Appropriate Implementation of

Medication Review

By: Adeline Saliba, PharmD, MBA

Acting Pharmacy Manager
Corniche Hospital

Disclosure
Adeline Saliba declares no conflicts of interest, and
no financial interests in any company, product or
service mentioned in this presentation. She is an
employee of the Corniche Hospital.

Outline
1) Define JCI medication management and use
standard 5: preparation and dispensing

2) Implement strategies to prevent errors at time of

medication review
3) Discuss innovative technologies for safer
medication review

Corniche Hospital

235 bed maternity hospital

with 50 neonatal intensive care cots

Medication Management and Use

Selection
and
Procurement

Storage

Preparation
and
Dispensing

Monitoring

Prescribing
and
Transcribing
Administering

Preventing Prescribing Errors

Although the root causes of medication errors
reside in systems, each individual health care
professional beginning with the prescriber must
take every possible precaution to prevent errors.

Michael Cohen
President, Institute for Safe Medication Practices (ISMP)

Cohen, M. Medication Errors. 2nd edition: 2007

Safe Prescribing Practices

1) Legible handwriting
2) Complete and accurate prescriptions
3) No unapproved abbreviations
4) Medication reconciliation

Computerized Prescriber Order Entry (CPOE)

Clinical decision support

Error Trajectory

Potential
error

Actual
error

Latent
error
James Reason 1991

Medication Order Review

Medication Order Review

1) Allergy
2) Height and weight
3) Drug components
4) PRN indications
5) Duplications

6) Interactions
7) Contraindications
8) Clinical guidelines

Medication Order Review

1) Standardized concentrations for IV admixtures
2) Standardized recipes for extemporaneous oral
preparations

3) Standardized labeling incorporating tall men

lettering for look alike sound alike medications
DOPamine

DOBUTamine

hydrALAZINE

hydrOXYzine

Medication Dispensing
Pre-Automation

Post-Automation

Blister pack

Unit dose packaging

Medication Dispensing
Pre-Automation

Post-Automation

Bulk bottle

Individualized oral syringes

Medication Distribution
Pre-Automation

Post-Automation

Locked cabinets

Decentralized automated dispensing

cabinets

Integrated Systems
Cerner EMR
Patient Registration
and Admission

Cerner Supply
Chain Management

Cerner PowerChart
Doctor prescribes
medications for
patients

Cerner PharmNet
Pharmacy verifies
medication orders

Interface Engine

Pyxis Server
Pyxis Medstation
Nurse removes
ordered medications
to administer

Medication Use Process Errors

Leape, Bates and colleagues 1995

Closing the Loop

Prescribing &
Transcribing

Preparation &
Dispensing

Administration

Scan patients wristband

Scan medication barcode

Scan for Safety

5 Rs:
Right patient
Right drug
Right dose
Right route
Right time

Health Information Technologies

1) Health information system
2) Unit dose packaging
3) Automated dispensing solutions
4) Bar code scanning
5) Robotic dispensing
Enhance both workflow and the
safety of medication management

Lessons Learned

Thank You