Pharmacy Practice
Pharmacy Practice tests medication safety, dispensing systems, compounding, inventory, automation, and pharmacovigilance. The exam expects practical control measures rather than slogans: how errors are prevented, detected, reported, and reduced.
Core rules
- High-alert medicines (concentrated potassium chloride, insulin, heparin, chemotherapy, opioids, neuromuscular blockers) require independent double checks, standard concentrations, and clear labelling.
- Eliminate error-prone abbreviations: 'U' for units, 'MS' or 'MSO4', 'q.d.'/'q.o.d.', trailing zeros, and naked decimal points.
- LASA names need tall-man lettering, separate storage, alerts, and barcode verification; override of automated cabinets should be audited.
- Sterile compounding requires validated cleanrooms, environmental monitoring, validated aseptic technique, and assigned beyond-use dates; non-sterile compounding needs master formulation records.
- Pharmacovigilance: report suspected serious ADRs and quality defects promptly; report near misses internally even when no harm occurred.
Worked example
A prescriber writes 'KCl 20 mEq IV push now.' The order is unsafe because undiluted potassium chloride can cause fatal cardiac arrest. The pharmacist does not dispense as written: verify the order, clarify the indication and rate, and recommend diluted potassium chloride via infusion pump with cardiac monitoring and appropriate maximum rate. If the patient is hypokalemic with a central line, the final concentration and rate must follow policy. Reasoning: high-alert drug + unsafe route = stop, clarify, document.
Traps
- Treating an automated dispensing cabinet override as authorization.
- Reporting only harm events and ignoring near misses.
- Accepting 'units' handwritten as 'U'.
- Using a beyond-use date based on the calendar rather than the formulation and storage conditions.
- Failing to segregate look-alike products in the pharmacy.