After summarizing several studies performed in hospitals and long-term care facilities, Allan and Barker (1990) estimated that medication errors occur at a rate of about 1 per patient per day. In a more recent study performed in ambulatory pharmacies, they found an overall dispensing accuracy rate for prescription medications of 98.3 percent (Allan, Barker, and Carnahan, 2003). While most of these errors probably have minimal clinical relevance and do not affect patients adversely, many experts believe that medication error rates may be higher in the ambulatory care setting because errors may not always be evident to the health professionals who work there. For example, medication errors can occur when a patient purchases nonprescription medications without speaking with the pharmacist about any potential interactions with his or her prescription medications or if patients fail to verify the appropriate dose of the over-the-counter (OTC) medication. 

Multidisciplinary educational programs should be developed for health care personnel about medication error prevention. Because many errors happen when procedures are not followed, this is one area on which to focus through newsletters and in-service training. It also is important for pharmacy staff not just to focus on their own internal errors but also to look at other pharmacies errors and methods of prevention and to learn from them. Organizations such as the ISMP, USP, and many others provide ongoing features to facilitate these reviews in publications such as Hospital Pharmacy, Pharmacy Today, U.S. Pharmacist, and Pharmacy and Therapeutics or newsletters that report on current medication safety issues and offer recommendations for changes. 

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

In Scenario 1, the pharmacist s success was due in part to his ability to develop relationships with members of the hospital s pharmacy and therapeutics committee, the medication safety committee, and the antibiotic control committee. 

This study was supported in part by Grant-in-Aid for Health and Labor Science Research (Research on Pharmaceutical and Medical Safety) from the Ministry of Health, Labor and Welfare of Japan by Grants-in-Aid for Scientific Research (B), Scientific Research on Priority Areas—System study on higher order brain functions and Research on Pathomechanisms of Brain Disorders, Core Research for Evolutional Science and Technology (CREST), from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. 

Coursing through the Body, 189 Medical Safety, 189 Medical Use, 196... 

Department of Health (2004) Building a safer NHS for patients improving medication safety (A Report by the Chief Pharmaceutical Officer). January. 

Preventive Medicine Activity (MIRADCOM). This operation surveys all processes and procedures for medical safety. They review (and approve in selected instances) standard operating procedures. Laboratories are surveyed for toxic chemical levels. Also, chemical procedures are monitored to determine the level of exposure to toxic substances. They perform annual physical examinations on all personnel involved in hazardous operations or exposed to hazardous chemicals. Medical histories are maintained. Techniques of emergency treatment for both standard and unusual incidents are kept updated. 

As increasing numbers of people experience the ill effects of medication use and realize that this is not an inevitable consequence of our health care system, the public outcry for answers will intensify. Medication safety has been the driving force for many health care advances, such as the 1937 Elixir Sulfanilamide scandal (FD C Act), the European thalidomide tragedy (1962 Kefauver Drug Amendments), and the incidence of adverse drug events in nursing homes (1974 Consultant Pharmacists Law). ... 

---