pharmacy technician - Ontario College of Pharmacists
pharmacy technician - Ontario College of Pharmacists
pharmacy technician - Ontario College of Pharmacists
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ERROR PREVENTION<br />
FOCUS ON<br />
ERROR PREVENTION<br />
Ian Stewart B.Sc.Phm., R.Ph.<br />
ALTERNATIVE DOSAGE FORMS<br />
As a result <strong>of</strong> drug shortages,<br />
pharmacists <strong>of</strong>ten provide an<br />
alternative dosage form, such as<br />
an oral liquid instead <strong>of</strong> a capsule.<br />
Similarly, a lower strength <strong>of</strong> a drug<br />
may be dispensed with an increase<br />
in the number <strong>of</strong> tablets to be<br />
taken. For example, two cephalexin<br />
250mg tablets may be given in the<br />
place <strong>of</strong> one 500mg cephalexin<br />
tablet.<br />
<strong>Pharmacists</strong> must, however, be<br />
aware <strong>of</strong> the potential for error<br />
when making these substitutions.<br />
CASE:<br />
Rx<br />
Clavulin 200mg po bid<br />
Mitte: 7 days<br />
A pediatrician wrote the above<br />
prescription for a one year old<br />
child. On entering the prescription<br />
into the computer, the <strong>pharmacy</strong><br />
<strong>technician</strong> intended that the lowest<br />
cost therapeutically interchangeable<br />
product be dispensed. However, the<br />
<strong>Ontario</strong> Drug Benefit Formulary<br />
does not list any generic products<br />
that are therapeutically equivalent<br />
to Clavulin®-200 oral suspension.<br />
The <strong>technician</strong> incorrectly assumed<br />
that Ratio-Aclavulanate® 250F<br />
oral suspension was therapeutically<br />
interchangeable with Clavulin®-200<br />
oral suspension. He therefore<br />
entered the prescription as Ratio-<br />
Aclavulanate® 250F oral suspension<br />
with the label instructions “Give four<br />
millilitres twice daily”.<br />
However, four millilitres <strong>of</strong> Ratio-<br />
Aclavulanate® 250F oral suspension<br />
contain 50mg clavulanic acid while<br />
five millilitres <strong>of</strong> Clavulin®-200 oral<br />
suspension contain only 28.5mg<br />
clavulanic acid.<br />
On checking the prescription,<br />
the pharmacist did not detect the<br />
error. Therefore, the child received<br />
almost twice the prescribed dose<br />
<strong>of</strong> clavulanic acid. As a result <strong>of</strong><br />
the excessive dose <strong>of</strong> clavulanic<br />
acid, the child experienced severe<br />
diarrhea with an accompanying<br />
severe diaper rash. The mother was<br />
understandably not pleased after<br />
learning <strong>of</strong> the error.<br />
POSSIBLE CONTRIBUTING<br />
FACTORS:<br />
• Clavulin® products contain<br />
amoxicillin and clavulanic acid at<br />
different ratios. See table below.<br />
PRODUCT<br />
Clavulin®-125F oral<br />
suspension<br />
Clavulin®-250F oral<br />
suspension<br />
Clavulin®-200 oral<br />
suspension<br />
Clavulin®-400 oral<br />
suspension<br />
Clavulin®-250 tablets<br />
Clavulin®-500F tablets<br />
Clavulin®-875 tablets<br />
CONTENT<br />
Each 5ml oral suspension contains 125 mg <strong>of</strong> amoxicillin as the<br />
trihydrate and 31.25 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each 5ml oral suspension contains 250 mg <strong>of</strong> amoxicillin as the<br />
trihydrate and 62.5 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each 5ml oral suspension contains 200 mg <strong>of</strong> amoxicillin as the<br />
trihydrate and 28.5 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each 5ml oral suspension contains 400 mg <strong>of</strong> amoxicillin as the<br />
trihydrate and 57 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each tablet contains 250 mg amoxicillin as the trihydrate and<br />
125mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each tablet contains 500 mg amoxicillin as the trihydrate and<br />
125 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
Each tablet contains 875 mg amoxicillin as the trihydrate and<br />
125 mg <strong>of</strong> clavulanic acid as the potassium salt<br />
DRUG RATIO<br />
4:1<br />
4:1<br />
7:1<br />
7:1<br />
2:1<br />
4:1<br />
7:1<br />
PAGE 54 ~ SPRING 2011 ~ PHARMACY CONNECTION