Ch 7: Medication Safety and Quality Improvement Flashcards
medication error definition
any preventable event that may cause or lead to inappropriate med use or pt harm while the med is in the control of the healthcare professional, pt, or consumer
response to med errors
internal reporting like supervisor or P&T committee and med safety committee. external reporting like pt safety organizations. disclosed to pt or fam. investigate the error (root cause analysis). process improvement
med errors reporting program
MERP by the ISMP. confidential natl voluntary reporting program, provides expert analysis of sys causes of med errors and diseminates rec for prevention
root cause analysis
RCA. retrospective investigation of event that has already occurred to design changes that will prevent future error. this is a repetitive process
failure mode and effects analysis
FMEA is proactive to evaluate the potential for failures
on site surveys
by the joint commission every 3 years. surveys might be unannounced
national patient safety goals
set annually by the joint commission. may include: 2 pt identifiers to verify pt, critical results of tests/dx in timely basis, all meds must be labels, reduce harm with anticoags, maintain and communicate accurate pt info, comply with CDC handwashing
high alert drugs
heightened risk of causing significant patient harm when used in error. insulin, anticoags, conc lytes, anesthetics, antiarrhythmics, chemo, opioids, inotropic meds, epidural/intrathecal meds, PO hypoglycemics. use more safely with protocols, premixed products, limiting conc avail, stocking only in the pharmacy
MTM
med tx mgmt. comprehensive med review (CMR) through MTM. a personal med record (PMR) is prepared, a med related action plan (MAP) is developed and includes next steps.
medication reconciliation
compares med orders to home meds. most effective when complete and accurate in pt med record. admission orders should not be written until med rec completed. should be done at every TOC, including outpt clinics d/t possibilities of multiple pharmacies and MDs
high incidence of preventable med errors
ICU, peds, ED
education
in services should be done for new high alert meds, med safety issues, procedural changes, any new guidelines. limit access of pharma companies and reps d/t bias.
barcoding
most important med error reduction tool avail. follows drug thru the med use process. auto-poulates on the med admin record (MAR)
ADCs
rph must review order before med can be removed from ADC for pt except in emergency (override), barcode scanning improves ADC safety. look alike sound alike drugs must be stored in diff locations within the ADC. certain meds should not be in ADCs (insulin, warfarin, high dose narcotics). RNs not allowed to put meds back. keep out of noisy or dark area
contact precautions
MRSA, VRE, CDAD. single pt rooms preferred. wear gown and gloves for all interactions that may involve contact with pt or contaminated areas in pt room
droplet precautions
flu, resp syncytial virus, adenovirus, rhinovirus, n. meningitis, b. pertussis. wear a mask (respirator not required. single pt room preferred.
airborne precautions
pt in airborne infection isolation room (AIIR) equipped with special air and vent handling pressure rooms. wear mask and respirator. used for active TB, measles, or chickenpox
hand hygiene, when soap and water only
alcohol based hand rubs are more effective in healthcare setting. soap and water: before eating, after restroom, after visible soil, after CDAD, before pts with food allergies.
sharps disposal
FDA cleared sharps container should be used: puncture resistant, labeled or color-coded appropriately, closable, leak-proof. never compress contents. consider full at line (usually 3/4 way full).
PCAs
use only by well-coordinated healthcare teams. not all pts are appropriate candidates for PCA. friends and fam should not admin PCA. limit the opioids avail, use std order sets, educate staff about dilaudid and morphine mix ups, implement PCA protocols on the MAR, use barcoding, assess pt pain/sedation/RR on the reg
