clinically important prescribing problems (p = 0.007) and decreased omission errors (p = 0.01) (Kennedy and Littenberg, 2004b).

An intervention in an outpatient clinic included a quality improvement review of prescriptions, the use of a self-inking name stamp, and an educational program that gave examples of poorly written prescriptions and emphasized legal requirements. A follow-up survey showed that 72 percent of local community pharmacies saw the stamps being used. When stamps were not used, illegible signatures continued to be a problem (Meyer, 2000).

Proposed strategies for reducing medication administration errors in the ambulatory clinic setting include failure modes and effects analysis, access to patient records for all health care professionals, use of appropriate abbreviations and formulations, standardized protocols, clearly labeled storage bins for medications, and educational training for staff and health care professionals.

Medication Administration

There are two sets of guidelines for medication administration in the ambulatory clinic—for vaccine administration and chemotherapeutic agent administration—but no studies evaluating these guidelines.

U.S. Pharmacopoeia (USP) has proposed the following guidelines for vaccine administration: (1) conduct a failure modes and effects analysis on the names, packaging, and labeling of the available vaccines in each facility; (2) review appropriate vaccine abbreviations and formulations; (3) establish clear protocols on the prescribing, documenting, dispensing, and administering of vaccinations; (4) use an adequate number of clearly labeled storage bins in the refrigerator; and (5) incorporate training sessions regarding the facility’s vaccine protocols into physician, pharmacy, and nursing staff meetings (USP, 2003).

The American Society of Health-System Pharmacists has produced guidelines on how to improve the antineoplastic medication-use system and error prevention programs for all care settings (ASHP, 2002). The American Society of Clinical Oncology has developed some specific guidance for outpatient chemotherapy (ASCO, 2003).

Medication Therapy Management

Pharmacist–physician collaborative medication therapy management services, which involve collaborative practice between physicians and pharmacists, have improved medication safety and achieved therapeutic goals. For example, during the period January 1999 through March 2002, the medication therapy management services in the Fairview Clinics System of Minneapolis–St. Paul resolved 5,780 drug therapy problems for 2,524 pa-



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