Public Interest Law Initiative


By U. Ashton. Presbyterian College. 2018.

The use of verbal prescriptions (spoken aloud in person or by telephone) introduces a number of variables that can increase the risk of error quality sinequan 25 mg anxiety symptoms tinnitus. These variables include:  Potential for misinterpretation of orders because of accent or pronunciation sinequan 25mg low price anxiety fever;  Sound alike drug names;  Background noise;  Unfamiliar terminology; and  Patients having the same or similar names. For example, numbers in the teens such as 15 and 16 may be heard and transcribed as 50 and 60. Once received, a verbal prescription must be reduced to writing which adds further complexity and risk to the prescribing process. No one except the prescriber can verify the accuracy of a verbal order against what was intended, and identification of an error in a verbal prescription by a prescriber relies on their memory of what was spoken. Medication safety literature recognizes that the more direct the communication between a prescriber and a pharmacist, the lower the risk of error. The introduction of intermediaries into the prescribing process has been identified as a prominent source of medication error. Communicating a prescription by telephone through an intermediary:  Blurs accountability;  Further increases the risk of miscommunication;  Reduces the effectiveness of the prescription confirmation process; and  Lessens the likelihood that effective communication occurs if questions arise about a prescription. Patients can and should be supported to question why they are receiving a medication, verify that it is the appropriate medication, dose, and route, and alert the health professional involved in prescribing, dispensing, or administering a medication to potential problems such as allergies or past drug-drug interactions. There is significant legal risk associated with the use of intermediaries because current legislation does not support or is silent on the role of intermediaries in the communication of medication prescriptions. Given this level of risk, we recommend that health professionals involved in the communication of medication prescriptions in 1 community and ambulatory settings apply the core principles outlined in this document. The principles provide guidance to health professionals involved in the prescribing and management of medication prescriptions in community and ambulatory practice settings. In endorsing these principles, these organizations also acknowledge that some period of transition and redesign of processes may be required. Practitioners are encouraged to work collaboratively in addressing needed changes and to consult with their professional colleges for advice as required. Core Principles for Safe Communication of Medication Prescriptions in Community and Ambulatory Settings: 1. To minimize the risk of error, medication prescriptions must be issued clearly and completely. Health professionals involved in the management of medication prescriptions have a responsibility to question any medication prescription issued by another health professional if they believe that it may not be safe or may otherwise not be in the patient’s best interest. In-hand delivery of a written prescription to the pharmacist by the patient/guardian is preferred over a verbal prescription order. The faxed communication of a medication prescription from the prescriber’s office to the pharmacist is preferred over a verbal prescription order when in-hand delivery of a written prescription by the patient/guardian is not possible. Verbal communication of prescriptions must be limited to situations where immediate written or faxed communication is not feasible. If necessary, verbal prescriptions communicated by telephone to a pharmacy are best conveyed by direct communication between the authorized prescriber and the pharmacist. The accuracy of a verbal prescription should be confirmed using strategies such as a ‘read back’ of the prescription and/or a review of the indication for the medication. The use of an intermediary to communicate verbal prescriptions between a prescriber 2 and a pharmacist must be a last resort. Patient safety and well-being is of utmost importance in making a decision to use an intermediary. When filling a medication prescription on an urgent basis, the benefit to the patient must be weighed along with the recognition of the legal risk incurred by the intermediary and the prescriber. If a decision to use an intermediary is made, the use of the intermediary must be done according to the guidelines outlined below: a) Communication of verbal prescriptions through intermediaries does not diminish the prescriber’s responsibility for accuracy and appropriateness of prescribing or the responsibility to be available if the pharmacist requires direct communication with the prescriber. Intermediaries also refer to electronic devices such as voice messaging systems and telephone answering devices used to receive medication prescriptions. Urgent/Emergent situations are circumstances that call for immediate action or attention f) A new prescription that is communicated verbally to a pharmacist through an intermediary must be confirmed as soon as possible through direct communication between the prescriber and the pharmacist or via fax.

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Nonphar- macologic therapy generic sinequan 75 mg anxiety symptoms confusion, such as diet and exercise generic sinequan 75 mg amex anxiety symptoms at bedtime, should be considered whenever possible. If a medication is determined to be necessary, health care providers need to consider the medication’s pharmacokinetic and pharmacodynamic properties, side effect profile, and current hepatic and renal function for accurate dosing. Medication cost, patient preference, and potential for drug-drug and drug-disease interactions should also be considered in prescribing. Reasonable therapeutic goals and monitoring parameters will help guide therapy to prevent unwanted side effects. It is also wise for health care providers to create their own personal formularies where they become very familiar with prescribing a few drugs. Simplifying medication regimens as well as educating patients regarding medications can improve adherence. When drug therapy has been titrated to ideal doses, try to combine medications into single pills to reduce pill burden. Indication Ensure each medication has an indication and a defined, realistic therapeutic goal. List List the name and dose of each medication in the chart and share it with the patient and/or caregiver. Individualize Apply pharmacokinetic and pharmacodynamic principles to individualize medication regimens. Avoid potentially dangerous interactions, such as those that can increase the risk for torsades de pointes. Educate Educate the patient and caregiver regarding pharmacologic and nonpharmacologic treatments. Discuss expected medication effects, potential adverse effects, and monitoring parameters. Medications should start at lower than usual doses and be titrated slowly, often referred to as “start low, go slow. Discuss expected medication effects, potential adverse effects, and drug-drug interactions and monitoring parameters. Providers should evaluate all existing medications at each patient visit for appropriateness and weigh the risks and benefits of starting new medications to minimize polypharmacy. Administration on Aging of the United State Department of Health and Human Services. Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey. Potentially inappropriate medication use among elderly home care patients in Europe. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. Polypharmacy and inappropriate prescrib- ing in elderly internal-medicine patients in Austria. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Inappropriate medication prescribing in residential care/assisted living facilities. The impact of clinical pharmacists’ consultations on physicians’ geriatric drug prescribing. Effects of geriatric evaluation and management on adverse reactions and suboptimal prescribing in the frail elderly. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1: Overview, etiology, and drug interactions. Clinically important drug-disease interactions and their prevalence in older adults. Measurement, correlates, and health outcomes of medication adherence among seniors.

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The late phase pipeline holds 2 discount sinequan 25mg with amex anxiety symptoms 2,320 novel products and 43-49 New Active Substances are expected to be launched on average for each of the next fve years buy 10mg sinequan with visa anxiety symptoms grief. Chart notes: Measures total value of spending on prescription medicines and insulins by retail pharmacies, hospitals, and other institutional pharmacies at invoice prices. Net spending refects company recognized revenue after of- invoice discounts, rebates and price concessions are applied. Patent expiry category shows the impact of lower spending on products that lost exclusivity. Net values denote company recognized revenue after discounts, rebates and other price concessions. Chart notes: Includes all branded medicines that have lost patent exclusivity and faced competition from generics or non-original biologics. Loss of exclusivity dates were determined using patent expiry dates and generic entry dates. Older expiries category includes all branded medicines that lost exclusivity prior to 2012. Chart notes: Spending based on invoice price and does not refect of-invoice discounts and price concessions. Specialty medicines are mostly initiated by specialists, and include treatments for cancer and other chronic conditions. Chart notes: Newer generics are unbranded generics that have launched in the past two years. Chart notes: The protected brand segment includes products that are over two years old and have not yet faced generic competition. Protected brand growth is split by volume and price in Chart 2; only the contribution from volume is shown here. This analysis does not separate mix change, or shifts to more or less expensive brands, from volume and price. They are often initiated by specialists, and include treatments for cancer and other chronic conditions. Chart notes: Oncology market defned as L1 antineoplastics, L2 cytostatic hormone therapies, V3C radio pharmaceuticals, denosumab, lenalidomide, pomalidomide, and aldesleukin. Chart notes: New patients are defned as new to brand prescriptions for Daklinza, Incivek, Victrelis, Sovaldi, Olysio, Harvoni, Technivie and Viekira Pak. Chart notes: Multiple sclerosis market is defned as interferons, dimethyl fumarate, fngolimod, glatiramer, natalizumab, and terifumonide. Other diabetes category includes sulphonylureas, biguanides, glucosidase inhibitors, glinides, insulin devices, glucugon, and combination therapies. Net sales and growth values denote company recognized revenue after discounts, rebates and other price concessions. Existing Mechanism refers to subsequent products with existing mechanisms of action for an indication. All indications are for metastatic disease and second line or lower treatment sequence unless otherwise indicated. Chart notes: Averages are calculated among paid claims where a co-pay card is used as the secondary payer and normalized to 30 days. Chart notes: Cost exposure is calculated using paid and reversed claims where a coupon is the secondary payer and excludes instances in which a coupon is the primary payer, normalized to 30 days. Chart notes: Out-of-pocket costs include co-pay ofsets through coupons; patient categories are defned using longitudinal data to identify deductible spending patterns or mode payer, normalized to 30 days. Chart notes: The cohort of Facility-Other includes facilities for alternative medicine, elder care, labs, correctional programs, and workplace wellness. All facilities from the Healthcare Organization services ofering included except veterinarian facilities. Chart notes: The top states with a healthcare provider gap are defned by the percent of population in healthcare professional s gap areas as compared to the overall state population. Chart notes: Forecast growth reported on an invoice basis excluding of-invoice discounts and rebates. The prices do not refect of-invoice price concessions that reduce the net amount received by manufacturers. The approximately 640,000 facilities includes single ownership relationships and multiple purchasing, distribution, academic and alliance relationships. Formulary measures include tiered co-pay beneft designs, prior authorization restrictions, and often result in non- preferred prescriptions being rejected or switched at the pharmacy.

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Sex infection screening protocol will result in improved case finding for Transm Dis 2012 purchase sinequan 75mg with mastercard anxiety kava;39:1–7 safe 75 mg sinequan anxiety symptoms breathing problems. Comparison of self-obtained penile- in male sexual partners: implications for diagnosis, treatment, and meatal swabs to urine for the detection of C. Am J Obstet Gynecol detection of Trichomonas vaginalis vaginitis in specimens from women 2009;200:e41–7. A prospective study in high-risk a point-of-care test for trichomoniasis as accurately as clinicians. Determinants of per-coital- Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Failure of nitazoxanide to cure trichomoniasis in metronidazole and tinidazole in female reproductive organs after a single three women. Double-blind comparison of vaginalis in women with suspected metronidazole hypersensitivity. Am a single dose and a five-day course of metronidazole in the treatment J Obstet Gynecol 2008;198:e371–7. Split-dose metronidazole or single-dose associated with increased risk of preterm birth in South Carolina women tinidazole for the treatment of vaginal trichomoniasis. Tinidazole in the treatment of trichomoniasis, and mental retardation in children. Interventions for treating trichomoniasis in of trichomonas in pregnancy and adverse outcomes of pregnancy: women. Does patient-delivered pregnancy in sub-Saharan Africa does not appear to be associated with partner treatment improve disclosure for treatable sexually transmitted low birth weight or preterm birth. J Perinatol and tinidazole activities against metronidazole-resistant strains of 2010;30:717–23. Utility of antimicrobial efficacy of antibiotics to prevent chorioamnionitis and preterm birth. Resistant trichomoniasis: successful or recurrence of trichomoniasis among human immunodeficiency virus treatment with combination therapy. Tinidazole therapy for metronidazole- transmitted infections, and sex risk among African American women resistant vaginal trichomoniasis. Objectivized diagnosis of acute pelvic trial: single versus 7-day dose of metronidazole for the treatment of inflammatory disease. Am J Obstet Gynecol study comparing the effect of single-dose 2 g metronidazole on 1991;164(1 Pt 1):113–20. Infect Dis of the pharmacokinetic interactions of azole antifungal drugs with other Obstet Gynecol 2011;2011:561909. Reduced fluconazole susceptibility of Candida alternative outpatient pelvic inflammatory disease treatment strategies. Vulvovaginal candidiasis caused by comparison of ampicillin-sulbactam to cefoxitin and doxycycline or non-albicans Candida species: new insights. Curr Infect Dis Rep clindamycin and gentamicin in the treatment of pelvic inflammatory 2010;12:465–70. Efficacy and safety of by Candida glabrata: use of topical boric acid and flucytosine. Am J azithromycin as monotherapy or combined with metronidazole Obstet Gynecol 2003;189:1297–300. Comparing ceftriaxone immunodeficiency virus-infected women receiving fluconazole plus azithromycin or doxycycline for pelvic inflammatory disease: a prophylaxis. Effectiveness of inpatient and treatment of acute, uncomplicated pelvic inflammatory disease. Am J Obstet Gynecol for moxifloxacin versus ofloxacin/metronidazole for first-line treatment 2002;186:929–37. A serological study of inflammatory disease and on efficacy of ambulatory oral therapy. Am the role of Mycoplasma genitalium in pelvic inflammatory disease and J Obstet Gynecol 1999;181:1374–81. Is Mycoplasma genitalium in immunodeficiency virus-1 infection on treatment outcome of acute women the “New Chlamydia? Accuracy of five different diagnostic intrauterine devices in women who acquire pelvic inflammatory disease: techniques in mild-to-moderate pelvic inflammatory disease.

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Hos- and meta-analysis of randomized controlled tri- systems approach to inpatient glycemic man- pital Guidelines for Diabetes Management and als 10 mg sinequan fast delivery anxiety symptoms quotes. Multifaceted Med Sci 2016 buy sinequan 25 mg online anxiety krizz kaliko lyrics;351:333–341 sulin glargine and glulisine in hospitalized approach to reducing occurrence of severe 13. Clinical Tools | subjects with type 2 diabetes and renal insuffi- hypoglycemia in a large healthcare system. Menu selection, glycaemic Toolkits/Glycemic_Control/Web/Quality___ bidity in diabetic patients undergoing cardiac control and satisfaction with standard and pa- Innovation/Implementation_Toolkit/Glycemic/ surgery with a combined intravenous and sub- tient-controlled consistent carbohydrate meal Clinical_Tools/Clinical_Tools. Accessed cutaneous insulin glucose management strat- plans in hospitalised patients with diabetes. Conversion from enteral nutrition in managing patients with di- group of the American Diabetes Association intravenous insulin to subcutaneous insulin af- abetes: a systematic review. Diabetes Care 2013; ter cardiovascular surgery: transition to target 5142–5152 36:1384–1395 study. Endocr Pract Diabetes 2014;38:126–133 (54 mg/dL) should be reported in clinical trials: a 2015;21:54–58 43. Inpatient hy- regular insulin in hospitalized patients with hy- tesAssociationandtheEuropeanAssociationfor perglycemia management: a practical review perglycemia during enteral nutrition therapy. Safety and efficacy of sitagliptin therapy intensive care patient: featuring subcutane- glucose control in critically ill patients. Endocr Pract 2011;17: icine and surgery patients with type 2 diabetes: 249–260 Med 2009;360:1283–1297 17. Man- Care 2013;36:3430–3435 agement of diabetes and hyperglycemia in Enhancing insulin-use safety in hospitals: prac- 31. Diabetes Spectr 2014;27: Point-of-Care Use: Guidance for Industry and Food of basal-bolus insulin in patients receiving 180–188 and Drug Administration Staff [Internet], 2016. Is incretin- high-dose steroids for hyper-cyclophospha- Available from http://www. Accessed has proven itself and is considered the mainstay 2014;16:874–879 21 November 2016 of treatment. Continuous glu- 2117 glucose control in the diabetic or nondiabetic cose monitoring in insulin-treated patients in 34. Diabetes Care 2013;36:2169–2174 diabetes: a randomized controlled trial in Latin drugsafety/drugsafetypodcasts/ucm507785 51. Impact experience in hyperglycemic crises: diabetic regimensintype2diabetes:asystematicreview of a hypoglycemia reduction bundle and a ketoacidosis and hyperglycemic hyperosmolar care. Adverse events after hospital discharge Multiple hospitalizations for patients with dia- tinuous intravenous regular insulin for the [article online], 2010. Diabetes Care 2003;26:1421–1426 treatment of patients with diabetic ketoacido- psnet. Med Clin diabetes: effect of a dedicated diabetes treat- bicarbonate therapy in severely acidotic dia- North Am 2015;99:351–377 ment unit. Available from e000104 from the hospital to home for patients with di- http://www. Diabetes Care 2014;37:2864–2883 S128 Diabetes Care Volume 40, Supplement 1, January 2017 American Diabetes Association 15. People living with diabetes should not have to face additional discrimination due to diabetes. Care of Young Children With Diabetes in the Child Care Setting (2) First publication: 2014 Very young children (aged ,6 years) with diabetes have legal protections and can be safely cared for by child care providers with appropriate training, access to resources, and a system of communication with parents and the child’s diabetes provider. Diabetes and Driving (3) First publication: 2012 Peoplewithdiabeteswhowishtooperatemotorvehiclesaresubjecttoagreatvarietyof licensing requirements applied by both state and federal jurisdictions, which may lead to loss of employment or significant restrictions on a person’s license. Presence of a medical condition that can lead to significantly impaired consciousness or cognition may lead to drivers being evaluated for fitness to drive. People with diabetes should be individually assessed by a health care professional knowledgeable in diabetes if license restrictions are being considered, and patients should be counseled about detecting and avoiding hypoglycemia while driving. Employment decisions Readers may use this article as long as the work is properly cited, the use is educational and not should never bebased on generalizationsorstereotypesregardingtheeffectsof diabetes.

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