New USP Chapter Addresses Physical Environment for Safe Medication Use

By May 28, 2010

BETHESDA, MD 13 May 2010-Pharmacy personnel should consider demarcating the critical area where pharmacists review medication orders or inspect medications before dispensing them, according to a new United States Pharmacopeia (USP) chapter that aims to promote safe medication use.

Such an area, which USP calls a medication safety zone, has appropriate lighting and sound levels, a physical design conducive to the use of information and performance of the specific tasks, and a minimal potential for distraction and interruption.

Interpretive, not mandatory. The new chapter, "Physical Environments That Promote Safe Medication Use," in and of itself has no mandatory requirements.

Its number is 1066, putting the chapter in the part of USP considered by the publisher to be interpretive.

Safety-zone necessities. According to USP chapter 1066, a medication safety zone is "a critical area where medications are prescribed, orders are entered into a computer or transcribed onto paper documents, and where medications are prepared, dispensed, or administered."

In brief, the chapter recommends that

  • A computer-order-entry area have an illumination level of at least 1000 lux,
  • A prescription-fill or medication-inspection area have an illumination level of 900-1500 lux,
  • Lighting be provided by fluorescent "cool white deluxe" or compact fluorescent lamps,
  • Sound levels not exceed 50 decibels, the level of conversation,
  • Materials and records be readily available, and
  • The potential for distraction and interruption be minimized, perhaps by a physical barrier.

"Improving the physical work environment," said Elizabeth A. Flynn, the primary drafter of the chapter, "is a pretty inexpensive way to optimize accuracy."

Flynn is an affiliate associate research professor at Alabama's Auburn University in the Harrison School of Pharmacy's Center for Pharmacy Operations and Designs.

Establishing a USP-recommended physical environment in the hospital pharmacy specifically for order review and dose-preparation checks, however, is not as simple as it sounds, said Marjorie Shaw Phillips, who serves as the medication safety officer at Medical College of Georgia (MCG) Health in Augusta.

Like Flynn, Phillips is a member of the group that developed USP chapter 1066.

A challenging concept to implement. MCGHealth's central pharmacy a few years ago tried out having a quiet area where pharmacists could review medication orders and profiles without interruptions, Phillips said. A divider similar to one for a cubicle demarcated the area and isolated at least one of the pharmacists assigned to those tasks.

"The pharmacists almost uniformly rebelled against" working in the isolated area, she said.

"They wanted to be able to see their coworkers, to see what the technicians were doing, to see when someone came into the pharmacy," Phillips said. "And so they asked that the barrier be taken down."

Nonetheless, the concept of a safety zone for medications other than pharmacy-compounded sterile preparations remains alive in MCGHealth's central pharmacy.

"It's one of those ongoing works in progress," Phillips said.

With MCGHealth's adoption of an electronic medication administration record system, she said, nurses now can alert the pharmacy about a missing dose by right-clicking on the patient's record to send a message rather than calling. A printer in the pharmacy generates a hard copy of the message for a pharmacy technician or pharmacist to review.

"This has been very successful," Phillips said, in decreasing phone calls that can distract or interrupt pharmacists who are reviewing orders and profiles in the central pharmacy.

She said the central pharmacy has had some success in attacking another big problem: entry of information into the incorrect patient's profile.

Phillips attributed the problem to pharmacists diverting their attention from one profile to examine an issue or answer a phone call concerning another profile.

The partially successful answer, she said, has been to encourage the pharmacists to segregate some tasks.

With regard to pharmacy-compounded sterile preparations, the central pharmacy has a built-in medication safety zone, Phillips said. One of the anterooms for the i.v. preparation suite has a table where a pharmacist can inspect medications away from the compounding room, the rest of the pharmacy, and the telephones. This anteroom is not the one where personnel don garb and wash up.

Impetus. By issuing USP chapter 1066, the United States Pharmacopeial Convention (USP) partly fulfills a resolution adopted in 2005: to continue developing programs to promote safe medication use and disposal.

The chapter was developed by a subcommittee of USP's Safe Medication Use Expert Committee.

Flynn, who has researched pharmacy facility design for about 20 years, said she has seen community pharmacies that have placed lines on the work counter to demarcate the prescription-inspection area. A pharmacist, when in this special area, is not to be interrupted.

She also has heard of pharmacies dedicating spaces to certain tasks in the medication-use process in order to improve safety. For example, a pharmacy may situate the order-entry pharmacist in an area separate from the rest of the pharmacy to prevent interruptions by telephone calls.

"But I'm not aware of anybody that's specifically said, 'Well, this is our medication safety zone,'" Flynn said. "I would like people to start doing that to draw attention to the importance of the physical environment for those tasks."

She acknowledged that implementing a medication safety zone in a hospital pharmacy can be difficult because of the expectation for pharmacists to multitask.

"But I think that we do need to spend a little more time finding a solution to . . . those problems," Flynn said. "I think you could have a zone for just inspection in a hospital pharmacy and dedicate that person to only that task and they wouldn't have any phone-call responsibilities."

Also, with an official zone, other personnel would know not to interrupt the person therein, she said.

According to a report on USP's Medmarx database covering entries submitted in 2003-06, distractions were a contributing factor in 35.4% of the 14,258 medication errors involving look- or sound-alike drug names.

No other factor was identified more frequently as a situational, organizational, or environmental element that increased the opportunity for errors with drugs having names that look or sound alike.

Chapter 1066 is scheduled to appear as a revision bulletin on May 28 at and becomes official on October 1.

[June 1, 2010, AJHP News]
Cheryl A. Thompson

[June 1, 2010, AJHP News]

Cheryl A. Thompson



Would you like to comment?

You must be a member. Sign In if you are already a member.

  • 1 version
Posted By:
Peter Leach
May 28, 2010

Related Content

    Search this area

    About this channel

    • 25 articles

    Viewed 1,190 times