MOH/P/KEL/90.

13 BUL)

Edisi Mei 2013

Terbitan Jabatan Farmasi 2013

Medication safety
Strive to enSure patientS Safety

HIGH ALERT MEDICATION : PREVENTING ERRORS

If you have any queries with regards to drugs / health, feel free to contact us at Drug Information Service (DIS), Pharmacy Department HRPZ II

09-7452000 Ext: 2478 (Office hours) , HRPZIIDIS@gmail.com

We source the answers from:

Micromedex, Internet and our References

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Supervisor : Pn Fatimah

Chief Editor : Pn Sudarwaty

Editor :
Cik Zaimawati Pn Wan Najwa Pn Wan Mahani Cik Tg. Norfarhah Pn Sharina Cik Siti Noratiqah Cik Suhaine

Cik Balqis

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Look alike drug

MEDICATION SAFETY
One of the important missions of the healthcare providers is to help patients make the best use of medications and very importantly, strive to ensure patient safety.

trol of the healthcare professional, patient or consumer. Types of medication error:

error
Administration tech-

nique error Deteriorated drug error With guidance and cooperation of the Medication Safety Technical Advisory Committee, the Pharmaceutical Services Division has embarked on a reporting system called the Medication Error Reporting Example of error

Medication safety is one of the major components in patient safety but unfortunately medication errors do occur and often go undetected. Medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the con-

Prescribing error Wrong time error Dose error Dosage form error Drug preparation error Omission error Unauthorized drug error Route of administration

Medication Error Reporting System (MERS)

In Malaysia, medication error reporting is at the moment on a voluntary basis. Objectives of MERS:
To obtain information

on the occurrence of medication errors Maintain a database of medication errors Analyse reports Propose remedial actions Monitor the situations in an effort to minimize

http://mers.moh.gov.my/MERS/

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KEKUCHA AS SYURA JOHANAN FUTSAL ANAN FUTSAL ANTARA JABATAN

Institute for Safe Medication Practices (ISMP) in the United States has termed medications that have the highest risk of causing injury when misused as High-Alert Medications. These are more likely to be associated with harm compared to other medications, and the harm are likely to be more severe. The consequences of an error associated with use of these medications can result in significant patient injury and special precautions must be employed with their overall management. CATEGORIES OF HIGH ALERT MEDICATIONS
1. ADRENERGIC AGONISTS Adrenaline, Noradrenaline. 2. ADRENERGIC ANTAGONISTS Propanolol, Labetalol 3. ANESTHETIC AGENTS Propofol, Ketamine 4. ANTIARRYTHMIC Lignocaine, Amiodarone 5. ANTIFIBRINOLYTICS 6. ANTITHROMBOTIC AGENTS Warfarin, Heparin, Streptokinase 7. ANTIVENOM Sea snake, cobra, pit viper 8. CHEMOTHERAPEUTIC AGENTS 9. DEXTROSE, HYPERTONIC10. EPIDURAL & INTRATHECAL MEDICATIONS 11. GTN INJECTION 12. INOTROPIC MEDICATIONS Digoxin, Dobutamine, Dopamine 13. INSULIN 14. MAGNESIUM SULPHATE INJECTION 15. MODERATE SEDATION AGENTS 16. NEUROMUSCULAR BLOCKING AGENTS Pancuronium, Atracurium, Rocuronium 17. OPIATES & NARCOTICS 18. PARENTERAL NUTRITION PREPARATION 19. POTASSIUM SALT INJECTIONS

COMMON RISK FACTORS 1. Poor handwriting. 2. Incorrect dilution procedure. 3. Confusion between route of administration (IM, IV, Intrathecal, epidural). 4. Confusion between different strengths. 5. Look-alike product. 6. Sound-alike product. STRATEGIES IN PREVENTING ERRORS 1. Limit the drugs strengths available in the formulary. 2. Avoid frequent changes of brand. 3. All HAM should be kept in individual labeledcontainers. Avoid look-alike and sound-alike drugs or different strengths of the same drug from being stored side by side. 4. Use TALL-man letter to emphasize differences in medication names (ex: DOPamine and DOBUtamine). 5. Label all containers used for storing HAM in red as "HIGH ALERT". 6. All HAM must be counter-checked before dispensing.

CONCLUSION High Alert Medications require a heightened vigilance and a joint effort from all health-care practitioners to improve patient safety with respect to minimizing the errors and their consequences.

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An appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product. WHO-

website to refer : www.pharmacy.gov.my www.farmasiklt.moh.gov.my www.bpfk.gov.my

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NEW DRUGS IN MOH FORMULARY3/2012

NO 1. 2. 3. 4. GENERIC NAME Amoxicillin 500 Cloxacillin 500 mg Capsule Memantine HCl Quetiapine Fumarate 100 mg Immediate Re5. Quetiapine Fumarate 200 mg Immediate Re6. Metformin HCl 750 mg Extended Benzydamine Hydrochloride 3.0 mg/ml throat spray A/KK As Metformin Hydrochloride 500 mg Extended Release Tablet Temporary relief of painful conditions of the mouth and throat including tonsillitis, sore throat, radiation mucositis, aphthous ulcers, pharyngitis, swelling, redness, inflammatory conditions, post-orosurgical and periodontal procedures. (For pediatric and otorhinolaringology use. Restrict to patients who are not 8. Oxymetazoline HCI 0.01% Nasal Calcipotriol monohydrate 50 mcg/g and Betamethasone dipropionate 0.5 mg/g Gel 10 Ropinirole HCI 2 . mg Extended Release Tablet 11 Ropinirole HCI 4 mg Extended Release Tablet A* A* Indication Treatment of idiopathic Parkinson?s disease. It may be used as monotherapy or in combination with levodopa A* Indication i)Acute colds, ii)Paranasal sinusitis, iii)Otitis media A* Indication Topical treatment of scalp psoriasis A* PRESCRIBER CATEGORY B B A* A* DETAILS As Amoxicillin 250 mg Capsule As Cloxacillin 250 mg Capsule As Memantine HCL 10 mg Tablet Indication i) Schizophrenia, ii) Short term treatment of acute manic episodes associated with bipolar I disorder, either monotherapy or adjunct to lithium or divalproex, iii) Treatment of depressive episodes associated with bipolar disorder

7.

A*

9.

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ADD STRENGTH/ FORMULATION3/2012

NO 1 2 3 4

GENERIC Amoxicillin 500 Cloxacillin 500 Memantine HCl Quetiapine Fumarate 100 mg Immediate

PRESCRIBER B B A* A*

DETAILS As Amoxicillin 250 mg Capsule As Cloxacillin 250 mg Capsule As Memantine HCL 10 mg Tablet Indication i) Schizophrenia, ii) Short term treatment of acute manic episodes associated with bipolar I

Quetiapine Fumarate 200 mg Immediate

A*

disorder, either monotherapy or adjunct to lithium or divalproex, iii) Treatment of depressive episodes associated with bipolar disorder

Metformin HCl 750 mg Extended Release Tablet

A/KK

As Metformin Hydrochloride 500 mg Extended Release Tablet

Benzydamine Hydrochloride 3.0 mg/ml throat spray

A*

Temporary relief of painful conditions of the mouth and throat including tonsillitis, sore throat, radiation mucositis, aphthous ulcers, pharyngitis, swelling, redness, inflammatory conditions, post-orosurgical and periodontal procedures. (For pediatric and otorhinolaringology use. Restrict to patients who are not able to gargle)

Oxymetazoline HCI 0.01% Nasal Drops Calcipotriol monohydrate 50 mcg/g and Betamethasone dipropionate 0.5

A*

Indication i)Acute colds, ii)Paranasal sinusitis, iii)Otitis media

A*

Indication Topical treatment of scalp psoriasis

10

Ropinirole HCI 2 mg Extended Ropinirole HCI 4 mg Extended

A*

Indication Treatment of idiopathic Parkinson?s disease. It may be used as monotherapy or in combina-

11

A*

tion with levodopa

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Indication Long-acting 2-agonist indicated for maintenance bronchodilator treatment of airflow obstruction in adult patients with chronic obstructive pulmonary disease(COPD).

Dosage Recommended Dosage: Once-daily inhalation of one 150 mcg cap Maximum Dose: 300 mcg once-daily. Elderly: No dosage adjustment is required in elderly patients.

Mechanisme of Action Relaxes bronchial smooth muscle by selective action on 2receptors with little effect on heart rate ; acts locally in the lung

Contraindications Hypersensitivity to indacaterol maleate, to lactose or to any of the other excipients of Onbrez Breezhaler.

Storage Store capsules at controlled room temperature of 25C ; excursions permitted to 15C to 30C. Protect from direct sunlight

Common Side Effect Throat Irritation Head pain Cough

Administration For inhalation using Brezehaler. Do not swallow capsules. Do not use remove capsules from blister until immediately before use. Use at the same time everyday. Do not wash mouthpiece.

How To Manage Missed Dose If missed a dose, take the dose as soon as possible as long as it is 12 hours before the next dose If it is less than 12 hours to the next dose, do not take the dose that was missed Do not take a double dose to make up for the dose missed

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1. Pull off the cap. 2.Opens the inhaler 3.Hold the base of the
inhaler firmly and tilt the mouthpiece.

4.With dry hands, remove one capsule from the blister.

5. Place the capsule

into the capsule chamber. Close the inhaler until you hear a click.

6. Pierce the capsule

by firmly pressing together both side buttons at the same time. You should

7. Release the side

buttons fully.

8. Before placing the mouthpiece in your mouth, breathe out fully. 9. Hold the inhaler as shown in the picture. The side buttons should be facing left and right.Place the mouthpiece in your mouth and close your lips firmly around it. Breathe in rapidly but steadily and as deeply as you can. 10. As you breathe in through the inhaler, you should hear a whirring noise. You will experience a sweet flavour as the medicine goes into your lungs.

11. Hold your breath for at least 5-10 seconds while taking the inhaler out
of your mouth.Then breathe out.

12. Open the mouthpiece again, and remove the empty capsule.

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MEMORY LANE 2012

HARI KELUARGA JABATAN FARMASI HRPZII Date: 28-29 SEPTEMBER 2012 Venue: PCB BEACH RESORT

Presenter Pn Nor Azura Mohd Noor giving a detailed explanation & guide on the reporting of medication errors through the Medication Error Reporting System (MERS)

QAP 2012
Tajuk Kajian: Meningkatkan Tahap Kepatuhan Ubat Di Kalangan Pesakit Hipertensi di HRPZII. Pencapaian: -Johan QAP Peringkat Hospital, HRPZII -Naib Johan QAP Peringkat Negeri Kelantan Fasilitator: Pn. Hasnah Ahli: Pn. Nor Azura Mohd Nor Pn Masnor Mat daud Cik Fitriah Cahyani Che Will En. Wan Mohd Khairul Wan Mahmud

Page 1

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NEWS FROM CAMBODIA

KEKUCHA AS SYURA JOHANAN FUTSAL ANAN FUTSAL ANTARA JABATAN

Misi Kemanusiaan ke Kg. Chhnang, Kemboja anjuran Persatuan Pekerja Islam, HRPZ II. Bertarikh 24/10/2012 sehingga 29/10/2012.

KUCHA AS SYURA
Pada 13 Disember 2012 Hari Kucha As-Syura peringkat HRPZ II telah diadakan di perkarangan Kuarters HRPZII. Jabatan Farmasi telah muncul sebagai Johan bagi kategori Kebersihan.

KEJOHANAN FUTSAL ANTARA JABATAN

Perlawanan futsal peringkat Hospital telah diadakan di MASA Sport Centre , Panji Kota Bharu pada 10 November 2012. Pasukan futsal wanita telah menyertai pertandingan ini buat julung-julung kalinya dan berjaya muncul sebagai Johan Peringkat Hospital dan mengharumkan nama Jabatan Farmasi.

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Cik Ong Huey Chin Pharmacist U 41 Grad : International Medical University 2011 Date of report duty: 1/9/2013

En Muhamad Tohiri Bin Mohd Zulkifli Pharmacist U 41 Grad : Universiti Islam Antarabangsa 2011 Date of report duty: 29/11/2012

En Ahmad Nashriq Bin Cik Hanan Hayati Bt Mamat Pharmacist U 41 Grad : Universiti Islam Antarabangsa 2010 Date of report duty: 17/2/2013 Setapa@Mustapha Pharmacist U41 Grad : UITM 2009 Date of report duty: 17/2/2013

Pn Nazmi Liyana Azmi Pharmacist U 48 Grad : Universiti kebangsaan Malaysia 2004 Date of report duty: 17/2/2013 Cik Siti Nurul Zuliana Bt Abdullah Pharmacist U 44 Grad : Universiti Islam Antarabangsa 2006 Date of report duty 17/2/2013

En Shafei Ahmad Pharmacist Assistant U 36 Grad : Sekolah Latihan Pen.Pegawai Farmasi 1985 Date of report duty :03/09/2012

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Left : Pn Nor Sharina Bt Mohamed Nor Pharmacist U 41 Grad : UITM 2011

Right : Cik Wan Mastura Bt Wan Mohd Azlan Pharmacist U 41 Grad : UITM 2011

Middle : Pn Nur Husna Ibrahim Pharmacist U 41 Grad : UITM 2011 Date of report duty :20/11/2012

From Top Left : Tee Eng Chun, Liew Zhan Yit, Eddy Lim, K.Heygaajivan From Left : Chee Shu Wen, Wan Karen, Yusra, Nabilah, Ilmi Najwa, Yap Sze Yin, Shahratul Hafizan From Bottom Left : Chu Ee Wen, Tham Szhe Woon, Syuhidatun, Hidayah Awang, Hidayah Ghazali, Zulaikha, Azleen, Sarah Tan Not in the picture : Intisar, Hasanah, Khalifah, Tan Jing Rou, Wee Joo Lie, Syamimi, Qalif, Tg Norfarhah, Siti Noratiqah, Nadwanie,

SPECIAL THANKS TO:

Puan Nik Marahhan Nik Jaafar Pharmacist Assistant U 32 ( kup)

Pension Date : Januari 2013

Working experiences: 1979: petaling jaya makmal perubatan 1980: KK Pasir Putih 1981: Hosp Marchang 1982-2013: Hosp Raja Perempuan Zainab II ( 30th services)

Joke #1 (Just for laugh and not related to any real situation) Every morning during ward round, there will be a Specialist, a Medical Officer, a Houseman, a Nurse and a Pharmacist will see and discuss the patient in ward. One day when a pharmacist is not around during ward round : Specialist : Can anyone tell me what I wrote for PLAN on the case note yesterday? MO : Ermmm... I think is Pantoprazole 40mg stat, and....ermmmm...errr.... HO : Yesterday I gave Frusemide 40mg stat...So is frusemide!!! Nurse : I think you write KIV discharge if peak low improve 75%? Specialist: OMG!! You all don't simply guess my writing if you don't know!!! Please call the pharmacist to help us interpret what I write yesterday... Joke #2 Customers gets a topical cream. Direction : apply locally two times a day. Customer says to the pharmacist: "I can't apply locally, I'm going overseas."