Jennifer Gold

Jennifer Gold

Saturday, 21 January 2012 04:44

Insulin Safety Center

Why an Insulin Safety Center?

 

The Insulin Safety Center is a unique resource dedicated entirely to medication error prevention with the use of insulin.

Insulin is an essential and lifesaving drug safely used by millions of Americans every year. Insulin enables individuals with diabetes to lead a healthy lifestyle. However, insulin use is associated with some risks and any misuse can cause harm or even death.

Insulin is considered a "high-alert medication" by the Institute for Safe Medication Practices. High alert medications have been proven to be safe and effective when taken according to instructions approved by your healthcare provider. But, they are more likely to cause injury or even death if a mistake happens while taking them. This means that it is critically important for you to know about this medicine and how to take it exactly as prescribed by your healthcare provider or explained to you by your pharmacist.

In addition to insulin being considered a high-alert medication, insulin has also been known to be associated with more medication errors than most other medicines. The Institute for Safe Medication Practices performed a safety study on drug use in hospitals and found that 11% of all serious drug errors involved insulin misadministration. Another recent study at four U.S.A. poison centers looked at calls taken over the past 10 years. They found that calls about insulin concerns have "skyrocketed." On average, the number of calls per year has almost tripled since 2002.

This Insulin Safety Center is a great place to access information regarding all aspects of safe insulin use. Here you will learn all about the most frequent types of errors associated with insulin use. In addition, you will see how these errors can occur and what you and your caregivers can do to prevent them from happening to you.

Friday, 20 January 2012 20:13

Get Financial Help with Purchasing Medicine

Tough economic times make it hard for people to fill their prescriptions and take the medicine as directed. There are no easy solutions to the high cost of medicines. But there are often safer alternatives than cutting back on your medicine, skipping doses, taking less than the recommended dose, or not filling your prescription at all. If you find it hard to pay for your prescription medicines:

Talk to your doctor. Don't be embarrassed to tell your doctor if you have trouble paying for your prescriptions. He might be able to prescribe a less costly medicine that will work for you. He also may have samples of medicine that he can give you, at least in small supplies to hold you over. If your doctor gives you samples, always ask for written directions on how to take the medicine. Keep the directions with the sample medicine.

Search out assistance programs. There are many patient assistance programs that might be able to help you obtain medicines at no cost or at a significant discount. Look at these websites that steer patients to public and private support programs that may be useful.

Partnership for Prescription Assistance

http://pparx.org

Needy Meds

www.needymeds.com

RxAssist

www.rxassist.org

RxHope

www.rxhope.com

Patient Advocate Foundation

http://www.copays.org

FreeDrugCard.US

http://freedrugcard.us

Together Rx Access

http://www.togetherrxaccess.com

Also visit the website of the drug manufacturer who makes your medicine. Many companies offer coupon discounts or other forms of assistance (for those who qualify). In addition, look for groups that support patients with your particular disease. A few examples are provided:

Mental Health America

http://www.mentalhealthamerica.net/prescription-assistance 

The American Kidney Foundation

http://www.kidneyfund.org

The Epilepsy Foundation

http://www.aesnet.org/files/dmfile/PatientAssistanceProgramsFINAL2010.pdf

National Organization for Rare Diseases

www.rarediseases.org/patients-and-families/patient-assistance

freerxTough economic times make it hard for people to fill their prescriptions and take the medicine as directed. There are no easy solutions to the high cost of medicines. But there are often safer alternatives than cutting back on your medicine, skipping doses, taking less than the recommended dose, or not filling your prescription at all. If you find it hard to pay for your prescription medicines:

Talk to your doctor. Don't be embarrassed to tell your doctor if you have trouble paying for your prescriptions. He might be able to prescribe a less costly medicine that will work for you. He also may have samples of medicine that he can give you, at least in small supplies to hold you over. If your doctor gives you samples, always ask for written directions on how to take the medicine. Keep the directions with the sample medicine.

Search out assistance programs. There are many patient assistance programs that might be able to help you obtain medicines at no cost or at a significant discount. Look at these websites that steer patients to public and private support programs that may be useful.

Partnership for Prescription Assistance

http://pparx.org

Needy Meds

www.needymeds.com

RxAssist

www.rxassist.org

RxHope

www.rxhope.com

Patient Advocate Foundation

http://www.copays.org

FreeDrugCard.US

http://freedrugcard.us

Together Rx Access

http://www.togetherrxaccess.com

Also look for groups that support patients with your particular disease. A few examples are provided:

The American Kidney Foundation

http://www.kidneyfund.org

The Epilepsy Foundation

http://www.aesnet.org/files/dmfile/PatientAssistanceProgramsFINAL2010.pdf

National Organization for Rare Diseases

www.rarediseases.org/patients-and-families/patient-assistance

Friday, 20 January 2012 18:04

Keep Track of Your Medicine

Keeping an up-to-date record of your medicines may help protect you from a mistake. First, it helps you and your family remember all the medicines you are taking. Next, it helps your doctor, nurses, and pharmacists make sure that the medicines prescribed for you can be taken safely together. A list also helps make sure that important medicines you take at home will be continued if you are hospitalized. Finally, your medicine list will help your doctor determine if any illness or symptoms you experience could be related to the medicine you take.

To create an up-to-date medicine list, think about the doctors you visit and the medicines each one has prescribed for you. Then think about your health conditions and the over-the-counter and prescription medicines you take for each one. Finally, think about the vitamins and herbal products you take to stay healthy.

Below is an example of a form you can use to help organize your medicine list.

For a PDF version of this form click here.

For a Word document click here

 

medform1

medform2

medform3

medform4

Thursday, 19 January 2012 03:31

Unsafe Medical Abbreviations

Download: ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations

The abbreviations, symbols, and dose designations found in this table have been reported to ISMP through the USP-ISMP Medication Error Reporting Program as being frequently misinterpreted and involved in harmful medication errors. They should NEVER be used when communicating medical information. This includes internal communications, telephone/verbal prescriptions, computer-generated labels, labels for drug storage bins, medication administration records, as well as pharmacy and prescriber computer order entry screens. The Joint Commission (TJC) has established a National Patient Safety Goal that specifies that certain abbreviations must appear on an accredited organization's do-not-use list; we have highlighted these items with a double asterisk (**). However, we hope that you will consider others beyond the minimum TJC requirements. By using and promoting safe practices and by educating one another about hazards, we can better protect our patients.

AbbreviationsIntended MeaningMisinterpretationCorrection
μg Microgram Mistaken as "mg" Use "mcg"
AD, AS, AU Right ear, left ear, each ear Mistaken as OD, OS, OU (right eye, left eye, each eye) Use "right ear," "left ear," or "each ear"
OD, OS, OU Right eye, left eye, each eye Mistaken as AD, AS, AU (right ear, left ear, each ear) Use "right eye," "left eye," or "each eye"
BT Bedtime Mistaken as "BID" (twice daily) Use "bedtime"
cc Cubic centimeters Mistaken as "u" (units) Use "mL"
D/C Discharge or discontinue Premature discontinuation of medications if D/C (intended to mean "discharge") has been misinterpreted as "discontinued" when followed by a list of discharge medications Use "discharge" and "discontinue"
IJ Injection Mistaken as "IV" or "intrajugular" Use "injection"
IN Intranasal Mistaken as "IM" or "IV" Use "intranasal" or "NAS"
HS

hs
Half-strength

At bedtime, hours of sleep
Mistaken as bedtime

Mistaken as half-strength
Use "half-strength" or "bedtime"
IU** International unit Mistaken as IV (intravenous) or 10 (ten) Use "units"
o.d. or OD Once daily Mistaken as "right eye" (OD-oculus dexter), leading to oral liquid medications administered in the eye Use "daily"
OJ Orange juice Mistaken as OD or OS (right or left eye); drugs meant to be diluted in orange juice may be given in the eye Use "orange juice"
Per os By mouth, orally The "os" can be mistaken as "left eye" (OS-oculus sinister) Use "PO," "by mouth," or "orally"
q.d. or QD** Every day Mistaken as q.i.d., especially if the period after the "q" or the tail of the "q" is misunderstood as an Use "daily"
qhs Nightly at bedtime Mistaken as "qhr" or every hour Use "nightly"
qn Nightly or at bedtime Mistaken as "qh" (every hour) Use "nightly" or "at bedtime"
q.o.d. or QOD** Every other day Mistaken as "q.d." (daily) or "q.i.d. (four times daily) if the "o" is poorly written Use "every other day"
q1d Daily Mistaken as q.i.d. (four times daily) Use "daily"
q6PM, etc. Every evening at 6 PM Mistaken as every 6 hours Use "6 PM nightly" or "6 PM daily"
SC, SQ, sub q Subcutaneous SC mistaken as SL (sublingual); SQ mistaken as "5 every;" the "q" in "sub q" has been mistaken as "every" (e.g., a heparin dose ordered "sub q 2 hours before surgery" misunderstood as every 2 hours before surgery) Use "subcut" or "subcutaneously"
ss Sliding scale (insulin) or ½ (apothecary) Mistaken as "55" Spell out "sliding scale;" use "one-half" or "½"
SSRI

SSI
Sliding scale regular insulin

Sliding scale insulin
Mistaken as selective-serotonin reuptake inhibitor

Mistaken as Strong Solution of Iodine (Lugol's)
Spell out "sliding scale (insulin)"
i/d One daily Mistaken as "tid" Use "1 daily"
TIW or tiw 3 times a week Mistaken as "3 times a day" or "twice in a week" Use "3 times weekly"
U or u** Unit Mistaken as the number 0 or 4, causing a 10-fold overdose or greater (e.g., 4U seen as "40" or 4u seen as "44"); mistaken as "cc" so dose given in volume instead of units (e.g., 4u seen as 4cc) Use "unit"

 

Dose Designations
and Other Information
Intended MeaningMisinterpretationCorrection
Trailing zero after decimal point (e.g., 1.0 mg)** 1 mg Mistaken as 10 mg if the decimal point is not seen Do not use trailing zeros for doses expressed in whole numbers"

 

Dose Designations
and Other Information
Intended MeaningMisinterpretationCorrection
Drug name and dose run together (especially problematic for drug names that end in "l" such as Inderal40 mg; Tegretol300 mg) Inderal 40 mg

Tegretol 300 mg
Mistaken as Inderal 140 mg

Mistaken as Tegretol 1300 mg
Place adequate space between the drug name, dose, and unit of measure
Numerical dose and unit of measure run together (e.g., 10mg, 100mL) 10 mg

100 mL
The "m" is sometimes mistaken as a zero or two zeros, risking a 10- to 100-fold overdose Place adequate space between the dose and unit of measure
Abbreviations such as mg. or mL. with a period following the abbreviation mg

mL
The period is unnecessary and could be mistaken as the number 1 if written poorly Use mg, mL, etc. without a terminal period
Large doses without properly placed commas (e.g., 100000 units; 1000000 units) 100,000 units

1,000,000 units
100000 has been mistaken as 10,000 or 1,000,000; 1000000 has been mistaken as 100,000 Use commas for dosing units at or above 1,000, or use words such as 100 "thousand" or 1 "million" to improve readability

 

Drug Name AbbreviationsIntended MeaningMisinterpretationCorrection
ARA A vidarabine Mistaken as cytarabine (ARA C) Use complete drug name
AZT zidovudine (Retrovir) Mistaken as azathioprine or aztreonam Use complete drug name
CPZ Compazine (prochlorperazine) Mistaken as chlorpromazine Use complete drug name
DPT Demerol-Phenergan-Thorazine Mistaken as diphtheria-pertussis-tetanus (vaccine) Use complete drug nam
DTO Diluted tincture of opium, or deodorized tincture of opium (Paregoric) Mistaken as tincture of opium Use complete drug name
HCl hydrochloric acid or hydrochloride Mistaken as potassium chloride
(The "H" is misinterpreted as "K")
Use complete drug name unless expressed as a salt of a drug
HCT hydrocortisone Mistaken as hydrochlorothiazide Use complete drug name
HCTZ hydrochlorothiazide Mistaken as hydrocortisone (seen as HCT250 mg) Use complete drug name
MgSO4** magnesium sulfate Mistaken as morphine sulfate Use complete drug name
MS, MSO4** morphine sulfate Mistaken as magnesium sulfate Use complete drug name
MTX methotrexate Mistaken as mitoxantrone Use complete drug name
PCA procainamide Mistaken as patient controlled analgesia Use complete drug name
PTU propylthiouracil Mistaken as mercaptopurine Use complete drug name
T3 Tylenol with codeine No. 3 Mistaken as liothyronine Use complete drug name
TAC triamcinolone Mistaken as tetracaine, Adrenalin, cocaine Use complete drug name
TNK TNKase Mistaken as "TPA" Use complete drug name
ZnSO4 zinc sulfate Mistaken as morphine sulfate Use complete drug name

 

Stemmed Drug NamesIntended MeaningMisinterpretationCorrection
"Nitro" drip nitroglycerin infusion Mistaken as sodium nitroprusside infusion Use complete drug name
"Norflox" norfloxacin Mistaken as Norflex Use complete drug name
"IV Vanc" intravenous vancomycin Mistaken as Invanz Use complete drug name

 

SymbolsIntended MeaningMisinterpretationCorrection


Dram

Minim
Symbol for dram mistaken as "3"

Symbol for minim mistaken as "mL"
Use the metric system
x3d For three days Mistaken as "3 doses" Use "for three days"
> and < Greater than and less than Mistaken as opposite of intended; mistakenly use incorrect symbol; "< 10" mistaken as "40" Use "greater than" or "less than"
/
(slash mark)
Separates two doses or indicates "per" Mistaken as the number 1 (e.g., "25 units/10 units" misread as "25 units and 110" units) Use "per" rather than a slash mark to separate doses
@ At Mistaken as "2" Use "at"
& And Mistaken as "2" Use "and"
+ Plus or and Mistaken as "4" Use "and"
° Hour Mistaken as a zero (e.g., q2° seen as q 20) Use "hr," "h," or "hour"

 

**These abbreviations are included on TJC's "minimum list" of dangerous abbreviations, acronyms and symbols that must be included on an organization's "Do Not Use" list, effective January 1, 2004. Visit www.jointcommission.org for more information about this TJC requirement.

Permission is granted to reproduce material for internal newsletters or communications with proper attribution. Other reproduction is prohibited without written permission. Unless noted, reports were received through the USP-ISMP Medication Errors Reporting Program (MERP). 

Wednesday, 18 January 2012 19:58

Tools and Resources

Monday, 16 January 2012 21:23

Watch Medication Safety Video's

Monday, 16 January 2012 19:54

High Alert Medication Learning Guides

Just a handful of drugs are considered high-alert medicines. These medicines have been proven to be safe Warfarin teaching page imageand effective when taken properly. But they can cause injury or death if a mistake happens while taking them. This means that it is vitally important for you to know about this medicine and take it exactly as intended.

During a study on medication safety in community pharmacies, the Institute for Safe Medication Practices (ISMP) identified which medications should be included on this list of high-alert medications. For some of these medications, the Institute created safety pamphlets for consumers. By clicking on the medications listed below, you can access these pamphlets, which can help keep you safe while taking these medications.

The leaflets are FREELY available for download and can be reproduced for free distribution to consumers. 

Learning Guides (also available in Spanish)

If you or a family member has been hospitalized, the first few days after returning home can be confusing. In fact, let's use the word "risky" when it comes to medication use.