3_Enabling Safe and Efficacious Medication Use Flashcards
a system of interconnected parts that work together to achieve the common goal of safe and effective medication therapy.
Medication Use Process (MUP)
Parts of MUP
- people
- system
- procedures
- policies
MUP is commonly ______ and uses several forms of health information technology (HIT)
cyclical
MUP is commonly cyclical and uses several forms of _________
health information technology (HIT)
Name the 5 steps in the MUP
Prescribe > Transcribe > Dispense > Administration > Monitoring > back to prescribe
identify the HIT:
computer programs that use electronic data and predetermined set of rules or guidelines to IDENTIFY ADE when occurs or is about to occur.
Adverse Drug Event (ADE) Monitoring
identify the HIT:
automated devices with a range of function: medication storage and retrieval for administration, medication charging, and automated inventory management.
Automated Dispensing Cabinets (ADCs)
identify the HIT:
ensures that the 5 RIGHTS OF MEDICATION ADMINISTRATION is followed at the point of care.
Bar Code Verification
identify the HIT:
computer programs that AUGMENT clinical decision making by combining referential information with patient-specific information to prevent negative actions and update providers of patient status.
Clinical Decision Support System (CDSS)
identify the HIT:
allows provider instructions (e.g., prescriptions, clinical notes) to be electronically entered for the treatment of patient who are under a provider’s care
COMPUTERIZED PROVIDER ORDER ENTRY (CPOE)
what are the 5 RIGHTS OF MEDICATION ADMINISTRATION
drug, dose, route, time, patient
identify the HIT:
electronic version of traditional medication administration records with support from CDSS and Bar Coding Verification
ELECTRONIC MEDICATION ADMINISTRATION RECORD (eMAR)
identify the HIT:
Enables real-time documentation and billing of medication administration.
ELECTRONIC MEDICATION ADMINISTRATION RECORD (eMAR)
identify the HIT:
a process where prescriptions are made electronically, verified and then processed resulting in a labelled medication product with supportive documentation and shareable patient medication profile.
ELECTRONIC PRESCRIBING
identify the HIT:
software-driven medication pumps that help eliminate pump programming errors using standardized drug database and dosing parameters.
INTELLIGENT INFUSION PUMPS (SMART PUMPS)
identify the HIT:
similar to ADE monitoring, built with logic rules to aid in monitoring specific aspects of patient care.
RULES ENGINES
4 focus of The Meaningful Use Program
- improve quality, safety, and efficiency of information transfers
- engage patients and families about important health information
- improve care coordination among healthcare providers
- maintain privacy and security of health information
It refers to a form of clinical informatics that focuses on the following:
* use of information,
* use of information technology, and
* use of automation technology to ensure safe and effective medication usage.
Pharmacy Informatics
Two Information Categories used in Pharmacy Informatics.
- Patient-specific information
- Knowledge-based information
Information Categories used in Pharmacy Informatics created and applied in the process of caring for individual patients
Patient-specific Information
examples: medical/medication history, physical assessments, laboratories test
and interpretations.
Patient-specific Information
information commonly stored in health care facilities
Patient-specific Information
a field where patient generates and manages their health information in addition to traditional settings. This field may include internet-based systems and DTCA.
Consumer Health Informatics
forms the scientific basis of healthcare which includes referential information
Knowledge-based Information
example: clinical practice guidelines, medication literature
Knowledge-based Information
Pharmacist and other healthcare providers makes use of a ________ of patient- specific and knowledge-based information to create safe and effective therapeutic plans.
combination
3 key issues in pharmacy informatics
- Interoperability
- Lack of Government Initiative
- Security, Privacy, and Confidentiality of PHI
in the PH, there is no coordination of EHRs for patients. It is not even recorded in the community setting. This is most likely to result in uncoordinated medication therapy or even oversight.
Interoperability
in the PH, there is no coordination of EHRs for patients. It is not even recorded in the community setting. This is most likely to result in _______________
uncoordinated medication therapy or even oversight.
there is no hospital to community or community branch to branch interoperability, every patient is treated like a new patient every time.
Interoperability
in the PH, the gov’t with DOH and other health offices are not keen into showing more support for Pharmacy Informatics.
Lack of Government Initiative
There are no programs like “The Meaningful Use Program” in the US that pushes for innovation and technological advancements in the general health care.
Lack of Government Initiative
PHI means
protected Health Information
despite presence of data privacy act, it is still a concern on how effective this measures are in the protection PHI of patients.
Security, Privacy, and Confidentiality of PHI
professional standards, policies, and regulations must be made to instruct different professionals on their specific roles towards managing PHI.
Security, Privacy, and Confidentiality of PHI
restricting access to PHI only to authorized people
security
being free from unauthorized intrusion and protection of PHI
Privacy
limit of access or restriction to certain types of information.
Confidentiality
In a report published by the Institute of Medicine (IOM), 19% of ADEs were due to ___________
medication errors
The ADEs were all related to order entry: (3)
- handwritten reports
- manual order entry
- use of non-standard abbreviations
CPOE and Electronic Prescribing eliminates: (3)
- illegal handwriting
- decrease medication errors
- delay in order completion
CPOE must support clinical workflows that results into ____, _____ and _______ advice and warnings.
clear, concise, and actionable
should also be paired with other HITs (e.g., CDSS) to ensure safe and effective medication orders.
CPOE
CPOE must have secure access with _________
permanent access logs.
CPOE may also cause _______ and may require care setting design changes to improve responsible use of CPOE and other HIT.
alert fatigue
alerts and warning forms CPOE or other HITs that
appear too frequently may lead providers to ignore or override the CDSS messages.
alert fatigue
computing systems that provides intelligently filtered
information to clinicians and patients to foster better health processes.
CDSS/CDS
3 parts of CDSS
Inference engine, Knowledge base, Communication mechanism
brain of the CDSSS, it evaluates the available information with consideration to patient-specific information.
Inference engine
composed of various clinical knowledge (e.g., clinical guidelines, diagnoses, drug interactions), it feeds information to the inference engine.
Knowledge base
where patient information is entered and feedback from the CDSS is communicated to the clinician.
Communication mechanism
Support provided by CDSS: (5)
- diagnosis information
- evidence-based treatment plans
- medication decision support
- dose adjustments
- ADE monitoring
can help decrease ADEs, costs and length of stay of patients and improve clinical workflow and use of information at point of care.
CDSS
Pharmacist are expected to interpret medication orders and assess for any drug- related problems.
Transcription
common problems for transcription are similar to the problems mentioned with _________
order entry
HIT-associated transcribing errors (use of CPOE) (are not/may still be) encountered.
may still be
mistaken inventory display for dosage guideline, fragmented CPOE,
inflexible formats resulting to wrong orders
HIT-associated transcribing errors
CDSS is very useful in checking drug-related problems but pharmacists must remain diligent in __________
reviewing orders.
___________ vary depending in the care setting
Dispensing medications
carousel cabinets, ADCs, robotic cart filling system, and sterile compounding
devices are common forms of HITs.
Acute Care Pharmacy Setting
most HITs in this setting depend on properly assigned bar coding system
Acute Care Pharmacy Setting
patient information management system (PIMS), Interactive Voice Response
(IVR), e-prescribing, automated counting and dispensing systems.
Community Pharmacy Setting
the goals are to fill prescriptions efficiently, keep track of prescription records, provide reminders for pick-up, and monitor inventory.
Community Pharmacy Setting
carried out by physicians, nurses, pharmacists, caregiver, or the patient themselves.
Medication administration
2 Major HITs in administration
- Bar Code Medication Administration (BCMA)
- E-prescribing
ensures that the 5 Rights of medication administration is followed.
Bar Code Medication Administration (BCMA)
eliminates errors from handwritten Rx and allows real-time updates of medication.
E-prescribing
end goal of monitoring is to create ____________
CLINICAL INTERVENTIONS
activities that intercedes to modify the medication use process.
Clinical interventions
promote safety, quality, efficient and cost-effective medication therapy.
monitoring
Monitoring process and clinical interventions should be ________ properly.
documented
should be easy to use, fits in the workflow, sufficient with details, flexible with modifications, searchable, and shareable.
Documentations
The electronic information systems shifted the vision of healthcare into becoming more _________-centered.
patient
