Patient Safety

The pharmacy news section of the MPA Web site is designed to provide members with immediate access to timely and relevant information about pharmacy and our Association. In this section, you will find information on MPA activities, Association members, the latest issues impacting the pharmacy profession and press releases from MPA and its affiliates.

Members are also encouraged to join the conversation by following MPA on Twitter @MIPharmacists for the latest breaking news. For more information on MPA's presence on social networking sites, visit our social media page.


Patient Safety

Patient safety news, including recalls and safety alerts, important consumer information and updates on safe medication practices.

Michigan Task Force Releases Findings and Recommendations to Address Prescription Drug and Opioid Abuse

On Oct. 26, the Michigan Prescription Drug and Opioid Abuse Task Force released a comprehensive report of their findings and more than two dozen recommendations for changes in regulations and practices to address this growing problem in the state. Gov. Rick Snyder held a press conference on Monday to present the report, along with some alarming statistics.

 

Lt. Gov. Brian Calley, chair of the Task Force, cited an 11-fold increase in heroin overdoses from 2000-2013. In addition, Michigan ranks 10th nationally in per capita prescription rates of opioid pain relievers and 18th in the nation for all overdose deaths.

 

The group examined trends, evaluated strategic options and developed this statewide plan that includes 25 primary recommendations and seven contingent recommendations related to prevention, treatment, regulation, policy, outcomes and enforcement. Highlights of the recommendations from a press release distributed by the Governor’s office include the following:

  • Updating or replacing the Michigan Automated Prescription System.
  • Requiring registration and use of MAPS by those who are prescribing and dispensing prescription drugs.
  • Updating regulations on the licensing of pain clinics, which hasn’t been done since 1978.
  • Increasing licensing sanctions for health professionals who violate proper prescribing and dispensing practices.
  • Providing easier access to Naloxone, a drug that reduces the effects of an opioid overdose.
  • Limiting criminal penalties for low-level offenses for those who seek medical assistance with an overdose.
  • Increasing access to care through wraparound services and Medication Assisted Treatment programs.
  • Requiring additional training for professionals who prescribe controlled substances.
  • Reviewing successful drug takeback programs for possible replication and expansion.
  • Increasing the number of addiction specialists practicing in Michigan.
  • Reviewing programs to eliminate doctor and pharmacy shopping and requiring a bona-fide doctor-patient relationship for prescribing controlled substances.
  • Creating a public awareness campaign about the dangers of prescription drug use and abuse and how people can get help for themselves or family members.
  • Increasing training for law enforcement in recognizing and dealing with addiction for those officers who do not deal directly with narcotics regularly.
  • Considering pilot programs for the development of testing to reduce the increasing incidence of Neonatal Abstinence Syndrome, which leads to severe withdrawal symptoms for babies born to mothers who have been using opioids.

The 21-member Task Force consists of state government representatives, legislators, law enforcement, a prosecutor and a district judge, and representatives from various health care disciplines, including pharmacy. MPA Chief Executive Officer Larry Wagenknecht as well as Blue Cross Blue Shield of Michigan Director of Pharmacy Services Clinical Laurie Wesolowicz, a member of MPA, serve as part of the group. They are pictured with Lt. Gov. Brian Calley (center).

 

The complete report from the Task Force is available online. In addition, click here to access a handout summarizing the recommendations and view an infographic online showcasing Michigan’s growing drug and opioid abuse problem by the numbers.

Posted in: Patient Safety
Coumadin and International Normalized Ratio

by Dori Kern, CPhT, EMT-B, MSPT Executive Committee

If you've had a stroke, atrial fibrillation (a-fib) or major surgery, your doctor may prescribe an anticoagulant such as warfarin (Coumadin®). Warfarin, often referred to as a "blood thinner," doesn't actually thin the blood but rather it blocks the clotting factors preventing them from forming clots. With a very small therapeutic window, warfarin needs to be monitored frequently, usually 1-2 times a week initially then monthly once levels are stabilized.

 

Prothrombin time (PT) is a blood test that measures how long it takes blood to clot. A prothrombin time test is a blood test used to check if the medicine (warfarin) is at the correct dose. Too high of a dose can cause bleeding, and too low could increase the risk for blood clots so it is extremely important to get the dose just right.

A PT test is usually cross-referenced to an international normalized ratio (INR) chart (see Figure 1). INR is the accepted way of standardizing the results of prothrombin time tests, no matter the testing method or whether they come from different labs or different test methods.

Figure 1. INR Range Chart1

 

 

The therapeutic target range for the PT is 10-13 seconds, which converts to an INR target range of 2-3. If a patient is being monitored after a heart valve replacement, a more intense range of 2.5-3.5 is preferred.

 

Due to the high risk of clotting post-surgery or for more specific conditions, many hospitals have the equivalent of a "Coumadin Clinic" directed by pharmacists who are aware of the importance of keeping patients compliant with their correct warfarin dose. These clinics regularly contact patients, counsel them on proper nutrition and lifestyle habits, and monitor and adjust dosing to maintain ideal INR levels.


References available upon request from MPA office.

Posted in: Patient Safety
Pharmacist’s Asthma Report is on “PAR” with Guidelines-based Care

The Pharmacist’s Asthma Report, or PAR, is a one-page tool to help improve communication between pharmacists and clinicians about their patients’ asthma control and medication use. It is available in electronic and paper formats, and can be customized with the pharmacy’s logo and contact information. The electronic format uses a writeable pdf with drop-down menus and check boxes that make it quick and easy to use. It was developed by the asthma program at the Michigan Department of Health and Human Services and asthma quality improvement leaders, and is available in several versions: PAR, PAR Light and PAR Clinic.

  • The original PAR includes information about the patient’s asthma-related medication fill history, an optional guidelines-based section to describe control level and pharmacist’s recommendations for clinician action.
  • PAR Light includes the same medication fill and recommendation information, but uses a simplified asthma control section.
  • PAR Clinic was designed to be used in a clinic setting where all patients with asthma can be assessed, not just ones with inappropriate asthma medication issues. It’s the original PAR with an additional recommendation option for keeping the same regimen or stepping down.

Pharmacies across Michigan are piloting PAR and PAR Light, and several Ferris State University pharmacy ambulatory care rotations are using Clinic PAR. Feedback from these pilots has been very positive, and has resulted in changes to the tool to better serve pharmacies and patients. One pharmacist who uses the Clinic PAR with students said, “The best part about it is that it’s an awesome assessment tool and the providers really appreciate it. It can be hard to get the students to use it consistently, but I’m making it a routine part of their workload.” To learn more about the PAR, contact Tisa Vorce at VorceT@michigan.gov or (517) 335-9463.

Posted in: Patient Safety
FDA Releases Safety Communication Regarding Dose Confusion and Medication Errors for Antibacterial Drug Zerbaxa

The U.S. Food and Drug Administration (FDA) is warning health care professionals about the risk for dosing errors with the antibacterial drug Zerbaxa® (ceftolozane and tazobactam) due to confusion about the drug strength displayed on the vial and carton labeling. The vial label for Zerbaxa® was initially approved with a strength that reflects each individual active ingredient (e.g., 1 g/0.5 g); however, the product is dosed based on the sum of these ingredients (e.g., 1.5 g). To prevent future medication errors, the strength on the drug labeling has been revised to reflect the sum of the two active ingredients. Thus, one vial of Zerbaxa® will now list the strength as 1.5 g equivalent to ceftolozane 1 g and tazobactam 0.5 g.


Zerbaxa® is used to treat complicated infections in the urinary tract, or in combination with the antibacterial drug metronidazole to treat complicated infections in the abdomen. For more information, please visit the FDA Web site.

Posted in: Patient Safety
AHRQ Releases Two New CE Resources on Key Patient Safety Topics

The Agency for Healthcare Research and Quality (AHRQ) recently released new continuing education (CE) resources aimed toward helping hospital-based caregivers. The resources explain how to recognize which patients are at high risk for falls or pressure ulcers, and what steps can be taken to prevent these potentially serious problems. Learn about how leadership support and education/training of clinical staff as well as other elements can increase the chances of success for improving patient safety in hospitals. The materials also provide information about accessing toolkits to help foster prevention efforts. 

Access both resources online at the following links and obtain CE credit at no cost:

Additional clinician resources related to these topics include the following:

Posted in: Patient Safety
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