Prescription errors and beyond-use dateProf. Dr. Henny Lucida, Apt

Prescription errors

Definition:Unintentional mistakes in the prescription, transcription, dispensing, and administration of medication

Medical Errors by Type

11%

12%

38%

39%

PrescriptionErrors

Other

Ordering/Prescribing

Administration

Dispensing

Transcribing

80%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Prescription/Medication errorsSOME COMMON CAUSES OF MEDICATION

ERRORS : Failed communication Poor drug distribution practices problems Dose miscaculations Drug and drug device-related problems Incorrect drug administration Lack of patient education

Types of errors Handwriting

Terutama yang namanya mirip: longatin – largactil, epatin – enatin, difenilhidantoin - difenilhidramin

Drugs with similar names Losec – Lasix, Seldane (terfenadine)-Feldene (NSAID), taxol

(anticancer)-paxil (antidepressant) Zerroes and decimal points

Vincristin 2.0 mg – 20 mg Digoxin 0.017 mg – 0,17 mg

Metric and apothecary systems Supaya ada standar 1/200 grain (0,3 mg) nitroglycerin tablet menggunakan

2x1/100 grain (0,6 mg masing-masing, atau 1,2 dosis total) .

Ambiguous or incomplete orders Cyclophosphamide dosis 4 g, 1 – 4 hari, maksudnya

4 gram untuk total 4 hari ( 1 gram per hari, tetapi diberikan 4 gram per hari

Abbreviations D/C – discharge and discontinue: digoxin,

propranolol, insulin Pasien pulang, obat masih diteruskan, dikira pulang obat discontinue

HS – half strength,. Pasien menerima HS – hora somni, hora somni dan full strength

QD – QID i/d (one per day) – TID (tdd)

PROBLEM RELATED to DRUGS and DRUG DEVICES Profesi kesehatan membaca label tiga

kali yaitu waktu mengambil, menggunakan dan mengembalikan.

Labeling dan packaging menyebabkan medication errors.

INCORRECT DRUG ADMINISTRATION Walaupun dalam persiapan dispensing

sudah benar tetapi masih kemungkinan terjadi kesalahan pada penggunaan obat.

Untuk memperoleh pengobatan tepat pasien dengan tepat route dan tepat waktu adalah esensial.

Pasien kadang kurang perhatian. Misal tetes mata, tetes hidung, tetes diminum; obat topikal diminum (vaginal tablet, suppositoria), enteral feeding dengan gasric tube diberikan iv

LACK of PATIENT EDUCATION Farmasis mendidik pasien secara profesional

merupakan hal yang penting dalam meyakinkan penggunaan obat.

Pasien yang tahu penggunaan obat untuk apa, cara pemakaian, seperti apa obat tersebut, bagaimana obat bekerja sangat membantu meminimalkan tidak terjadinya medication errors

Konseling dan edukasi tentang pengobatan dan semua pengelolaan obat dan penyakit sangat penting

Pasien diusahakan untuk bertanya dan mendapat jawaban yang memuaskan

Prescription errorsIncludes: wrong patient incorrect medication inappropriate dose wrong time wrong route of administration Wrong rate of administration

Kategori error (Feinberg, ed. Med Pass Survey, ASCP, 1993)Omission Error Terlambat/terlalu cepat

memberikan regimen dosis berikutnya

Unauthorized Drug error Pasien membeli antibiotika tanpa resep

Extra Dose Error Dosis ganda

Wrong Dose Error Dosis lebih besar atau lebih kecil dari yg diresepkan dokter

Wrong Route Error Tidak tepat cara pemberian

Wrong Rate Error Laju infus kurang/lebih

Kategori error (Feinberg, ed. Med Pass Survey, ASCP, 1993)Wrong Time Error Tidak tepat Interval

dosis

Wrong Drug preparation Error

- Suspensi tidak dikocok- Sediaan sustained

release dibikin puyer- Incompatible- Inadequate product

packaging

Wrong Administration Technique Error

- Injeksi tanpa metode steril

- Tidak tepat dalam menggerus obat

Deteriorated Drug Error Obat rusak, kadaluarsa, obat tidak disimpan di lemari es

Psychological classification of medication errors (the Lancet, vol 355, 2000)

Tipe error/mistakes

Contoh-contoh

Knowledge-based error

Memberikan penisilin dan turunannya tanpa menanyakan riwayat alergi

Rule-based error Memberikan injeksi diklofenak di paha samping bukan di gluteus

Applying a bad rule

Memberikan captopril dosis besar pada awal gejala

Slips and lapses Slips of action (skill-based error): bermaksud meresepkan “chlorpromazine” tapi tertulis “chlorpropamide”

Lapses of memory Memberi beta blocker, tahu, tapi lupa bhw pasien penderita asma

To prevent prescription & medication errorsFive right principles: The right medication In the right dose To the right patients At the right time By the right route of administration

Guidelines to a pharmacist1. A systematic, step-by-step checking

would be very helpful2. Make sure that the information is

correctly transferred to the prescription label

3. Make sure that the correct drug is being dispensed, whether generic or brand

Contoh Preparation errorR/ Azythromycin mg 100

Ibuprofen mg 100GG tab ½Dexametason tab ½Luminal mg 30Vitamin C mg 20mf la dtd no. XIIS 3 dd 1

Pro: Anak, 2 thn

Contoh 2R/ Piroksikam no. 10

Licodekson no. 10Ibuprofen no. 10Dexametason no. 10

Pro: S , 40 thn

Expiration date vs beyond-use date Expiration date: a projection of the length of

time the product can be expected to retain its purity and potency based on accelerated stability studies. Exp date is used for commercial products

Beyond-use date: an estimate of the time interval that the compounded preparation can be expected to retain its purity and potency based on general guidelines, literature references or actual real-time stability studies using prescribed conditions

Beyond-use date In general: a maximum beyond-use date

of 6 months is used Most pharmacists prepare or dispense

small quantities of compounded products, recommend storage at room or cold temperatures

Maximum recommended beyond-use dateFor nonsterile compounded drug preparation packaged in tight, light-resistant containers when stored at a controlled room temperature or as otherwise indicated: Non aqueous liquids and solid

formulations:the beyond-use date should be no later

than 25% of the time remaining on the original product’s exp date, or 6 months, whichever is earlier

Maximum recommended beyond-use date Water-containing formulations

when prepared from ingredients in solid form, the beyond-use date should be no later than 14 days when stored at cold temperatures

Maximum recommended beyond-use date All other formulations

the earlier of 30 days or the intended duration of therapy should be used