Adverse Events & Med Errors

Question 1

What is an ADE (adverse drug event)?

Answer 1

-injury from a medicine or lack of an intended medicine

Question 2

What is MedWatch?

Answer 2

FDA program started in 1993 to monitor adverse drug events

Question 3

Who should report ADEs?

Answer 3

• all health care practitioners who suspect an ADE

- also manufacturers

Question 4

What ADEs should be reported?

Answer 4

-SERIOUS ADEs: death, life-threatening event, hospitalization, disability, congenital anomaly, medical or surgical intervention to prevent permanent damage

Question 5

What is a type A ADE reaction?

Answer 5

• predictable
• extension of known pharmacologic properties
• most common

Question 6

What is a type B ADE reaction?

Answer 6

• unpredictable

- idiosyncratic, allergic, carcinogenic, teratogenic

Question 7

How can ADEs be reported?

Answer 7

• mail
• online
• call
• fax

Question 8

What is the definition of a medication error?

Answer 8

-any preventable event that may cause or lead to inappropriate medication use or patient harm

Question 9

How many preventable ADEs occur in the US each year? What is the annual cost related to these?

Answer 9

• 1.5 million preventable ADEs/year

- costs $3.5 billion per year

Question 10

What are 4 types of medical errors?

Answer 10

1. diagnostic: error or delay in dx, failure to employ necessary tests
2. treatment: error in operation or procedure, error in dose or method of drug use
3. preventive: failure to provide prophylactic tx
4. other: failure of communication, equipment failure

Question 11

What is the most common type of medication error? What are other possible med errors?

Answer 11

• most common: overdose

- also have underdose, allergy, dosage form, wrong drug, duplicate therapy, wrong route, wrong patient

Question 12

When do most preventable adverse drug events occur?

Answer 12

• ordering 56%

- administration 34%

Question 13

What prescriber problems are related to medication errors?

Answer 13

• illegible handwriting
• improper use of abbreviations or use of improper drug names
• improper expression of drugs strengths
• unnecessary verbal orders
• ambiguous drug orders

Question 14

What prescriber problems are related to medication errors?

Answer 14

• illegible handwriting
• improper use of abbreviations or use of improper drug names
• improper expression of drugs strengths
• unnecessary verbal orders
• ambiguous drug orders

Question 15

What are some high hazard medications?

Answer 15

• benzodiazepines
• calcium
• chemo drugs
• heparin
• insulin
• mag sulfate IV or potassium chloride IV
• opiate narcotics

Question 16

What does the institute of medicine recommend to prevent ADEs?

Answer 16

• encourage patients to take active role in their care
• make greater use of information technologies
• improve drug nomenclature and pt ed materials
• fed govt should pay for broad research into preventing med errors

Question 17

What are tips to providers to prevent medication errors?

Answer 17

• include reason for use on the prescription
• always use a leading zero, never use trailing zero
• avoid dangerous abbreviations (U, IU, QD, QOD)
• avoid verbal orders
• educate pt and caregiver

Question 18

Which approach to correcting errors will lead to decreased errors in the future?

Answer 18

-systems approach: concentrate on working conditions and build defenses to avoid future errors

Question 19

What is a fiduciary relationship?

Answer 19

• physician-patient relationship
• fiduciary has specialized knowledge, holds trust of others, held to high standards of conduct, avoid conflicts of interest, is ethically and legally accountable

Question 20

What is the best action in managing conflicts of interest?

Answer 20

• avoid the conflict if possible
• disclose the conflict
• mitigate the conflict

Question 21

What questions must one ask when determining whether to accept a gift?

Answer 21

• what is the purpose of the gift and does it truly benefit your patients?
• what would patients and colleagues think about this?

Question 22

What is considered an appropriate gift?

Answer 22

• primarily benefits the patients
• not of substantive value
• if an educational event, unbiased and legitimate
• no strings or conditions