All Things Vancomycin

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Believe it or not, vancomycin was first isolated in the fifties from an isolate of dirt in the jungles of Borneo by a missionary. It is a naturally occurring antibiotic made by the soil bacterium Actinobacteria. The name vancomycin comes from the word vanquish.  Initially it was used as a sort-of last resort for penicillinase-producing strains of Staphylococcus aureus.  Today, vancomycin is one of the most widely used antibiotics for the treatment of serious gram positive infections involving methicillin-resistant S. aureus (MRSA). Years ago, early use of vancomycin was associated with several different types of toxicities including infusion related effects (Red Man Syndrome), nephrotoxicity (kidney), and possible ototoxicity (damage to ears).  It was determined later that the majority of these adverse effects were due to the early formulations that contained impurities; however, by that time, its use was decreased with the development of other penicillin-type medicines like methicillin, oxacillin, and nafcillin).  Thanks to MRSA, Vancomycin is making a huge comeback, or has been since the early 1980s.

On a side note, Red Man Syndrome is not an allergic reaction.  This can be managed with a histamine blocker or slowing down the infusion.  Can't tell you how many times I have seen this listed as an allergy to vancomycin on someone's profile.

In monitoring Vancomycin, trough serum concentrations are the most accurate method.  Typically draw the trough level prior to the fourth dose (steady-state).  Keep trough levels above at least 10 mg/L to avoid development of resistance.  For a pathogen with an MIC of 1 mg/L, the minimum trough concentration would have to be at least 15 mg/L.  For complicated infections, the optimal trough concentrations are 15-20 mg/L to improve penetration, increase optimal serum concentrations, and improve clinical outcomes.

How to dose?  Dosing vancomycin is a bit of an art, but start at 15-20 mg/kg using actual body weight.  Many hospitals encourage a maximum dose of 2 grams.  Definitely adjust dose in renal dysfunction.

 

Creatinine Clearance(based on Cockcroft and Gault and not eGRF) Dose*
>60 ml/min Uncomplicated Infections: 10-15 mg/kg q12h1 

Serious Infections: Consider loading dose of 25mg/kg IV x1, followed by 15-20 mg/kg q8-12h (45-60mg/kg/day divided q12h or q8h)2

 
40-60 ml/min 10-15 mg/kg q12h-q24h
20-40 ml/min 5-10 mg/kg q24h
10-20 ml/min 5-10 mg/kg q24h-q48h
<10 ml/min

10 - 15 mg/kg IV loading dose x1; redose according to serum levels
Hemodialysis 15-20 mg/kg load, then 500 mg IV post HD only
CVVH 10-15 mg/kg q24h

* round dose to 250mg, 500mg, 750mg, 1g, 1.25g, 1.5g, 1.75g or 2g (maximum: 2gm/dose)

Higher total daily doses of vancomycin have been associated with nephrotoxicity

1 For patients with uncomplicated infections requiring vancomycin, trough levels of 10-15 mcg/ml are recommended.

2 For patients with serious infections due to MRSA (central nervous system infections, endocarditis, ventilator-associated pneumonia, bacteremia or osteomyelitis) , trough levels of 15-20 mcg/ml are recommended.

Vancomycin troughs are not recommended in patients in whom anticipated duration of therapy is short (≤ 3 days)

Trough levels are recommended for routine monitoring (for intermittent hemodialysis, a pre-dialysis level should be drawn). Trough levels should be obtained within 30 minutes before 4th dose of a new regimen or dosage change.

Once weekly monitoring is reasonable in patients with stable renal function and clinical status. (Data supporting safety or prolonged troughs of 15-20 mcg/ml is limited.)

There is a great app out there I recommend called Vancomycin ClinCalc Full.  The author also has a website called ClinCalc you can check out to see if the dosing matches how your particular program wants you to do it.

I don't earn a dime for that link either, I just enjoy finding quality programs to work more efficiently.

I love Dr. Walter Crittenden, PharmD MD "An Infections Disease Compendium:  A Persiflagers Guide" on the iPad as well.

One of my biggest pet-peeves is when I hear someone say, "Oh I have blown their kidneys!" in regards to one serum creatinine level coming back higher.  Hey, let's wait until 2-3 consecutive high serum creatinine concentrations (increase of 0.5 mg/dL or 150% increase from baseline, whichever is greater) after several days before making such a claim.  Seriously.

And the "Rants and Screeds" of Dr. Crittenden, "Vancomycin is a shitty drug; mostly static, toxic, lousy pharmacokinetics, penetrates poorly into all tissues.  When compared to beta lactams, it is always worse."

Gotta love that!

Antidepressants and High Blood Pressure

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Unfortunately, you may have to try several different antidepressants until you find the one that is right for you and your symptoms.  If you have depression and high blood pressure, you have to find the right med that won't exacerbate blood pressure. A good physician will find out several things.  First, he/she will examine you and your symptoms and take into consideration medications that have worked for others in your family.  Usually someone presenting with blood pressure and depression will have someone else in their family suffering with the same thing.  He/she should ask what other medications you are taking.  You don't want to select a drug that will interact with something you are already on.  For example, if you are taking imitrex for headaches, I wouldn't want to see an SSRI added, or maybe change the imitrex to something else.

A good physician should also ask what other conditions you suffer from, if you are pregnant or breastfeeding, what symptoms you are experiencing, and even what insurance you have or what will be covered.  I know this last one is overlooked, but if a patient can't afford a medicine, what is the point of even seeing a physician if cost isn't taken into consideration DURING the visit.

There are a few antidepressants that are documented to possibly cause an increase in blood pressure.  Bupropion (Wellbutrin, Zyban), venlafaxine (Effexor), and duloxetine (Cymbalta) are a few.  Ironically enough there are some studies out there to show that depression itself can cause a decrease in blood pressure and treating depression an increase.

Keep in mind, these medications are not off the table for treating depression, your physician just may have to adjust your blood pressure medications while you are taking antidepressants.  Close monitoring, adherence to regimen and lifestyle changes can make this situation a lot better.

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The Perfect Medical Model

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I have been doing a lot of thinking lately in regards to my career.  I am still in waiting mode about the BCPS exam, but in the meantime have spent some time making lists of how pharmacists are utilized and even on a smaller level within pharmacy departments.  You see, it is tough being on this side of a career.  I guess you could say I'm in the middle in regards to time and experience.  I have been a pharmacist now for thirteen years. I have watched, usually with protest unfortunately, as pharmacists are labeled and grouped depending on different criteria.  Back in 1999, it was about having a residency in order to be a "clinical" pharmacist.  That is still the case today except in the smaller hospital where residency trained pharmacists aren't in supply.  Other criteria is used at that point.

In a perfect medical model, especially in the small hospital, I think it would be beneficial if the physician handled diagnoses, testing, and collaborated with the clinical pharmacist for treatment.  It is fairly obvious when you study the medical school curriculum that the focus is on diagnosis.  Yes, it is important to know what we are treating, but it does no good if you throwing ertapenem at pseudomonas or if you are dosing vancomycin at 1 gm every 12 hours in a young obese man for MRSA.

Hospitals really should consider encouraging all their pharmacists, especially PharmDs to learn the material that the BCPS requires.  It has seriously helped me in the past several months personally.  It is worth the investment of money and time and makes a FABULOUS resume' builder.

And in the end, it's about the patient receiving the best care possible.  Wouldn't a collaboration encourage that?

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Fungal Meningitis and the End of Lackadaisical FDA Involvement in Compound Pharmacies

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New England Compounding Center (NECC) is at the center of this quite horrific tragedy that has affected the lives of many with fourteen already dead. I cannot personally fathom such a loss over something so seemingly accidental. As a pharmacist my thoughts immediately go to sterile technique and the FDA's regulation of our industry. You see, the states oversee the pharmacies compounding and normally that should be enough. However, something went terribly wrong here. But what is coming out lately is the role of compounding pharmacies and how in this case, there was a grey area they were working in. Basically compound pharmacies can make patient specific medications, what is not allowed is these compounding pharmacies acting as manufacturing and bulk shipping repackaged medications without FDA oversight.

It's all about the dollar, but in this case many priceless lives have been lost.

There are two fungi involved: aspergillus and Exserohilum rostratum.

In the past, these pharmacies have been the heroes making things like bioidentical hormones and other specialty concoctions.

Under the FDA's definition, compounding pharmacies are supposed to mix drugs to order only on a specific patient in response to a prescription from a doctor. Under this definition NECC was not operating as a compounding pharmacy but as a large-scale production of a drug. The FDa should have stepped in before these lives were lost.

BCPS 2012 | a small review of my thoughts of the test

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The BCPS is the abbreviation for Board Certified Pharmacotherapy Specialist.  Basically according to the BPS website:

Pharmacotherapy is that area of pharmacy practice that is responsible for ensuring the safe, appropriate, and economical use of drugs in patient care. The pharmacotherapy specialist has responsibility for direct patient care, often functions as a member of a multidisciplinary team and is frequently the primary source of drug information for other healthcare professionals. Those who are granted certification in this specialty may use the designation Board Certified Pharmacotherapy Specialist and the initials BCPS, as long as certification is valid.

So, this is what I have been doing with every (or most) every free moment since April.  It is over now, and this is the first day I have had to sit and reflect.  I did not have the opportunity to finish the review of the test itself, and I was seated last (my own choice) for the second part so did not receive the handwritten review of the test.  I really spent all my time on the test itself, and my feedback wasn't given.

I wish it had been in hindsight.

I signed this paragraph at the beginning of the test but I don't remember what it said.  Something about not trying to memorize the test itself or copying the questions in any way.  So with that in mind, my review will not be specific but broad.

I am a hospital pharmacist who graduated in 1999 from the University of TN School of Pharmacy.  At the time we were rated number 7 in the United States, and I have never had any issues with being clinical minded in the jobs that required that role in the past 13 years.  Times have changed.  Schools have multiplied, and the residency which was a "side thought" in 1999 is a must today.  BCPS certification is also important if one did not do a residency or the cherry on the top if you did.

So, I decided at the ripe old age of 39 to study like a fiend and pay all sort of money to this organization to have study materials including written, web, and audio.  I spent most days listening to the likes of pharmacy lecturers discuss things from stats to ID to cardiology to oncology to nephrology.  It kind of made me realize I haven't really been using my brain at work, and to all the patients out there I have treated, I am sorry I haven't been a more thorough and clinically-minded pharmacist.

You see, an order entry pharmacist enters orders and most of the time relies on the computer system itself to flag for interactions and other things, but you know what?  Just yesterday I found something pretty profound.  The computer fails.  I found a place in our current process where I made a difference.  Just one of the many that are to come.

The test:  200 questions.  2 sections of 100 questions each.  I found the first part harder; but many I heard said the reverse.  I have always been the one marching at the beat of a different drummer.  Topics:  tons of stats, pharmacy regulations was everywhere.  I wasn't prepared for regs.  Psoriasis.  Acne.  Both of those disappointing as I haven't had an acute admission to the hospital yet for either.  And I have not found acne guidelines with the American  Dermatological Society yet.  I know I missed the psoriasis question.  Tons of COPD, albuterol, and not so much STEMI.  Angina more stressed.  Maybe due to the new Chest Guidelines that came out.  One chemo question I remember.  Tons of stats.  Did I already say that?

There were a couple kinetics questions.  Guess what?  I bought a $5 cheapie calculator from Walgreens that died.  YEP.  I had THAT luck.

Temperature was given in C rather than F.  I was bummed about that.  Guess it's time to join the rest of the world on that one!

There was one INR question I remember.  Pretty specific.  I got it right ;).

And the usual question that appears every year was there.  I don't think I can say what it is on here, but if you talk to anyone that has taken the test, they can tell you what it is ;).

Psychiatry a couple of times.  All side effects of drugs.  CYP3A4.  All CYP really.  Pharmacoeconomics more than I would have liked.

Guideline driven.  Mostly accp.com material so would recommend studying that.  Keep in mind if there's something not in that material though, you may want to find a review book to read on the side.

If I failed, which is possible (last year passed 70% of test takers with cut-off being 111/200 or so) I will retake it again next October.  I really liked the challenge, liked the things I have learned, and like the possibility of continuing my education in this field to grow in my career.

What did I study?

1.  ACCP materials.  I purchased the slides, handouts, and audio to listen in the car on my iPhone.

2.  http://quizlet.com/  There were tons of BCPS flashcards made by some pretty smart pharmacists.  Just search BCPS on Quizlet.

3.  High Yield Med Reviews  We will see how this goes.  It's a subscription service with test questions.  I think it helped me.  I will probably resubscribe around July if I failed for next year.

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BCPS - some flashcards from quizlet

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So as promised, I'm sitting here studying (not really) for the BCPS and wanted to share with you some flashcards that I have found online.  I did personally purchase the ACCP study materials in print and I bought last year's audio lectures.  I really don't think I have enough time to devote entirely the amount of time that I need; however, I'm going to just go for it.  If I fail, I will retake in 2013.  Goals.  You need goals in your personal and professional life, ok? Enjoy.  I would like to personally thank the pharmacists that created these.  I've made a few sets, but once I stumbled upon these I realized it is all about studying smarter, correct? So today's set:  GI

Choose a Study ModeScatterLearnFlashcards

This should get you going.  Better yet go to http://www.quizlet.com and search "BCPS."  I promise you'll find a lot of study materials that will help.

There's a study guide online.  Of course we are almost two months out.  (UNREAL):
Jul 23 Amb Care
Outpt Cards
M/W Health
Jul 30 GI
Nephrology
Oncology
Aug 06 Biostats
Policy/Practice
Economics
Aug 13 Pediatrics
Geriatrics
Kinetics
Aug 20 Neurology
Psychiatry
Fluids/Elytes
Aug 27 Ac Care Cards
Crit Care
Sep 03 ID
HIV/ID
Endocrine
Sep 10 Amb Care
Outpt Cards
M/W Health
Sep 17 GI
Nephrology
Oncology
Sep 24 Free Study
Oct 01 Free Study
Oct 06, 2012 BCPS Exam

I am also subscribed to http://www.highyieldmedreviews.com.  We'll see if it helps after October 6th, right?

 

 

 

 

Depakote and Abbott's $1.6 Billion Mistake

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Abbott never had FDA approval to promote Depakote for aggression and agitation in the elderly or schizophrenia. The total includes a criminal fine of $700 million and civil settlements with the states and federal government totaling $800 million. Abbott pleaded guilty to a criminal misdemeanor for misbranding the medication. Abbott is also going to pay 45 states $100 million to resolve liability with consumer protective laws. Luckily the Justice Department found no deaths due to this crime.

The company admitted that from 1998 through 2006, it "maintained a specialized sales force trained to market Depakote in nursing homes for the control of agitation and aggression in elderly dementia patients, despite the absence of credible scientific evidence that Depakote was safe and effective for that use," the Justice Department said in a news release.

"In addition, from 2001 through 2006, the company marketed Depakote in combination with atypical antipsychotic drugs to treat schizophrenia, even after its clinical trials failed to demonstrate that adding Depakote was any more effective than an atypical antipsychotic alone for that use."

Heaphy said Abbott earned about $13 billion from Depakote sales during the period investigated, but he said it was difficult to determine how much of that was the result of sales for illegal purposes. He expressed confidence that, once the fines are factored in, Abbott will not have profited from the improper practices.

Um... Ok. $13 billion minus $1.6 billion equals a profit.

No wonder this will keep happening.

The Top 10 iPad Apps for Pharmacists

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Want to know the top 10 apps I use in pharmacy practice?

1. MedCalc Pro - is a medical calculator that gives you easy access to complicated medical formulas, scores, scales and classifications.MedCalc has been available on mobile platforms for more than a decade, so it leverages years of experience in bringing medical equations to physicians in an easy to use, yet very powerful format. The Pro version offers premium features such as native iPad support, a patient database to store results and many ways to export results (email, airprint, copy to clipboard). If you're on a tight budget, you can always check out the cheaper but still amazing MedCalc.

2. Sanford Guide - The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy 2011 application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care. Always a pocket guide, still a pocket guide. Portability has been a hallmark of The Sanford Guide for over 40 years. The Sanford Guide to Antimicrobial Therapy 2011 application extends that portability to iOS4 devices: iPhone, iPod Touch and iPad. The most trusted infectious diseases treatment resource in print now presents the same comprehensive, treatment- focused coverage of infectious diseases and clinical conditions, anti-infective drug information, therapeutic adjuncts and comparative spectra of activity in a clean, uncluttered, device-optimized interface. Based on the Sanford Guide Web Edition, the application features expanded coverage of topics compared to the print edition.

3. Medscape - The #1 free medical app in iTunes containing drug reference, daily medical news, CME/CE, drug interaction checker, disease and condition reference, procedure and protocols, and other special features. A must!

4. MedPage - MedPage Today is the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading. Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news, with summaries and actionable information enabling them to better understand the implications.

5. WebMD - WebMD helps you with your decision-making and health improvement efforts by providing mobile access 24/7 to mobile-optimized health information and decision-support tools including WebMD’s Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings. WebMD also gives you access to first aid information without having to be connected wirelessly – critical if you don’t have Internet access in the time of need. Personalize your app by saving drugs, conditions and articles relevant to you — through secure access and easy sign-in.

6. Epocrates - Get quick access to reliable drug, disease, and diagnostic information at the point of care. Epocrates is the #1 mobile drug reference among U.S. physicians. Trusted for accurate content and innovative offerings, 50% of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency.

7. Lexicomp - Committed to improving medication safety with innovative products and technology designed for healthcare professionals, Lexicomp offers a variety of drug information and medical applications for iPhone, iPad and iPod touch. These applications are tailored to meet the point-of-care needs of pharmacists, physicians, nurses, nurse practitioners and dentists by storing content directly on the mobile device. Access to Lexicomp's up-to-date drug information and clinical content is a must for the busy healthcare professional who desires the necessary tools to make important medication and clinical decisions from the palm of their hand! Download your Lexicomp mobile drug information application on the app store.

8. Redi-Reader – the reader I use to read articles, studies, etc…

9. Pharmacy Times – Keeping up with pharmacy news. I choose this app.

10. PACID - Last, but certainly not least, ID Compendium, A Persiflager's Guide by Mark Crislip, MD and programming by Walter Crittenden, PharmD (shout out to the PharmD!). This app is sweet for infectious disease!

p.s. I saved the best for last ;)

Meet Mr. MRSA

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I thought I would introduce you to an infectious organism every week!  Today, the lucky "bug" as they are referred to in the medical community is methicillin resistant staphylococcus aureus (MRSA). If I was a common layperson in the field of medicine, I would view this microorganism as a very nasty flesh eating entity.  I thought I would shed some light about MRSA.  Whether you are dealing with a soft tissue infection, pneumonia, central nervous system infection, endocarditis (heart), or bone and joint, the treatment differs.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening. Many public health experts are alarmed by the spread of tough strains of MRSA. Because it's hard to treat, MRSA is sometimes called a "super bug."  Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening.  Many public health experts are alarmed by the spread of tough strains of MRSA.  Because it's hard to treat, MRSA is sometimes called a "super bug." 

Also just news today... an almost instant test in detecting MRSA.

Skin and soft-tissue infections

  1.  Abscess  - incision and drainage
  2. Purulent cellulitis
    • Clindamycin 300-450 mg PO TID (C diff)
    • Bactrim 1-2 DS tablets BID (pregnancy category C/D)
    • Doxycycline 100 mg BID (pg category D and not recommend for children under 8)
    • Minocycline 200 mg x 1, then 100 mg PO BID
    • Linezolid 600 mg BID (expensive)
  3.  Nonpurulent cellultis
    • Beta lactam (cephalexin and dicloxacillin) 500 mg QID
    • Clindamycin 300-450 mg TID
    • Beta lactam and/or Bactrim or a tetracycline – amoxicillin 500 mg TID
    • Linezolid 600 mg BID
  4. Complicated SSTI
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
    • Linezolid 600 mg PO/IV BID
    • Daptomycin (cubicin) 4 mg/kg/dse IV QD
    • Telavancin 10 mg/kg/dose IV QD
    • Clindamycin 600 mg PO/IV TID
  5. Bacteremia
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
    • Daptomycin 6 mg/kg/dose IV QD
  6. Infective endocarditis, native valve – same as bacteremia
  7. Infective endocarditis prosthetic valve
    • Vancomycin and gentamicin and rifampin – 15-20 mg/kg/dose IV every 8-12 hrs,                                          i.      1 mg/kg/dose IV every 8 h,  300 mg PO/IV every 8 h
  8.  Persistant bacteremia
  9. Pneumonia
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours        
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
  10. Osteomyelitis (Bone and Joint Infections)
    • Vancomycin 15-20 mg/kig/dose IV every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • TMP-SMX and rifampin – 3.5-4.0 mg/kg/dose PO/IV every 8-12 h
  11. Septic arthritis
    • Vancomycin 15-20 mg/kg every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • Bactrim 3.5-4.0 mg/kg/dose PO/IV every 8-12 hours
  12. Meningitis
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
    • Linezolid 600 mg PO/IV BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
  13. Brain abscess, subdural empyema, spinal epidural abcess
    • Vancomycin 15-20 mg/kg/dose every 8-12 hours
    • Linezolid 600 mg po/iv BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
  14. Septic thrombosis of cavernous or dural venous sinus
    • Vanc same
    • Zyvox
    • Bactrim same

 

 

Pharmacy Perfection

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One of the biggest things I struggle with as a pharmacist is the idea of a profession that requires absolute perfection in everything you do; yet I am human. There is not a lot of room for error because it can detrimentally affect a patient. I remember back when I was as green as the spring grass freshly graduated from pharmacy school in 1999. I landed my first job with K-Mart, not exactly the job that I had dreamed of while I was attending pharmacy school, but they paid for my relocation from one city to another. They also did not do a lot of volume in the particular store where I was assigned. I do not remember the name of the pharmacist that worked there opposite from me initially. What I do remember about her is the words that came out of her mouth almost at her introduction, “I have never made an error while being a pharmacist.” I was too naïve at the time to realize that there was no way she was telling the truth. We are human; we will make mistakes. And at the time K-Mart did not have any mandates in place on flow or any bar-coding scanning to ensure more safety as Walgreens and CVS had. They were way behind the times as far as technological advances go.

I believe one of my first errors was dispensing Adalat CC 30 mg when the prescriptions called for 60 mg. Yes, I felt SICK. But over time I have come to realize that there are things you can do as a pharmacist to be more accurate whether it be hospital, retail, or anything in between.

According to a 2006 report by the Institute of Medicine, medication errors cause harm to roughly 1.5 million patients annually.5 Millions more are caught prior to administration, before they reach the patient. Not only do medication errors adversely impact the patient population, they are estimated to cost billions of dollars in additional treatment costs. Read more: http://www.uspharmacist.com/content/c/31431/

Here are some tips to help you become more accurate

1. Concentrate. Don’t allow distractions to stop your flow of thinking. If a technician comes up to you and needs something right away, go ahead, but realize when you start back on the order, you need to continue the exact same flow from beginning to end. Don’t try to “pick up where you left off.”

2. Do the same thing every single time. Consistency.

3. Do a second double check after you are finished checking. If that means pulling up the profile on the computer screen and holding up the order or pulling it back up electronically, just double check at the very end.

4. Any time you are going outside the usual, there is a higher incidence for errors. For example, if you have to build something from scratch in the computer on a new medication, you can be sure you are more likely to mess up on something else within the order than normal.

5. If you work retail, utilize every program they have to improve accuracy. In the hospital, just do another last review of MAR prior to moving to the next order. If in doubt; ask. It’s always better to phone the office if you work in retail or phone the nurse if you work in hospital to bounce off what you are seeing.

The most important thing is to make sure you have enough staff to safely fill medications and orders.