Safe prescribing practices

Concept to Action Educating Health Care Professionals about Safe Prescribing Practices... 

The steady drumbeat of fresh ideas has improved safe prescribing practices in the most common error groups, from a combined average of 73.7 percent to 84.3 percent since the initiative began. In the next year, computerized order entry will effectively put speed bumps, in the form of alerts, decision support, and forcing functions, in front of busy providers to require them to clarify their orders when misunderstandings could arise. 

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. 

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) ... 

OSHA does not prescribe training requirements for scissor lifts used in general industry however, the agency says in a July 2011 Hazard Alert that operators need to be trained. Specifically, OSHA says training must be based on the manufacturer s instructions and recommendations outlined in the operator s manual for each lift, as well as safe work practices established by the employer. The American National Standards Institute (ANSI) also says employers must train both operators and maintenance personnel in accordance with the equipment manufacturer s recommendations, as well as those outlined in applicable ANSI standards. The ANSI standards covering scissor lifts are ... 

Skillful practice of psychopharmacology requires a broad knowledge of psychiatry, pharmacology, and medicine. In this chapter, we present general principles relevant to the safe and effective use of psychotropic medications. In subsequent chapters, we discuss the major classes of psychotropic medications—antidepressants, anxiolytics, antipsychotics, mood stabilizers, stimulants, and cognitive enhancers—and the disorders for which they are prescribed. The reader should be aware that this nomenclature is somewhat artificial for example, many antidepressant medications are also used to treat anxiety disorders. Generic names are used throughout this book. The appendix provides a fist of trade (brand) names. 

Protection requires a combination of approaches. There are a number of factors that are intrinsic to the physiological and psychological makeup of the worker. Individual susceptibility and interaction with other biological stresses will vary from individual to individual. Personal hygiene and work habits also vary. It is important that the worker fully comprehends the nature of the hazards and the consequences of careless actions or failure to follow prescribed safe procedures. The attitudes of workers and managers are important in implementing working practices that will minimize risks. 

There are three reasons why it is essential for clinicians to be familiar with this class of products. First, many OTC medications are effective in treating common ailments, and it is important to be able to help the patient select a safe, effective product. Because managed care practices encourage clinicians to limit the cost of drugs they prescribe, many will begin to recommend effective OTC treatments to their patients, since these drugs are rarely paid for by the insurance plan. (See Table... 

The 1938 law states that the label of a medication should contain adequate information regarding its use. However, in practice, it became evident that some pharmaceuticals and medications had to be administered by or under the orientation of a medical practitioner, due to the inability of a layman to diagnose a disease, choose an effective treatment, and recognize the cure or the symptoms. Several products were thus classified, but the prescription concept of a medication was introduced only after Alteration in the Law of Durham-Humphrey s in 1951. Since then, a label had to carry the warring Caution, the Federal Law prohibits dispensation without medical prescription. The use of these medications had to be restricted to prescription by a practitioner and the packing or printed material inside had to contain adequate information so that the practitioner could prescribe them safely. 

AMH publications are designed as practice, teaching, and learning tools, and aim to promote Quality Use of Medicines (QUM) by providing readily accessible, concise, up-to-date, clinically relevant information that facilitates effective, rational, safe, and economical prescribing and dispensing. 

It is of prime importance in process design to recognize and incorporate the minimum safe practices prescribed by nationally recognized fire protection associations, engineering authorities, and governing bodies. Table 2-3 lists a number of these. Such recommendations and regulations should be followed as closely as possible, and in every case supplemented as indicated by experience (see Chap. 8). 

The European Commission s report eHealth for Safety summarises that In the case of clinical and organisational decision support systems, internationally, there are over two decades of sound evidence on their benefits [12]. Indeed, large numbers of healthcare organisations are turning to electronic decision support systems to forge consistency in care provision and develop best practice particularly in prescribing. But where clinicians become reliant on decision support to deliver safe clinical care, it is a short step to harm occurring when these systems are found to... 

Inadequate Control Algorithms This level of the accident analysis provides an interesting example of the difference between prescribed procedures and established practice, the adaptation of procedures over time, and migration toward the boundaries of safe behavior. Because of the many helicopter missions that ran from Diyarbakir to Zakhu and back, the controllers testified that it did not seem worth... 

The Health and Safety Executive recommend that employers should devise their own policy statement in cooperation with school management teams and other employees. An adopted policy, for example, Be Safe (ASE, 1990) in science or Safe Practice in Physical Education (BAALPE, 1996), might not reflect the individual circumstances of each school. However, some LEAs might insist that their policy statements should be used, in which case it is recommended that schools annotate such documents and/ or add appendices to prescribed guidelines that specify the needs of the school. 

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