PSI Patient Safety — Questions and Answers
Question 1: What is a 'near miss' in the pharmacy context?
- A dispensing error that is detected and corrected before the medicine reaches the patient (Correct answer)
- A patient who nearly missed collecting their prescription
- A delivery of medicines that nearly arrived late
- A prescription that was nearly written incorrectly
Correct answer: A dispensing error that is detected and corrected before the medicine reaches the patient
A pharmacy near miss is an error caught during the checking process before the medicine is handed to the patient. Recording and analysing near misses is crucial for patient safety as they reveal system weaknesses that could lead to actual errors reaching patients.
Question 2: What is the LASA (Look-Alike, Sound-Alike) issue in pharmacy?
- The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing (Correct answer)
- A quality assessment tool for pharmacy labels
- An inventory management system
- A patient classification system
Correct answer: The risk of medication errors caused by medicines with similar names, similar packaging, or both, leading to potential selection errors during dispensing
LASA medicines pose a significant safety risk because their similar names (e.g., hydroxyzine/hydralazine) or packaging can lead to wrong drug selection errors. Pharmacies should implement strategies such as tall-man lettering, physical separation of LASA products, and electronic alerts.
Question 3: What is the pharmacist's role in adverse drug reaction (ADR) reporting in Ireland?
- To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions (Correct answer)
- ADR reporting is only the doctor's responsibility
- ADRs do not need to be reported
- Only report ADRs that cause hospitalisation
Correct answer: To identify, document, and report suspected ADRs to the HPRA through the national ADR reporting system, especially for new medicines and serious reactions
Pharmacists have a professional duty to report suspected ADRs to the HPRA (Health Products Regulatory Authority). Reports should be made for all suspected ADRs to medicines, vaccines, herbal products, and devices, particularly for new medicines (marked with a black triangle ▼) and serious reactions.
Question 4: What safety checks should a pharmacist perform when dispensing a new prescription for a patient already on other medications?
- Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies (Correct answer)
- Only check the patient's name matches the prescription
- No additional checks are needed
- Only check the expiry date of the medicine
Correct answer: Check for drug-drug interactions, therapeutic duplication, contraindications based on the patient's medical history, appropriate dose for age/weight/renal function, and allergies
A comprehensive clinical check includes: drug-drug interactions with current medications, therapeutic duplication, contraindications (medical history, pregnancy), dose appropriateness (age, weight, renal/hepatic function), allergy status, and whether the new medicine is consistent with the patient's conditions.
Question 5: What is the importance of patient counselling at the point of dispensing?
- It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm (Correct answer)
- Patient counselling is a waste of time
- Counselling should only be provided if the patient asks for it
- Written labels are sufficient — no verbal counselling is needed
Correct answer: It improves medication adherence, helps patients understand their treatment, reduces errors in self-administration, and identifies potential problems before they cause harm
Patient counselling is a core pharmacy activity that significantly impacts treatment outcomes. It should cover: how to take the medicine, expected effects, potential side effects, storage, what to do if a dose is missed, and when to seek medical attention. Counselling improves adherence by up to 50%.
Question 6: What is the 'high alert medications' concept and which medicines fall into this category?
- Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents (Correct answer)
- Any medicine that costs over €100
- Only medicines administered by injection
- Medicines that have been recalled
Correct answer: Medicines that bear a heightened risk of causing significant patient harm when used in error, including anticoagulants, insulin, opioids, and chemotherapy agents
High-alert medications carry an elevated risk of harm when errors occur. The ISMP (Institute for Safe Medication Practices) list includes anticoagulants, insulin, opioids, neuromuscular blocking agents, and concentrated electrolytes. Extra safeguards (independent double-checks, dose limits) should be applied.
PSI Patient Safety
What is a 'near miss' in the pharmacy context?