The Kentucky Pharmacist Vol. 9, No. 6

Vol. 9, No. 6 November 2014

TTTHEHEHE KKKENTUCKYENTUCKYENTUCKY

PPPHARMACISTHARMACISTHARMACIST

News & Information for Members of the Kentucky Pharmacists Association

Get Involved -

Stay Involved

Membership Matters

in YOUR KPhA

KPhA Rebuilding for the Future –

Work on YOUR KPhA Building

November 2014

THE KENTUCKY PHARMACIST 2

Table of Contents

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

KPhA Emergency Preparedness 17 Continuing Education Article Submission Guidelines 18 Dec. 2014 CE — Preventing Errors in the Pharmacy 19 December Pharmacist/Pharmacy Tech Quiz 26 Kentucky Renaissance Pharmacy Museum 27 KPhA New and Returning Members 28 Pharmacy Law Brief 32 Pharmacy Policy Issues 34 Pharmacists Mutual 36 Cardinal Health 37 KPhA Board of Directors 38 50 Years Ago/Frequently Called and Contacted 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 [email protected]. 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.

November 2014


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 dis-

cussed the need for these repairs and the methods of fund-

ing 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 eve-

ry 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 War-

ren 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 offic-

es. From 1939 – 1965, E. M. Josey served as both the Ex-

ecutive 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

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.

Initially, when Mr. Josey had passed away, a group of phar-

macists 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 pic-

ture 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 fu-

ture.” 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 independ-

ence.” 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.”

In late July 1968, employees of KPhA (Mrs. Margaret Du-

vall 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

PRESIDENT’S

PERSPECTIVE

Robert Oakley

KPhA President

2014-2015

President’s Perspective

Continued on Page 5

KPhA Rebuilding for the Future –

Work on YOUR KPhA Building

November 2014


2014 Mid-Year Conference on Legislative Priorities

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.)

Featuring the

KPhA Student

Legislative Day in partnership with

Sullivan University College of Pharmacy

and

University of Kentucky College of Pharmacy

November 2014


2014 Mid-Year Conference on Legislative Priorities

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

the front of our building? How it is still standing, I don’t

know. The KPhA building is no longer the show place it was

when it first opened.

I believe that the KPhA members in 1966 were visionary

and forward thinking in their decision to build the current

KPhA office. I also believe that the current members of

KPhA need to be equally forward thinking to protect and

maintain their legacy. Therefore, I would like to announce

the start of a campaign to raise funds for the maintenance

and to upgrade YOUR KPhA building. It will be called

“Rebuilding for the Future.” KPhA will establish a separate

fund, entirely through donations, to use for building im-

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.

We are in the very early stages of our campaign. I will be

working closely with our Executive Director, Bob McFalls, to

finalize the details of our campaign. We will be launching it

soon, and we will be sending more information on the de-

tails. I also would like to hear from you, the members. If you

have ideas or suggestions on the rebuilding fund campaign,

please let me know. If you have stories you would like to

share about the history of the building or the original build-

ing fund campaign, please let us know. We can share these

stories with the members of YOUR KPhA.

Have a happy and joyous holiday season. Remember, it is

the season for sharing and giving.

Continued from Page 3

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

CAPT Doug Thoroughman, PhD, MS, CDC Career Epide-

miology Field Officer, presents on the Ebola Crisis in West

Africa.

KPhA Thanks our 2014 Mid-Year Conference

Sponsors

Unanimous Consent Majority Vote

($2,000 and up)

American Pharmacy

Cooperative Inc.

American Pharmacy

Services Corp.

Kentucky Customers of

Cardinal Health

Pfizer

Sullivan University College

of Pharmacy

Richard and Zena Slone

Center for the

Advancement of Pharmacy

Practice at UKCOP

Celgene

Passport Health Plan

Pharmacists Mutual

November 2014


From Your Executive Director

MESSAGE FROM YOUR

EXECUTIVE DIRECTOR

Robert “Bob” McFalls

Technically, I am not sure if it is truly Fall or a pseudo Win-

ter that has returned to Kentucky, but one thing is for sure

— it is basketball season once again throughout the Com-

monwealth. 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 Lexing-

ton to Louisville and all points in between. We love our bas-

ketball 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 leg-

acy that is ours as dedicated fans. It is quite an exciting re-

sponsibility to undertake and to share together.

As a member of YOUR KPhA, you share a similar, rich his-

tory 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 re-

spect, I would like to offer a few brief observations about

the legacy of E.M. Josey, R.Ph., former Executive Secre-

tary 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 Me-

morial 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, commit-

ment and service, Mr. Josey and his legacy continue to rep-

resent 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 be-

came 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 acknowl-

edgement 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 headquar-

ters: “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 be-

fore us to those who now carry the torch forward today and

to those who will lead in the future. At the luncheon ceremo-

ny following the official ground-breaking in October 1967,

George Grider spoke eloquently as APhA President to the

profession, stating in part: “…State pharmaceutical associa-

tions, as in our own case, have alternately thrived and with-

ered 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.”

November 2014


From Your Executive Director

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 pharma-

cy 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, let’s take time to exam-

ine 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!

Reminder: CE deadline for 2014 is December 31 To maintain your Kentucky Pharmacist li-

cense, you must complete 15 hours of con-

tinuing education each year between Janu-

ary 1 and December 31. These hours can be

live or home based activities. But they must

be COMPLETED between those dates.

In April 2014, ACPE released a few updates on CPE Moni-

tor. 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 Communica-

tions and Continuing Education) must have activities up-

loaded to CPE Monitor within 60 days of the completion of

the activity.

On home activities (the CE articles in these pages each

issue), activities must be uploaded within 60 days of the

completion date. So make sure you send in your quizzes

soon after you complete them. Beginning Jan. 1, 2015,

CPE Monitor will not accept activities completed more

than 60 days prior to submission. If you

submit home based activities to KPERF

after the 60 day deadline, they will be re-

turned 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 val-

id. So, if you put a completion date on a quiz in Decem-

ber 2014, but mail it to KPhA for credit in January 2015,

it will count toward your total for 2014.

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

date at the top of the page of answer sheets. You can still

complete CE activities from past years for current year

credit, as long as the program hasn’t expired. All KPERF

CE articles are available online for KPhA members under

the Education tab on www.kphanet.org.

Watch eNews and

subsequent editions

of The Kentucky

Pharmacist for more

information on ways

YOU can help

rebuild YOUR KPhA

Headquarters!

November 2014


APSC

November 2014


2014 Oral Chemo Parity Bill

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

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.

Intravenous (IV)/infused anticancer medications are typical-

ly covered under a health plan's medical benefit, with pa-

tients responsible for a nominal copayment, per treatment.

Orally-administered anticancer medications, however, are

usually covered under a health plan's pharmacy benefit.

Under the pharmacy benefit, oral anticancer medications

are often included in the highest tier of a health plan’s drug

benefit and come with the highest out-of-pocket cost, re-

quiring patients to pay a coinsurance – or a percentage of

the overall total cost of the drug. This percentage coinsur-

ance 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.

Come Jan. 1, 2015, this will change for cancer patients in

Kentucky, when HB 126 goes into effect, giving them great-

er access to the latest and most effective anticancer treat-

ments. The bill, which passed at the end of the 2014 legis-

lative session after a hard fought battle by YOUR KPhA

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 sup-

ply of orally administered anticancer medications. The orig-

inal bill was sponsored by Sen. Buford and overwhelmingly

passed both houses of the state legislature. HB 126 was

signed into law by Governor Steve Beshear in April.

“We are proud to have been a part of the successful out-

come of this important legislation needed by cancer pa-

tients”, stated KPhA President Bob Oakley. “Improving ac-

cess to one’s medication therapy by controlling out of pock-

et costs will increase adherence and be positive for the

patient overall.”

The law does not require health plans to cover a new ser-

vice and only impacts those that currently list chemothera-

py 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

33 other states and the District of Columbia, including Mis-

souri, Wisconsin and Ohio, in enacting similar legislation.

For more information about KAR Chapter 304/HB126,

please visit: www.kphanet.org.

November 2014


Technician Review

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.

FREE

CE

KPhA Member Pharmacy Technicians

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 [email protected]

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 Pharma-

cy’s Advisory Council concerning future recommendations

to the Board of Pharmacy. We have addressed the KPhA

Professional Affairs Committee’s concerns about our pro-

posals and look forward to gaining their support.

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

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 [email protected]. If you

are not a member of KPhA yet and wish to join the associa-

tion you can join via the website.

The members of the Pharmacy Technician Academy would

like to wish everyone a Merry Christmas and Happy New

Year.

http://www.kphanet.org/

mailto:[email protected]

November 2014


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

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 ap-

peared. 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

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

1. Properly evaluate common gastrointestinal complaints and recognize when to refer patients to their physicians. 2. Identify medications that commonly cause diarrhea and constipation. 3. Describe risk factors and symptoms associated with GERD. 4. Evaluate the characteristics and common causes of leg pain . 5. Recognize typical symptoms associated with various types of headaches, transient ischemic attack (TIA) and cerebrovascular accident (CVA).

KPERF offers all CE

articles to members

online at

www.kphanet.org

Introduction

Each and every day, thousands of people seek guidance

from their pharmacist regarding the appropriate use of their

medications. Pharmacists must rely upon not only their

pharmaceutical knowledge base, but also upon effective

communication and patient assessment skills in order to

meet the needs of these individuals.

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, muscu-

loskeletal system and nervous system. By understanding

these vital concepts, pharmacists can confidently make an

early impact on patient care.

Abdomen

The pharmacist’s role in assessment of the abdomen nor-

mally does not entail performing a physical examination.

However, the pharmacist should be able to interpret the

information from an exam or a patient interview in order to

make sound, medication related recommendations. In most

cases, patients who present to the pharmacy with ab-

dominal pain should be referred to their physician.

Patients with other common gastrointestinal complaints

such as nausea and vomiting, diarrhea, constipation, peptic

ulcer disease (PUD) and gastroesophageal reflux disease

(GERD) may or may not need to be referred; in these cas-

es, a thorough patient history will help the pharmacist to

determine the best course of action.

Nausea is generally nonspecific and may be associated

with a number of conditions including viral illness, pregnan-

cy, motion sickness, liver or pancreatic disease or malig-

nancy. Nausea also is a very common side effect of many

medications. Vomiting may occur with more specific illness-

es such as gastroenteritis, bile duct obstruction, intestinal

obstruction or it may be the result of head trauma or inges-

tion of a toxic substance. Since nausea and vomiting can

be caused by such a variety of benign to serious condi-

tions, one of the major goals of treatment should be to

identify and resolve the underlying disorder. Assessment of

the situation includes identifying how long the patient has

been experiencing the nausea or vomiting, when it began,

what it was associated with (e.g., food, new medication),

what the vomitus looks and smells like (e.g., vomited mate-

rial with a fecal smell indicates intestinal obstruction and

November 2014



mandates immediate referral), whether associated symp-

toms 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 situa-

tions in which nausea and vomiting might be a pertinent

finding, clinical judgment is needed to determine which pa-

tients 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 pa-

tient 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 re-

ferred.1

Dehydration may result from excessive vomiting and is es-

pecially important with infants and young children. Warning

signs of dehydration in children include excessive thirst,

decreased urine output, dry mucous membranes, fever

without sweating, unusual listlessness or decreased alert-

ness, a sunken fontanelle and crying with little tear produc-

tion.1 Additionally, patients may experience dizziness and

lightheadedness, fainting or low blood pressure. Any pa-

tient exhibiting symptoms of dehydration should be referred

to their physician.

Diarrhea and constipation also are frequent complaints of

patients, especially in the elderly population. Diarrhea is the

abnormal passage of watery stools, and constipation is in-

frequency of, and/or difficulty in passing hard stools. Com-

mon finding of patients with diarrhea include sudden onset

of abnormally frequent stools, which also may be accompa-

nied by abdominal cramping, weakness, fatigue, abdominal

bloating and flatulence, nausea, vomiting and fever. Signs

of dehydration and electrolyte/metabolic abnormalities may

be found on physical exam. Low back pain, abdominal dis-

tention, vague discomfort, anorexia and headache may be

found in patients

with constipation.

Similar assess-

ment questions

apply to diarrhea

and constipation

as for nausea and

vomiting.

Drug-induced

causes of diar-

rhea and consti-

pation 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

and fiber also may cause constipation; each of these fac-

tors should be addressed when treating this common com-

plaint. As with vomiting, rehydration should always be

stressed to patients who experience severe and/or pro-

longed episodes of diarrhea. In general, if the diarrhea or

constipation has been present for one week or more, or if

there is evidence of bleeding, the patient should be re-

ferred. Other exclusions for self-treatment are listed in Ta-

ble 3.

Common causes of peptic ulcer disease (PUD) include Hel-

icobacter pylori and NSAIDs. A patient may present with

melena (dark, sticky stools), hematochezia (bright red

blood in stool), epigastric pain, pain that awakens the pa-

tient at night, weight loss, nausea and vomiting, belching or

bloating. Pain that is relieved by eating, or that occurs 1 to

3 hours after eating is more typically associated with a duo-

denal ulcer, while pain that is exacerbated by eating is

more suggestive of a gastric ulcer. Encourage the patient

to remove aggravating factors such as cigarette smoking,

NSAID or aspirin use and alcohol. Avoiding foods that

cause dyspepsia also will aid in healing. Any patient with

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

History of a recent head injury

Underlying chronic medical condition such as glaucoma, BPH, gastrointestinal

disease or diabetes

Suspected medication side-effect or sign of toxicity (e.g,, digoxin, theophyl-

line, lithium)

Suspected eating disorder

Pregnancy

DIARRHEA

Antibiotics

Antacids (containing magnesium)

Acarbose

Bethanecol

Colchicine

Metformin

Metoclopramide

Quinidine

CONSTIPATION

Opiate analgesics

Antacids (containing aluminum or

calcium)

Anticholinergics

Antihypertensives

Diuretics

Iron supplements

Neuroleptics

Vincristine

Table 2. Medications that commonly

cause diarrhea and constipation

November 2014



suspected PUD should be referred to a physician for further

evaluation.

GERD is a disorder in which gastric contents are refluxed

into the esophagus. Risk factors for this disorder may in-

clude:

Large meals and eating before bedtime

Dietary fat

Chocolate, peppermint, alcohol and caffeine

Medications (e.g.,alpha blockers, beta blockers, calci-

um channel blockers, anticholinergics, theophylline,

benzodiazepines, barbiturates)

Pregnancy and obesity

The patient may present with heartburn (retrosternal burn-

ing and discomfort), water brash (hypersalivation), belch-

ing, dysphagia or respiratory symptoms (e.g., morning

hoarseness, pneumonitis, cough, wheezing and chest tight-

ness).

Generally, GERD is a chronic condition that is character-

ized by recurrent symptoms and may require long-term or

maintenance therapy. Self treatment may include nonphar-

macologic therapy such as changing the diet, elevating the

head of the bed and avoiding medications that affect the

lower esophageal sphincter. Patients presenting with warn-

ing symptoms (e.g., dysphagia, choking, bleeding, weight

loss) or atypical symptoms (e.g., chest pain, pulmonary

symptoms, chronic hoarseness, chronic cough or pharyngi-

tis) 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 re-

ferred for a complete evaluation.2

MUSCULOSKELETAL

Leg pain is a frequent complaint relating to the peripheral

vascular system. Leg pain, cramping or weakness that oc-

curs with walking and is relieved with rest is termed inter-

mittent claudication, and is a primary symptom associated

with peripheral vascular disease (PVD). It is caused by hy-

poxia, or lack of oxygen to the leg muscles. Leg pain also

can result from musculoskeletal problems, trauma and vari-

ous other causes (e.g., deep vein thrombosis or DVT).

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,

press your index finger on the extremity and hold for sever-

al seconds. A depression that does not rapidly refill and

resume its original contour indicates pitting edema. This

finding is not usually accompanied by a thickening or

change in pigmentation of the overlying skin, which may be

more indicative of venous stasis. Peripheral edema may be

secondary to heart failure, PVD, DVT, trauma or renal fail-

ure.

If a patient presents with unilateral leg swelling, warmth,

erythema and tenderness, a DVT may be suspected. A

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 com-

monly affected include the iliac, femoral and popliteal. Risk

factors associated with DVT include:

Orthopedic surgical procedures

Cancer

Fractures of the spine, pelvis, femur and tibia

Immobilization

Pregnancy

Estrogen use

Hypercoagulable disease states

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 dia-

betes, immunosuppression)

Pregnancy

Chronic or persistent diarrhea (e.g, symptoms not re-

solved after 48 hours)

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

Unexplained changes in bowel habits or significant weight

loss

Dark, tarry, bloody, or pencil thin stools

Persistent (i.e., two weeks or more) or recurrent (i.e., over

3 months or more) symptoms

History of inflammatory bowel disease

Table 3. Exclusions for self-treatment of diarrhea

and constipation1

November 2014



Occasionally, a cord-like obstruction

may be felt on palpation of the affect-

ed 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 suspi-

cion of a DVT or PE should be re-

ferred for emergency attention.

NERVOUS SYSTEM

The nervous system is divided into

two parts, the central nervous system

(CNS) and the peripheral nervous

system (PNS). The brain and spinal

cord are included in the CNS, while the PNS includes the

12 pairs of cranial nerves, the 31 pairs of spinal nerves and

the corresponding branches. The PNS carries messages to

the CNS from sensory receptors and from the CNS out to

the muscles, organs and glands. The evaluation of motor,

sensory, autonomic, cognitive and behavioral elements

makes neurologic assessment one of the most complex

portions of the physical examination.

Many neurologic and systemic medical illnesses result in

specific abnormalities in cranial nerve function. Some of the

most common conditions that elicit questions from patients

concerning neurologic diseases include headaches, transi-

ent ischemic attack (TIA) and cerebrovascular accident

(CVA), or stroke.

Pharmacist assessment of headaches relies heavily on

subjective information from the patient. Summarized in Ta-

ble 4 are the most common types of headaches and their

corresponding signs and symptoms. Because the majority

of initial treatment options for patients with headaches in-

clude OTC products, it is important for pharmacists to famil-

iarize themselves with the common signs and symptoms so

they can assist patients with product selection, or refer to a

physician for further assessment.

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 melli-

tus, cardiac disease, cigarette smoking, alcohol abuse,

family history and/or previous history of cerebrovascular

disease. Hypertension and atherosclerosis are the most

common causes of cerebrovascular disease.

Cerebrovascular disease is generally divided into transient

ischemic attacks (TIAs) and cerebrovascular accidents

(CVAs). Transient ischemic attacks are sometimes referred

to as “mini-strokes”, and although they typically last less

than five minutes, both TIAs and CVAs should be consid-

ered medical emergencies. Patients with acute neurologic

events, such as a CVA or TIA, must be hospitalized and

monitored closely.

On initial presentation to an emergency department, hem-

orrhagic events are ruled out with computed tomography

(CT) or magnetic resonance imaging (MRI) before initiation

of therapy. A pharmacist should be able to recognize symp-

toms of a stroke and make an appropriate immediate refer-

ral to the physician. Because acute treatment options are

often based on the time since the onset of symptoms, phar-

macists suspecting a CVA or TIA should contact emergen-

cy personnel. Symptoms of cerebrovascular disease may

include the following symptoms:

Weakness

Paralysis

Numbness

Aphasia

Visual changes

Dizziness

Sudden, severe and unexplained headache

Slurred speech

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

Cluster Evening pain Unilateral pain Stabbing pain Pain clusters over an eye

Table 4. Common headache signs and symptoms1,2

November 2014



Conclusion

With the rising cost of health care, more and more patients

find themselves looking for opportunities to self treat a vari-

ety of medical ailments. While some conditions are amena-

ble to self-treatment, others call for prompt medical evalua-

tion. By using effective communication and patient assess-

ment skills, pharmacists are in an ideal position to help

guide patients towards the best course of care.

References

1. Berardi RR, Ferreri SP, Hume AL, Kroon LA, Newton

GD, Popovich NG et al, editors. Handbook of Nonpre-

scription Drugs: An Interactive Approach to Self-Care.

16th ed. Washington DC: The American Pharmaceuti-

cal Association; 2009.

2. Dipiro JT, et al (eds): Pharmacotherapy: A Pathophysi-

ologic Approach. 7th ed. McGraw Hill; 2008.

Suggested Readings

1. Jones RM and Rospond RM. Patient Assessment in

Pharmacy Practice. 2nd ed. Baltimore (MD): Lippincott

Williams & Wilkins; 2006.

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. 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. 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.

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

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.

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.

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 7. A B C D 9. A B C D 11. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D 10. 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)

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 7. A B C D 9. A B C D 11. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D 10. 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


November 2014


KPhA Pharmacy Emergency Preparedness

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

[email protected], 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.

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 Prepared-

ness, 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 pharma-

cies including retail, hospital, long term care and com-

pounding. 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!

November 2014


The following broad guidelines should guide an au-

thor to completing a continuing education article for

publication in The Kentucky Pharmacist.

Average length is 4-10 typed pages in a word pro-

cessing document (Microsoft Word is preferred).

Articles are generally written so that they are per-

tinent to both pharmacists and pharmacy techni-

cians. If the subject matter absolutely is not perti-

nent to technicians, that needs to be stated clearly

at the beginning of the article.

Article should begin with the goal or goals of the

overall program – usually a few sentences.

Include 3 to 5 objectives using SMART and meas-

urable verbs.

Feel free to include graphs or charts, but please

submit them separately, not embedded in the text

of the article.

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.

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 should address topics designed to narrow

gaps between actual practice and ideal practice in

pharmacy. Please see the KPhA website

(www.kphanet.org) under the Education link to see

previously published articles.

Articles must be submitted electronically to the KPhA

director of communications and continuing education

([email protected]) by the first of the month pre-

ceding publication.

YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT!

Continuing Education Article Guidelines

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. Con-tributions by cashier’s check or money order are lim-ited to $50 per election unless the instrument identi-fies the payor and payee. KRS 121.150(4)

Anonymous Contributions: $50 per contributor, per elec-tion, maximum total of $1,000 per election.

(This information is in accordance with KRS 121. 150)

CE Article Guidelines

November 2014


Dec. 2014 CE — Preventing Errors

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)

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.

KPERF offers all CE

articles to members

online at

www.kphanet.org

Medication Errors

The National Coordinating Council for Medication Error

Reporting and Prevention (NCC MERP) defines a medica-

tion error as "… 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 profes-

sional, patient, or consumer. Such events may be related to

professional practice, health care products, procedures and

systems, including prescribing; order communication; prod-

uct labeling, packaging and nomenclature; compounding;

dispensing; distribution; administration; education; monitor-

ing; 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 se-

verity 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 Er-

rors (see chart below).

How do pharmacists and pharmacy staff prevent these er-

rors?

The first step in preventing errors is gathering information

on what leads to errors. Recognizing that a medication er-

ror has occurred is the beginning of the quality improve-

ment 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 pro-

cess. 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 Failing to include strength of a medication on a prescription

Failing to administer a dose of medication

Errors of commission Doing something incorrectly Prescribing the wrong antibiotic Dispensing an incorrect dose of an

appropriate drug Bypassing a drug interaction alert

System error An error that is not the result of an individu-al's actions but the predictable outcome of a series of actions and factors that com-

prise a diagnostic or treatment process

Poor lighting Inadequate staffing Handwritten orders Ambiguous drug labels

November 2014



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 nec-

essary. 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.

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”

November 2014



This scenario is an example of the risks of missing infor-

mation on a prescription and encourages the use of pre-

scription pad templates with a prompt for the medication’s

indication.

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 direc-

tions and/or quantities.5 For example, the following pre-

scription is easily read, but the instructions for use leave

the pharmacist to question what the physician actually in-

tended.

The electronic prescription contains two different directions,

leaving the pharmacist to call and clarify with the physician.

Dispensing Step:

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 dis-

pensing medication error:

Patient profiles should be current and contain enough

information for pharmacists to assess appropriateness.

Work areas should be well designed to help prevent

errors with adequate lighting, low noise and few dis-

tractions.

Drugs should be organized to reduce confusion be-

tween similar names, labels or strengths.

Pharmacists should counsel patients when dispensing

medications. This is an important safety check for dis-

pensing and patient comprehension.

Pharmacies should have and follow dispensing policies

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

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 In-

stitute 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 pharma-

cists and prescribers so that errors can be prevented.

Abbreviations, though useful, have proven to be danger-

ous. The Joint Commission released its “Do Not Use” List

to prevent these errors. The table on pages 24 and 25 in-

cludes 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 con-

fused generic medications. For example, glipizide is printed

as glipiZIDE to avoid confusion with glyBURIDE, or predni-

sone and prednisoLONE.

Drug Name Suffixes:

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 stand-

ardized meanings of suffixes. This can lead to product mix-

ups, prescriptions written with incorrect dosing intervals or

frequencies, omission of a suffix, incorrect suffix, etc.8

Wellbutrin SR and Wellbutrin XL are commonly confused

suffixes. Both Wellbutrin SR and Wellbutrin XL formulations

of bupropion are expected to have similar efficacy for treat-

ing depression. The difference is that Wellbutrin XL is given

once a day instead of twice a day. For example, Wellbutrin

XL 300 mg once a day is equivalent to Wellbutrin SR 150

mg twice a day. It is important to note also what the incor-

rect suffix is, as seen below:

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"

IU 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

MS 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., TAC)

Varies Misread as drug with similar name or abbreviation

Write entire drug name

@ At 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-iar to some health care professionals

Use metric system

APAP Acetaminophen Not recognized as meaning aceta-minophen

Write full drug name

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 formula-

tion, the pharmacy staff must not assume it is the SR for-

mulation based on the dosing interval. Both SR and XL

Wellbutrin formulations have a 150mg dose. Assuming cor-

rect suffixes is just as dangerous as confusion between

correct suffixes.

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

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 pre-

scriptions.

High-Alert Medications:

These medications listed below by the ISMP require con-

stant 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.

November 2014



Examples of Other Abbreviations to Avoid

/ Separate doses or “per" Misread as the numeral “1" Write “per"

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

Write “half-strength" or “at bedtime"

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"

UD 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"

ss One-half or sliding scale (insulin) Misread as “55" Write “1/2" or “one-half;" write “sliding-scale"

qn Nightly or at bedtime Misread as “qh" (every hour) Write “nightly"

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

Write “intranasal"

IT Intrathecal Mistaken for other routes of admin-istration (e.g., intratracheal)

Write “intrathecal"

November 2014



Patient Counseling:

Not enough can be said about the importance of patient

education. Patients are the final step in preventing a medi-

cation error. When counseling patients, be sure to use lan-

guage that is simple and clear, free from "medical jargon"

that patients may not understand. Furthermore, patient in-

formation is meant to help patients understand and proper-

ly use their medications. This information is often distribut-

ed through medication leaflets, commonly known as patient

information sheets. Patient information sheets should sup-

ply 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

Even more so, by simply counseling a patient, one could

find out that the medication prescribed was Ditropan, in-

stead of Diazepam, as mentioned in our previous example.

If the pharmacist had not counseled the patient, a medica-

tion error would have occurred and possibly caused harm

to the patient.

How Can Medication Errors be Prevented?

Individual Responsibilities:

Individual responsibility for each pharmacy clerk, technician

and pharmacist should be based on the Five “RIGHTS”, i.e.

RIGHT PATIENT

RIGHT DRUG

RIGHT DOSE

RIGHT TIME

RIGHT ROUTE

Taking a moment to verify this information could mean the

difference between Mr. Rodger’s and Mr. Roger’s prescrip-

tion being incorrectly filled, a 2 year old child receiving Om-

nicef Suspension QD vs. QID or using Ciprodex Otic in the

eye compared to the ear. Looking over the Five “RIGHTS”

is imperative to preventing medication errors.

Organizational Responsibilities:

The best way to prevent medication errors is to design a

system that includes adequate safety nets with checks and

balances. When errors do slip through, documenting and

evaluating the cause of the error will help improve the en-

tire system. Individual members of organizations must be

motivated and rewarded for using safe practices. Shortcuts

for the sake of speed or impatient customers should be

discouraged, as problems must be identified and replaced

with behaviors and practices that keep patients safe.

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. Com-

puterized pharmacy programs still require human interven-

tion and checking by all staff in the pharmacy.

References

1. National Coordinating Council for Medication Error Re-

porting and Prevention. About Medication Errors.

www.nccmerp.org/aboutMedErrors.html. (Accessed

September 29, 2014).

2. Malone PM, Mosdell KW, Kier KL, et al. Drug Infor-

mation: A Guide for Pharmacists. 2nd ed. New York,

NY: McGraw-Hill Publishing, 2001.

3. Kennedy AG, Littenberg B. A modified outpatient pre-

scription form to reduce prescription errors. Jt Comm J

Qual Saf 2004;30:480-487.

4. Gilligan AM, Miller K, Mohney A, et al. Analysis of phar-

macists’ interventions on electronic versus traditional

prescriptions in two community pharmacies. Res So-

cial Adm Pharm 2012;8:523-532.

5. Grossman JM, Cross DA, Boukus ER, Cohen GR.

Transmitting and processing electronic prescriptions:

experiences of physician practices and pharmacies. J

Am Med Inform Assoc 2012;19:353-359.


porting and Prevention. About Medication Errors.

www.nccmerp.org/aboutMedErrors.html. (Accessed

September 29, 2014).

7. Institute for Safe Medication Practices. Special Issue -

Do Not Use These Dangerous Abbreviations or Dose

Designations. www.ismp.org/Newsletters/acutecare/

articles/20030220_2.asp. (Accessed September 29,

2014).


porting and Prevention. Council recommendations.

Promoting the safe use of suffixes in prescription drug

names. http://www.nccmerp.org/council/council2008-08

-01.html. (September 29, 2014).

9. Svarstad BL, Mount JK, Tabak ER. Expert and con-

sumer evaluation of patient medication leaflets provid-

ed in U.S. pharmacies. J Am Pharm Assoc (2003)

2005;45:443-451.

http://www.nccmerp.org/aboutMedErrors.html

http://www.nccmerp.org/aboutMedErrors.html

http://www.ismp.org/Newsletters/acutecare/articles/20030220_2.asp

http://www.ismp.org/Newsletters/acutecare/articles/20030220_2.asp

http://www.nccmerp.org/council/council2008-08-01.html

http://www.nccmerp.org/council/council2008-08-01.html

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.”

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 medication.

D. That an antibiotic suspension was not refrigerated properly.

4. Which of the following medication(s) should be regarded as a “High-Alert” Medication, per ISMP? A. Coumadin B. Humalog R C. Carbatrol D. All of the above 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

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?

A. The technician can safely assume “TB24” means the “ER” formulation of metformin.

B. A normal dose of Metformin 500mg is given once daily. C. The pharmacist should call to verify “TB24” for safe

dispensing to the patient. D. Since this prescription was sent electronically, it should

be filled as written and not questioned.

Save the

Date

137th KPhA Annual Meeting

& Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center

Bowling Green, KY

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.

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.


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 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. 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


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 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. 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


November 2014


In 2009 the Centers for Medicare and Medicaid Services

(CMS) implemented Surety Bond Requirements for sup-

pliers 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.

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.

To see if you qualify for a $250 Medicare Surety Bond,

or would like information regarding our other products,

please contact us:

Call 800.247.5930 Extension 4260

E-mail [email protected]

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.

Pharmacists Mutual Insurance offers Medicare Surety Bond

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.

Kentucky Renaissance Pharmacy Museum

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 [email protected]

For more information on the museum, see

www.pharmacymuseumky.org or contact Gloria Doughty at

[email protected] or Lynn Harrelson at [email protected].

mailto:[email protected]

http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx

http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx

November 2014


KPhA New and Returning Members

KPhA Welcomes New and Renewing Members

September-October 2014

Michael Akers

Grayson

Cynthia Akers

Grayson

Jennifer Anderson

Morehead

Sandra Anderson

Monticello

Charla Applegate

Nicholasville

Robin Applegate

Nicholasville

Thomas Arnold

Nicholasville

John Ausenbaugh

Dawson Springs

Nancy Barker

Winchester

Kerri Barman

Scottsville

Ronald Barned

Glasgow

Justin Bell

Lexington

Jim Bell

Sebree

Victoria Bell

Burkesville

Christopher Betz

Louisville

Joseph Bickett

Louisville

Kaleb Blair

Whitesburg

Lanny Branstetter

Horse Cave

James Brown

Bowling Green

Johnny Burke

Prestonsburg

Wendell Butler

Burkesville

Kenneth Calvert

Glasgow

Marietta Campoy

Pikeville

Don Carpenter

Olive Hill

Joseph Carr

Owensboro

Michelle Casto-Litton

Zionsville, Ind.

Vickie Chaudry

Corbin

Donald Clark

Rockfield

Charles Clifton

Fort Thomas

Rhonda Cochran

Liberty

Elizabeth Cole

Louisville

Kimberly Corley

Owensboro

Randy Crawford

Franklin

Robert Cull

Owenton

Marcelle Curtis

Shelbyville

Rachel Damaske

Saint Joseph, Mich.

Kimberly Daugherty

Louisville

Michelle DeLuca Fraley

Lexington

Brittany Downing

Pine Knot

Derek Downing

Alexandria

David Dubrock

Arlington

Michael Durbin

McKee

Jennifer Dyer

Albany

Cathy Edwards

Richmond

Mark Edwards

Richmond

Rita Etter

Williamson, W.Virg.

Brian Fingerson

Louisville

Jennifer Fitch

Lexington

Laura Fleener

Leitchfield

William Fleming

Prospect

Charles Fletcher

Monticello

Shane Fogle

Central City

Timothy Ford

Campbellsville

Milton Frizzell

Murray

Barry Frost

Columbia

Keith Fuller

Kimper

Kelli Funk

Louisville

Judy Gallagher

Madisonville

MEMBERSHIP MATTERS:

To YOU, To YOUR Patients To YOUR

Profession!

November 2014



Timothy Gallagher

Madisonville

Joyce Gardner

Hodgenville

Linda Gormley

Villa Hills

John Gorrell

Morehead

Daniel Gray

London

Marsha Greer-Arnold

Louisville

Richard Griffieth

Lexington

Jack Gross

Louisville

Erik Grove

Madison, IN

Philip Hamilton

Ludlow

Gary Hamm

Elizabethtown

Kyle Harris

London

Jeffrey Harrison

Tompkinsville

Emily Henderson

Shelbyville

Clara Herrell

Lexington

Amanda Holder

Bowling Green

Michael Horne

Georgetown

Jerry Horwitz

Cincinnati, OH

Marylou Hoskins

Hawesville

Marylou Hoskins

Owensboro

H. Harper Housman

Paducah

James Howze

St. Augustine, Fla.

Patrick James

Louisville

Phillip Johnson

Georgetown

Constance Jones

Russell Springs

Karen Jones

Gilbertsville

Megan Kappes

Fort Mitchell

Leigh Keeton

Flatwoods

Erin Kingrey

Austin

Jerry Knifley

Columbia

Kerry Knochenmus

Louisville

Robert Knott

Paducah

Dhaval Kotak

Radcliff

Kevin Lamping

Lexington

Judith Lawson

Monticello

Jill Lee

Frankfort

Robert Lester

Elkhorn City

Donna Lile

Campbellsville

Douglas Linger

Georgetown

Leslie Little

Berea

Jimmie Lockhart

Lexington

Aaron Lohnes

Stanville

Kathy Long

Benton

Robert Long

Louisville

Carolyn Mallory

Russellville

Terry Manley

Mount Sterling

Nicholas Maroudas

Williamson, W.Virg.

John Marshall

Henderson

Charles Martin

Crestwood

Aleshea Martin

Crestwood

William Mattingly

Lebanon

Ronald McClish

Simpsonville

Thomas McConnell

Kuttawa

Charlene McCown

Grayson

Jennifer Mccreary

Louisa

Sheldon Mccreary

Louisa

Leeann McDonald

Dunnville

Christopher McGlone

Vanceburg

William McMakin

La Grange

John McMeans

Ashland

Nicole McNamee

Forest Hills

Jesica Mills

Louisville

Boyd Minnich

Mount Sterling

Mickey Monroe

Frankfort

Emily Morton

Hardinsburg

Amy Mueller

Louisville

Steven Mueller

Petersburg

Lance Murphy

Louisville

November 2014


Daniel Nall

Louisville

David Nation

Owensboro

Troy Neagle

Glasgow

James Neat

Louisville

William Nebel

Kuttawa

Clarinda Newell

Greenup

Jamie Norman

Russellville

Kenneth Norwood

Louisville

Fred Nowak

Independence

Robert Oakley

Louisville

Jeff O'Connor

Frankfort

Jennifer O'Hearn

Louisville

Jennifer Parker

Florence

Willie Patton

Grayson

Vincent Peak

Louisville

Robert Perkins

Clinton

Bernard Poe

Owenton

Andrea Potter-Adams

Isom

Walter Powell

Louisville

John Prine

Bowling Green

Nicholas Rawe

WIlder

James Ray

Hopkinsville

Levi Rice

Beaver Dam

Eugene Riley

Russellville

Stewart Riley

Elkton

Kristie Roark

Whitesburg

Elizabeth Routh

Louisville

Ashley Saling

Mammoth Cave

Gregory Sanders

Lexington

Angela Sandlin

Louisville

Phillip Sandlin

Louisville

Stanley Scates

Lexington

Ellen Schueler

Franklin

Aron Schwartz

Louisville

Benjamin Scott

Lexington

Joseph Serafini

Frankfort

Susanna Sexton

Cornettsville

Charles Shannon

Louisville

Michael Sheets

Fisherville

Nancy Shepherd

Paducah

Kelli Shirley

Glasgow

Jarrod Shirley

Glasgow

Thomas Shively

Owensboro

Angela Shoulders

Bowling Green

JD Shoulders

Bowling Green

Joe Simmons

Glasgow

Angela Slaughter

Covington

Lois Smith

Blackey

Francis Southall

Lebanon

Glenn Stark

Frankfort

Sandra Staton

Albany

Cheryl Steiner

Hopkinsville

Laura Stone

Louisville

Jack Stone

Mayfield

Larry Stovall

Scottsville

Brittany Taylor

Lancaster

Gloria Taylor

Louisville

Deborah Thorn

Bowling Green

Sandra Thornbury

Pikeville

Joel Thornbury

Pikeville

David Triplett

Louisville

Brenda Turner

Jackson

John Vaal

Edgewood

Lorne Virgin

Grayson

Kelly Walker

Philpot

Robert Wallace

Dry Ridge

Todd Walters

Pineville

Jeffrey Warner

Jamestown


November 2014


Know someone who

should be on this list?

Ask them to join YOU in

supporting YOUR KPhA!

Julie Warren

Gamaliel

Kim Wheatley

Bardstown

David Whitley

Russellville

Ronald Whitmore

Alvaton

Denis Wiggins

Louisville

Lisa Williamson

Nicholasville

Brenda Wilson

Danville

Jacob Wishnia

Louisville

Carol Wishnia

Louisville

Simon Wolf

Louisville

William Wooden

Leitchfield

Glenn Wooden

Leitchfield

Leland Wright

Lexington

Arnold Zegart

Prospect

KPhA Honorary

Life Members

Ralph Bouvette

Leon Claywell

Gloria Doughty

Ann Amerson Stewart


November 2014


Pharmacy Law Brief

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 recent-

ly at a social function who indicated that mediation is occur-

ring with increasing frequency and in some fields reducing

the number of cases going to court, especially cases involv-

ing allegations of professional malpractice. Is this a local

trend or something of wider impact?

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 mat-

ter. The arbitrator meets with both sides to hear their per-

spectives and then issues a decision which is binding. One

will frequently hear of arbitration being used with salary dis-

putes 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.”

Sometimes mediation is seen in conjunction with a court

proceeding. For example, if one were to go to Small Claims

Court in Fayette County for resolution of a dispute involving

less than $2,500, the jurisdictional limit of such a court, the

judge will direct the parties to meet with one of a cadre of

mediators standing by in an adjacent room to attempt to

resolve the matter without occupying the court’s time.

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

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.

Many mediators are social workers who mediate family dis-

putes.

Referring back to the original question or comment, I was

speaking with an attorney friend from Louisville who is ac-

tive in the field of medical malpractice litigation who indicat-

ed that he knows several attorneys in the field who’ve not

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 repu-

tation is so very important that argument is not hard to buy.

Finally, it is noteworthy for pharmacists that alternative dis-

pute resolution is sometimes referred to as “ADR”, an ab-

breviation that in our field sometimes has a different mean-

ing – adverse drug reaction! The two should not be con-

fused.

Submit Questions: [email protected]

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 education-

al 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 pharma-

cist to seek counsel from an attorney who can become thorough-

ly familiar with the intricacies of a specific situation, and render

advice in accordance with the full information.

November 2014


KPhA Save the Date/Connect/ EPIC

@KyPharmAssoc

@KPhAGrassroots

Facebook.com/KyPharmAssoc

KPhA Company Page

Are you connected

to YOUR KPhA?

Join us online!

Save the Date 137th KPhA Annual Meeting & Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

November 2014


Pharmacy Policy Issues

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 phar-

macist this question. Anyway, I’ve read in the professional literature about a major problem with counterfeiting of phar-

maceuticals, some of which is very well done so the product really looks like the real thing. Can you provide an update

on this issue?

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 au-

thority or right, and then marketing the forged drug as the

original.”1 Unfortunately, the illegal and counterfeit medi-

cines 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.

According to the FDA, more than 19,600 packages contain-

ing counterfeit medicines

were sequestered in the

action, involving authori-

ties from 111 countries.

Many of the unapproved,

fake drugs originated

from countries in South-

east Asia, including Chi-

na, India, Laos, Malay-

sia, Singapore and Tai-

wan. In addition, counter-

feit medicine packages

were found in Australia, New Zealand, Great Britain and

the United States. All in all, law enforcement agents arrest-

ed a total of 237 individuals in May as a part of the world-

wide crackdown, which resulted in the seizure of counter-

feit and illegal medicines worth $31.4 million.2

Some of the counterfeit drugs that U.S. consumers ordered

included medications such as pain relievers, hormone

medications (estrogen and human chorionic gonadotropin),

insulin and medication for erectile dysfunction. In fact, 583

packages, many of which included the medications listed

above, were seized from international mail facilities in the

United States. Many of these packages contained illegal

and counterfeit prescription medicines that had been or-

dered from Internet pharmacies online.

With today’s technology, a package of sophisticated coun-

terfeit 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 dan-

gerous to consumers. When individuals purchase prescrip-

tion 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,

the most serious being

health risks — patients

may experience a reac-

tion to the counterfeit

medication, or may re-

ceive no therapeutic ben-

efit at all. In addition, con-

sumers can face other

risks, such as credit card

fraud, identity theft or

computer viruses.3

The FDA has been work-

ing to target the counterfeit medicines market, and this

worldwide operation worked to do just that. The FDA not

only seized almost 20,000 counterfeit medicine packages,

but also notified Internet service providers and domain

name registrars of the 10,603 websites that were guilty of

selling illegal prescription medications.

In conclusion, the Food and Drug Administration stated that

it will continue to reinforce its national as well as interna-

tional affiliations to “shed light on these Internet-based

fraudulent activities,” indicated Philip Walsky, acting direc-

tor of the FDA’s Office of Criminal Investigations. Hopefully

the FDA also will continue to uphold the stringent drug

manufacturing standards and regulations that are present

in our country, to help protect our people.

Have an Idea?: This column is designed to address timely and practical

issues of interest to pharmacists, pharmacy interns and

pharmacy technicians with the goal being to encourage

thought, reflection and exchange among practitioners.

Suggestions regarding topics for consideration are wel-

come. Please send them to [email protected].

November 2014


Pharmacy Policy Issues

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 [email protected] 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.

References:

1. "General Information on Counterfeit Medicines." WHO.

World Health Organization, n.d. Web. 07 July 2014.

<http://www.who.int/medicines/services/counterfeit/

overview/en/>.

2. Hirschler, Ben. "Fake Medicines worth $31 Million

Seized in Global Crackdown." Reuters. Thomson Reu-

ters, 22 May 2014. Web. 07 July 2014. <http://

www.reuters.com/article/2014/05/22/us-

pharmaceuticals-counterfeit-

idUSKBN0E21DG20140522>.

3. Preidt, Robert. "Illegal Online Meds Targeted in World-

wide Crackdown, FDA Says." Consumer HealthDay.

Food and Drug Administration, 22 May 2014. Web. 07

July 2014. <http://consumer.healthday.com/health-

technology-information-18/computers-internet-144/

breaking-brief-5-22-illegal-online-pharmacies-fda-

release-688137.html>.

November 2014


Pharmacists Mutual

November 2014


Cardinal Health

November 2014


KPhA BOARD OF DIRECTORS

Duane Parsons, Richmond Chair

[email protected] 502.553.0312

Bob Oakley, Louisville President

[email protected]

Chris Clifton, Villa Hills President-Elect

[email protected]

Brooke Hudspeth, Lexington Secretary

[email protected]

Glenn Stark, Frankfort Treasurer

[email protected]

Raymond J. Bishop Past President

[email protected] Representative

Directors

Matt Carrico, Louisville*

[email protected]

Tony Esterly, Louisville

[email protected]

Matt Foltz, Villa Hills

[email protected]

Chris Killmeier, Louisville

[email protected]

Mallory Megee, Nicholasville University of Kentucky

[email protected] Student Representative

Jeff Mills, Louisville

[email protected]

Chris Palutis, Lexington

[email protected]

Christian Polen Sullivan University

[email protected] Student Representative

Richard Slone, Hindman

[email protected]

Mary Thacker, Louisville

[email protected]

Sam Willett, Mayfield

[email protected]

* At-Large Member to Executive Committee

HOUSE OF DELEGATES

Ethan Klein, Louisville Speaker of the House

[email protected]

Chris Harlow, Louisville Vice Speaker of the House

[email protected]

KPERF ADVISORY COUNCIL

Kim Croley, Corbin

[email protected]

Kimberly Daugherty, Louisville

[email protected]

Mary Thacker, Louisville

[email protected]

Matt Carrico, Louisville

[email protected]

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

Robert McFalls, M.Div.

Executive Director

[email protected]

Scott Sisco, MA

Director of Communications & Continuing Education

[email protected]

Angela Gibson

Director of Membership & Administrative Services

[email protected]

Leah Tolliver, PharmD

Director of Pharmacy Emergency Preparedness

[email protected]

Elizabeth Ramey

Receptionist/Office Assistant

[email protected]

KPhA Board of Directors/Staff

KPhA sends email announcements weekly. If you aren’t receiving: eNews, Legislative

Updates, Grassroots Alerts and other important announcements, send your email address to

[email protected] to get on the list.

November 2014


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 [email protected]

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 [email protected]

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

Frequently Called and Contacted

50 Years Ago/Frequently Called and Contacted

KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA

informed by sending this information to [email protected].

Deceased members for each year will be honored permanently at the KPhA office.

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 Scholar-

ship 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.

November 2014


THE

Kentucky PHARMACIST

1228 US 127 South

Frankfort, KY 40601

For more upcoming events, visit www.kphanet.org.

Save the Date

137th KPhA Annual

Meeting & Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center

Bowling Green, KY

Come see Liz and Angela!

The Kentucky Pharmacist Vol. 9, No. 6

Documents

Transcript of The Kentucky Pharmacist Vol. 9, No. 6