Using Prospective Risk Analysis Tools to Improve Safety in Pharmacy Settings: A Systematic Review and Critical Appraisal.

OBJECTIVES: This study aimed to review and critically appraise the published literature on 2 selected prospective risk analysis tools, Failure Mode and Effects Analysis and Socio-Technical Probabilistic Risk Assessment, as applied to the dispensing of medicines in both inpatient and outpatient pharmacy settings. METHODS: A comprehensive search of electronic databases (PubMed and Scopus) was conducted (January 1990-March 2016), supplemented by hand search of reference lists. Eligible articles were assessed for data sources used for the risk analysis, uniformity of the risk quantification framework, and whether the analysis teams assembled were multidisciplinary. RESULTS: Of 1011 records identified, 11 articles met our inclusion criteria. These studies were mainly focused on dispensing of high-alert medications, and most were conducted in inpatient settings. The main risks identified were transcription, preparation, and selection errors, whereas the most common corrective actions included electronic transmission of prescriptions to the pharmacy, use of barcode, and medication safety training. Significant risk reduction was demonstrated by implementing corrective measures in both inpatient and outpatient pharmacy settings. The main Failure Mode and Effects Analysis limitations were its subjectivity and the lack of common risk quantification criteria. CONCLUSIONS: The prospective risk analysis methods included in this review revealed relevant safety issues and hold significant potential for risk reduction. They were deemed suitable for application in both inpatient and outpatient pharmacy settings and should form an integral part of any patient safety improvement strategy.

Prospective systemic risk analysis of the dispensing process in German community pharmacies.

BACKGROUND: Medicine dispensing represents an error-prone activity, carrying a considerable risk for patients. OBJECTIVE: To prospectively identify and prioritize potential failure modes in the medicine dispensing process as well as to develop corrective actions for patient safety improvement in German community pharmacies. METHOD: Failure mode and effects analysis was performed in 2 community pharmacies in North Rhine-Westphalia, Germany, in October 2016. A 9-member team was assembled, comprising of a leader and process experts who prospectively assessed the medicine dispensing process by brainstorming, quantified the attributed risks, proposed corrective actions, and reassessed the risks. RESULTS: The analysis identified 39 failure modes, out of which the highest criticality scores were assigned to inadequate assessment of therapy appropriateness (Risk Priority Number 45), reluctance to deviate from rebate contracts (36), and dispensing the wrong medicine (30). The corrective actions proposed demonstrated a considerable potential for risk reduction in most failure modes, the most effective of which were introducing obligatory continuous education for pharmacists, organizing communication training, and implementing electronic prescribing. CONCLUSION: This analysis not only detected various potential safety issues concerning the dispensing in Germany but also strongly indicated that application of failure mode and effects analysis could be highly effective in prospective risk reduction in community pharmacies.

[Evaluation of effect of local administration of desoximetasone and ditranol in psoriatic lesion byapplying 20 MHz ultrasound].

INTRODUCTION: This prospective study was aimed at examining the modification of ultrasound characteristics of psoriatic plaques during desoximetasone and dithranol treatment. MATERIAL AND METHODS: The examination included 50 patients with chronic plaque-type psoriasis to whom 0.25% desoximetasone and dithranol was applied on the psoriatic lesions in the period of 21 days. The changes were measured before and every 7 days after the beginning of therapy by the combined application of A- and B-mode echosonography. RESULTS. At the beginning of the examination, the average values of the enter echo were 0.67 +/- 0.53 mm; hypoehogen shadow 0.30 +/- 0.11 mm, and dermis thickness 3.03 +/- 1.05 mm. On the first check up, the average values of the enter echo were 0.45 +/- 0.29 mm; hypoechogen shadow 0.23 +/- 0.08 mm and dermis thickness 2.65 +/- 0.97 mm. On the second check up, the average values of the enter echo were 0.30 +/- 0.18 mm; hypoechogen shadow 0.21 +/- 0.18 mm, dermis thickness 2.18 +/- 0.82 mm. On the third check up, the average values of the enter echo were 0.24 +/- 0.17 mm; hypoechogen shadow 0.18 +/- 0.17 mm, and dermis thickness 1.8 +/- 0.69 mm. DISCUSSION. The evaluation of the ultrasonographic characteristics revealed a significant reduction in the values in the course of the examination. Statistically significant differences were found before, during, and at the end of the examination by recording the ultrasound parameters of the epidermis and dermis and by following their modification. CONCLUSION. Precise determination of ultrasound parameters of epidermis and dermis and the possibility of recording their modification in a shorter or longer time interval can be used for monitoring and assessment of therapy effect of a medication.