medsafetyonline

A forum for caregivers and pharmacy professionals concerned with patient and provider safety.

Medication Safety

Tools to Support Success

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For the infusion center nurse, not being familiar with a drug they need to prepare and administer can be a source of stress and anxiety.

This is an experience I am personally familiar with. At one point early in my career, I received an order for a drug called ELAPRASE (idursulfase). I knew nothing about this drug at that time. How do I prepare it? How is it administered? What instructions do I give the staff asking me questions? What concentration do I prepare?

The experience made me feel vulnerable and honestly pretty stressed out. I realized in that moment, that I desperately needed a quick resource to help me determine the answers to my questions about this drug and allow me to provide accurate directions to my staff.

This moment was the birth of RxWORKFLOW™ — an operationally integrated reference tool that includes the critical information and tools needed to dose, prepare, and administer any infusion drug.

In the beginning, however, I was still using my trusty handheld calculator to do the math necessary to complete the tasks at hand. I, like everyone else, have fat fingers and the vulnerability of using this tool became more and more apparent. That’s when we decided to build RxQuickCALC™, RxCALC™, and RxDoseCHECK™ and integrate them right into RxWORKFLOW™.

These drug specific calculation tools are designed to minimize user input and provide accurate calculations. This is especially important when infusion nurses need to calculate dose specific taper steps for a drug like RITUXAN (rituximab). Without a tool like this, nurses will often need to call the pharmacy (or coworker) to double check their math, then write down the taper steps on a piece of paper, and tape that paper to the IV pole where the medication is hanging—Certainly not the safest or most efficient method!

Following the premise that consistency promotes safe practices and predictable patient outcomes, we have also recently introduced enhancements to our RxCALC™ preparation and RxCALC™ administration pop up calculators.

Not only do the calculators provide the math for dose preparation, they also provide step-by-step procedural information to help ensure consistent medication preparation. This provides the nurses a consistent method of administering all drugs, especially those with some complex administration calculations such as rituximab, infliximab, or any of the immune globulins.

Our new RxCALC™ for Dose Administration follows the same format and includes many specific weight-based dose calculators that incorporate these same features. For the free standing infusion nurse, we provide a consistent procedure for preparation and help to insure the details such as needle size or filtration requirements are not forgotten.

RxWORKFLOW™ is our most popular application for good reason! When these tools are integrated into an operation’s day-to-day policies and procedures, it significantly improves patient and staff safety, efficiency, consistency and staff confidence, even for those with minimal or outdated experience. Our most successful users require the use of RxWORKFLOW™ every time a drug is dosed, prepared, and administered. Dose preparation and dose administration become a consistent step-by-step procedure insuring patient safety and clinician confidence.

Ditch that paper binder! RxWORKFLOW™ provides a cloud-based procedure manual that is always up to date with the most current information and the integrated tools like RxCALC help to ensure efficient, consistent, and successful patient outcomes. Eliminate the daunting task of establishing the proper procedures for preparation and administration of an ever-changing drug library and maintaining staff competency. Drug specific tools, procedural reference, and competency education are at the heart of what we do.

 

Increasing Confidence with Best Practices for Infusion Therapy

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There have been so many improvements in the outpatient infusion market in recent years. The good news is that patients can now achieve a higher quality of life even when they are afflicted with a lifetime chronic condition through treatments utilizing periodic injections or infusions. If you place yourself in any patient’s shoes, what would be most important to you? Besides things like clean, comfortable surroundings, or a location close to home, my top two would be:

  1. Confidence in those rendering care.
  2. Confidence in my treatment and its safe delivery.

RxWORKFLOW for IV Safety™ was created to help infusion centers provide these important benefits to their patients.

RxWORKFLOW for IV Safety™ provides a collection of user-friendly drug specific monographs with interactive reference, tools, and procedural information designed specifically for clinicians who prepare and administer IV medications.

In every RxWORKFLOW for IV Safety™, the interactive reference (drug information) is organized in a simplified, concise format, giving any nurse the ability to find what they are looking for, within just a click or two. We include only the most important information that is commonly needed and format it for easy access.

There is a lot of information available out there, often it can feel like you are “drinking from a fire hose”, especially when it comes to drug information. If you aren’t providing concise up-to-date supporting information for your staff, how can you know where they are getting it? Clinicians often need to make critical decisions very quickly. Easy access to accurate reference can improve efficiency and staff confidence. It also eliminates guesswork based on potentially incorrect or out-of-date information.

We have also included tools in every RxWORKFLOW for IV Safety™ monograph including RxQuickCALC™, RxCALC™, and RxDoseCHECK™ to provide consistency and minimize the potential for errors in drug preparation and administration. The tools provide step-by-step instructions and are always what clinicians need for that specific drug. They establish a standardized process for preparation and administration, getting every nurse on the same page, and helping to instill best practices.

Not having support tools or an established process in place for preparation and administration tends to make clinicians inefficient and prone to error, especially when they haven’t performed a particular task in some time. It’s easy to forget or get mixed up—How does this go? Is there a filter on this? Can I use D5W as a diluent? Providing support tools can minimize mistakes and set the standard of practice for ensuring positive patient outcomes.

With knowledge comes a sense of confidence that is palpable. For a patient, being treated by a confident caregiver who they trust can provide:

  • Increased confidence in their treatment
  • Increased confidence in the staff and organization
  • Satisfaction that they chose their caregivers correctly
  • Reduction in potential for treatment failures
  • Lowered potential for side effects

Many of the highest risk medications are delivered by IV infusion. In fact, 61 percent of the most serious and life-threatening potential adverse drug events are IV drug related.1 IV drug administration often results in the most serious outcomes of medication errors.2

Many patient safety and professional organizations now strongly recommend IV preparation and administration process standardization especially for vulnerable populations or high-risk drugs. Standardization and training become even more critical when you combine multiple drugs, staff members, and/or clinic locations.

In the Chronic Care Infusion setting, it is especially important to establish consistency and make sure the dose is appropriate for the patient weight or age range. Often, the person preparing or administering a medication may have limited experience or the drug may have complex requirements, be high-risk or expensive.

RxWORKFLOW for IV Safety™ gives every clinician the information and ability to safely prepare and administer any drug in our library with confidence.

RxWORKFLOW for IV Safety™ makes it easy to provide drug-specific support ­for your staff including standardized reference, tools, and procedural information. By doing so, your practice can reap the many benefits: minimize the risk for errors, increase patient and caregiver safety, provide cost savings, establish best practices, and of course, increase both patient and caregiver confidence.

For more information about this awesome tool, check out this short video, contact us, or visit RxTOOLKIT.com.

[1–2]: http://www.hqinstitute.org/highriskmed (sdpsc_safe_administration_of_high-risk_iv_medication.pdf):[1] Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women’s Hospital in Boston, October, 2001. [2] Hicks, RW, Cousins, DD, Williams, RL. (2003). Summary of Information Submitted to MEDMARX® in the Year 2002. The Quest for Quality. Rockville, MD: USP Center for the Advancement of Patient Safety.

Ensuring Drug Specific Competency for Infusion Center Clinicians

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As with any occupation, there’s a lot to know in order to become a competent and proficient professional. Healthcare is no different. Based on your specific discipline, be it pharmacy, nursing, or physician, there are skills and tasks that are essential to the successful completion of your responsibilities.

For infusion center clinicians, the most essential information is undoubtedly in-depth drug knowledge. That includes knowledge of: drug preparation, drug administration, patient response(s) to drugs, and what to do in the event of an adverse patient reaction. In an article published in the British Journal of Clinical Pharmacology[1], Jeffrey K. Aronson explains the following (as it relates to medication errors):

Errors are first broken down into two separate categories:

1. Mistakes
2. Skill-based errors

Mistakes are then divided into two categories:

1. Knowledge based errors
2. Rule-based errors

Skill-based errors are divided into two categories as well:

1. Action based errors (slips)
2. Memory based errors (lapses)

What does this mean to the infusion center clinician?

To prevent both rule-based and action-based errors, we recommend utilizing RxTOOLKIT’s RxWORKFLOW for IV Safety™. These user-friendly drug specific monographs provide interactive reference, tools, and procedural information, right where every clinician really needs them, at the point of care. Within each drug specific monograph, the “rules” for drug preparation and administration are presented in an easy to follow format that guides the clinician through a safe and consistent process.

RxWORKFLOW for IV Safety also helps to prevent “slips” by providing drug specific on-the-spot tools that assist in preparation or administration (RxQuickCALC™, RxCALC™, and RxDoseCHECK™). These tools are always what you need for that specific drug and include step-by-step instructions, tapering tables, and automated calculations helping clinicians to avoid an action based error.

So how do you address Knowledge and Memory Based Errors?

Let’s start with Knowledge Based Errors.

RxTOOLKIT provides a Drug Specific Competency Tracking Program in our popular LMS platform, RxTOOLKIT eLEARNING. Drug Specific Competency Tracking is an ongoing program that was built specifically for training, certification, and tracking of drug knowledge. The program provides drug specific courses with interactive assignments and competency exams. Clinicians can retake the courses periodically whenever their certification expires (as determined by your organization). This program enables clinicians (and their managers) to verify that their drug knowledge is complete and up to date.

To help with Memory Based Errors, which the author describes as “lapses”, we return to the point of care, right inside every RxWORKFLOW for IV Safety monograph, where clinicians find up-to-date, standardized, and easily “scanable” reference help to ensure your staff is familiar with both a drug and related dosing parameters. It’s easy to find a fast answer, there’s even a Quick Summary section, consolidating drug specific tools and providing quick reference, helping to confirm the necessary parameters and increasing caregiver confidence.

RxTOOLKIT’s goal is to provide the infusion center clinician a single source of standardized reference, tools, and training. We can help any center to establish standardization in practice and staff training and ensure their positive patient outcomes.

For more information about these two awesome tools, RxWORKFLOW for IV Safety and Drug Specific Competency Tracking, check out these short videos, contact us, or visit RxTOOLKIT.com.

 

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723196/pdf/bcp0067-0599.pdf

Taking Control of Your Internal Reference Library

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We’ve all seen this; a healthcare worker in a white coat, pockets stuffed with papers. In hand, they have a notebook, handheld calculator, and a variety of dog-eared papers.

Early in my career, I decided to take a clinical supervisory position after serving 15+ years as a traveling executive for a healthcare company. Though I had been a licensed pharmacist for 25+ years, I had not “practiced pharmacy” in a long time. One of my colleagues at the time jokingly referred to me as “clinically dead”.

Pharmacy practice had seen many changes in my 15-year “absence”. When I left, hospital pharmacists were consigned to one room together, typically in the basement somewhere. But now, I was observing a highly diversified and far more clinically evolved practice. Pharmacists were out on the floor with nurses and the dispensing function was being integrated more fully with direct patient care.

My biggest concern was that I had no idea what reference information was in the pockets of all those white coats for which I had the responsibility to supervise. I felt that I had no control over the information my staff was using in the clinical decision making process.

I asked each of my staff to give me a copy of what there where using as a reference and/or tool in their decision-making process. Once they were gathered, we complied those papers and put them on the web for ease of access. We added search terms to make it even easier to find the information and RxDOCUMENT™ was born. Actually, it was the birth of RxTOOLKIT® itself, as that was our very first app.

RxDOCUMENT™ provided an easy to access standardized internal reference library and eventually grew to hold slide presentations, in-service materials, policies, procedures, and best practice recommendations.

RxDOCUMENT™ was our first application and is still one of our most popular!

Of course, now days, your staff could be using a digital notepad full of links. But whatever method they use, what really matters is taking control, and getting everyone on the same page. RxDOCUMENT™ can help you to establish your standardized reference library and provide a strong foundation for your staff’s clinical decision-making process.

For more information about RxDOCUMENT™ please contact us or visit RxTOOLKIT.com.

We Support Pennsylvania House Bill 770!

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“An ounce of prevention is worth a pound of cure.”

B. Franklin

On April 9, 2019 my colleagues and I from the Pennsylvania Society of Health System Pharmacists (PSHP) will be attending a meeting with Pennsylvania State Representative Tony DeLuca. Representative DeLuca, along with 12 other co-sponsors, have sponsored House Bill 770 into the General Assembly of Pennsylvania.

This bill, when passed and signed into legislation, will amend the Pharmacy Act to “further provide for definitions; and providing for pharmacy technician and pharmacy technician registration, qualifications and supervision”. Pennsylvania is currently one of only four states that do not provide Board of Pharmacy oversight of pharmacy technicians through registration or licensure.

In 2006, Ohio was one of those states without any oversight of pharmacy technicians. In February of that year, a tragic error committed by a pharmacy technician and not caught by a pharmacist resulted in the death of 2‑year-old Emily Jerry. Once Emily’s dad, Chris, understood the cause of Emily’s death, he took it upon himself to change the law in Ohio. Emily’s Law was passed in December 2008 and went into effect on April 8, 2009.

As with any change in law and/or regulations, there are voices on both sides of the argument. House Bill 770 is no exception. On one hand, it seems so logical. Why would you not want to regulate and demand standards of practice for individuals who prepare medications? On the other hand, there are economic issues that come with regulations and competency.

The answer, in my opinion lies with Ben Franklin. Prevention in healthcare typically leads to a better quality of life and can at the same time provide cost savings for patients and providers alike. It’s why we do things like vaccinate and perform cancer screenings. There are so many benefits to pharmacy technician training, but the most important one is that trained, competent, and reliable techs can drastically reduce any facility’s overall medication error rate.

When Pennsylvania adopts House Bill 770, my home state will take a step forward to prevent a tragedy like Emily’s from ever happening again. This makes Emily’s short time on this earth all the more meaningful and it is absolutely worth the continued fight!

Pennsylvania residents please call or write your representatives and ask them to support this bill!

About the bill:

Who is my Pennsylvania Legislator?:

 

Photo Credit: Governor Tom Wolf, The Pennsylvania State Capitol in Fall, November 4, 2015, Harrisburg, PA used under Attribution 2.0 Generic (CC BY 2.0) source: https://flic.kr/p/AH98zR