Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Let us see what Pharmacists, Doctors and Patients can do about it.

1. ROLE OF PHARMACIST
in
PATIENT SAFETY
DR. AVINASH BHONDWE
IMM. PAST PRESIDENT
I.M.A. MAHARASHTRA STATE

4. PHARMACIST
DEFINITION
• A PERSON WHO IS TRAINED TO PREPARE
MEDICINES AND WHO WORKS IN A HOSPITAL
OR PHARMACY (= SPECIAL STORE SELLING
MEDICINES)
• PHARMACISTS ARE EXPERTS ON DRUG
THERAPY. (CAMBRIDGE BUSINESS ENGLISH
DICTIONARY)

5. PHARMACIST
DEFINITION-
• A person licensed to prepare, compound, and
dispense drugs upon written order ( prescription)
• From a licensed Medical Practitioner such as a
Physician, Dentist
• A Pharmacist is a Health Care Professional who
cooperates with, consults with, and sometimes
advises the licensed practitioner concerning
DRUGS.

6. PHARMACIST- VARIOUS ROLES
• ACADEMIC SET UP- RESEARCHERS, PROFESSORS
• COMMUNITY HEALTH CENTERS
• COMPOUNDING PHARMACIES
• GOVERNMENT/PRIVATE PHARMACY
• HOME HEALTH CARE
• MANAGED CARE
• NUCLEAR PHARMACY
• OFFICE-BASED MEDICATION MANAGEMENT
• PHARMACEUTICAL INDUSTRY

7. Patient Safety- W.H.O.
DEFINITION-
• Patient Safety is a health care discipline that
emerged with the evolving complexity in health
care systems and the resulting rise of patient
harm in health care facilities.
• It aims to prevent and reduce risks, errors and
harm that occur to patients during provision of
health care.
• A cornerstone of the discipline is continuous
improvement based on learning from errors and
adverse events.

8. Patient safety- W.H.O.
DEFINITION-
• Patient safety is fundamental part of
delivering quality essential health services.
• Quality health services across the world
should be effective, safe and people-centred.
• To realize the benefits of quality health care,
health services must be timely, equitable,
integrated and efficient.

9. Patient safety- W.H.O.
To ensure successful implementation of
Patient Safety Strategies followings points are
needed-
• Clear policies
• Leadership capacity
• Data to drive safety improvements
• Skilled health care professionals
• Effective involvement of patients in their care

10. Patient safety- Key Issues
• The occurrence of adverse events due to unsafe care is
one of the 10 leading causes of Death and Disability
in the world.
• In high-income countries, it is estimated that one in
every 10 patients is harmed while receiving hospital
care.
• The harm can be caused by a range of adverse events,
with nearly 50% of them being Preventable .
• Each year, 134 million adverse events occur in hospitals
in low and middle-income countries (LMICs), due to
Unsafe care, resulting in 2.6 million deaths .

11. Patient safety- Key Issues
• A study has estimated that around two-thirds of
all adverse events cause the death and years lost
due to disability result from unsafe care.
• Known as disability adjusted life years, or DALYs
occur in LMICs.
• Globally, as many as 4 in 10 patients are harmed
in Primary and Outpatient Healthcare.
• Up to 80% of harm is preventable.
• The most detrimental errors are related to
diagnosis, prescription and the use of medicines .

12. Patient safety- Key Issues
• In the Organisation for Economic Co-operation
and Development (OECD) countries, 15% of
total hospital activity and expenditure is a direct
result of adverse events .
• Investments in reducing patient harm can lead
to significant financial savings and better patient
outcomes.
• If the prevention is done well, it can reduce the
burden of harm by 15% .

13. WHO Response
PATIENT SAFETY
AS A GLOBAL HEALTH PRIORITY
Resolution (WHA 72.6) on Patient Safety
• Recognizing that Patient Safety is a global
health priority, the World Health Assembly
(WHA) adopted a resolution on Patient Safety
which endorsed the establishment of
World Patient Safety Day to be observed
annually by Member States on 17 September.

22. ERRORS IN MEDICINES
Errors of Omission: errors related to WRONG
prescription, WRONG drug dispensed by pharmacist,
• WRONG drug administration by Medical Personnel like
Nurses & Patient themselves
Errors of Commission: most common form of errors
encountered in clinical practice, this include –
• 1.) Wrong Medicine for the disease
• 2.) Drug interaction
• 3.) Communication failure
• 4.) Failure to follow appropriate policies related to drug
use
• 5.) Failure to follow drug-specific instructions
• 6.) Overuse of a drug-irrational drug use & poly-pharmacy

23. ROLE OF PHARMACIST
A MEMBER OF THE HEALTH CARE TEAM.
Evaluating medication appropriateness
• Pharmacy Colleges give rigorous training in Medicinal
Chemistry and Therapeutics.
• Physicians/ Healthcare Professionals get extensive training
on Diagnosis and Treatment plans.
• Pharmacists are the ultimate resource for managing and
adjusting a medication action plan, by-
 Changing dosage, frequency, duration of a Medication
 Identifying combination products that can reduce “pill
burden”
 Removing medications that are unnecessary or redundant.

24. ROLE OF PHARMACIST
Improving medication adherence –
• Pharmacists meet patients routinely in the
community and often have more touch points
with a patient than any other healthcare
provider.
• Improving patient’s adherence to a medication
meaningfully.
• Any opportunity to improve adherence should
always include an appropriate medication
review.

25. ROLE OF PHARMACIST
Patient may have prior issues with medication
adherence because
• Side effects
• Not receiving a clinical benefit
• Issues with cost for the therapy.
• Pharmacists counselling improves adherence by
considering these key elements.
• The Goal of Pharmacist- Patients should take
the right medication every time to improve their
health.

26. ROLE OF PHARMACIST
COMMUNITY PHARMACY AREA
Pharmacists’ patient safety actions include
Making sure the patient is taking the correct medication
 Dose, and directions;
 Checking for drug–drug and drug–disease interactions; a
 Checking for allergies.
• Patient should understand what the medication is for
• How to take it
• What to do if adverse effects occur.
• Pharmacist- provided immunizations and medication
therapy management help to keep patients safe.

27. ROLE OF PHARMACIST
Pharmacists in the Hospital pharmacy
• Checking IVs and patient dose charts
• Floor medication dispensing machines making
sure orders are correct;
• Make sure patients are on the safest most
effective medication dose.

30. PRESCRIPTION AUDIT
• The prescription order is an important link between
the doctor and the patient.
• The prescribing of the doctor depends upon the input
from various sources like patients, academic
literatures, professional colleagues, commercial
publicity and government regulations.
• Various prescribing errors are result of ineffective use
of these inputs and are very common in clinical
practices.
• One of the most pressing problem encountered by
public health providers and administrators in many
countries is the rational use of drugs

31. PRESCRIPTION AUDIT
• Prescription audit is one of the systematic
tools for determining the quality of medical
care which provides the documented
evidence to support diagnosis and treatment.
• Medical Audit seeks to monitor, evaluate and
suggest modifications in the prescribing
practices of medical practitioners.

32. PRESCRIPTION AUDIT
Objective of Prescription Audit is curbing excess
prescription of Medicines by Physicians through-
• Unnecessary Medicines
• Irrational Treatment
• Wrong dosages, frequency and durations
• Inappropriate Medicines
An inevitable outcome of excess prescription of
drugs is the growing drug resistance

39. ROLE OF PHARMACIST
Clinical Pharmacists
Conducting a Medication review -
• To make sure that patients are on the safest & the
most effective medication dose.
• Medicines are providing proper pharmacokinetic
as per standard medication recommendations;
• Reconciliation of all the medicines
• Providing discharge counselling to the patient,

40. ROLE OF PHARMACIST
• Consultant Pharmacists are long-term care
pharmacists.
• Improve patient safety for patients in
institutes.
• Providing appropriate feedback to providers.
This may result in-
Improve prescribing practices.

41. ROLE OF PHARMACIST
Health and Wellness Services
 Learning not only About Medications.
 Learning to provide other services along with other healthcare
providers ? part of the curriculum.
Some of the services like
• SCREENINGS FOR BLOOD PRESSURE, BLOOD GLUCOSE OR
CHOLESTEROL,
• IMMUNIZATION ASSESSMENT AND SCREENING,
• SMOKING CESSATION
• AN AMBULATORY PHARMACY
• PROVIDE AND ADVERTISE THE SERVICE TO LOCAL PATIENTS,
EMPLOYERS AND OTHER HEALTHCARE PROVIDERS.

42. ROLE OF PHARMACIST
Transitions of Care:
• Hospitals and Clinics face problems in reducing
readmissions and improve care of discharged patients.
• During Hospitalisation patients are given regimen of
medications and the medications they were on before
admission are continued or held.
• When the patient is discharged, changes to dosing,
medications temporarily halted or temporarily/ added
can add problems and lead to confusion with the
medication action plan.
• Pharmacists are once again positioned as the medication
experts to review every medication for appropriateness.

43. ROLE OF PHARMACIST
• Pharmacists remain an underutilized resource
in the Healthcare System.
• Pharmacists have the education and training
necessary to improve the medication process
• Pharmacists for their role(s) outside of
dispensing will a welcome change to the
current status-quo of pharmacy operations
• & improving the Patients’ Safety at all levels.

44. ROLE OF PHARMACIST
Pharmacists in the pharmaceutical industry
• Focus on patient safety.
• Developing new medications that are safe and
effective to use,
• Serving as medical service liaisons that help
prescribers learn how to appropriately
prescribe new medication

45. ROLE OF PHARMACIST
Non-clinical pharmacists
in Academia
• Responsible for training
the next generation of
practicing pharmacists to
practice in a way that
keeps patients safe.

46. ROLE OF PHARMACIST

47. SOME ETHICAL ISSUES
• CONFIDENTIALITY
• KNOWLEDGE UPDATE
• NO LOOSE COMMENTS
• MONEY- BE PROFESSIONAL
• RULES FOR STRIP