Adverse Drug Reactions and Medication Errors - Ch. 7

Question 1

What are adverse drug events (ADEs)?

Answer 1

Harm associated with any dose of a drug

Question 2

What are adverse drug reactions (ADRs)?

Answer 2

Any noxious, unintended and undesired effect that occurs at normal drug doses
-Excludes excessive dosages
-Can range from annoying to life-threatening

Question 3

What are ADRs often equated to?

Answer 3

Adverse side effect

Question 4

What are specific types of ADRs?

Answer 4

-Toxicity
-Allergic reaction
-Idiosyncratic effect
-Paradoxical effect
-Iatrogenic disease
-Physical dependence
-Carcinogenic effect
-Teratogenic effect

Question 5

Medication Error

Answer 5

Preventable events that may cause or lead to inappropriate medication use or patient harm
-From healthcare professional to patient administration/omission

No significant effect —> Disability, death

Question 6

What are types of medication errors?

Answer 6

Direct
Indirect
Fatal

Question 7

Example of direct medication error?

Answer 7

Dose is too high

Question 8

Example of indirect medication order?

Answer 8

Dose is too low

Question 9

Fatal medication orders

Answer 9

Overdose: 36.4%
Wrong drug: 16.2%
Wrong route: 9.5%

Question 10

Why is the risk of medication error in hospitals high?

Answer 10

Each medication order is processed by several people

• The nurse is the last person in this sequence
• Thus, the nurse is the last line of defence against
  mistakes
• This places a responsibility on the nurse to ensure
  patient safety

Question 11

What organization advances medication safety in healthcare settings?

Answer 11

ISMP - Institute for Safe Medication Practices

Question 12

What are the high-alert medications?

Answer 12

Cardiovascular Effects (adrenergic agonists and antagonists)

Chemo drugs

Hemostasis drugs (warfarin, heparin)

Insulins

Anesthetics

Neuromuscular blocking agents

Question 13

How can medication errors be prevented (Order specific)?

Answer 13

Minimize verbal/phone orders
-repeat order
-Spell drug aloud
-Speak slow, clearly

List indications next to each other

Be aware of dangerous abbreviations, symbols, and dose designations

Never assume anything about items not specified in order e.g, route

Don’t hesitate to question a medication order

Do not try to decipher illegibly written orders

Never use trailing zeros (1.0 vs 1)

Always use a leading zero (.25 vs 0.25) no naked decimal

Always write a line through the number 7

Question 14

What are the 10 Rights of Medication use?

Answer 14

1. Right Patient
2. Right Drug
3. Right time
4. Right route
5. Right dose
6. Right documentation
7. Right reason
8. Right pt. education
9. Right to refuse
10. Right evaluation

Question 15

What are the components of AHS: Independent Double-Check?

Answer 15

Double-check all medication administration
Get orders checked by 2 professionals
Independently check all aspects of drug administration

Question 16

How can medication errors be prevented unrelated to the order itself?

Answer 16

Read all labels, expiration dates and dilution requirements

Use trade names and generic names

Always listen to and honour any concerns expressed by patients regarding medications

Check pt. allergies and ID

Advocate for good working conditions

Always double-check labeling

Safeguard medications on admission or transfer

Verify medication administration records that have been rewriteen or re-entered

Compare the pharmacy label against medication admini. record before giving 1st dose

Use computerized prescriber order entry and pharmacy systems

Provide for mandatory entry of pt. weight

Mandatory recalculation of drug dosage for high-risk drugs/populations

Always suspect an error whenever adult form is dispensed for a child

Provide a translator for non-english speaking pt.

Ensure readability og labels

Use tall-man lettering to differentiate look-alike drug names

Question 17

What are some pyschosocial factors contributing to drug errors?

Answer 17

Disruptive behaviour among nurses and physicians

Question 18

How should HCP resmond to errors?

Answer 18

-Shared professional responsibility
-Follow facility-based error reporting systems
-Encourage the reporting of “near-misses”
-Complete documentation
-Notify patients of errors

Question 19

Medication reconciliation

Answer 19

Updating and communication of the patient’s list
of medications at various intervals throughout
the health care process (i.e., admission, transfer,
discharge)
- Verification – complete history
- Clarification – professional review of this information
- Reconciliation – further investigation of any discrepancies and documentation of relevant communications and changes in medication orders