7. Safe Prescribing Flashcards
What is medicines reconciliation?
What are the 3 steps to medicines reconciliation? (3 C’s)
At what 3 hospital stages is medicines reconciliation carried out?
Process designed to ensure all medication a patient is taking is correctly documented on admission and at each transfer of care.
- Collect drug history using most recent and accurate info sources
- Check/verify list against initial inpatient prescription. Check any discrepancies and follow up
- Communicate drug history with any action taken on changes/omissions/discrepancies via documentation
Admission (within 24h), post admission verification (by pharm team), discharge
List some sources of information you could find a patient’s drug history in.
What does a black triangle next to a medicine in the BNF indicate?
What is bioavailability?
Patient, patient’s own drugs (PODs), summary care records (SCR), relative/carer or nursing/residential home - MAR sheet (medication admission record) (make sure have consent), GP surgery, previous eTTA (discharge summary), community pharmacy, prescription from another hospital, repeat prescription list
New compound/formulation/delivery device/indication. So if pt experiences any adverse affects they need to report via Yellow Card
Amount of drug available in body after metabolised by liver. So if IV, conc in body is higher compared to tablet, so adjust doses accordingly
What is modified release dosage?
Differentiate between pharmacodynamic and pharmacokinetic drug interactions.
The BNF lists drug interactions. What does the black dot mean if it is beside an interaction?
Mechanism that delivers drug with a delay after its administration, or for a prolonged period of time, or to a specific target in the body.
Pharmacodynamic: when 2 drugs have additive or antagonistic pharmacological effects. Often predictable. E.g. amlodapine (CCB) and ramipril (ACE-I) = enhanced hypotensive effect
Pharmacokinetic: when drug increases or decreases amount of another drug available in the body by affecting its absorption, distribution, metabolism or excretion. E.g. rifampicin - induces hepatic enzymes which accelerate metabolism of several drugs including corticosteroids and anticoagulants
Most serious
What are the 3 different stages that errors with medicine can occur in?
Define prescribing error.
What are the 2 main error types?
Prescribing, dispensing, administration.
Result of a prescribing decision or prescribing writing process that results in unintentional but significant reduction in probability of treatment being timely and effective, or increased risk of harm.
Slips and lapses (actions don’t go according to plan), mistakes (plan is wrong)
