Medication use system

The purpose of pharmacy administration course work is to teach pharmacy students how to design and manage medication use systems that produce optimal results for patients. In pharmacy administration courses, students learn how to conduct medication use evaluations that measure patient outcomes. They are taught how to communicate effectively with patients and with other health care providers. Pharmacy administration courses also teach ethical and legal responsibilities to monitor drug therapy and to protect patients from problems with drug therapy. 

Health care quality finally has achieved a position of high visibility on the national agenda, and the pharmacist has been recognized as a key player in this process (Kusserow, 1990). Thus pharmacists will be called on increasingly to ensure quality in all portions of the medication use system. 

Complex systems such as the medication use system create an environment that allows these errors to occur. Slips or mistakes can apply to any of the steps in the medication use system. The volume of existing and new medications, therapies, and nuances used in medical practices is overwhelming. Systems that prevent the need to depend on memory improve medication safety. 

The medicahon use system can be divided into five areas selecting, ordering, dispensing, administering and monitoring. Error potenhal is prevalent in each area. Some causes of errors transcend segments of the medicahon use system and occur in two or more phases. In particular, violations of rules and slips, or memory lapses, are seen in each of the five areas of the medication use system. 

Branches dealing with special populations, such as pediatrics and oncology, require additional vigilance to promote monitoring for patient safety. Many of the products for such populations have narrow fherapeutic indices. Small changes in dosage can result in disastrous effects. Additional checks of these agents should be built into the medication use system. 

Error points can occur throughout the medication use system. As systems and technology evolve, pharmacists must adapt new methods to promote medication safety. For example, potential medication errors might evolve, depending on the sophistication of the medication system used and the patient s level of care (Table 16.9). 

Phase of the Medication Use System Bed Patient in an Institution Ambulatory Patient... 

Lee developed a set of principles of a fail-safe medication use system striving for a sysfem thaf is pafienf cenfered, based on respect for others, and requires an acceptance of responsibility and a collaboration of interests. ... 

These principles sef the tone for characteristics of a fail-safe medication use system that ... 

The existence of a pharmacist shortage in the United States is an established fact. This situation has developed at the same time that national priorities for improved safety and quality in the medication use system have achieved wide support. Because it is unlikely that the number of new pharmacists can be greatly increased, the simultaneous implementation of multiple partial solutions should be considered. These solutions should be considered in the light of continuing progress toward a medication use system of fhe highest quality and a likely scenario that the demand for pharmacisfs and their services will continue to exceed the available supply. 

Re-engineering the medication use system proceedings of a national interdisciplinary conference conducted by the Joint Commission of Pharmacy Practitioners. Am J Health-Syst Pharm. 2000 57(6) 537-601. 

The objective of this chapter is to review medication use quality issues in an institutional context and highlight their impact on patient care and clinical research. The focus is on three themes understanding the medication use system and organizational interests in medication use, understanding the application of drug use monitoring as a tool to improve medication use and understanding processes to identify and improve medication errors. 

The medication use system in an institutional setting offers even more complexity, with more chances for error. The five subsystems of the medication system in a hospital are selection and procurement of drugs, drug prescribing, preparation and dispensing, drug administration, and monitoring for medication or related effects (11). Evaluation and improvement of medication use quality require consideration of all of these subsystems. 

The latent errors in the medication use system have been described in several studies. Major contributors to errors in medication use were found to be knowledge gap related to drug therapy (30%) ... 

Some examples of tasks associated with the provision of pharmaceutical care through CDTM have been published. Many of these tasks are necessary to help patients use their medication optimally, but may be prohibited for pharmacists to perform independently by some state pharmacy statutes and regulations. CDTM may also be prohibited in some current practice sites of traditional pharmacy because they lack some core requirements from the list given above. Note that we arc discussing a fundamental change in the medication use system. 

It is the mission of ISMP—Spain to enhance the safety of the medication-use system and to improve the quality of patient healthcare. The most important goal is to reduce the risk of medication errors and preventable adverse drug events. 

Thus, the process-improvement approach to the safety of the medication-use cycle goes beyond the celebrated cases and first stories to scientifically investigate the system as a whole. Data on near-misses and uncelebrated errors should be analyzed to find hidden flaws and strengths, and to better understand the dynamics of our medication-use system. Scientific investigation of the whole cycle— peeling away the layers of the onion—will reveal latent points of failure and facilitate a redesign that substantially reduces the occurrence of harmful outcomes. 

In the process-improvement or outcomes-measurement approaches, medication-use system redesign should 1) identify and assess lynchpin safety components of the medication-use cycle as well as improving event capture and reporting, 2) develop a medication system safety... 

Instead of focusing strictly on the pharmacy profession, the fourth conference addressed the quality of the entire medication-use system. The objectives were to describe—and publicize—the extent of preventable morbidity, mortality, and excess costs resulting from suboptimal medication use to stimulate discussion of the social and economic impact of dysfunction in the medication-use system to develop a reengineered system for medication use that would optimize clinical, economic, and humanistic outcomes to identify strategies that could be used to evaluate and implement the models developed and to foster greater interprofessional collaboration and a shared commitment to optimal medication use. 

Re-engineering the Medication-Use System—Proceedings of a National Interdisciplinary Conference Conducted by the Joint Commission of Pharmacy Practitioners, October 1-3, 1999, Baltimore, Maryland, Am. J. Health-Syst. Pharm., 2000 57, 537-601. 

Conversely, failure to document activities and patient outcomes can directly affect patients quality of care. There are several reasons for failure to document in the medication-use system, and these are... 

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