texas pharmacy board required to report a medication error to patient

by Roselyn Greenfelder 9 min read

Joint Position Statement on Medication Errors - Texas

23 hours ago TEXAS STATE BOARD OF PHARMACY GUIDELINES FOR DISPENSING ERROR COMPLAINTS. The mission of the Texas State Board of Pharmacy (TSBP) is to promote and protect the public health, safety and welfare, and specifically, consumers of pharmacy services in Texas. If numerous dispensing errors are occurring in a pharmacy or are being committed by an individual pharmacist, it is TSBP’s duty and responsibility to take … >> Go To The Portal


Chapter 149 of the Acts of 2004 (Fiscal Year 2005 Budget) requires the Board to prepare a compilation of cases involving preventable medical error reports received by the board that resulted in harm to a patient or health care provider for the purpose of assisting health care providers, hospitals and pharmacies to modify their practices and techniques to avoid error.

Full Answer

What makes a medication error reporting system work?

To be successful a medication error reporting system must have protections for those reporting. Often, pharmacists view mandatory reporting laws and regulations as punitive, especially if public disclosure is included.

How do I find Texas Pharmacy laws and regulations?

Controlled Substances Order the Texas Pharmacy Laws and Regulations through: LexisNexis or call: 1-800-533-1637. Pharmacies operating in Texas are required to maintain a copy of the laws and rules governing the practice of pharmacy in hard copy or electronic format.

What is a medication error in nursing?

TEXAS BOARD OF NURSE EXAMINERS/BOARD OF PHARMACY JOINT POSITION STATEMENT ON MEDICATION ERRORS. Medication errors occur when a drug has been inappropriately prescribed, dispensed, or administered. Medication errors are a multifaceted problem which may occur in any health care setting.

How does physician sampling of medications contribute to medication errors?

Physician sampling of medications can contribute to medication errors due to the lack of both adequate documentation and drug utilization review. The term dispensing error refers to medication errors linked to the pharmacy or to whatever health care professional dispenses the medication.

Do medication errors need to be reported?

Medication errors are detected by voluntary reporting, direct observation, and chart review. Organizations need to establish systems for prevention of medication errors through analyzing the cause of errors to identify opportunities for quality improvement and system changes (Morimoto, Seger, Hsieh, & Bates, 2004).

Who should you notify when a medication error occurs?

If an error occurs, the appropriate steps should be taken to address the patient's condition. It is important to document the incident or near-miss and report it immediately to the patient's primary healthcare provider and your employer. In addition, complete any additional documentation required by your employer.

Who is responsible for reporting a medication error?

Figure 1. An error report may be transmitted internally to health care agency administrators, managers, physicians, nurses, pharmacists, laboratory technicians, other caregivers, and agency legal counsel.

Can a pharmacist be liable for pharmacy mistakes?

When pharmacy errors lead to harm, the patient may have the right to bring a pharmacy error lawsuit seeking compensation. Pharmacists may liable for malpractice if they dispense the wrong drug, the incorrect dosage or fail to recognize a contraindication with other medicines the patient is taking.

What must be completed if a medication error occurs?

someone else has made a medication error, you must IMMEDIATELY REPORT THE ERROR TO THE RN CM/DN AND APPROPRIATELY DOCUMENT THE ERROR. According to your agency's policy, your supervisor should also be notified.

How do you disclose a medical error to a patient?

Disclosing medical errors the right wayBegin by stating there has been an error;Describe the course of events, using nontechnical language;State the nature of the mistake, consequences, and corrective action;Express personal regret and apologize;Elicit questions or concerns and address them; and.More items...

Who is responsible for medication administration errors?

The three most common dispensing errors are: dispensing an incorrect medication, dosage strength or dosage form; miscalculating a dose; and failing to identify drug interactions or contraindications. Errors caused by drug administration can be made by the health care provider or by the patient themselves.

When a medication error occurs what information must be included in an incident report regarding the occurrence?

This report should include: client's ID, name and dose of med, time and place of incident; accurate and objective account of the event, who you notified, what actions you took, your signature (or that of the person who completed the report).

Who is responsible for ensuring medication errors do not occur?

Clinical leaders and senior managers of a health service organisation implement systems to reduce the occurrence of medication incidents, and improve the safety and quality of medicine use.

What do you do in your pharmacy when an error is made?

You should be open and honest with the patient — apologise and explain what went wrong. You should record the mistake and ensure that it is reported appropriately within the organisation. For example, notifying the superintendent pharmacist.

What if the pharmacy gives you the wrong medication?

If you suspect that a pharmacy has given you the wrong prescription for any reason, stop taking the medication at once. Contact your physician if you have already taken the medication. Call 911 or visit medical emergency services if are experiencing adverse symptoms.

What to do with a dispensing error?

A summary of the action points is listed below:Establish if the patient has taken any of the incorrect medicine.Ask to inspect the incorrect medicine.Apologise.Never try to minimise the seriousness of a complaint.Make a correct supply of the correct medicine ordered on the prescription if appropriate.More items...

Where are the pharmacy rules in Texas?

Pharmacy Rules - The Texas Pharmacy Rules are located in Chapters 281-315 of the Texas Administrative Code . Order the Texas Pharmacy Laws and Regulations through: LexisNexis or call: 1-800-533-1637.

Do pharmacies have to keep a copy of the Texas Pharmacy Act?

Pharmacies operating in Texas are required to maintain a copy of the laws and rules governing the practice of pharmacy in hard copy or electronic format. Please note that the electronic version must be accessible to pharmacy personnel at all times.

What information does a pharmacist provide when you receive a new prescription?

When you receive a new prescription, the pharmacist is required to verbally counsel you about the prescription and also provide you written information about the prescription drug. The pharmacist may provide you with information such as: action to be taken in the event of a missed dose.

What is special directions and precautions?

special directions and precautions; common severe side or adverse effects or interactions that may be encountered; techniques for self-monitoring of drug therapy ; proper storage; refill information; and. action to be taken in the event of a missed dose.

Do pharmacies have to make patient references?

In addition, every pharmacy is required to make available to you a patient reference, which provides written information designed for the consumer about prescription drugs. This reference must be easily accessible to all consumers in the pharmacy.

Does a prescription fail to work?

YES! The National Council on Patient Information and Education (NCPIE), a patient education coalition of nearly 200 organizations (including the Texas State Board of Pharmacy), reports up to 50% of all prescriptions fail to work because they are used improperly.

How many checks of the right should a nurse perform before administering medication?

Evidenced-Based Best Practice states that prior to the administration of medication to a resident, not only should the nurse check the first 5 “rights” but he/she should perform 3 checks of the “right”, in order to ensure that the medication is administered safely. These checks should be performed:

What is medication administration?

Due to the potential danger of medication administration, it is imperative that the nurse understand the importance of performing the task safely. Becoming proficient in all of the aspects of medication administration will ensure that the residents are kept safe through all areas of the care provided to them.

What are the properties of a medication?

Medication properties such as absorption, distribution, metabolism, and excretion make up the pharmacokinetic profile of a medication and affect the medication’s action, peak concentration, duration of action, and bioavailability.

Why are psychotropic medications prescribed in nursing homes?

Nurses care for older adults in many different practice settings but have varying degrees of knowledge about these kinds of medications. Because of severe adverse side effects and inappropriate prescribing practices , the use of psychotropic medications first came under scrutiny with nursing home residents. As a result, the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), federal legislation mandating minimum health and care requirements for nursing homes, placed limitations on the use of psychotropic medications with nursing home residents. Age-related changes such as altered absorption, altered distribution, changed hepatic metabolism, reduced renal excretion, and altered neurophysiology all affect pharmacokinetics and pharmacodynamics.

How do medications affect the human body?

When properly used, medications are a great resource for mankind; indiscriminately or improperly used, they can lead to anything from minor irritating problems to death. Medications are chemical compounds that modify human body processes. They may alter chemical reactions, fight, cure, or prevent disease, relieve disease symptoms, maintain health, aid in diagnosis, or alter a normal process. For example, psychotropic medications change behavior through altering, blocking, destroying, or augmenting brain chemicals. FDA studies show that medication errors injure about 1.3 million people in the United States each year and cause the death of 7,0001. Safe medication administration is essential to nursing practice, and nurses need to have knowledge and skill in the techniques of administering all pharmaceutical agents because the nurse is the last line of defense to protect a resident against a medication error. In order to ensure resident safety, the Medication Administration Module of this tool-kit was developed.

Why is medication important in nursing?

Medications are administered to individuals to diagnose, treat, or prevent illness. Drugs are potentially dangerous, even if they are meant to improve our health. It is important that those you care for take any and all medications that they are prescribed, correctly, ensuring that the doctor’s orders are always followed. Medications have different ways in which they need to be given in order for them to work properly. The responsibility that you as the nurse have in medication administration will vary and be based on the needs of your residents and the policies and procedures that are in place at the facility in which you work. The administration of medications is a very important task that requires a great deal of attention while being performed, in order to be done safely.

Can a resident take medications orally?

For residents who are unable to take medications orally, use of an existing G-tube may be required for medication administration to take place. CMS requires, in accordance with F42515, that the nursing facility, in consultation with the pharmacist, must provide procedures for the accurate administration of all medications. The nurse is responsible for understanding these policies and procedures prior to the administration of any enteral medications. The procedures must reflect current standards of practice, including but not limited to:

How many people die from pharmaceutical errors in the US?

It has been reported that pharmaceutical errors cause at least one death every day and injure approximately 1.3 million people annually in the United States. An estimated 106,000 deaths occur every year from no-error, adverse effect of medication.

What happens if a pharmacist fills a prescription?

A pharmacist might incorrectly fill a prescription causing many potential consequences to a patient. Pharmacy mistakes range from providing a patient the incorrect dosage of a medicine (either too strong, or too weak, for the medical need), or giving the wrong medicine altogether.

What are the most common errors in healthcare?

The most common errors were giving patients medication at the wrong time or missing a dose. The Joint Commission on Accreditation of Healthcare Organization (JCAHO) has set safety standards to reduce errors in a medical setting as pertaining to prescriptions. Pharmaceutical injuries are sometimes difficult to identify.

Why are pharmaceutical injuries so hard to identify?

The damage may be caused because two or more drugs interact improperly or the manufacturer may have failed to adequately test its drug. In some situations, it is learned that a company neglected to accurately report the side effects of taking a drug.

Can you recover from Vioxx?

Those people injured by Vioxx or Baycol, or other drugs, may be able to recover for the injuries and suffering. Pharmaceutical and prescription drug errors harm innocent people. It is important that you find a lawyer who has the experience and talent to represent you fully.

Who can report medication errors?

Reporting Medication Errors. Health care professionals and consumers have the opportunity to report the occurrence of medication errors to a variety of organizations. Examples include the Institute of Safe Medication Practices (ISMP) and the Food and Drug Administration (FDA).

Why do prescription errors occur?

Errors may occur because a prescription is never transmitted to a pharmacy, or a prescription is never filled by the patient. Physician sampling of medications can contribute to medication errors due to the lack of both adequate documentation and drug utilization review.

What is automated pharmacy dispensing system?

Automated pharmacy dispensing systems are more efficient at performing pharmacists’ tasks that require tedious, repetitive motions, high concentration and reliable record keeping, which can all lead to medication dispensing errors.

How can electronic technology improve patient safety and reduce medication errors?

One way in which electronic technology can improve patient safety and reduce medication errors is through the use of standard machine-readable codes ("bar codes"). Medication bar coding is a tool that can help ensure that the right medication and the right dose are administered to the right patient.

Why do I get errors in prescribing?

Errors in prescribing can occur when an incorrect drug or dose is selected, or when a regimen is too complex. When prescriptions are transmitted orally, sound-alike names may cause error. Similarly, drugs with similar-looking names can be incorrectly dispensed when prescriptions are handwritten.

What is patient education?

Patient Education#N#Health care professionals must provide adequate patient education about the appropriate use of their medications as part of any error prevention program. Proper education empowers the patient to participate in their health care and safeguard against errors. Some examples of instructions to patients that can help prevent medication errors are:

Why are over the counter medications wrong?

Over-the-counter medications can lead to medication errors because labels may not be sufficiently read or understood, and health care providers are often unaware when patients are taking over-the-counter medications. The types of errors described above are primarily errors of commission.