Using Simulation to Improve First-Year Pharmacy Students' Ability to Identify Medication Errors Involving the Top 100 Prescription Medications

By Atayee, Rabia S.; Awdishu, Linda et al. | American Journal of Pharmaceutical Education, June 2016 | Go to article overview

Using Simulation to Improve First-Year Pharmacy Students' Ability to Identify Medication Errors Involving the Top 100 Prescription Medications


Atayee, Rabia S., Awdishu, Linda, Namba, Jennifer, American Journal of Pharmaceutical Education


INTRODUCTION

The Council on Credentialing in Pharmacy defines the mission of the pharmacy profession as the improvement of "public health through ensuring safe, effective, and appropriate use of medications." (1) Reviewing prescription accuracy is a fundamental pharmacist responsibility to achieve safe medication use that is recognized within the United States and internationally. (2,3) However, 2% of prescriptions result in medication errors, (4,5) and 28% of prescription errors can result in harm to the patient. (6) The most common error reported is medication selection (7) within the pharmacy.

The Accreditation Council for Pharmacy Education (ACPE) Standards and the Center for Advancement of Pharmacy Education (CAPE) (8,9) Educational Outcomes require that pharmacy school curricula provide education and ensure competency in the area of accurate medication prescription review and preparation. The ACPE Standards include education and training in the areas of mathematical skills for accurate preparation of prescriptions, "identification and prevention of medication errors," and "assurance of safety in the medication-use process." (8) In addition, ACPE states that education should involve active learning to help pharmacy students mature in their problem-solving skills. (8) The North American Pharmacist Licensure Examination (NAPLEX) also tests prospective pharmacists' ability to review medication prescriptions accurately "in a manner that promotes safe and effective use." (10)

St. Louis College of Pharmacy conducted a survey of both hospital and community pharmacists in which prescription interpretation and verification was identified as one of the most important skills. (11) Initial studies in the area of prescription review in pharmacy school curricula demonstrated that with the use of active-learning techniques such as role playing and simulations, students perform better when required to identify and correct the prescription error rather than identifying the error alone. (12,13) Furthermore, students' awareness of their role in preventing medication errors increased as a result of taking the medication safety laboratory sessions. (13) Computer-based modules (2,3,14) and "mock pharmacy" (12) techniques have also been identified as modes to further enhance active learning.

At the University of California, San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS), the first-year curriculum includes a Pharmacy Practice course that focuses on therapeutics of self-care diseases and introduces the top 100 prescription medications. Based on the ACPE Standards and CAPE Outcomes, the course co-chairs recognized a need to standardize curricula on prescription review using a combination of a didactic lecture, workshop, and individual and group simulation exercises.

DESIGN

The objective of this study was to determine the effect of a prescription review module on first year pharmacy students' ability to identify and correct prescribing and dispensing medication errors involving the top 100 medications (Figure 1). In the fall quarter, students completed a baseline knowledge and confidence survey, a didactic lecture, individual and group simulations on prescribing and dispensing medication errors involving the top 40 medications, and a postknowledge and confidence survey. In the winter quarter, students participated in a hands-on workshop, followed by individual and group simulations on prescribing and dispensing medication errors involving the top 80 medications (40 previous top medications plus 40 new medications), and another postconfidence survey. The top 100 medications were adapted from The Top 200 Prescriptions as published in 2012 Drug Topics. (15)

The prescription review exercises were conducted in the first and second quarters of the required Pharmacy Practice course for first-year pharmacy students. This 3-quarter course focuses on self-care management, the top 100 drugs, pharmaceutical calculations, and patient communication and counseling through lectures, workshops, and conferences. …

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