The Kentucky Pharmacist Vol. 9, No. 6 by Kentucky Pharmacists Association

Y K C U T N E K THE T S I C A M R A PH Vol. 9, No. 6 November 2014

KPhA Rebuilding for the Future â&#x20AC;&#x201C; Work on YOUR KPhA Building

Get Involved Stay Involved Membership Matters in YOUR KPhA

News & Information for Members of the Kentucky Pharmacists Association

Table of Contents

November 2014 KPhA Emergency Preparedness Continuing Education Article Submission Guidelines Dec. 2014 CE — Preventing Errors in the Pharmacy December Pharmacist/Pharmacy Tech Quiz Kentucky Renaissance Pharmacy Museum KPhA New and Returning Members Pharmacy Law Brief Pharmacy Policy Issues Pharmacists Mutual Cardinal Health KPhA Board of Directors 50 Years Ago/Frequently Called and Contacted

Table of Contents Table of Contents— Oath— Mission Statement 2 President’s Perspective 3 KPhA Mid-Year Conference on Legislative Priorities 4 From your Executive Director 6 APSC 8 2014 Oral Chemo Therapy Bill 9 Technician Review 10 Nov. 2014 CE — Evaluation of Abdomen, Musculoskeletal, and Nervous System 11 November Pharmacist/Pharmacy Tech Quiz 16

17 18 19 26 27 28 32 34 36 37 38 39

Oath of a Pharmacist At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy. I will consider the welfare of humanity and relief of human suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will embrace and advocate change in the profession of pharmacy that improves patient care. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association The mission of the Kentucky Pharmacists Association is to promote the profession of pharmacy, enhance the practice standards of the profession, and demonstrate the value of pharmacist services within the health care system.

Editorial Office: © Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association. Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email ssisco@kphanet.org. Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research Foundation (KPERF), established in 1980 as a non-profit subsidiary corporation of the Kentucky Pharmacists Association (KPhA), fosters educational activities and research projects in the field of pharmacy including career counseling, student assistance, post-graduate education, continuing and professional development and public health education and assistance. It is the goal of KPERF to ensure that pharmacy in Kentucky and throughout the nation may sustain the continuing need for sufficient and adequately trained pharmacists. KPERF will provide a minimum of 15 continuing pharmacy education hours. In addition, KPERF will provide at least three educational interventions through other mediums — such as webinars — to continuously improve healthcare for all. Programming will be determined by assessing the gaps between actual practice and ideal practice, with activities designed to narrow those gaps using interaction, learning assessment, and evaluation. Additionally, feedback from learners will be used to improve the overall programming designed by KPERF. 2

THE KENTUCKY PHARMACIST

President’s Perspective

November 2014

KPhA Rebuilding for the Future – Work on YOUR KPhA Building PRESIDENT’S PERSPECTIVE

Lichtefeld was kinder in his comments; he recalled that it was “not a nice place.” There was much discussion in the convention minutes as to what should be done about the current KPhA and Board offices. This discussion led to the initial planning for the building.

Robert Oakley

Initially, when Mr. Josey had passed away, a group of pharmacists raised money for a scholarship fund in his honor; however, once discussion began of the construction of a KPhA building, the scholarship changed into a building fund campaign to honor Mr. Josey (the current KPhA building is named the E. Murphy Josey Memorial Building). The Board agreed to continue to lease office space in what would be called a “pharmaceutical building.” Through the hard work of many pharmacists, a building campaign co-chaired by Ben Koby and Earl P. Slone, was started. On the cover of the March 1967 cover of The Kentucky Pharmacist is a picture of the proposed building and a slogan to describe it. It reads: “Dedicated to those who have served Kentucky pharmacy in the past and to those who will serve in the future.” I could not agree more! Another great quote comes from past KPhA president, Ralph J. Schwartz, who wrote in the October 1967, issue “The future home of Kentucky pharmacy shows that we are on the move again, that we are not tired and content, that we want to build upon the solid foundation of service laid down by our past members and leaders. It also symbolizes our new spirit of independence.” The ground breaking for the new building was at noon Oct. 2, 1967. To quote past-president Schwartz again, “So – a comment became an idea. The idea became a dream.”

KPhA President 2014-2015 In 2017, KPhA will celebrate the 50th anniversary of the start of construction of YOUR KPhA building. As with any 50 year old, it is beginning to show its age. Over the last few years, there have been a number of “emergency” repairs that needed to be made that were not in the KPhA budget. As we discussed the need for these repairs and the methods of funding them, it occurred to me that this might be a recurring concern in future Board meetings. What will go wrong next, and how will we pay for it? I began to think that we need to start planning for future building needs and emergencies. KPhA is very fortunate to own our own building, but as every homeowner knows, there will always be problems to fix. In order to plan for the future, I thought it would be best to look back at the KPhA pioneers who had the vision to build an office for KPhA. Scott Sisco and UK PY-4 student Warren Finlinson were kind enough to dig through the archives of The Kentucky Pharmacist to uncover some of the history of the building. Many pharmacists may not realize it, but up until 1995 KPhA and the Board of Pharmacy shared offices. From 1939 – 1965, E. M. Josey served as both the Executive Director of KPhA and the Executive Secretary of the Kentucky Board of Pharmacy. At the time of his death, KPhA and the Board shared office space in downtown Frankfort. Following his death, separate appointments were made for the Executive Director of KPhA (Bob Lichtefeld) and Board of Pharmacy (C.O. Ducker as acting director). They discovered then that there was office space for only one director! Also during this time, many KPhA members came to the offices for the first time after his passing. As quoted in the minutes of the KPhA House of Delegates meeting July 27, 1966, Mary Frances Feiler was quoted as saying “what are we doing in a dump like this?” Bob

In late July 1968, employees of KPhA (Mrs. Margaret Duvall and Robert J. Lichtefeld) and the Kentucky Board of Pharmacy (John H. Voige, Richard Ross and Earl Becknell) moved into the new building. It was a great moment in the history of pharmacy in Kentucky and of YOUR KPhA. The building was possible because of the donations of over 500 pharmacists, pharmacies, wholesalers, local associations and other individuals and businesses. Approximately $100,000 was raised during the building campaign. Let’s now fast forward 48 years. Our building is beginning

Continued on Page 5 3

THE KENTUCKY PHARMACIST

2014 Mid-Year Conference on Legislative Priorities

November 2014 Featuring the

KPhA Student Legislative Day in partnership with Sullivan University College of Pharmacy and

University of Kentucky College of Pharmacy

Stacie Maass, APhA Senior VP, Pharmacy Practice and Government Affairs, presents on Federal Provider Status at the 2014 KPhA Mid-Year Conference on Legislative Priorities. (Below, left) Maass met with the Provider Status Workgroup and the Government Affairs Committee.

KPhA Member Jill Rhodes explains the Oral Chemo Therapy Parity bill passed in the 2014 Legislative Session. (For more on the bill, see page 9.)

THE KENTUCKY PHARMACIST

2014 Mid-Year Conference on Legislative Priorities

November 2014 KPhA Thanks our 2014 Mid-Year Conference Sponsors Unanimous Consent

Majority Vote

($2,000 and up)

Richard and Zena Slone

American Pharmacy Cooperative Inc.

Center for the Advancement of Pharmacy Practice at UKCOP

American Pharmacy Services Corp. Kentucky Customers of Cardinal Health

Celgene Passport Health Plan Pharmacists Mutual

Pfizer

CAPT Doug Thoroughman, PhD, MS, CDC Career Epidemiology Field Officer, presents on the Ebola Crisis in West Africa.

Sullivan University College of Pharmacy

Show your Pharmacist Pride with a KPhA Roamey Window Cling! $5 — All proceeds benefit the KPhA Building Fund Available at the KPhA Online Store www.kphanet.org, click on About Tab, Online Store provements. We will be seeking donations from individuals, pharmacies, organizations and corporations. I recognize that we will be competing with many other organizations for your donations just as it was in 1966-67 when over 500 individuals, companies and organizations made the initial donations to build the KPhA building.

Continued from Page 3

to show its age. There are many items in current need of repair or replacement and the appearance is worn looking. There has been little work done on the outside to improve appearances. For example, how many of you have visited the offices lately and noticed the “leaning wall of KPhA” at We are in the very early stages of our campaign. I will be the front of our building? How it is still standing, I don’t working closely with our Executive Director, Bob McFalls, to know. The KPhA building is no longer the show place it was finalize the details of our campaign. We will be launching it when it first opened. soon, and we will be sending more information on the deI believe that the KPhA members in 1966 were visionary tails. I also would like to hear from you, the members. If you and forward thinking in their decision to build the current have ideas or suggestions on the rebuilding fund campaign, KPhA office. I also believe that the current members of please let me know. If you have stories you would like to KPhA need to be equally forward thinking to protect and share about the history of the building or the original buildmaintain their legacy. Therefore, I would like to announce ing fund campaign, please let us know. We can share these the start of a campaign to raise funds for the maintenance stories with the members of YOUR KPhA. and to upgrade YOUR KPhA building. It will be called “Rebuilding for the Future.” KPhA will establish a separate Have a happy and joyous holiday season. Remember, it is the season for sharing and giving. fund, entirely through donations, to use for building im5

THE KENTUCKY PHARMACIST

From Your Executive Director

November 2014

MESSAGE FROM YOUR

EXECUTIVE DIRECTOR Robert “Bob” McFalls Technically, I am not sure if it is truly Fall or a pseudo Winter that has returned to Kentucky, but one thing is for sure — it is basketball season once again throughout the Commonwealth. And that can only mean one thing to a state full of people in love with the sport of basketball, from Paducah to Pikeville, from northern Kentucky to Albany, from Lexington to Louisville and all points in between. We love our basketball team of choice, and we hunger to see them win. We are a people steeped in rich tradition and in love with our championships, even as we hunger for more. And for the mini fans that are learning the history and the rules, we strive to pass on our heritage, to help them to claim the legacy that is ours as dedicated fans. It is quite an exciting responsibility to undertake and to share together. As a member of YOUR KPhA, you share a similar, rich history of an Association dating back to 1877 as the 14th state association to be formed nationally. Our legacy is rich, and the words of the past continue to speak to the present while outlining the future in advancing the profession. In this respect, I would like to offer a few brief observations about the legacy of E.M. Josey, R.Ph., former Executive Secretary both of the Kentucky Pharmacists Association and of the Kentucky Board of Pharmacy. Following his untimely death, Mr. Josey’s contributions were honored by action of the 89th Annual Convention of the Kentucky Pharmacists (then Pharmaceutical) Association meeting in Covington, which memorialized him at the KPhA Headquarters Building in Frankfort by designating that KPhA (and at the time, the Board of Pharmacy) would be housed in the new Josey Memorial Building. In reading Mr. Josey’s detailed reports from the 1960s in The Kentucky Pharmacist, one quickly realizes how engaged he was in making a difference for others and for pharmacists as a whole. Mr. Josey literally died “on the job” when he passed away suddenly on June 17, 1965, not far from where YOUR KPhA headquarters now stands. And, just as he led the way in his professional life, commitment and service, Mr. Josey and his legacy continue to represent you and your professional colleagues today. YOUR KPhA’s records document how the voluntary action and commitment of another individual, C.O. Ducker, Inspector for the Board of Pharmacy, offered the first pledge of

$200.00 at a meeting in July 1966 that immediately led to six matching pledges at the same meeting to establish the initial building fund. The Kentucky Pharmacist (October 1967) goes on to report, “Thus with the assurance of this initial $1,400.00 the ball was ready to roll. “A comment became an idea. The idea became a dream.” And with a lot of sweat, determination, efforts, leadership and participation of the pharmacy family, the dream became reality. Later, in October 1967, YOUR KPhA declared in its dedication of the “Home of Pharmacy in Kentucky” the ultimate acknowledgement of service — recognizing not only Mr. Josey and his commitment but extending that level of service to each and every one who would walk beside him and follow in his professional footsteps — by dedicating the new headquarters: “To Those Who Have Served Kentucky Pharmacy in the Past and To Those Who Will Serve in the Future.” Indeed, YOUR KPhA Headquarters is a living memorial to the sacrifice and commitment of those who have gone before us to those who now carry the torch forward today and to those who will lead in the future. At the luncheon ceremony following the official ground-breaking in October 1967, George Grider spoke eloquently as APhA President to the profession, stating in part: “…State pharmaceutical associations, as in our own case, have alternately thrived and withered over the years, depending upon their membership number and vigor. State associations have, for the most part, been ill-housed and ill-fed, with never enough space, enough equipment, enough staff and, of course, enough money. Today’s action marks the end of such inadequacy for Kentucky pharmacy, as we join the ever growing list of state associations that are erecting permanent homes for themselves. The future home of Kentucky pharmacy shows that we are on the move again, that we are not tired and content, that we want to build upon the solid foundation of service laid down by our past members and leaders. It also symbolizes our new spirit of independence…. Under the aggressive and intelligent leadership of President (Ralph) Swartz, our officers and of our Executive Director Bob Lichtefeld, Kentucky pharmacy is advancing swiftly into the mainstream of American pharmacy. We are showing new vigor, new enthusiasm.” 6

THE KENTUCKY PHARMACIST

From Your Executive Director

November 2014

On behalf of YOUR KPhA staff, I want to say how exciting it is to be a part of a winning team, as we seek the next opportunity to advance the ball down the court, to block the opposition, to score by getting the ball to and in the basket and to win endless championships for our pharmacy team. Let us be thankful for those who have given so much, as we also acknowledge those who are faithfully

serving the association NOW. And, as we reflect during the holiday season that is upon us, letâ&#x20AC;&#x2122;s take time to examine the key elements of our individual legacy as well. For what is it that you seek to be remembered, and what do you intend to pass on as your legacy to the profession of pharmacy? Thank you Mr. Josey. And thank you, KPhA Member!

Watch eNews and subsequent editions of The Kentucky Pharmacist for more information on ways YOU can help rebuild YOUR KPhA Headquarters!

Reminder: CE deadline for 2014 is December 31 To maintain your Kentucky Pharmacist license, you must complete 15 hours of continuing education each year between January 1 and December 31. These hours can be live or home based activities. But they must be COMPLETED between those dates.

than 60 days prior to submission. If you submit home based activities to KPERF after the 60 day deadline, they will be returned to you. In regards to the completion date for home activities, which is next to your signature on the answer sheets for the CE quizzes, ACPE considers this date to determine when the credit for the activity is valid. So, if you put a completion date on a quiz in December 2014, but mail it to KPhA for credit in January 2015, it will count toward your total for 2014.

In April 2014, ACPE released a few updates on CPE Monitor. Beginning May 1, ACPE enabled a 60-day submission rule for activities. What does this mean for you? Probably not much for live activities. YOUR KPERF Administrator (that would be Scott Sisco, KPhA Director of Communications and Continuing Education) must have activities uploaded to CPE Monitor within 60 days of the completion of the activity.

The expiration date for home-based CE programs remains the same as it always has. Programs are valid for three years after the release date. KPERF lists the expiration On home activities (the CE articles in these pages each date at the top of the page of answer sheets. You can still issue), activities must be uploaded within 60 days of the complete CE activities from past years for current year completion date. So make sure you send in your quizzes credit, as long as the program hasnâ&#x20AC;&#x2122;t expired. All KPERF soon after you complete them. Beginning Jan. 1, 2015, CE articles are available online for KPhA members under CPE Monitor will not accept activities completed more the Education tab on www.kphanet.org. 7

THE KENTUCKY PHARMACIST

APSC

November 2014

THE KENTUCKY PHARMACIST

2014 Oral Chemo Parity Bill

November 2014

New Law in Effect January 2015:

Oral Chemo Parity Bill to expand access to effective cancer therapies As of Jan. 1, 2015, many Kentucky cancer patients will benefit from the state’s new Oral Cheomtherapy Parity Bill, which passed in the 2014 Kentucky Legislative session as part of House Bill 126.

patients, patient advocacy organizations and Senator Tom Buford, requires health insurance companies to charge patients no more than $100 out-of-pocket for a 30-day supply of orally administered anticancer medications. The original bill was sponsored by Sen. Buford and overwhelmingly Intravenous (IV)/infused anticancer medications are typicalpassed both houses of the state legislature. HB 126 was ly covered under a health plan's medical benefit, with pasigned into law by Governor Steve Beshear in April. tients responsible for a nominal copayment, per treatment. Orally-administered anticancer medications, however, are “We are proud to have been a part of the successful outcome of this important legislation needed by cancer pausually covered under a health plan's pharmacy benefit. tients”, stated KPhA President Bob Oakley. “Improving acUnder the pharmacy benefit, oral anticancer medications are often included in the highest tier of a health plan’s drug cess to one’s medication therapy by controlling out of pocket costs will increase adherence and be positive for the benefit and come with the highest out-of-pocket cost, requiring patients to pay a coinsurance – or a percentage of patient overall.” the overall total cost of the drug. This percentage coinsurance can often equal thousands of dollars each month; a price tag that restricts access to life-saving oral anticancer therapies for untold numbers of cancer patients.

The law does not require health plans to cover a new service and only impacts those that currently list chemotherapy as a covered benefit. The state law impacts residents covered by a private commercial health plan. The law does not impact the federal Medicare program. Kentucky joins Come Jan. 1, 2015, this will change for cancer patients in 33 other states and the District of Columbia, including MisKentucky, when HB 126 goes into effect, giving them greatsouri, Wisconsin and Ohio, in enacting similar legislation. er access to the latest and most effective anticancer treatments. The bill, which passed at the end of the 2014 legis- For more information about KAR Chapter 304/HB126, please visit: www.kphanet.org. lative session after a hard fought battle by YOUR KPhA

KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________

Email: ______________________________________________________________ Address: _____________________________________________________________ City: ___________________________________________ State: _________ Zip: ____________ Phone: ________________ Fax: __--_______________ E-Mail: ______________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601

THE KENTUCKY PHARMACIST

Technician Review

November 2014

Technician Review From the KPhA Academy of Technicians Your KPhA Pharmacy Technician Academy continues to grow in numbers and support. We are 40 members strong and hope to see more growth in the coming New Year. Currently, we are in discussion with the Board of Pharmacyâ&#x20AC;&#x2122;s Advisory Council concerning future recommendations to the Board of Pharmacy. We have addressed the KPhA Professional Affairs Committeeâ&#x20AC;&#x2122;s concerns about our proposals and look forward to gaining their support.

Pharmacy Technician Academy, you are eligible to receive up to 10 hours of free online technician-specific continuing education from the Collaborative Education Institute. If you are already of member of KPhA you may go to the KPhA website at http://www.kphanet.org/ and join the Academy or contact Don Carpenter at dacarpenter@st-claire.org. If you are not a member of KPhA yet and wish to join the association you can join via the website.

The Academy would like to remind all certified pharmacy technicians that beginning in 2015 all continuing education must be technician specific. As a member of the KPhA

The members of the Pharmacy Technician Academy would like to wish everyone a Merry Christmas and Happy New Year.

KPhA Member Pharmacy Technicians

FREE CE

KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost. The mission of the KPhA Academy of Pharmacy Technicians is: To unite the pharmacy technicians throughout the Commonwealth to have one voice toward the advancement of our profession. To follow what is currently happening with your profession please read our newsletter articles and become involved.

For more information contact Don Carpenter via email at dacarpenter@st-claire.org

THE KENTUCKY PHARMACIST

Nov. 2014 CE — Abdomen, Musculoskeletal, and Nervous Systems

November 2014

Pharmacist Patient Assessment Skills for Optimizing Self-Care, Part 4 of 4: Evaluation of the Abdomen, Musculoskeletal, and Nervous Systems By: Kimberly A. Messerschmidt, PharmD; Professor of Pharmacy Practice, SDSU College of Pharmacy. Clinical Pharmacist, Sanford USD Medical Center and Kelley J. Oehlke, PharmD; Residency Program Director, Clinical Pharmacy Specialist, Ambulatory Care, Sioux Falls VA Health Care System Reprinted with permission of the authors and the South Dakota Pharmacists Association where this article originally appeared. This activity may appear in other state pharmacy association journals. There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-9999-14-011-H01-P&T 2.0 Contact Hours (0.2 CEU) Goal: To enhance pharmacists’ knowledge regarding patient assessment. Objectives

KPERF offers all CE articles to members online at www.kphanet.org

At the conclusion of this article, the reader should be able to: 1. 2. 3. 4. 5.

Properly evaluate common gastrointestinal complaints and recognize when to refer patients to their physicians. Identify medications that commonly cause diarrhea and constipation. Describe risk factors and symptoms associated with GERD. Evaluate the characteristics and common causes of leg pain . Recognize typical symptoms associated with various types of headaches, transient ischemic attack (TIA) and cerebrovascular accident (CVA).

Patients with other common gastrointestinal complaints such as nausea and vomiting, diarrhea, constipation, peptic Each and every day, thousands of people seek guidance ulcer disease (PUD) and gastroesophageal reflux disease from their pharmacist regarding the appropriate use of their (GERD) may or may not need to be referred; in these casmedications. Pharmacists must rely upon not only their es, a thorough patient history will help the pharmacist to pharmaceutical knowledge base, but also upon effective determine the best course of action. communication and patient assessment skills in order to meet the needs of these individuals. Nausea is generally nonspecific and may be associated Introduction

with a number of conditions including viral illness, pregnancy, motion sickness, liver or pancreatic disease or malignancy. Nausea also is a very common side effect of many medications. Vomiting may occur with more specific illnesses such as gastroenteritis, bile duct obstruction, intestinal obstruction or it may be the result of head trauma or ingestion of a toxic substance. Since nausea and vomiting can Abdomen be caused by such a variety of benign to serious conditions, one of the major goals of treatment should be to The pharmacist’s role in assessment of the abdomen noridentify and resolve the underlying disorder. Assessment of mally does not entail performing a physical examination. the situation includes identifying how long the patient has However, the pharmacist should be able to interpret the information from an exam or a patient interview in order to been experiencing the nausea or vomiting, when it began, make sound, medication related recommendations. In most what it was associated with (e.g., food, new medication), what the vomitus looks and smells like (e.g., vomited matecases, patients who present to the pharmacy with abrial with a fecal smell indicates intestinal obstruction and dominal pain should be referred to their physician. In this final section of our four part series, we continue to explore opportunities for utilizing basic patient assessment skills, with a focus on assessment of the abdomen, musculoskeletal system and nervous system. By understanding these vital concepts, pharmacists can confidently make an early impact on patient care.

THE KENTUCKY PHARMACIST

Nov. 2014 CE â&#x20AC;&#x201D; Abdomen, Musculoskeletal, and Nervous Systems

Table 1. Exclusions to self-treatment of nausea and vomiting1 Suspected food poisoning that has lasted for more than 12 hours Accompanying symptoms such as: severe abdominal pain, fever and diarrhea, blood in the vomitus, signs of liver dysfunction (e.g., yellow skin or eyes, dark urine, pale stools) or stiff neck and headache with light sensitivity

November 2014

Table 2. Medications that commonly cause diarrhea and constipation DIARRHEA Antibiotics Antacids (containing magnesium)

History of a recent head injury

Acarbose

Underlying chronic medical condition such as glaucoma, BPH, gastrointestinal disease or diabetes

Bethanecol

Suspected medication side-effect or sign of toxicity (e.g,, digoxin, theophylline, lithium)

Colchicine Metformin Metoclopramide

Suspected eating disorder

Quinidine

Pregnancy

CONSTIPATION

mandates immediate referral), whether associated symptoms such as pain or fever are present, and whether the patient has any underlying medical conditions. Because it is impossible to discuss all of the clinical situations in which nausea and vomiting might be a pertinent finding, clinical judgment is needed to determine which patients are not candidates for self-care. Table 1 lists some examples of patients that should typically be referred to their physician for further evaluation. Additionally, any patient who experiences nausea and vomiting for more than one or two days, or who has a complicated medical history or a continued worsening of their condition should be referred.1

found in patients with constipation. Similar assessment questions apply to diarrhea and constipation as for nausea and vomiting.

Opiate analgesics Antacids (containing aluminum or calcium) Anticholinergics Antihypertensives Diuretics Iron supplements

Neuroleptics Drug-induced causes of diarVincristine rhea and constipation may be found in Table 2. Patients should be warned of the potential side effects of medications and what to do if they occur. Lack of exercise and inadequate intake of fluids Dehydration may result from excessive vomiting and is es- and fiber also may cause constipation; each of these facpecially important with infants and young children. Warning tors should be addressed when treating this common comsigns of dehydration in children include excessive thirst, plaint. As with vomiting, rehydration should always be decreased urine output, dry mucous membranes, fever stressed to patients who experience severe and/or prowithout sweating, unusual listlessness or decreased alertlonged episodes of diarrhea. In general, if the diarrhea or ness, a sunken fontanelle and crying with little tear produc- constipation has been present for one week or more, or if tion.1 Additionally, patients may experience dizziness and there is evidence of bleeding, the patient should be relightheadedness, fainting or low blood pressure. Any paferred. Other exclusions for self-treatment are listed in Tatient exhibiting symptoms of dehydration should be referred ble 3. to their physician. Common causes of peptic ulcer disease (PUD) include Helicobacter pylori and NSAIDs. A patient may present with Diarrhea and constipation also are frequent complaints of patients, especially in the elderly population. Diarrhea is the melena (dark, sticky stools), hematochezia (bright red abnormal passage of watery stools, and constipation is in- blood in stool), epigastric pain, pain that awakens the pafrequency of, and/or difficulty in passing hard stools. Com- tient at night, weight loss, nausea and vomiting, belching or mon finding of patients with diarrhea include sudden onset bloating. Pain that is relieved by eating, or that occurs 1 to of abnormally frequent stools, which also may be accompa- 3 hours after eating is more typically associated with a duonied by abdominal cramping, weakness, fatigue, abdominal denal ulcer, while pain that is exacerbated by eating is bloating and flatulence, nausea, vomiting and fever. Signs more suggestive of a gastric ulcer. Encourage the patient of dehydration and electrolyte/metabolic abnormalities may to remove aggravating factors such as cigarette smoking, be found on physical exam. Low back pain, abdominal dis- NSAID or aspirin use and alcohol. Avoiding foods that tention, vague discomfort, anorexia and headache may be cause dyspepsia also will aid in healing. Any patient with 12

THE KENTUCKY PHARMACIST

Nov. 2014 CE — Abdomen, Musculoskeletal, and Nervous Systems

Table 3. Exclusions for self-treatment of diarrhea and constipation1

November 2014

ized by recurrent symptoms and may require long-term or maintenance therapy. Self treatment may include nonpharmacologic therapy such as changing the diet, elevating the head of the bed and avoiding medications that affect the lower esophageal sphincter. Patients presenting with warning symptoms (e.g., dysphagia, choking, bleeding, weight loss) or atypical symptoms (e.g., chest pain, pulmonary symptoms, chronic hoarseness, chronic cough or pharyngitis) should be evaluated by a physician. Patients who do not respond to self-care, including lifestyle modifications and OTC treatment, after two weeks also should be referred for a complete evaluation.2

Exclusions for self-treatment of diarrhea Patients less than 6 months of age Significant dehydration Persistent fever or vomiting, or abdominal pain Significant medical comorbidities (e.g., uncontrolled diabetes, immunosuppression) Pregnancy Chronic or persistent diarrhea (e.g, symptoms not resolved after 48 hours)

MUSCULOSKELETAL Leg pain is a frequent complaint relating to the peripheral vascular system. Leg pain, cramping or weakness that occurs with walking and is relieved with rest is termed intermittent claudication, and is a primary symptom associated with peripheral vascular disease (PVD). It is caused by hypoxia, or lack of oxygen to the leg muscles. Leg pain also can result from musculoskeletal problems, trauma and various other causes (e.g., deep vein thrombosis or DVT).

Poor response to self-treatment Blood, mucus, or pus in the stool Exclusions for self-treatment of constipation Significant abdominal pain or distention Accompanying fever, nausea, and/or vomiting

Edema in the extremities, manifested as a change in the usual contour of the leg, also may be a common complaint of patients. When assessing a patient’s peripheral edema, Dark, tarry, bloody, or pencil thin stools press your index finger on the extremity and hold for severPersistent (i.e., two weeks or more) or recurrent (i.e., over al seconds. A depression that does not rapidly refill and 3 months or more) symptoms resume its original contour indicates pitting edema. This finding is not usually accompanied by a thickening or History of inflammatory bowel disease change in pigmentation of the overlying skin, which may be suspected PUD should be referred to a physician for further more indicative of venous stasis. Peripheral edema may be evaluation. secondary to heart failure, PVD, DVT, trauma or renal failure. GERD is a disorder in which gastric contents are refluxed into the esophagus. Risk factors for this disorder may inIf a patient presents with unilateral leg swelling, warmth, clude: erythema and tenderness, a DVT may be suspected. A Unexplained changes in bowel habits or significant weight loss



Large meals and eating before bedtime



Dietary fat



Chocolate, peppermint, alcohol and caffeine



Medications (e.g.,alpha blockers, beta blockers, calcium channel blockers, anticholinergics, theophylline, benzodiazepines, barbiturates)



Pregnancy and obesity

DVT is defined as the presence of a thrombus, or clot in a deep vein and is accompanied by an inflammatory process in the vessel wall. Blood flow stasis, vascular damage and hypercoagulability are all factors which may predispose the patient to thrombus formation. Major veins that are commonly affected include the iliac, femoral and popliteal. Risk factors associated with DVT include: 

Orthopedic surgical procedures



Cancer

The patient may present with heartburn (retrosternal burning and discomfort), water brash (hypersalivation), belching, dysphagia or respiratory symptoms (e.g., morning hoarseness, pneumonitis, cough, wheezing and chest tightness).



Fractures of the spine, pelvis, femur and tibia



Immobilization



Pregnancy



Estrogen use

Generally, GERD is a chronic condition that is character-



Hypercoagulable disease states

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Nov. 2014 CE — Abdomen, Musculoskeletal, and Nervous Systems Occasionally, a cord-like obstruction may be felt on palpation of the affected leg, but patients also may be asymptomatic. Skin color may vary between erythema (redness), pallor (paleness) or cyanosis (a dusky blue hue). The major concern of a DVT is the risk of a thrombus detaching and moving to the lung, which is termed pulmonary embolism (PE). Any suspicion of a DVT or PE should be referred for emergency attention.

November 2014

Table 4. Common headache signs and symptoms1,2 HEADACHE TYPE

SIGNS

SYMPTOMS

Tension

May be non-specific

Bilateral Pain “Band-like” Pressing/tightening Constant Pain

Migraine

Aura Visual disturbances Sensory disturbances Local weakness

Unilateral pain Pulsating Nausea Vomiting Photophobia Phonophobia Pain aggravated by physical activity

NERVOUS SYSTEM

The nervous system is divided into Cluster Evening pain Unilateral pain Stabbing pain two parts, the central nervous system Pain clusters over an eye (CNS) and the peripheral nervous system (PNS). The brain and spinal cord are included in the CNS, while the PNS includes the disease. Hypertension and atherosclerosis are the most 12 pairs of cranial nerves, the 31 pairs of spinal nerves and common causes of cerebrovascular disease. the corresponding branches. The PNS carries messages to Cerebrovascular disease is generally divided into transient the CNS from sensory receptors and from the CNS out to ischemic attacks (TIAs) and cerebrovascular accidents the muscles, organs and glands. The evaluation of motor, (CVAs). Transient ischemic attacks are sometimes referred sensory, autonomic, cognitive and behavioral elements to as “mini-strokes”, and although they typically last less makes neurologic assessment one of the most complex than five minutes, both TIAs and CVAs should be considportions of the physical examination. ered medical emergencies. Patients with acute neurologic Many neurologic and systemic medical illnesses result in events, such as a CVA or TIA, must be hospitalized and specific abnormalities in cranial nerve function. Some of the monitored closely. most common conditions that elicit questions from patients On initial presentation to an emergency department, hemconcerning neurologic diseases include headaches, transiorrhagic events are ruled out with computed tomography ent ischemic attack (TIA) and cerebrovascular accident (CT) or magnetic resonance imaging (MRI) before initiation (CVA), or stroke. of therapy. A pharmacist should be able to recognize sympPharmacist assessment of headaches relies heavily on toms of a stroke and make an appropriate immediate refersubjective information from the patient. Summarized in Ta- ral to the physician. Because acute treatment options are ble 4 are the most common types of headaches and their often based on the time since the onset of symptoms, pharcorresponding signs and symptoms. Because the majority macists suspecting a CVA or TIA should contact emergenof initial treatment options for patients with headaches incy personnel. Symptoms of cerebrovascular disease may clude OTC products, it is important for pharmacists to famil- include the following symptoms: iarize themselves with the common signs and symptoms so  Weakness they can assist patients with product selection, or refer to a physician for further assessment.  Paralysis Cerebrovascular disease is a broad term encompassing conditions relating to the blood vessels of the CNS, which is one of the leading causes of morbidity and mortality in the United States. It results from decreased blood flow to the brain or hemorrhage into the CNS with subsequent neurologic dysfunction. Risk factors for cerebrovascular disease include hypertension, dyslipidemia, diabetes mellitus, cardiac disease, cigarette smoking, alcohol abuse, family history and/or previous history of cerebrovascular



Numbness



Aphasia



Visual changes



Dizziness



Sudden, severe and unexplained headache



Slurred speech

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Nov. 2014 CE — Abdomen, Musculoskeletal, and Nervous Systems

November 2014

16th ed. Washington DC: The American Pharmaceutical Association; 2009.

Conclusion

With the rising cost of health care, more and more patients find themselves looking for opportunities to self treat a vari- 2. Dipiro JT, et al (eds): Pharmacotherapy: A Pathophysiety of medical ailments. While some conditions are amenaologic Approach. 7th ed. McGraw Hill; 2008. ble to self-treatment, others call for prompt medical evaluation. By using effective communication and patient assess- Suggested Readings ment skills, pharmacists are in an ideal position to help 1. Jones RM and Rospond RM. Patient Assessment in guide patients towards the best course of care. Pharmacy Practice. 2nd ed. Baltimore (MD): Lippincott Williams & Wilkins; 2006. References 1. Berardi RR, Ferreri SP, Hume AL, Kroon LA, Newton GD, Popovich NG et al, editors. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care.

2. Longe RL and Calvert JC. Physical Assessment: A Guide for Evaluating Drug Therapy.1st ed. Vancouver: Applied Therapeutics, Inc; 1994.

November 2014 — Pharmacist Patient Assessment Skills for Optimizing Self-Care, Part 4 of 4: Evaluation of the Abdomen, Musculoskeletal, and Nervous Systems 1. Nausea may be associated with a number of conditions including: A. Viral illness. B. Pregnancy. C. Motion sickness. D. All of the above.

7. Constipation may be caused by all of the following EXCEPT: A. Opiate analgesics. B. Lack of exercise. C. Iron supplements. D. Antacids containing magnesium.

2. Excessive thirst, decreased urine output, dry mucous membranes and fever without sweating are all signs of: A. Peptic ulcer disease. B. Gastroesophageal reflux disease. C. Dehydration. D. Constipation.

8. Which of the following medications may cause diarrhea? A. Opiate analgesics B. Antacid (containing magnesium) C. Vincristine D. Anticholinergics

3. A disorder in which gastric contents are refluxed into the esophagus is termed: A. Dysphagia. B. Pneumonitis. C. GERD. D. Pharyngitis. 4. Weakness, numbness, visual changes, slurred speech and aphasia are all symptoms associated with: A. Tension headache. B. Cerebrovascular accident. C. Cluster headache. D. Intermittent claudication. 5. Bilateral, "band-like", pressing/tightening and constant pain are symptoms of which type of headache? A. Tension B. Migraine C. Cluster D. Withdrawal 6. Risk factors that are associated with a DVT include all of the following EXCEPT: A. Orthopedic surgical procedures. B. Regular exercise. C. Pregnancy. D. Estrogen use.

9. Self treatment for GERD may include all of the following EXCEPT: A. Consuming a large glass of caffeine prior to bedtime. B. Changing the diet. C. Elevating the head of the bed. D. Avoiding medications that affect the lower esophageal sphincter. 10. Pharmacists suspecting a CVA or TIA should: A. Wait until 3 symptoms are present. B. Contact emergency personnel immediately. C. Consider changing the patient’s medications. D. Wait 1 day to see if symptoms persist. 11. If a patient presents with unilateral leg swelling, warmth, erythema and tenderness, a _________ may be suspected. A. DVT B. Tension headache C. TIA D. PE 12. Which of the following would exclude a patient from selftreatment of constipation? A. Significant abdominal pain or distention B. Dark, tarry, bloody or pencil thin stools C. History of inflammatory bowel disease D. All of the above are exclusions to self-treatment

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Nov. 2014 CE — Abdomen, Musculoskeletal, and Nervous Systems

November 2014

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: December 2, 2017 Successful Completion: Score of 80% will result in 2.0 contact hour or 0.2 CEU. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. November 2014 — Pharmacist Patient Assessment Skills for Optimizing Self-Care, Part 4 of 4: Evaluation of the Abdomen, Musculoskeletal, and Nervous Systems (2.0 contact hours) Universal Activity # 0143-9999-14-011-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D 10. A B C D

11. A B C D 12. A B C D

Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ______________________________________________Completion Date __________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) PHARMACISTS ANSWER SHEET November 2014 — Pharmacist Patient Assessment Skills for Optimizing Self-Care, Part 4 of 4: Evaluation of the Abdomen, Musculoskeletal, and Nervous Systems (2.0 contact hours) Universal Activity # 0143-9999-14-011-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D 10. A B C D

11. A B C D 12. A B C D

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ______________________________________________Completion Date __________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

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KPhA Pharmacy Emergency Preparedness

November 2014

Coming Soon! Emergency Preparedness Training YOUR KPhA has developed two emergency preparedness training programs for the KPhA Pharmacy Volunteers that will be available online in the next few weeks. Watch eNews for more information on these programs. Also, KPhA Director of Pharmacy Emergency Preparedness, Leah Tolliver, is developing a new CE program that will roll out this winter and spring at our local organizations about preparing your pharmacy in the event of a disaster.

These tips and procedures will be relevant to all pharmacies including retail, hospital, long term care and compounding. If you are interested in seeing this program at your local organization meeting, contact your local leader or KPhA! This program also will be offered at the 137th KPhA Annual Meeting and Convention June 25-28, 2015 in Bowling Green!

KPhA Pharmacy Emergency Preparedness Initiative Interest Form Name: ______________________

Status (Pharmacist, Technician, Other): ___________________

Email: ______________________________ Phone: ___________________________ For Pharmacists: Interest in serving as a volunteer: Yes____ No _____ You also may join the Medical Reserve Corps by following the KHELPS link on KPhA Website to register (www.kphanet.org under Resources) Please send this information to Leah Tolliver, KPhA Director of Pharmacy Emergency Preparedness via email at ltolliver@kphanet.org, fax to 502-227-2258 or mail at KPhA, 1228 US 127 South, Frankfort, KY 40601.

For more Emergency Preparedness Resources, visit www.kphanet.org, click on Resources and Emergency Preparedness. 17

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CE Article Guidelines

November 2014

YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to completing a continuing education article for publication in The Kentucky Pharmacist.  

 



Include a quiz over the material. Usually between 10 to 12 multiple choice questions.



Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers.

Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred). 

When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.

Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not pertinent to technicians, that needs to be stated clearly Articles should address topics designed to narrow at the beginning of the article. gaps between actual practice and ideal practice in Article should begin with the goal or goals of the pharmacy. Please see the KPhA website overall program – usually a few sentences. (www.kphanet.org) under the Education link to see Include 3 to 5 objectives using SMART and meas- previously published articles. urable verbs.



Articles must be submitted electronically to the KPhA director of communications and continuing education Feel free to include graphs or charts, but please submit them separately, not embedded in the text (ssisco@kphanet.org) by the first of the month preceding publication. of the article.

Kentucky Pharmacists Political Advocacy Contribution Form Name: _________________________________ Pharmacy: ___________________________ Address: _______________________ City: ________________ State: _____ Zip: ________ Phone: ________________ Fax: __--_______________ E-Mail: __________________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601

CONTRIBUTION LIMITS The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election. Individuals may contribute no more than $1,500 per year to all PACs in the aggregate. In-kind contributions are subject to the same limits as monetary contributions.

Cash Contributions: $50 per contributor, per election. Contributions by cashier’s check or money order are limited to $50 per election unless the instrument identifies the payor and payee. KRS 121.150(4) Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election. (This information is in accordance with KRS 121. 150)

THE KENTUCKY PHARMACIST

Dec. 2014 CE â&#x20AC;&#x201D; Preventing Errors

November 2014

Preventing Errors in the Pharmacy to Improve Patient Safety By: Lauren E. Glaze, PharmD, Julie N. Burris, PharmD, Sullivan University College of Pharmacy There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-14-012-H05-P&T 1.5 Contact Hours (0.15 CEU)

KPERF offers all CE articles to members online at www.kphanet.org

Objectives At the conclusion of this article, the reader should be able to:

1. Define medication errors and identify the most common errors made in the community pharmacy setting. 2. Describe at what point(s) medication errors may occur in the chain of pharmaceutical patient care. 3. Recognize the common causes of medication errors. 4. Identify methods for pharmacy clerks, technicians and pharmacists to prevent medication errors. Medication Errors The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as "â&#x20AC;Ś 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."1 To define medication errors, the Council also classifies medication errors by whether the error reached the patient, if the patient was harmed and the severity of the outcome (if applicable). The classification of medication errors are listed in the chart on the next page. Another way to consider medication errors is to classify them by type instead of outcome. For example, common

errors that occur in the community pharmacy setting are Errors of Omission, Errors of Commission and System Errors (see chart below). How do pharmacists and pharmacy staff prevent these errors? The first step in preventing errors is gathering information on what leads to errors. Recognizing that a medication error has occurred is the beginning of the quality improvement cycle. Finding out why it occurred is the next step. The next section will focus on the causes of medication errors and the most common scenarios for the errors to take place. Where do Medication Errors Occur? Prescribing Step: A medication error may take place at any step of the process. The first and most common errors occur during the prescribing step, with the vast majority of these errors due

TYPE

DEFINITION

EXAMPLE(S)

Errors of omission

Failing to do something correctly

Errors of commission

Doing something incorrectly

System error

An error that is not the result of an individual's actions but the predictable outcome of a series of actions and factors that comprise a diagnostic or treatment process 19

Failing to include strength of a medication on a prescription Failing to administer a dose of medication Prescribing the wrong antibiotic Dispensing an incorrect dose of an appropriate drug Bypassing a drug interaction alert Poor lighting Inadequate staffing Handwritten orders Ambiguous drug labels

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Dec. 2014 CE — Preventing Errors

to missing patient information on the prescription.2,3 One way to prevent this from happening is for prescribers to be provided with prompts on exactly what information is necessary. An "ideal" prescription pad with prompts for the common parts of a prescription (i.e., name, strength, dose, frequency, etc.) could decrease the amount of possible “guesswork” for pharmacy staff. The prescription pad also can include a prompt for the medication's indication, further increasing communication between the prescriber and pharmacist. Let’s look at the following prescription for any prescribing errors.

November 2014

The pharmacy technician enters the information as “Diazepam 5mg Take 1 tablet by mouth three times daily Dispense: #40” The staff pharmacist verifies the order, as this is a common strength and dosage duration for diazepam, and therefore approves the prescription for sale to the patient. Upon the patient’s arrival for the medication, the pharmacist asks the patient what the medication is for. The patient responds, “my doctor said my bladder was having spasms.” Quickly, the pharmacist calls to verify the order with the physician’s office and learns that the prescription is for bladder spasms and reads as follows: “Ditropan 5mg Take 1 tablet by mouth three times daily Dispense: #40”

THE KENTUCKY PHARMACIST

Dec. 2014 CE — Preventing Errors

November 2014

This scenario is an example of the risks of missing information on a prescription and encourages the use of prescription pad templates with a prompt for the medication’s indication.

and procedures. This creates a standard of practice for all to follow. These can also be reviewed if an error occurs; procedures can then be improved to prevent future errors.6

Electronic prescriptions are legible, neat and a faster option for prescriptions, but they are not without error. Over half of all prescriptions in the U.S. are transmitted electronically. These electronic prescribing systems still require human intervention. It's estimated that a pharmacist intervenes in one out of every 10 e-prescriptions.4 With electronic prescriptions, errors have occurred such as the prescriber choosing the wrong product, selecting a liquid form or more expensive tablet when a cheaper capsule is available, selecting the wrong patient or inconsistent directions and/or quantities.5 For example, the following prescription is easily read, but the instructions for use leave the pharmacist to question what the physician actually intended.

What are the Causes of Medication Errors? Abbreviations: While it is important to know where medication errors may occur, it is equally important to recognize the most common causes of medication errors. Many factors along the way can contribute to the failure of the medication use system and result in medication errors. Organizations like The Institute for Safe Medication Practices (ISMP) and the Joint Commission collect data on medication errors, analyze the data to reveal the causes of errors and then alert pharmacists and prescribers so that errors can be prevented. Abbreviations, though useful, have proven to be dangerous. The Joint Commission released its “Do Not Use” List to prevent these errors. The table on pages 24 and 25 includes other common errors with abbreviations.7 Sound-Alike, Look-Alike Drugs:

Another common cause of medication errors is the mix-up of “Sound-Alike, Look-Alike Drugs.” The FDA requires TALL MAN lettering for at least 33 of these potentially confused generic medications. For example, glipizide is printed The electronic prescription contains two different directions, as glipiZIDE to avoid confusion with glyBURIDE, or prednileaving the pharmacist to call and clarify with the physician. sone and prednisoLONE. Dispensing Step:

Drug Name Suffixes:

Another area where the majority of medication errors may occur is during the dispensing step. This also is where the most legal claims are filed against the pharmacist, so it is important to avoid these errors. According to the NCC MERP, the following rules for best pharmacy practice should be implemented to the pharmacy staff to avoid dispensing medication error:

Suffixes at the end of drug names such as CD, LA, ER, XR, SR, and XL can lead to errors. Errors that result from the use of suffixes may happen because of confusion about the suffix, not knowing what the suffix means and lack of standardized meanings of suffixes. This can lead to product mixups, prescriptions written with incorrect dosing intervals or frequencies, omission of a suffix, incorrect suffix, etc.8



Wellbutrin SR and Wellbutrin XL are commonly confused Patient profiles should be current and contain enough information for pharmacists to assess appropriateness. suffixes. Both Wellbutrin SR and Wellbutrin XL formulations of bupropion are expected to have similar efficacy for treatWork areas should be well designed to help prevent ing depression. The difference is that Wellbutrin XL is given errors with adequate lighting, low noise and few disonce a day instead of twice a day. For example, Wellbutrin tractions. XL 300 mg once a day is equivalent to Wellbutrin SR 150 mg twice a day. It is important to note also what the incorDrugs should be organized to reduce confusion berect suffix is, as seen below: tween similar names, labels or strengths. Pharmacists should counsel patients when dispensing medications. This is an important safety check for dispensing and patient comprehension. Pharmacies should have and follow dispensing policies 21

THE KENTUCKY PHARMACIST

Dec. 2014 CE — Preventing Errors

November 2014 Dangerous Abbreviations

Abbreviation

Intended Meaning

Potential Error

Recommendation

Joint Commission’s “Do Not Use" List U or u

Unit

Misread as “0", “4", or “cc"

Write “unit"

International unit

Misread as IV (intravenous) or “10"

Write “international unit"

q.d., Q.D., qd

Every day

Misread as four times daily (qid)

Write “daily"

q.o.d., Q.O.D., QOD

Every other day

Misread as daily (q.d.) or four times daily (qid)

Write “every other day"

X.0 mg

X mg

Decimal point is missed

Never write a “0" by itself after a decimal point

.X mg

0.X mg

Decimal point is missed

Write “0" before a decimal point

Morphine sulfate or magnesium sulfate

Confused for the opposite intended

Write “morphine sulfate"

MSO4

Morphine sulfate

Confused for magnesium sulfate

Write “morphine sulfate"

MgSO4

Magnesium sulfate

Confused for morphine sulfate

Write “magnesium sulfate"

Possible Future Inclusions on Joint Commission’s “Do Not Use" List µg

Microgram

Misread as milligram (mg)

Write “mcg" or “micrograms"

Greater than

Misread as “7" or “less than"

Write “greater than"

Less than

Misread as “L" or “greater than"

Write “less than"

Drug abbreviations (e.g., Varies TAC)

Misread as drug with similar name or Write entire drug name abbreviation

Misread as “2"

Write “at"

c.c.

Cubic centimeter

Misread as “U" (units)

Write “mL" or “milliliters"

Apothecary units (e.g., minims, grains)

Varies

Confused with metric units; unfamil- Use metric system iar to some health care professionals

APAP

Acetaminophen

Not recognized as meaning acetaminophen

AZT

Zidovudine (Retrovir)

Mistaken as azathioprine, aztreonam Write full drug name

CPZ

Compazine (prochlorperazine)

Mistaken as chlorpromazine

Write full drug name

MTX

Methotrexate

Mistaken as mitoxantrone

Write full drug name

TAC

Triamcinolone

Mistaken as “tetracaine, Adrenalin, cocaine"

Write full drug name

Even though Wellbutrin does not come in an LA formulation, the pharmacy staff must not assume it is the SR formulation based on the dosing interval. Both SR and XL Wellbutrin formulations have a 150mg dose. Assuming correct suffixes is just as dangerous as confusion between correct suffixes.

and is usually given two to three times a day. Both are equally effective at their recommended doses for seizure management. Strong caution and consideration should be used by the pharmacy staff when processing these prescriptions.

There also is potential for confusion between Depakote ER and the original Depakote tablets, which are delay-release. Depakote ER comes in a 250 mg and a 500 mg tablet and is approved for preventing both migraines and seizures. The original Depakote releases drug over eight to 12 hours

These medications listed below by the ISMP require constant and thorough attentiveness to their strength, dosing, dosage forms, directions, etc. For example, methotrexate dosed daily can be lethal, and it must be put on high-alert for its correct once weekly dosing.

High-Alert Medications:

THE KENTUCKY PHARMACIST

Dec. 2014 CE — Preventing Errors

November 2014

Examples of Other Abbreviations to Avoid /

Separate doses or “per"

Misread as the numeral “1"

H.S.

Half-strength or at bedtime

Misread as the opposite intended. If Write “half-strength" or “at written “qH.S." misread as every bedtime" hour.

T.I.W.

Three times a week

Misread as three times a day or twice weekly

Write “three times weekly"

S.C. or S.Q.

Subcutaneous

Misread as sublingual (SL) or “5 every"

Write “Sub-Q," “subQ" or “subcutaneously"

D/C

Discharge

Misread as “discontinue" whatever follows (e.g., discharge meds are discontinued)

Write “discharge"

A.S., A.D., A.U.

Left, right, both ears

Misread as OS, OD, OU (left, right, both eyes)

Write “left ear," “right ear," “both ears"

O.S., O.D., O.U.

Left, right, both eyes

Misread as AS, AD, AU (left, right, both ears)

Write “left eye," “right eye," “both eyes"

Use as directed

Misread as unit dose

Write “as directed"

“Plus" or “and"

Misread as the numeral “4"

Write “and"

q 6PM, etc.

Nightly at 6 PM

Misread as every 6 hours

Write “nightly at 6 PM"

x3d

For three days

Misread as for three doses

Write “for three days"

One-half or sliding scale (insulin)

Misread as “55"

Write “1/2" or “one-half;" write “sliding-scale"

Nightly or at bedtime

Misread as “qh" (every hour)

Write “nightly"

Intranasal

Misread as “IV" (intravenous) or “IM" (intramuscular)

Write “intranasal"

Intrathecal

Mistaken for other routes of administration (e.g., intratracheal)

Write “intrathecal"

Write “per"

THE KENTUCKY PHARMACIST

Dec. 2014 CE — Preventing Errors

November 2014

Patient Counseling:

with behaviors and practices that keep patients safe.

Not enough can be said about the importance of patient education. Patients are the final step in preventing a medication error. When counseling patients, be sure to use language that is simple and clear, free from "medical jargon" that patients may not understand. Furthermore, patient information is meant to help patients understand and properly use their medications. This information is often distributed through medication leaflets, commonly known as patient information sheets. Patient information sheets should supply sufficiently specific information, including directions for use and/or adverse reactions. They also should be easy for patients to read and understand by using patient-friendly language and having proper print size and spacing.9

Technology is a huge benefit to the community pharmacy, whether by automating prescriptions, electronic prescribing, computer data entry or barcoding medications. However, it cannot be overstated that technology is not flawless. Computerized pharmacy programs still require human intervention and checking by all staff in the pharmacy.

References 1. National Coordinating Council for Medication Error Reporting and Prevention. About Medication Errors. www.nccmerp.org/aboutMedErrors.html. (Accessed September 29, 2014). 2. Malone PM, Mosdell KW, Kier KL, et al. Drug Information: A Guide for Pharmacists. 2nd ed. New York, NY: McGraw-Hill Publishing, 2001.

Even more so, by simply counseling a patient, one could find out that the medication prescribed was Ditropan, instead of Diazepam, as mentioned in our previous example. 3. Kennedy AG, Littenberg B. A modified outpatient prescription form to reduce prescription errors. Jt Comm J If the pharmacist had not counseled the patient, a medicaQual Saf 2004;30:480-487. tion error would have occurred and possibly caused harm to the patient. 4. Gilligan AM, Miller K, Mohney A, et al. Analysis of pharmacists’ interventions on electronic versus traditional How Can Medication Errors be Prevented? prescriptions in two community pharmacies. Res SoIndividual Responsibilities: cial Adm Pharm 2012;8:523-532. Individual responsibility for each pharmacy clerk, technician 5. Grossman JM, Cross DA, Boukus ER, Cohen GR. and pharmacist should be based on the Five “RIGHTS”, i.e. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. J RIGHT PATIENT Am Med Inform Assoc 2012;19:353-359. RIGHT DRUG RIGHT DOSE 6. National Coordinating Council for Medication Error ReRIGHT TIME porting and Prevention. About Medication Errors. RIGHT ROUTE www.nccmerp.org/aboutMedErrors.html. (Accessed September 29, 2014). Taking a moment to verify this information could mean the difference between Mr. Rodger’s and Mr. Roger’s prescrip7. Institute for Safe Medication Practices. Special Issue tion being incorrectly filled, a 2 year old child receiving OmDo Not Use These Dangerous Abbreviations or Dose nicef Suspension QD vs. QID or using Ciprodex Otic in the Designations. www.ismp.org/Newsletters/acutecare/ eye compared to the ear. Looking over the Five “RIGHTS” articles/20030220_2.asp. (Accessed September 29, is imperative to preventing medication errors. 2014). Organizational Responsibilities: 8. National Coordinating Council for Medication Error Reporting and Prevention. Council recommendations. The best way to prevent medication errors is to design a Promoting the safe use of suffixes in prescription drug system that includes adequate safety nets with checks and names. http://www.nccmerp.org/council/council2008-08 balances. When errors do slip through, documenting and -01.html. (September 29, 2014). evaluating the cause of the error will help improve the entire system. Individual members of organizations must be 9. Svarstad BL, Mount JK, Tabak ER. Expert and conmotivated and rewarded for using safe practices. Shortcuts sumer evaluation of patient medication leaflets providfor the sake of speed or impatient customers should be ed in U.S. pharmacies. J Am Pharm Assoc (2003) discouraged, as problems must be identified and replaced 2005;45:443-451.

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Dec. 2014 CE — Preventing Errors

November 2014

December 2014 — Preventing Errors in the Pharmacy to Improve Patient Safety 1. Which of the following is true concerning medication errors? A. Pharmacy technicians should not worry about medication errors, since the pharmacist will catch most of the errors. B. Medication errors are preventable. C. Medication errors will not harm patients. D. Medication errors do not have to be reported if the consequences to the patient are insignificant. 2. Good general practices to help prevent medication errors include which of the following? A. Use your best judgment and guess missing patient information. B. Gather as much information as you can, both from patients and from resources that help you keep up with new medications, etc. C. Hurry patients along, even if they have questions, to reduce noise and distractions in your pharmacy. D. Bypass computer alerts unless they look very serious, as the system alerts for too many “issues.”

7. When a patient receives the wrong dose of a medication, this is which type of medication error? A. System error B. Individual error C. Error of Commission D. Error of Omission 8. Which of the following is true concerning Electronic Prescriptions? A. Human intervention is never needed as the computer system will correct any mistakes. B. Prescribers can only select matching quantities for the medication’s specific dosing regimen. C. Instructions are always clearly understood and applicable to the prescribed medication. D. Over 50 percent of prescriptions are now sent electronically to the pharmacy. 9. In reference to the following prescription, which of the following is true?

3. Which of the following problems could potentially be detected at the order entry step during prescription processing? A. That dosing intervals don't match up with the drug name's suffix (or lack of a suffix), like immediate-release generic metoprolol tablets dosed once daily. B. That a patient is taking his or her medication in the morning, when the medication should be taken at bedtime. C. That the patient is having side effects from his or her A. The technician can safely assume “TB24” means the medication. “ER” formulation of metformin. D. That an antibiotic suspension was not refrigerated B. A normal dose of Metformin 500mg is given once daily. properly. C. The pharmacist should call to verify “TB24” for safe dispensing to the patient. 4. Which of the following medication(s) should be regarded as D. Since this prescription was sent electronically, it should a “High-Alert” Medication, per ISMP? be filled as written and not questioned. A. Coumadin B. Humalog R C. Carbatrol D. All of the above

Save the Date

5. Which of the following orders contains abbreviation(s) that should not be used in order to avoid medication errors? A. Omeprazole 20mg BID (twice daily) B. Vitamin D 50,000 IU (international units) C. Levothyroxine 0.05mg qam (every morning) D. Gabapentin 600mg q 8 hours (every eight hours) 6. Which of the following is/are encouraged to prevent “Look-Alike, Sound-Alike Drugs” from being confused? A. Using “TALL MAN” lettering (glipiZIDE) B. Separating these drugs on the pharmacy shelf with spacers or dividers C. Placing these medications on the pharmacy shelf with the same color shelf tags D. A & B

137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY THE KENTUCKY PHARMACIST

Dec. 2014 CE — Preventing Errors

November 2014

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: November 6, 2017 Successful Completion: Score of 80% will result in 1.5 contact hour or 1.5 CEU. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. December 2014 — Preventing Errors in the Pharmacy to Improve Patient Safety (1.5 contact hours) Universal Activity # 0143-0000-14-012-H05-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) PHARMACISTS ANSWER SHEET December 2014 — Preventing Errors in the Pharmacy to Improve Patient Safety (1.5 contact hours) Universal Activity # 0143-0000-14-012-H05-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

THE KENTUCKY PHARMACIST

Kentucky Renaissance Pharmacy Museum

November 2014

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's leading preservation organization for pharmacy. While contributions of any size are greatly appreciated, the following levels of annual giving have been established for your consideration.



Friend of the Museum $100  Proctor Society $250 

Damien Society $500  Galen Society $1,000

Name______________________________________ Specify gift amount________________________ Address ____________________________________ City____________________Zip______________ Phone H____________________W________________ Email___________________________________ Employer name_____________________________________________________for possible matching gift. Tributes in honor or memory of_____________________________________________________ Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax deductible contributions will be mailed to you annually.

Questions: Contact Lynn Harrelson @ 502-425-8642 or Lharrelsonky@aol.com

For more information on the museum, see www.pharmacymuseumky.org or contact Gloria Doughty at g.doughty@twc.com or Lynn Harrelson at lharrelsonky@aol.com.

Pharmacists Mutual Insurance offers Medicare Surety Bond In 2009 the Centers for Medicare and Medicaid Services (CMS) implemented Surety Bond Requirements for suppliers of Durable Medical Equipment, Prosthetics and Supplies (CMS-6006-F). This ruling requires that each existing supplier must have a $50,000 surety bond to CMS.

To see if you qualify for a $250 Medicare Surety Bond, or would like information regarding our other products, please contact us:   

Pharmacists Mutual Insurance Company, through its subsidiary PMC Advantage Insurance Services, Inc. d/b/  a Pharmacists Insurance Agency (in California), led the way to meet this requirement by negotiating the price of the bond from $1,500 down to $250 for qualifying risks.

Call 800.247.5930 Extension 4260 E-mail medbond@phmic.com Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/ services/ibs/Pages/Home.aspx In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.

Donate online to the Kentucky Pharmacists Political Advocacy Council! Go to www.kphanet.org and click on the Advocacy tab for more information about KPPAC and the donation form.

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

November 2014

KPhA Welcomes New and Renewing Members September-October 2014 Michael Akers Grayson

Kaleb Blair Whitesburg

Randy Crawford Franklin

Cynthia Akers Grayson

Lanny Branstetter Horse Cave

Robert Cull Owenton

Jennifer Anderson Morehead

James Brown Bowling Green

Marcelle Curtis Shelbyville

Sandra Anderson Monticello

Johnny Burke Prestonsburg

Rachel Damaske Saint Joseph, Mich.

Charla Applegate Nicholasville

Wendell Butler Burkesville

Kimberly Daugherty Louisville

Robin Applegate Nicholasville

Kenneth Calvert Glasgow

Michelle DeLuca Fraley Lexington

Thomas Arnold Nicholasville

Marietta Campoy Pikeville

Brittany Downing Pine Knot

Laura Fleener Leitchfield

John Ausenbaugh Dawson Springs

Don Carpenter Olive Hill

Derek Downing Alexandria

William Fleming Prospect

Nancy Barker Winchester

Joseph Carr Owensboro

David Dubrock Arlington

Charles Fletcher Monticello

Kerri Barman Scottsville

Michelle Casto-Litton Zionsville, Ind.

Michael Durbin McKee

Shane Fogle Central City

Ronald Barned Glasgow

Vickie Chaudry Corbin

Jennifer Dyer Albany

Timothy Ford Campbellsville

Justin Bell Lexington

Donald Clark Rockfield

Cathy Edwards Richmond

Milton Frizzell Murray

Jim Bell Sebree

Charles Clifton Fort Thomas

Mark Edwards Richmond

Barry Frost Columbia

Victoria Bell Burkesville

Rhonda Cochran Liberty

Rita Etter Williamson, W.Virg.

Keith Fuller Kimper

Christopher Betz Louisville

Elizabeth Cole Louisville

Brian Fingerson Louisville

Kelli Funk Louisville

Joseph Bickett Louisville

Kimberly Corley Owensboro

Jennifer Fitch Lexington

Judy Gallagher Madisonville

MEMBERSHIP MATTERS: To YOU, To YOUR Patients To YOUR Profession!

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

November 2014

Timothy Gallagher Madisonville

Jerry Horwitz Cincinnati, OH

Judith Lawson Monticello

Ronald McClish Simpsonville

Joyce Gardner Hodgenville

Marylou Hoskins Hawesville

Jill Lee Frankfort

Thomas McConnell Kuttawa

Linda Gormley Villa Hills

Marylou Hoskins Owensboro

Robert Lester Elkhorn City

Charlene McCown Grayson

John Gorrell Morehead

H. Harper Housman Paducah

Donna Lile Campbellsville

Jennifer Mccreary Louisa

Daniel Gray London

James Howze St. Augustine, Fla.

Douglas Linger Georgetown

Sheldon Mccreary Louisa

Marsha Greer-Arnold Louisville

Patrick James Louisville

Leslie Little Berea

Leeann McDonald Dunnville

Richard Griffieth Lexington

Phillip Johnson Georgetown

Jimmie Lockhart Lexington

Christopher McGlone Vanceburg

Jack Gross Louisville

Constance Jones Russell Springs

Aaron Lohnes Stanville

William McMakin La Grange

Erik Grove Madison, IN

Karen Jones Gilbertsville

Kathy Long Benton

John McMeans Ashland

Philip Hamilton Ludlow

Megan Kappes Fort Mitchell

Robert Long Louisville

Nicole McNamee Forest Hills

Gary Hamm Elizabethtown

Leigh Keeton Flatwoods

Carolyn Mallory Russellville

Jesica Mills Louisville

Kyle Harris London

Erin Kingrey Austin

Terry Manley Mount Sterling

Boyd Minnich Mount Sterling

Jeffrey Harrison Tompkinsville

Jerry Knifley Columbia

Nicholas Maroudas Williamson, W.Virg.

Mickey Monroe Frankfort

Emily Henderson Shelbyville

Kerry Knochenmus Louisville

John Marshall Henderson

Emily Morton Hardinsburg

Clara Herrell Lexington

Robert Knott Paducah

Charles Martin Crestwood

Amy Mueller Louisville

Amanda Holder Bowling Green

Dhaval Kotak Radcliff

Aleshea Martin Crestwood

Steven Mueller Petersburg

Michael Horne Georgetown

Kevin Lamping Lexington

William Mattingly Lebanon

Lance Murphy Louisville

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

November 2014

Daniel Nall Louisville

Andrea Potter-Adams Isom

Benjamin Scott Lexington

Cheryl Steiner Hopkinsville

David Nation Owensboro

Walter Powell Louisville

Joseph Serafini Frankfort

Laura Stone Louisville

Troy Neagle Glasgow

John Prine Bowling Green

Susanna Sexton Cornettsville

Jack Stone Mayfield

James Neat Louisville

Nicholas Rawe WIlder

Charles Shannon Louisville

Larry Stovall Scottsville

William Nebel Kuttawa

James Ray Hopkinsville

Michael Sheets Fisherville

Brittany Taylor Lancaster

Clarinda Newell Greenup

Levi Rice Beaver Dam

Nancy Shepherd Paducah

Gloria Taylor Louisville

Jamie Norman Russellville

Eugene Riley Russellville

Kelli Shirley Glasgow

Deborah Thorn Bowling Green

Kenneth Norwood Louisville

Stewart Riley Elkton

Jarrod Shirley Glasgow

Sandra Thornbury Pikeville

Fred Nowak Independence

Kristie Roark Whitesburg

Thomas Shively Owensboro

Joel Thornbury Pikeville

Robert Oakley Louisville

Elizabeth Routh Louisville

Angela Shoulders Bowling Green

David Triplett Louisville

Jeff O'Connor Frankfort

Ashley Saling Mammoth Cave

JD Shoulders Bowling Green

Brenda Turner Jackson

Jennifer O'Hearn Louisville

Gregory Sanders Lexington

Joe Simmons Glasgow

John Vaal Edgewood

Jennifer Parker Florence

Angela Sandlin Louisville

Angela Slaughter Covington

Lorne Virgin Grayson

Willie Patton Grayson

Phillip Sandlin Louisville

Lois Smith Blackey

Kelly Walker Philpot

Vincent Peak Louisville

Stanley Scates Lexington

Francis Southall Lebanon

Robert Wallace Dry Ridge

Robert Perkins Clinton

Ellen Schueler Franklin

Glenn Stark Frankfort

Todd Walters Pineville

Bernard Poe Owenton

Aron Schwartz Louisville

Sandra Staton Albany

Jeffrey Warner Jamestown

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

November 2014

Julie Warren Gamaliel

Denis Wiggins Louisville

Carol Wishnia Louisville

Leland Wright Lexington

Kim Wheatley Bardstown

Lisa Williamson Nicholasville

Simon Wolf Louisville

Arnold Zegart Prospect

David Whitley Russellville

Brenda Wilson Danville

William Wooden Leitchfield

Ronald Whitmore Alvaton

Jacob Wishnia Louisville

Glenn Wooden Leitchfield

Know someone who should be on this list? Ask them to join YOU in supporting YOUR KPhA!

KPhA Honorary Life Members Ralph Bouvette Leon Claywell Gloria Doughty Ann Amerson Stewart

THE KENTUCKY PHARMACIST

Pharmacy Law Brief

November 2014

Pharmacy Law Brief:

Alternative Dispute Resolution Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: I was speaking with a local attorney recently at a social function who indicated that mediation is occurring with increasing frequency and in some fields reducing the number of cases going to court, especially cases involving allegations of professional malpractice. Is this a local trend or something of wider impact?

Submit Questions: jfink@uky.edu Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.

Response: Mediation is one form of what is known as alternative dispute resolution, with the word “alternative” indicating that this is an option which avoids the courtroom and most legal processes attendant to a court proceeding. The two principal approaches are arbitration and mediation. Arbitration involves the two parties voluntarily agreeing to have a third party, known as the arbitrator, decide the matter. The arbitrator meets with both sides to hear their perspectives and then issues a decision which is binding. One will frequently hear of arbitration being used with salary disputes in the world of professional athletics. That imposition of a resolution differentiates arbitration from mediation. In mediation there is a third party known as the mediator, or sometimes called the “neutral,” who talks with the parties and then proposes a solution to the dispute. The mediator has no authority to impose the proposed outcome on the parties; they must both agree to the solution of their free will. Often a contract will then be used to formalize the agreed upon outcome. One description of mediation I’ve heard is that it represents presenting a “choice among a limited number of unwanted options.”

a role in deciding the final outcome rather than having it imposed by a judge, jury or arbitrator; (3) dispute may well be resolved more quickly; (4) ADR is a private affair thereby avoiding the public exposure of a court proceeding; and on and on.

The Kentucky Court of Justice has adopted Mediation Rules. To be placed on the Kentucky Roster of Approved Mediators one must complete a 40 hour training program and 15 hours of hands-on experience. One can then apply to be placed on the Roster of Mediators that is maintained by the Kentucky Administrative Office of the Courts. Like many professional fields, there is a mandatory continuing mediation education expectation for mediators of four hours every two years. A common misconception is that one must be an attorney to be a mediator; that is not at all the case. Sometimes mediation is seen in conjunction with a court Many mediators are social workers who mediate family disproceeding. For example, if one were to go to Small Claims putes. Court in Fayette County for resolution of a dispute involving less than $2,500, the jurisdictional limit of such a court, the Referring back to the original question or comment, I was judge will direct the parties to meet with one of a cadre of speaking with an attorney friend from Louisville who is acmediators standing by in an adjacent room to attempt to tive in the field of medical malpractice litigation who indicatresolve the matter without occupying the court’s time. ed that he knows several attorneys in the field who’ve not Mandatory arbitration clauses are being included in a wide variety of contracts as the means of handing disputes, e.g., credit card agreements, insurer-participating provider agreements, etc. In some cases this provision is buried near the end of a lengthy document and the parties are not both aware of its existence until a dispute arises. These approaches have gained in popularity in recent years for a number of reasons: (1) often less costly than going to court; (2) ability with mediation to continue to have

had a case go to trial in three years because mediation has become so popular as a way to resolve those disputes out of the public eye. In an area where one’s professional reputation is so very important that argument is not hard to buy. Finally, it is noteworthy for pharmacists that alternative dispute resolution is sometimes referred to as “ADR”, an abbreviation that in our field sometimes has a different meaning – adverse drug reaction! The two should not be confused. 32

THE KENTUCKY PHARMACIST

KPhA Save the Date/Connect/ EPIC

November 2014

Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

Are you connected to YOUR KPhA? Join us online!

Facebook.com/KyPharmAssoc

@KyPharmAssoc @KPhAGrassroots

KPhA Company Page

THE KENTUCKY PHARMACIST

Pharmacy Policy Issues

November 2014

PHARMACY POLICY ISSUES: New Federal Legislation Targets International Counterfeiting of Pharmaceuticals Author: Claire A. Hafner is a second professional year student at the University of Kentucky College of Pharmacy. A native of St. Charles, Ill., she completed her pre-professional preparation at UK. Issue: I’m a hospital pharmacist and I’ve had patients approach me with questions related to obtaining prescription pharmaceuticals from Internet pharmacies. I guess they ask me because they don’t want to ask their community pharmacist this question. Anyway, I’ve read in the professional literature about a major problem with counterfeiting of pharmaceuticals, some of which is very well done so the product really looks like the real thing. Can you provide an update on this issue? With today’s technology, a package of sophisticated counterfeit dosage units can look identical to the real product. Unfortunately, there is no way to tell if a tablet or capsule is real or fake, which is why online pharmacies are so dangerous to consumers. When individuals purchase prescription medications from outside the direct supply chain, there is no way to ensure that the medicines they are receiving contain the correct active ingredient and proper dosages. Customers of online pharmacies face many possible risks, According to the FDA, more than 19,600 packages containthe most serious being ing counterfeit medicines health risks — patients were sequestered in the may experience a reacaction, involving authorition to the counterfeit ties from 111 countries. medication, or may reThis column is designed to address timely and practical Many of the unapproved, ceive no therapeutic benissues of interest to pharmacists, pharmacy interns and fake drugs originated efit at all. In addition, conpharmacy technicians with the goal being to encourage from countries in Southsumers can face other thought, reflection and exchange among practitioners. east Asia, including Chirisks, such as credit card Suggestions regarding topics for consideration are welna, India, Laos, Malayfraud, identity theft or come. Please send them to jfink@uky.edu. sia, Singapore and Taicomputer viruses.3 wan. In addition, counterfeit medicine packages The FDA has been workwere found in Australia, New Zealand, Great Britain and ing to target the counterfeit medicines market, and this the United States. All in all, law enforcement agents arrest- worldwide operation worked to do just that. The FDA not ed a total of 237 individuals in May as a part of the worldonly seized almost 20,000 counterfeit medicine packages, wide crackdown, which resulted in the seizure of counterbut also notified Internet service providers and domain 2 feit and illegal medicines worth $31.4 million. name registrars of the 10,603 websites that were guilty of selling illegal prescription medications. Some of the counterfeit drugs that U.S. consumers ordered included medications such as pain relievers, hormone In conclusion, the Food and Drug Administration stated that medications (estrogen and human chorionic gonadotropin), it will continue to reinforce its national as well as internainsulin and medication for erectile dysfunction. In fact, 583 tional affiliations to “shed light on these Internet-based packages, many of which included the medications listed fraudulent activities,” indicated Philip Walsky, acting direcabove, were seized from international mail facilities in the tor of the FDA’s Office of Criminal Investigations. Hopefully United States. Many of these packages contained illegal the FDA also will continue to uphold the stringent drug and counterfeit prescription medicines that had been ormanufacturing standards and regulations that are present dered from Internet pharmacies online. in our country, to help protect our people. Discussion: A counterfeit drug is defined as a drug “made by someone other than the genuine manufacturer, or by copying or imitating an original product without authority or right, and then marketing the forged drug as the original.”1 Unfortunately, the illegal and counterfeit medicines market has expanded greatly in the past five years, enough so that the U.S. Food and Drug Administration was thrown into a worldwide crackdown this past May.

Have an Idea?:

THE KENTUCKY PHARMACIST

November 2014

Pharmacy Policy Issues

pharmaceuticals-counterfeitidUSKBN0E21DG20140522>.

References:

1. "General Information on Counterfeit Medicines." WHO. World Health Organization, n.d. Web. 07 July 2014. 3. Preidt, Robert. "Illegal Online Meds Targeted in World<http://www.who.int/medicines/services/counterfeit/ wide Crackdown, FDA Says." Consumer HealthDay. overview/en/>. Food and Drug Administration, 22 May 2014. Web. 07 July 2014. <http://consumer.healthday.com/health2. Hirschler, Ben. "Fake Medicines worth $31 Million technology-information-18/computers-internet-144/ Seized in Global Crackdown." Reuters. Thomson Reubreaking-brief-5-22-illegal-online-pharmacies-fdaters, 22 May 2014. Web. 07 July 2014. <http:// release-688137.html>. www.reuters.com/article/2014/05/22/us-

The Kentucky Pharmacist is online! Go to www.kphanet.org, click on Communications and then on The Kentucky Pharmacist link.

Would you rather receive the journal electronically? Email ssisco@kphanet.org to be placed on the Green list for electronic delivery. Once the journal is published, you will receive an email with a link to the online version.

THE KENTUCKY PHARMACIST

November 2014

Pharmacists Mutual

THE KENTUCKY PHARMACIST

Cardinal Health

November 2014

THE KENTUCKY PHARMACIST

KPhA Board of Directors/Staff

November 2014

KPhA BOARD OF DIRECTORS

HOUSE OF DELEGATES

Duane Parsons, Richmond dandlparsons@roadrunner.com

Chair 502.553.0312

Ethan Klein, Louisville kleinethan@gmail.com

Speaker of the House

Bob Oakley, Louisville Boakley@BHSI.com

President

Chris Harlow, Louisville cpharlow@gmail.com

Vice Speaker of the House

Chris Clifton, Villa Hills chrisclifton@hotmail.com

President-Elect

KPERF ADVISORY COUNCIL

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Secretary

Kim Croley, Corbin kscroley@yahoo.com

Glenn Stark, Frankfort glennwstark@aol.com

Treasurer

Kimberly Daugherty, Louisville kdaugherty@sullivan.edu

Raymond J. Bishop raybishop13@gmail.com

Past President Representative

Mary Thacker, Louisville mary.thacker@att.net

Directors

Matt Carrico, Louisville matt@boonevilledrugs.com

Matt Carrico, Louisville* matt@boonevilledrugs.com

KPhA/KPERF HEADQUARTERS 1228 US 127 South, Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc

Tony Esterly, Louisville tonye50@hotmail.com Matt Foltz, Villa Hills mfoltz@gomedcare.com Chris Killmeier, Louisville cdkillmeier@hotmail.com Mallory Megee, Nicholasville mallory.megee@uky.edu

University of Kentucky Student Representative

Jeff Mills, Louisville jeff.mills@nortonhealthcare.org

Scott Sisco, MA Director of Communications & Continuing Education ssisco@kphanet.org

Chris Palutis, Lexington chris@candcrx.com Christian Polen cpolen7392@my.sullivan.edu

Robert McFalls, M.Div. Executive Director rmcfalls@kphanet.org

Sullivan University Student Representative

Richard Slone, Hindman richardkslone@msn.com Mary Thacker, Louisville mary.thacker@att.net Sam Willett, Mayfield duncancenter@bellsouth.net

Angela Gibson Director of Membership & Administrative Services agibson@kphanet.org Leah Tolliver, PharmD Director of Pharmacy Emergency Preparedness ltolliver@kphanet.org Elizabeth Ramey Receptionist/Office Assistant eramey@kphanet.org

* At-Large Member to Executive Committee

KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the list. 38

THE KENTUCKY PHARMACIST

50 Years Ago/Frequently Called and Contacted

November 2014

50 Years Ago at KPhA FROM E.M. JOSEY’S SCOOPS ‘N’ SCRAPS First District Auxiliary The Auxiliary to the First District of the Kentucky Pharmaceutical Association has made a right generous contribution to the Kentucky Council on Pharmaceutical Education Scholarship Fund. First, we want to thank the girls in West Kentucky for their interest in Pharmacy and for their help, and second, we want to extend a most cordial invitation to anyone else who would like to contribute. - From The Kentucky Pharmacist, December 1964, Volume XXVII, Number 12.

Frequently Called and Contacted Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org

Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org info@kshp.org American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 info@ncpanet.org Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222

KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA informed by sending this information to eramey@kphanet.org. Deceased members for each year will be honored permanently at the KPhA office. 39

THE KENTUCKY PHARMACIST

November 2014

THE

Kentucky PHARMACIST 1228 US 127 South Frankfort, KY 40601

Come see Liz and Angela! Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY For more upcoming events, visit www.kphanet.org. 40

THE KENTUCKY PHARMACIST