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Include contrast media in monthly inspections
Learning objectives: After reading this article, you will be able to
1. list six steps to take when handling oral contrast media
2. identify the pharmacist's role in contrast media handling
3. explain when a pharmacist should review a contrast order
Pharmacists do not need to review most oral contrast media orders, but they should apply other medication management principles and standards to meet JCAHO requirements.
Among the tasks pharmacists should perform regarding contrast media are inspecting expiration dates, labels, and security issues when conducting monthly floor-stock checks.
"That is something that should be an ongoing standard," says Doug Wong, PharmD, senior executive consultant for the Grapevine, TX-based Pharmacy Healthcare Solutions. "That shouldn't be the exception. That should be the rule."
Meet six standards
JCAHO standard MM.4.10 requires hospitals to review all prescriptions and medication orders for appropriateness. Contrast media are considered medications, according to the commission.
But the accreditor does not require a pharmacist's prior review of oral contrast orders, according to an article in the June 2005 Joint Commission Perspectives . However, according to the newsletter, organizations should adhere to the following standards and safeguards:
The hospital must adopt clinical practice guidelines or screening tools to address safe administration, and the medical staff and pharmacy must approve those tools
Trained staff must retrieve the media from a limited set of medications
A qualified professional must review the media order's appropriateness
The hospital must have procedures to prevent retrieval errors
A pharmacist must be available to answer questions if necessary
The hospital must evaluate its system by sampling records of patients who received contrast media without prior pharmacy review
According to data from the U.S. Pharmacopeia MEDMARX error-reporting database for a five-year period ending in 2003, 912 reports listed radiology as the location of the error. Of those reports, 27% were wrong-dose errors, and 22% were the wrong drug.
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