FDU School of PharmacyAssignment #1: Inventory Control

Student: ________________________________ Date: _________________________Site: __________________________________________________________________

Preceptor Signature: ____________________Print Name: _______________________

Complete the following questions relating to inventory control and the hospital’s procedure for managing drug shortages. Additional information regarding ASHP’s guidelines for managing drug product shortages can be found at http://www.ashp.org/menu/DrugShortages.aspx.

1. Give one (1) example of a drug shortage at your facility.

2. What is the cause of the shortage?

3. How long has the medication been backordered?

4. What is the department’s policy for handling drug shortages?

5. Are alternate agents being used to treat patients?

6. How are prescribers notified when shortages occur?

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7. Give (1) example of an order received for a medication not routinely stocked by the pharmacy. How was this order handled?

8. Describe the pros and cons of utilizing a formulary system.

9. Describe the pharmacy department’s policy for handling medication recalls.

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #2: Controlled Substances in the Hospital Setting

Student: ________________________________ Date: _________________________Site: __________________________________________________________________

Preceptor Signature: ____________________Print Name: _______________________

1. Compare and contrast similarities and differences in the dispensing of controlled substances in the retail and hospital settings.

2. Who is authorized to write a medication order for a controlled substance in the hospital setting?

3. How often is the facility required to make a complete and accurate record of all controlled substances on hand? Does this differ from performing an inventory on all non-controlled substances on hand?

4. How long must the facility keep invoices for controlled substances?

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5. What documentation is required to account for unused controlled substances in patient-care areas and anesthesia?

6. How does the pharmacy department dispose of expired or unused controlled substances?

7. What are the security requirements for controlled substances in the pharmacy and in patient-care areas?

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #3: Clinical Interventions

Student: ________________________________ Date: _________________________

Site: __________________________________________________________________Preceptor Signature: ____________________Print Name: _______________________

Patient’s Initials.____________ Floor__________

Category (circle or if other please specify):1. Indication 11. Clarification of administration rate2. Length of therapy 12. Clarification of frequency3. Drug/drug, drug/food, or drug/lab interaction 13. Clarification of dose 4. Toxicity management 14. Clarification of administration route5. Pharmacokinetics consult 15. Recommendation of alternative agent6. Therapeutic duplication 16. Recommendation of alternative route7. Teratogenicity / breast feeding 17. Formulary / non-formulary issue8. Medication identification 18. Medication allergy9. Compatibility /stability 19. Drug information (not listed) 10. Restricted agent (needs approval) 20.Other (specify)___________

Question / Problem:

Response:

Reference (if applicable):

Outcome: (circle one) accepted denied

If denied, please specify a reason:

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #4: Clinical Interventions

Student: ________________________________ Date: _________________________

Site: __________________________________________________________________Preceptor Signature: ____________________Print Name: _______________________

Patient’s Initials.____________ Floor__________

Category (circle or if other please specify):1. Indication 11. Clarification of administration rate2. Length of therapy 12. Clarification of frequency3. Drug/drug, drug/food, or drug/lab interaction 13. Clarification of dose 4. Toxicity management 14. Clarification of administration route5. Pharmacokinetics consult 15. Recommendation of alternative agent6. Therapeutic duplication 16. Recommendation of alternative route7. Teratogenicity / breast feeding 17. Formulary / non-formulary issue8. Medication identification 18. Medication allergy9. Compatibility /stability 19. Drug information (not listed) 10. Restricted agent (needs approval) 20.Other (specify)___________

Question / Problem:

Response:

Reference (if applicable):

Outcome: (circle one) accepted denied

If denied, please specify a reason:

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #5: Medication Error Reporting

Student: ________________________________ Date: _________________________Site: __________________________________________________________________

Preceptor Signature: ____________________Print Name: _______________________

Using the form on the following page, identify, investigate, and document a medication error, including reviewing the patient chart.

Please read Guidelines for Preventing Errors in Hospitals at http://ashp.org/DocLibrary/BestPractices/MedMisGdlHosp.aspx. Thendescribe aspects of the pharmacy workflow process at your site that have been established to reduce the risk of dispensing errors (i.e. alterations to physical layout, double-check system, storage of look-alike/sound-alike medications, etc.). Elaborate on institution-wide policies that have been implemented with the goal of minimizing medication errors from occurring.

Describe the role of The Joint Commission in the minimization of medication errors in the hospital setting

List 5 abbreviations on The Joint Commission’s “Do Not Use List”. Explain why these abbreviations should be avoided.

PRECEPTOR COMMENTS (OPTIONAL):

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MEDMARX MEDICATION SAFETY REPORTING FORMComplete as soon as possible after discovering a medication error and giving

appropriate patient-care.

**PLEASE USE A SEPARATE MEDMARX FORM FOR EACH MEDICATION ERROR REPORT**

_________________________________________________________________________

Check the ONE category that describes the SEVERITY of the error based on harm to the patient

NO ERROR NO HARMCATEGORY A Circumstances or events have the capacity to cause errorERROR NO HARMCATEGORY B Error occurred but it did not reach patient

CATEGORY CError occurred that reached the patient, but did not cause harm (includes errors of omission)

CATEGORY D*

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 prevent harm

ERROR HARM

CATEGORY E*Error occurred that may have contributed to, or resulted in, temporary harm to the patient and required intervention

CATEGORY F*

Error occurred that may have contributed to, or resulted in, temporary harm to the patient and required initial or prolonged hospitalization

CATEGORY G*Error occurred that may have contributed to, or resulted in, permanent harm to patient

CATEGORY H*Error occurred that required intervention necessary to sustain life

ERROR DEATH

CATEGORY I*Error occurred that may have contribute to, or resulted in, patient death

 *Complete checklist of monitoring or interventions required for Category D – I errors at the end of this form

Source of record (circle one): Inpatient Outpatient LTC/AL Resident

Date of Error: ________ Date of Report: ________

DESCRIBE THE ERROR, how the error occurred, how it was discovered: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Check the type(s) of the error:□ Deteriorated product □ Prescribing error□ Drug prepared incorrectly □ Unauthorized/wrong drug□ Expired product □ Wrong admin technique□ Extra Dose □ Wrong dosage form□ Improper dose/quantity □ Wrong route□ Mislabeling □ Wrong patient□ Omission □ Wrong time

Check the cause(s) of the error:□ Abbreviations□ Barcode, medication mislabeled□ Barcode, override warning□ Barcode, failure to scan□ Blanket orders□ Brand names look alike□ Brand names sound alike□ Brand/generic names look alike□ Brand/generic names sound alike□ Calculation error□ Communication□ Computer entry□ Computer prescriber order entry□ Computer screen display unclear/confusing□ Computer software□ Contraindicated, drug allergy□ Contraindicated, drug/drug□ Contraindicated, drug/food□ Contraindicated in disease□ Contraindicated in

pregnancy/breastfeeding□ Decimal point□ Diluent wrong□ Dispensing device involved□ Documentation inaccurate/lacking□ Dosage form confusion□ Drug distribution system□ Drug shortage□ Equipment design confusing/inadequate□ Equipment (not pumps)

failure/malfunction□ Fax/scanner involved□ Generic names look alike□ Generic names sound alike□ Handwriting illegible/unclear□ Incorrect medication activation□ Information management system□ Knowledge deficit/training insufficient

□ Label (manufacturer’s) design□ Label (your facility’s) design□ Labeling (your facility’s)□ Leading zero missing□ MAR variance□ Measuring device inaccurate/inappropriate□ Monitoring inadequate/lacking□ Non-formulary drug□ Non-metric units used□ Overide□ Packaging/container design□ Patient identification failure□ Preprinted order form□ Performance (human) deficit□ Prefix/suffix misinterpreted□ Procedure/Protocol not followed□ Pump, failure/malfunction□ Pump, improper use□ Reconciliation-admission□ Reconciliation-discharge□ Reconciliation-transition□ Reference material confusing/inaccurate□ Repackaging by your facility□ Repackaging by other facility□ Similar packaging/labeling□ Similar products□ Storage proximity□ System safeguards inadequate□ Trailing/terminal zero□ Transcription inaccurate/omitted□ Unlabeled syringe□ Verbal order confusing/incomplete□ Weight missing/inaccurate□ Written order confusing/incomplete□ Workflow disruption

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Check factors that contributed to the error:□ A contributing factor not determined□ Barcode, missing□ Barcode, non-readable□ Barcode, system non-functional□ Code situation□ Computer system/network down□ Cross coverage□ Distractions□ Emergency situation□ Fatigue□ Imprint, identification failure□ Language barrier□ No 24-hour pharmacy

□ No access to patient information□ None□ Patient names similar/same□ Patient transfer□ Poor lighting□ Range orders□ Shift change□ Staff, agency/temporary□ Staff, floating□ Staff, inexperienced□ Staffing, alternative hours□ Staffing, insufficient□ Workload increase

Check the ONE PHASE where the error ORIGINATED:□ Procurement□ Prescribing□ Transcribing/Documenting□ Dispensing□ Administering□ Monitoring

Check the LOCATION of the initial error (Location Detail on Medmarx Data Entry Form—Required Field):□ Inpatient Acute□ Skilled Nursing□ Emergency Dept□ Outpatient Clinic□ Outpatient Surgery□ LTC

LEVEL of STAFF REPORTING and MAKING the ERROR – Check if knownReporting Making Reporting Making

RNLPNCNA/MAClerkNPNAFamily

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PAMDPharmacistPharmTechRRTStudent

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MEDICATION(S) INVOLVED (generic name if known), DOSE, FREQUENCY, ROUTE: ____________________________________________________________________________________________________________________________________________Patient Age (only): _________ Sex: □ M □ FPhysician Notified: □ No □ Yes Time of Error: ______________________Number of occurrences: ________________ (range: 1-300)

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Check actions taken to avoid future errors:□ Communication process improved□ Education/training provided□ Environment modified□ Formulary changed□ Informed staff who made the initial error

□ Informed staff involved in initial error□ Informed patient/caregiver of error□ Policy/procedure changed□ Policy/procedure instituted□ Staffing practice/policy modified

Further suggestions regarding system changes to prevent this error:__________________________________________________________________________________________________________________________________________________________________________________________________________________

*****REQUIRED FOR CATEGORY D – I ERRORS*****Check additional interventions/monitoring

□ A level of care not determined□ Airway established/patient ventilated□ Antidote administered□ Blood product infusion□ Cardiac defibrillation performed□ CPR administered□ Delay in diagnosis/treatments/surgery□ Dialysis□ Drug therapy initiated/changed□ Hospitalization, initial□ Hospitalization, prolonged 1 – 5 days

□ Hospitalization, prolonged 6 – 10 days□ Hospitalization, prolonged > 10 days□ Laboratory tests performed□ Narcotic antagonist administered□ Observation initiated/increased□ Oxygen administered□ Surgery performed□ Transferred to a higher level of care□ Vital signs monitoring initiated/increased□ X-ray/MRI/other diagnostic tests performed

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #6: Medication Error Reporting

Student: ________________________________ Date: _________________________Site: __________________________________________________________________

Preceptor Signature: ____________________Print Name: _______________________

Using the form on the following page, identify, investigate, and document a medication error, including reviewing the patient chart.

A total of TWO (2) medication error reports must be completed (Assignment #5 and Assignment #6).

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MEDMARX MEDICATION SAFETY REPORTING FORMComplete as soon as possible after discovering a medication error and giving

appropriate patient-care.

**PLEASE USE A SEPARATE MEDMARX FORM FOR EACH MEDICATION ERROR REPORT**

_________________________________________________________________________

Check the ONE category that describes the SEVERITY of the error based on harm to the patient

NO ERROR NO HARMCATEGORY A Circumstances or events have the capacity to cause errorERROR NO HARMCATEGORY B Error occurred but it did not reach patient

CATEGORY CError occurred that reached the patient, but did not cause harm (includes errors of omission)

CATEGORY D*

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 prevent harm

ERROR HARM

CATEGORY E*Error occurred that may have contributed to, or resulted in, temporary harm to the patient and required intervention

CATEGORY F*

Error occurred that may have contributed to, or resulted in, temporary harm to the patient and required initial or prolonged hospitalization

CATEGORY G*Error occurred that may have contributed to, or resulted in, permanent harm to patient

CATEGORY H*Error occurred that required intervention necessary to sustain life

ERROR DEATH

CATEGORY I*Error occurred that may have contribute to, or resulted in, patient death

 *Complete checklist of monitoring or interventions required for Category D – I errors at the end of this form

Source of record (circle one): Inpatient Outpatient LTC/AL Resident

Date of Error: ________ Date of Report: ________

DESCRIBE THE ERROR, how the error occurred, how it was discovered: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Check the type(s) of the error:□ Deteriorated product □ Prescribing error□ Drug prepared incorrectly □ Unauthorized/wrong drug□ Expired product □ Wrong admin technique□ Extra Dose □ Wrong dosage form□ Improper dose/quantity □ Wrong route□ Mislabeling □ Wrong patient□ Omission □ Wrong time

Check the cause(s) of the error:□ Abbreviations□ Barcode, medication mislabeled□ Barcode, override warning□ Barcode, failure to scan□ Blanket orders□ Brand names look alike□ Brand names sound alike□ Brand/generic names look alike□ Brand/generic names sound alike□ Calculation error□ Communication□ Computer entry□ Computer prescriber order entry□ Computer screen display unclear/confusing□ Computer software□ Contraindicated, drug allergy□ Contraindicated, drug/drug□ Contraindicated, drug/food□ Contraindicated in disease□ Contraindicated in

pregnancy/breastfeeding□ Decimal point□ Diluent wrong□ Dispensing device involved□ Documentation inaccurate/lacking□ Dosage form confusion□ Drug distribution system□ Drug shortage□ Equipment design confusing/inadequate□ Equipment (not pumps)

failure/malfunction□ Fax/scanner involved□ Generic names look alike□ Generic names sound alike□ Handwriting illegible/unclear□ Incorrect medication activation□ Information management system□ Knowledge deficit/training insufficient

□ Label (manufacturer’s) design□ Label (your facility’s) design□ Labeling (your facility’s)□ Leading zero missing□ MAR variance□ Measuring device inaccurate/inappropriate□ Monitoring inadequate/lacking□ Non-formulary drug□ Non-metric units used□ Overide□ Packaging/container design□ Patient identification failure□ Preprinted order form□ Performance (human) deficit□ Prefix/suffix misinterpreted□ Procedure/Protocol not followed□ Pump, failure/malfunction□ Pump, improper use□ Reconciliation-admission□ Reconciliation-discharge□ Reconciliation-transition□ Reference material confusing/inaccurate□ Repackaging by your facility□ Repackaging by other facility□ Similar packaging/labeling□ Similar products□ Storage proximity□ System safeguards inadequate□ Trailing/terminal zero□ Transcription inaccurate/omitted□ Unlabeled syringe□ Verbal order confusing/incomplete□ Weight missing/inaccurate□ Written order confusing/incomplete□ Workflow disruption

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Check factors that contributed to the error:□ A contributing factor not determined□ Barcode, missing□ Barcode, non-readable□ Barcode, system non-functional□ Code situation□ Computer system/network down□ Cross coverage□ Distractions□ Emergency situation□ Fatigue□ Imprint, identification failure□ Language barrier□ No 24-hour pharmacy

□ No access to patient information□ None□ Patient names similar/same□ Patient transfer□ Poor lighting□ Range orders□ Shift change□ Staff, agency/temporary□ Staff, floating□ Staff, inexperienced□ Staffing, alternative hours□ Staffing, insufficient□ Workload increase

Check the ONE PHASE where the error ORIGINATED:□ Procurement□ Prescribing□ Transcribing/Documenting□ Dispensing□ Administering□ Monitoring

Check the LOCATION of the initial error (Location Detail on Medmarx Data Entry Form—Required Field):□ Inpatient Acute□ Skilled Nursing□ Emergency Dept□ Outpatient Clinic□ Outpatient Surgery□ LTC

LEVEL of STAFF REPORTING and MAKING the ERROR – Check if knownReporting Making Reporting Making

RNLPNCNA/MAClerkNPNAFamily

□□□□□□□

□□□□□□□

PAMDPharmacistPharmTechRRTStudent

□□□□□□

□□□□□□

MEDICATION(S) INVOLVED (generic name if known), DOSE, FREQUENCY, ROUTE: ____________________________________________________________________________________________________________________________________________Patient Age (only): _________ Sex: □ M □ FPhysician Notified: □ No □ Yes Time of Error: ______________________Number of occurrences: ________________ (range: 1-300)

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Check actions taken to avoid future errors:□ Communication process improved□ Education/training provided□ Environment modified□ Formulary changed□ Informed staff who made the initial error

□ Informed staff involved in initial error□ Informed patient/caregiver of error□ Policy/procedure changed□ Policy/procedure instituted□ Staffing practice/policy modified

Further suggestions regarding system changes to prevent this error:__________________________________________________________________________________________________________________________________________________________________________________________________________________

*****REQUIRED FOR CATEGORY D – I ERRORS*****Check additional interventions/monitoring

□ A level of care not determined□ Airway established/patient ventilated□ Antidote administered□ Blood product infusion□ Cardiac defibrillation performed□ CPR administered□ Delay in diagnosis/treatments/surgery□ Dialysis□ Drug therapy initiated/changed□ Hospitalization, initial□ Hospitalization, prolonged 1 – 5 days

□ Hospitalization, prolonged 6 – 10 days□ Hospitalization, prolonged > 10 days□ Laboratory tests performed□ Narcotic antagonist administered□ Observation initiated/increased□ Oxygen administered□ Surgery performed□ Transferred to a higher level of care□ Vital signs monitoring initiated/increased□ X-ray/MRI/other diagnostic tests performed

PRECEPTOR COMMENTS (OPTIONAL):

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FDU School of PharmacyAssignment #7: Automated Medication Management Systems

Student: ________________________________ Date: _________________________Site: __________________________________________________________________

Preceptor Signature: ____________________Print Name: _______________________

Describe the types of automated systems utilized at your institution for prescription processing, preparation, dispensing and administration (for example. Pyxis, cart-fill robotics, computerized prescriber order entry systems, programmable infusion devices, etc.). Elaborate on the appropriate and safe use of such technology, as well as any unintended consequences that may result from such use.

PRECEPTOR COMMENTS (OPTIONAL):

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Fairleigh Dickinson UniversitySchool of Pharmacy

PHRM 7501 Completed Assignments Coversheet

Student:       Date:       Site:       Timeframe:      Preceptor Name:      

***This coversheet MUST be submitted with your completed assignments.***

Assignment Date Completed

Form/Assignment Attached

(✔)Inventory Control Assignment (Form #1)Controlled Substances in the Hospital Setting Assignment (Form #2)Clinical Interventions #1 (Form #3)Clinical Interventions #2 (Form #4)Medication Error Reporting #1(Form #5)Medication Error Reporting #2 (Form #6)Automated Medication Management Systems (Form #7)

End of Rotation Requirements Completed(✔)

Preceptor Evaluation completed in RxPreceptorSite Evaluation completed in RxPreceptorTime Tracking correctly entered in RxPreceptorAssignments submitted to Experiential Education

*Failure to submit coversheet will result in the loss of one professionalism point from your final grade.

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