Adverse Events & Med Errors Flashcards
What is an ADE (adverse drug event)?
-injury from a medicine or lack of an intended medicine
What is MedWatch?
FDA program started in 1993 to monitor adverse drug events
Who should report ADEs?
- all health care practitioners who suspect an ADE
- also manufacturers
What ADEs should be reported?
-SERIOUS ADEs: death, life-threatening event, hospitalization, disability, congenital anomaly, medical or surgical intervention to prevent permanent damage
What is a type A ADE reaction?
- predictable
- extension of known pharmacologic properties
- most common
What is a type B ADE reaction?
- unpredictable
- idiosyncratic, allergic, carcinogenic, teratogenic
How can ADEs be reported?
- online
- call
- fax
What is the definition of a medication error?
-any preventable event that may cause or lead to inappropriate medication use or patient harm
How many preventable ADEs occur in the US each year? What is the annual cost related to these?
- 1.5 million preventable ADEs/year
- costs $3.5 billion per year
What are 4 types of medical errors?
- diagnostic: error or delay in dx, failure to employ necessary tests
- treatment: error in operation or procedure, error in dose or method of drug use
- preventive: failure to provide prophylactic tx
- other: failure of communication, equipment failure
What is the most common type of medication error? What are other possible med errors?
- most common: overdose
- also have underdose, allergy, dosage form, wrong drug, duplicate therapy, wrong route, wrong patient
When do most preventable adverse drug events occur?
- ordering 56%
- administration 34%
What prescriber problems are related to medication errors?
- illegible handwriting
- improper use of abbreviations or use of improper drug names
- improper expression of drugs strengths
- unnecessary verbal orders
- ambiguous drug orders
What prescriber problems are related to medication errors?
- illegible handwriting
- improper use of abbreviations or use of improper drug names
- improper expression of drugs strengths
- unnecessary verbal orders
- ambiguous drug orders
What are some high hazard medications?
- benzodiazepines
- calcium
- chemo drugs
- heparin
- insulin
- mag sulfate IV or potassium chloride IV
- opiate narcotics
What does the institute of medicine recommend to prevent ADEs?
- 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
What are tips to providers to prevent medication errors?
- 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
Which approach to correcting errors will lead to decreased errors in the future?
-systems approach: concentrate on working conditions and build defenses to avoid future errors
What is a fiduciary relationship?
- 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
What is the best action in managing conflicts of interest?
- avoid the conflict if possible
- disclose the conflict
- mitigate the conflict
What questions must one ask when determining whether to accept a gift?
- what is the purpose of the gift and does it truly benefit your patients?
- what would patients and colleagues think about this?
What is considered an appropriate gift?
- primarily benefits the patients
- not of substantive value
- if an educational event, unbiased and legitimate
- no strings or conditions
