Ethics and Pharmacy Practice from Pharmacist s Letter p 1 2 Merriam Webster defines ethics as a set of moral principles and the principles of con duct governing an individual or group ethics comes from the Greek word ethos character distinction between ethics and morality is that morality is a personal societal pursuit of right action which ethics is a systemic pursuit of morality on a larger scale such as in a corporate organization experts point out that there is little literature published about pharmacy ethics with ex ception of specific topic of conscientious objection in pharmacy practice possible reason pharmacy may be seen as a technical fact based profession whereas in reality it is both values based and knowledge based ethics in pharmacy has shifted from a more paternalistic approach to one that acknowl edges patient autonomy some dilemmas that pharmacists face in daily practice dispensing meds to prescriptions that need clarification dispensing emergency hormonal contraception selling OTC meds that will neither benefit nor harm the patient selling OTC meds to patients who may be abusing them deciding whether or not to report prescribers and dispensing clinically equivalent meds without prescriber authorization surveyed pharmacists have expressed concern about both operating within law regula tions and also in the best interest of their patients in mid 1990s code of ethics for pharmacists was adopted by APhA also endorsed by ASHP year volved highlight 8 principles of code of ethics a pharmacist respects the covenantal relationship between the patient and pharmacist considering the patient pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society in return for this gift a pharmacist promises to help individuals achieve optimum benefit from their meds to be committed to their welfare and to maintain their trust Institute of Medicine estimates that 1 5 million preventable ADEs occur in the US every 2004 Canadian ADE study estimates 7 5 experience adverse event 24 000 Canadi ens dying annually as a result 1 4 adverse events were medication fluid administration related medication incidents happen because of deficiencies in the system as opposed to indi vidual negligence system problems tend to occur in recurrent patterns regardless of individuals who are in annual publication of National Patient Safety Goals by the Joint Commission has pro vided guidance for US health care organizations to improve patient safety Accreditation Canada has developed similar Required Organizational Practices health care practitioners can use this info to identify areas of risk in their own practice settings make appropriate process changes to reduce potential for errors to occur prescribing 29 transcribing 12 dispensing 11 administration 38 errors can occur at any step 50 of dispensing error claims involve dispensing the wrong drug 27 due to dispens ing the right drug in the wrong strength 8 due to incorrect labeling other claims filed against a pharmacist include failure to review drug regimen missed allergies failure to counsel warn of potential adverse drug reactions fastest growing seg ment of claims against pharmacists most med incidents can be avoided if preventive measures are in place contributing to prevention of medication incidents is just one step in ensuring patients re ceive optimum benefit from their meds Preventing Medication Errors drugs or dietary supplements of some sort in any given week four out of every five US adults will use prescription meds OTC 1 3 of adults will take five different medications most of these meds are beneficial no harm but sometimes have adverse drug events ADEs but sometimes harm is caused by error in prescribing can be prevented medication errors are surprisingly common costly to the nation Institute of Medicine created this report as a national agenda for reducing these errors this approach will require changes from doctors nurses pharmacists and others in the health care industry from the FDA hospitals and patients Unacceptable Costs of Medication Errors errors are common during every step of the medication process procuring the drug pre scribing it dispensing it administering it and monitoring its impact occur most frequently during the prescribing and administering stages hospital patient can expect on average to be subjected to more than one medication error a day ADE arising from error is considered preventable study estimated 380 000 preventable ADEs in hospitals each year another esti mated 450 000 believed to be estimates 800 000 preventable ADEs each year in long term care facilities 530 000 outpatient Medicare preventable ADEs year none of these studies includes errors of omission failure to prescribe medication in cases where it should be in total at least 1 5 million preventable ADEs year in the United States these medication errors costly to patients families employers hospitals health care providers and insurance companies hospital stay each preventable ADE that took place in a hospital added about 8 750 to the cost of the total annual cost 3 5 billion another study looked at preventable ADEs in Medicare enrollees aged 65 and found an annual cost of 887 million for treating medication errors in this group HOWEVER All of these studies do not take into account lost earnings or any compensa tion for pain suffering series of steps to prevent medication errors A Paradigm Shift in the Patient Provider Relationship first step allow encourage patients to take more active role in their own medical care past health care has been more paternalistic provider centric patients not expected to be involved in the process one of the most effective ways to reduce med errors is to move toward a model of health care where there is more partnership between patients health care providers patients should understand more about their medications take more responsibility for monitoring those meds while providers should take steps to educate consult with and listen to the patients doctors nurses pharmacists etc must communicate more with patients at every step of the way and make that communication a two way street listening to the patients as well as talk ing to them should inform patients fully about risks possible side effects of meds they are taking what to do if they experience a side effect need to be more forthcoming when med errors have occurred what consequences have been