Hospital Pharmacy

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP (www.ismp.org) or USP (www.usp.org) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (call 215-947-7797; fax 215-914-1492; E-mail: joel.shuster@temple.edu). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's medWatch Program and Temple University School of Pharmacy. ISMP is an FDA medWatch partner.

The increasing complexity of cancer chemotherapy increases the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, E-mail: OncRxSvc@aol.com; or J. Aubrey Waddell, Associate Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, E-mail: waddfour@charter.net.

Although most states have laws that explicitly allow physicians to refuse to provide certain medical services, the policies pertaining to pharmacists are less clear. The purpose of this report is to determine which states have laws or regulations that address a pharmacist's right to refuse to dispense prescriptions based on moral grounds.

Fifty Boards of Pharmacy were contacted via phone or E-mail regarding regulations as well as active or pending legislation. Information was also solicited from various state Governors' legislative offices and Web sites.

Typically, individual state practice codes allow pharmacists to refuse to fill a prescription if in their professional judgment the prescription is outside the scope of practice of the prescriber; if the validity of the prescription is in question; or to protect the health and welfare of the patient. Only five states have a “conscience clause” that allows a pharmacist to refuse to fill or refill certain prescriptions, which he or she finds morally objectionable: Arkansas (contraceptives only), California, Georgia, Mississippi, and South Dakota (abortifacients and assisted suicide only). In contrast, Illinois, Massachusetts, North Carolina, and Pennsylvania have an emergency rule or regulation, which states or implies that all legal prescriptions must be dispensed or transferred. Seventeen states considered proposed bills during their respective 2005 legislative session

The rights of pharmacists to refuse to dispense certain prescriptions vary widely from state to state. The protection provided to an individual pharmacist may be very broad or very specific depending on the wording of the statute or regulation.

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD-ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The December 2006 monograph topics are panitumumab, sitagliptin phosphate, fentanyl buccal tablet, arformoterol tartrate, and vorinostat. The DUE is fentanyl buccal.

This monthly feature will help readers keep current on new drugs, indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com.

This article of the Director's Forum provides hospital pharmacy directors with an introduction to the essential human resources skills of behavioral interviewing and performance management. While patients are a pharmacy department's most valued asset, the staff that care for those patients are critical to a patient-centered pharmacy service. Hospital pharmacy directors must practice effective human resource management to effectively recruit and retain a highly qualified and professionally satisfied staff.