Day 8: Drug Information/Medication Safety

Today was a different change of pace. About 8 of us (HIPPE students) were together in a conference room and were led through various activities.

First up was Drug Information (DI):
The speaker for the day was the DI pharmacist, who is available in the hospital to answer any and all questions regarding medications. She is usually saved for questions very rare adverse side effects or anything else that a physician and/or pharmacist can't look up right away or cannot find. She emphasized that every pharmacist should be knowledgable of all the ways to look up information. According to her, if you only look at LexiComp for your drug information, you're not optimizing patient care.

We were lead through various books that she has on hand. Here's a glimpse:

This book was HUGE, and claims to have information regarding every single-drug entity available in the U.S. It's a collection of monographs organized by drug class, so you can compare/contrast drugs within the same class, amongst other things. It is very informative; however, it is not good for quick reference or for specific cases in which you would use the books below. 

This book should be on hand in every retail/community pharmacy and family clinic. It's a guide specifically for contraceptives. It can help guide changing from one pill to another, has an overview of side effects, guidelines on missed doses (always a big question!), and more. It's also small, handbook-sized so it can fit in the white coat pockets. 

The pharmacist said that when she was in residency, she was on call some days for 24 hours at a time, and would sleep with this next to her because most of the calls were about drugs and kidney dysfunction. Because most drugs are filtered through the kidney, it's extremely important to take this into account, especially with doses. This book is helpful for pediatric and adult patients. There are lots of tables for quick reference. 

This was an interesting book that focused on just adverse effects caused by medications. It was written by pharmacists, which makes it even better! It doesn't have information about drugs (regarding dose, administration, indications, etc.). It is organized by disease and body systems and focuses on the more severe adverse effects, not every single adverse effect possible. 

We are exposed to this book in lab, so we were familiar with it. It's a reference for if a drug is compatible with a pregnant or lactating woman. It's also available online, which is good (not all books are available online). It also specifies if a drug is compatible in certain trimesters only. 

ImmunoFacts has information regarding vaccines, antibodies, interferons, interleukins, etc. It's organized by class, and has tables inside with dosing schedules for vaccines, etc. A good second source would be the CDC website. 

This is a very interesting book that focuses on toxicology (obviously) regarding drugs, radiation, metals, household products, occupational hazards (i.e., methylene blue, smoke, etc.), nature (i.e., poisonous plants, snake venom, spider venom, etc.). It specifically focuses on antidotes and managing toxic events, such as drug overdoses. We also were introduced to the term "toxicokinetics", which is similar to pharmacokinetics but specifically how your body handles drugs when in a toxic state. 

This book is specifically for managing bacterial, fungal, viral, etc. infections. It's organized by site of infection, and includes a vaccination section. It has primary therapy, and secondary options if the patient has allergy to the antibiotic or has developed resistance. 

Next up was Medication Safety:
The hospital's Medication Safety Officer, Dr. Kayla Hansen, is a pharmacist who specializes in medication safety. She analyzes reported medication errors that happen in the hospital and figures out ways to prevent them by implementing procedural changes and educating.

It seems like something that is obvious, but errors happen every single day, especially in institutions with so much interdisciplinary communication, and patients receive the consequences. More than half of all errors in a hospital are medication-related, and pharmacists have a key role in preventing them throughout the medication use process.

The most interesting fact is that at UNC Hospitals, the most errors are done by nurses, with pharmacists coming in second. HOWEVER, because error reporting is voluntary, this is not by any means comprehensive. What it does mean is that nurses care enough about patient safety that they will even report themselves doing an error. Many are afraid to report errors because of fear of punishment, but without reporting errors, we wouldn't know how to improve. The ultimate goal is to minimize errors to optimize patient care and safety!