ABSTRACT
Learning Objectives: After reading this chapter and working through the case, the reader will be able to:
1. Describe the medication use process 2. Discuss the impact of technology on the health-system pharmacy operations 3. List medication safety strategies for each step in the medication use process 4. Compare advantages and disadvantages of centralized versus decentralized
drug distribution in terms of operational and personnel costs
Medication Use Process ......................................................................................... 166 Prescribing......................................................................................................... 166 Transcribing ...................................................................................................... 167 Distribution ....................................................................................................... 168
Non-Parenteral Dispensing ........................................................................... 169 Parenteral Dispensing ................................................................................... 169 Delivery and Fulfillment Methodologies ...................................................... 170 Controlled Substances .................................................................................. 171
Medication Disposal, Shortage, and Counterfeits ............................................. 172 Administration .............................................................................................. 172
Monitoring......................................................................................................... 173 Risk and Safety ...................................................................................................... 174
Pharmacist as Medication Safety Leader .......................................................... 174 National Patient Safety Goals ........................................................................... 175 Researching and Preventing Errors ................................................................... 176 Adverse Drug Events and Safety Strategies ...................................................... 176 Health Information Systems .............................................................................. 179 Performance Standards...................................................................................... 180
Licensing ...................................................................................................... 180 Health-System Surveys ................................................................................ 181 Pharmacy Metrics ......................................................................................... 181 Performance Improvement ........................................................................... 183
Future of Health-System Pharmacy Practice ......................................................... 183 References .............................................................................................................. 185
During evolution of the practice of pharmacy during the latter half of the twentieth century, the concept of the medication use process was introduced to provide a conceptual framework to investigate all activities associated with the use of medications in the health system that result in medication errors. The medication use construct allowed the pharmacists to focus staff and activities to take on the enhanced role of advocating for proper use of medications to avoid medication errors and achieve desired outcomes. This framework allowed practitioners to launch quality improvement activities aimed at decreasing the number and severity of medication errors which were identified as a public health problem. Additionally, the framework addressed the expansion of health-system pharmacy services to include outpatient pharmacy and ambulatory clinics along with the traditional inpatient focus. The medication use process forms the organization of this chapter and will use the health system as its primary focus. The medication use process is composed of five activities: prescribing, transcribing, distribution, administration, and monitoring (Figure 10.1).
