b'LEADERSHIP GUIDE|online for the least expensive options.Require a valid prescription from aconfused-drug -names-list. The list should However, there are many rogue pharmacieslicensed healthcare provider. be used to identify drugs that need special that claim to sell prescription medicines atAre licensed by a state board orsafeguards to reduce the chance of error.significantly reduced prices without requir- pharmacy or equivalent state agency. ToRisk factors for adverse events and errors ing a valid prescription. Such pharmacieslocate such pharmacies access https:// include prescribing and administering high often sell counterfeit medications that arewww.fda.gov/Drugs/ResourcesForYou/ alert medications. The ISMP provides a list unsafe or unapproved. Many rogue sites dis- Consumers/BuyingUsingMedicine- of such medications on its website, which play a Canadian flag, but may be operated bySafely/BuyingMedicinesOverthelnter- can be accessed at https://www.ismp.org/persons throughout the world with no con- net/BeSafeRxKnowYourOnlinePhar- recommendations/high-alert-medica-nection to Canada (FDA, 201Ba). macy/ucm318487.htm tionsacute-list. Although mistakes may or Consumers should be wary of onlineDo not ask for personal information,may not be more common with these drugs, pharmacies that (FDA, 201Ba): such as social security numbers orthe consequences of an error are clearly Do not require a valid prescriptionhealth history. more devastating to patients (ISMP, 2018c).from healthcare providers. Will not sell personal information. Older adults and children are at high risk Do not have a U.S. state-licensedHave a U.S. state-licensed pharmacistfor adverse drug events and are at higher risk pharmacist available to answer youravailable to answer questions. for harm when errors occur compared to questions. Are in the U.S. and provide a streetyounger adults. Older adults often take mul-Offer such low prices that it seems tooaddress tiple medications and are vulnerable to side good to be true. effects. Pediatric patients are also a higher Send spam or unsolicited emails adver- RISK FACTORS FOR MEDICATION ERRORSrisk, especially when hospitalized. This is due tising cheap medication. AND ADVERSE DRUG EVENTS to the need for dosing according to patient Are located outside of the U.S. or shipThere are a number of risk factors for med- weight (Patient Safety Network, 2018a).worldwide. ication errors and adverse drug events inThere are also specific types of medica-Rogue pharmacies often sell medicationsaddition to the behaviors associated withtions where the potential for harm generally that are dangerous and cause harm. Thesemedication errors described earlier in thisoutweighs the benefits. For example, giving types of medications (FDA, no date given;program. benzodiazepine sedatives to older adults FDA, 201Ba): Martin is preparing to administer medi- often does more harm than good (Patient May be counterfeit. cations to his patients. One patient is receiv- Safety Network, 2018a). Nurses must be Have too much or too little of the ingre- ing Advicor to treat elevated cholesterol andacutely aware of these types of medications dients needed to be effective. triglyceride levels. The patients roommate isand how they impact patients of all ages.Do not contain necessary ingredientsreceiving Altocor, another agent used in theThe opioid epidemic, a declared pub-needed to be effective. treatment of elevated cholesterol. Martin islic health emergency, is another source of Contain wrong or harmful ingredients. feeling rushed since another of his patients isadverse drug events and potential errors. May be outdated. not doing well and he is waiting for a returnThere has been a dramatic increase in opi-Are not labeled, shipped, or storedcall from that patients physician. Prior tooid prescriptions over the past two decades. safely. administering prescribed medications,Opioid medications have significant risks May not be FDA approved. Martin pauses and takes a deep breath. Heof harm, including overdose deaths and May interact dangerously with otherdouble checks that he has the correct medi- abuse potential. The healthcare commu-medications. cation for each patient. He shakes his headnity is examining the appropriateness of A safe online pharmacy will haveand thinks/dont know why companies haveopioid prescriptions and how to deal with the National Association of Boards ofto name drugs that sound like or look likethe effects of the current epidemic (Patient Pharmacys (NABP) Verified Interneteach other. It would be so easy to make a mis- Safety Network, 2018a).Pharmacy Practice SitesTM Seal on its web- take with these two medications! In summary, risk factors are any circum-site. Also known as VIPPS Seal, it indicatesThe Institute for Safe Medicationstances or processes that place the patient at that the Internet pharmacy is safe to usePractices (ISMP) maintains a list of drugsa higher risk for adverse drug events or med-because it has met state licensure require- with names that look alike and/or soundication errors. Nurses must be aware of risk ments. Visit the VIPPS website at https:// alike (ISMP, 20186). These drugs can be afactors and the steps necessary to reduce nabp.pharmacy/programs/vipps/ to findfactor in medication errors and adverse drugrisk at all steps of the medication process, pharmacies that carry the seal (FDA, 201Ba). events. There are many, many look-alike,from prescription to administration.Other ways to identify safe online phar- sound alike drugs. For a complete list of macies are if they (FDA, no date given; FDA,these drugs as identified by the ISMP, accessGENERAL GUIDELINES201Ba): https://www.is mp.org/recommendations/ The Patient Safety Network (2018a) has pro-16 LEADERSHIP GUIDE|2020| www.elitecme.com'