Degnan Daniel D, Hertig John B, Peters Michael J, Stevenson James G
1 Center for Medication Safety Advancement, Purdue University College of Pharmacy, West Lafayette, IN, USA.
2 Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
J Pharm Pract. 2018 Jun;31(3):312-321. doi: 10.1177/0897190017715562. Epub 2017 Jun 20.
State boards of pharmacy are generally responsible for the governance of the practice of pharmacy. While the regulatory process and methods for accomplishing this task may vary by state, all boards of pharmacy must address medication errors committed by pharmacists. The National Association of Boards of Pharmacy (NABP) has recommended that state boards of pharmacy implement best practices and enforcement actions that are aimed to promote patient safety and reduce medication errors. The current study was designed to identify and compare current corrective action practices among boards of pharmacy in response to medication errors. An electronic survey regarding board policies and anticipated board actions in response to hypothetical medication error scenarios was sent to boards of pharmacy for completion. Approximately 45% of pharmacy boards responded. Survey responses demonstrated that corrective actions and consequences were levied against pharmacists inconsistently among state boards. Corrective action plans and process improvement components were lacking in a majority of state board of pharmacy practices. Medication safety education for pharmacists and for members on boards of pharmacy was insufficient in many states. Responses to hypothetical error scenarios indicated that most board actions are educational and punitive in nature, rather than focusing on systems improvement.
各州药房委员会通常负责药房执业的管理。虽然实现这一任务的监管程序和方法可能因州而异,但所有药房委员会都必须处理药剂师所犯的用药错误。美国国家药房委员会协会(NABP)建议各州药房委员会实施旨在促进患者安全和减少用药错误的最佳实践和执法行动。本研究旨在识别和比较药房委员会针对用药错误的当前纠正措施实践。一项关于委员会政策以及针对假设用药错误场景的预期委员会行动的电子调查被发送给各药房委员会以供完成。约45%的药房委员会做出了回应。调查结果表明,各州委员会针对药剂师的纠正措施和后果实施并不一致。大多数州药房委员会的实践中缺乏纠正行动计划和流程改进部分。在许多州,针对药剂师以及药房委员会成员的用药安全教育不足。对假设错误场景的回应表明,大多数委员会行动本质上是教育性和惩罚性的,而非侧重于系统改进。