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EO 002.03 Addressing Complaints and Errors

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01/09/2013

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Importance of Lesson(Dari)

• In the prior lectures you learned the aspects of effective communication, the logical process required to solve problems, and where to find technical pharmacy information to answer these questions.

• However, not all problems are as straight forward as simple questions.

• During Pharmacy activities many difficult situations can occur.

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Importance of Lesson(Dari)

• In the Pharmacy environment these difficult situations can include:– Patient complaints about:

• Service• Medication errors• Lack of empathy

– Complaints from other healthcare professionals.

• The purpose of this lecture is to teach you to deal with these situations professionally.

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Overview EO 002.03(Dari)

• Identify the skills required to handle difficult situations;

• Medication Errors:– Define– Impact of medication errors– Types of medication errors– Medication error reports– Follow-up actions to rectify

medication errors

• Lesson Review• Scenarios (not graded)

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Problem SolvingDari

Remember: All problems have two features in common:

Goals• To achieve some objective or desired state

of affairs and can include avoiding a situation or event.

Barriers• If there were no barriers in the way of

achieving a goal, then there would be no problem.

• Problem solving involves overcoming the barriers or obstacles that prevent the immediate achievement of goals.

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Communicating in Difficult Situations

DariMost people want to avoid conflict and potentially stressful situations – this is human nature.

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Why Can Communication be Difficult in These Situations

DariEmotion and Change• There are two main factors that make

communication seem difficult: emotion and change.

Emotion• People tend to look at emotions as being

positive or negative. – Happiness is positive and therefore sadness

must be negative.

• Emotions are a natural response to situations that we find ourselves in.

• Emotions are appropriate or inappropriate to a situation.

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Why Can Communication be Difficult in These Situations

DariChange• Difficult conversations can be about

some sort of changes (e.g finances or health).

• It is important to remember that change is inevitable.

There has to be a balance between communicating something difficult and being as sensitive as possible to those concerned

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Using Effective Communications Dari

In difficult situations assertiveness, empathy and remaining calm become very important:1. Gather Information

– Make sure you have your facts straight before you begin.

2. Be Assertive– Once you are sure that something needs to be

communicated then do so in an assertive way. (i.e. Do what you say you are going to do)

3. Be Empathic– Put yourself in the other person’s shoes and think

about how they feel.

4. Use Appropriate Verbal and Non-Verbal Language– Do not use confrontational language or body

language.

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Dealing with Difficult ConversationsDari

5. Listen– When we are stressed we listen less well, try to

relax and listen carefully to the views, opinions and feelings of the other person/people.

6. Try to Stay Calm and Focused– Communication becomes easier when we are

calm, take some deep breaths and try to maintain an air of calmness, others are more likely to remain calm if you do.

– Keep focused on what you want to say, don’t deviate or get distracted from the reason that you are communicating.

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Stages of Problem SolvingDari

Once the information is gathered use the Stages of Problem Solving:

1. Problem Identification

2. Structuring the Problem

3. Looking for Possible Solutions

4. Making a Decision

5. Implementation

6. Monitoring/Seeking Feedback

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Questions?

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Overview EO 002.03(Dari)

• Identify the skills required to handle difficult situations;

• Medication Errors:– Define– Impact of medication errors– Types of medication errors– Medication error reports– Follow-up actions to rectify

medication errors

• Lesson Review• Scenarios (not graded)

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Medication ErrorsDari

“A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.”

National Coordinating Council for Medication Error Reporting and Prevention

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Medication ErrorsDari

Consequences:• Many medication errors are probably

undetected. • The outcome(s) or clinical significance of many

medication errors may be minimal, with few or no consequences that adversely affect a patient.

• However, some medication errors result in serious patient morbidity or mortality.

ASHP Guidelines on Preventing Medication Errors in Hospitals

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Medication ErrorsDari

Ways to reduce errors:• Adequately trained and supervised

personnel • Adequate communications• Reasonable workloads• Effective drug handling systems• Multiple procedural and final product

checks by separate individuals • Quality management and • Adequate facilities, equipment, and

supplies.

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Medication ErrorsDari

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*When in doubt contact the prescriber*

ASHP Guidelines on Preventing Medication Errors in Hospitals

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Medication ErrorsDari

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*Always read twice and double check calculations*

ASHP Guidelines on Preventing Medication Errors in Hospitals

AFAMSAFAMSASHP Guidelines on Preventing Medication Errors in Hospitals

Classes of Medication ErrorDari

NO ERROR• Category A

– Circumstances or events that have the capacity to cause error

ERROR, NO HARM– [Note: Harm is defined as temporary or permanent

impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting there from requiring intervention.]

• Category B– An error occurred but the error did not reach the

patient

• Category C– An error occurred that reached the patient, but did not

cause patient harm

• Category D– An error occurred that reached the patient and

required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm

AFAMSAFAMSASHP Guidelines on Preventing Medication Errors in Hospitals

Classes of Medication ErrorDari

ERROR, HARM• Category E

– An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention

• Category F– An error occurred that may have contributed to or

resulted in temporary harm to the patient and required initial or prolonged hospitalization

• Category G– An error occurred that may have contributed to or

resulted in permanent patient harm

• Category H– An error occurred that required intervention necessary

to sustain life

ERROR, DEATH• Category I

– An error occurred that may have contributed to or resulted in the patient’s death.

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Overview EO 002.03(Dari)

• Identify the skills required to handle difficult situations;

• Medication Errors:– Define– Impact of medication errors– Types of medication errors– Medication error reports– Follow-up actions to rectify

medication errors

• Lesson Review• Scenarios (not graded)

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All Medication Error Questions Are Clinical Therefore, Refer to

the PharmacistDari

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NMH Medication Error Reporting Dari

•Medication Errors are recorded on a Pharmacy Medication Error Report.•The final report is signed off by the Chief of Pharmacy.

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Pharmacy Medication Error ReportDari

•Used to report the occurrence of a medication error or a potential error within NMH or Polyclinics.•It is a method of accounting for:– What happened?– How serious was the incident?– How was the incident handled?– What is being done to prevent it

from occurring again?

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Pharmacy Medication Error ReportDari

• This information can be gathered by a Pharm Tech.

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Pharmacy Medication Error ReportDari

• The following areas must be filled in by a Pharmacist.– Level of Error– Type of Error– Narrative of Incident– Provider’s Comments– Personnel Involved– Corrective measures to prevent

reoccurrence (Chief of Pharmacy)

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Level of Error

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Level of Error

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Scenarios (Assessment)Dari

Formative Assessment:• Not marked•Used to assess the students understanding of the correct handling of medication errors and patient complaints.•Instructors will provide guidance for each scenario.•Instructor will provide copies of Pharmacy Medication Error Reports.•Instructor will provide a debrief after each scenario.

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Scenario (Assessment)Dari

•The class will be divided into small groups of at least four people. •Each scenario will require:

• 1x Pharmacy Technician (Actor)• 1x Patient (Actor)• 2x Observers

• There will be three scenarios:• 2x Medication Errors• 1x Patient Complaint

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Scenario (Assessment)Dari

•Each scenario should take 10 to 15 mins.•Scenarios will involve interactions between the Pharm Tech and the patient actors. •After the interactions the observers are to provide constructive feedback to the Pharm Tech (actor) on how they handled the difficult situation. •Both positive and negative points on effective communication and problem solving should be highlighted. •After each scenario the Instructor can have a group who performed well re-enact the scenario in front of the class.

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Scenario OneDari

Situation:

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Scenario SixDari

A patient has returned to Afghanistan from Canada. They were given a drug called Zyloprim. They believe it is was for allopurinol. They wish to know what is Zyloprim.

Zyloprim is allopurinol. (Preparations: Proprietary preparations)

The patient wishes to know what ingredients are in Zyloprim. Where is this located?

Martindale Volume B

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Questions?Dari

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GameDari

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Game (Assessment)Dari

Formative Assessment:•Not marked•Used to assess the students understanding of technical versus clinical questions.•Instructor will start at the left most row of students.•The first two students in that row will stand-up.•The instructor will ask the students a question which is either technical or clinical.•The first student to answer correctly remains standing. The other sits down.•The next student in the row will stand up and another question is read by the instructor. The student who answers the most questions correctly is the winner.

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