Clinical Pharmacology: Drug Safety Flashcards
Mistakes
Errors in planning actions. Can be knowledge or rule based
Skill-based errors (slips and lapses)
Errors in executing correctly planned actions. Can be action based, memory based or technical
What types of healthcare errors are there
- Surgical related
- Complications from drug treatment
- Therapeutic mishaps
- Diagnostic errors -Cognitive errors
How common are errors?
- 69% of injuries were caused by errors
- 3.7% of adverse events lead to prolonged admission or produced disability at the time of discharge
How common are medical errors?
- An adverse event occurs in 16.6% of admissions, resulting in permanent disability in 13.7% of patients and death in 4.9%
- 51% of adverse events were considered to have been preventable
What type of healthcare error is more likely to be preventable?
Cognitive errors such as incorrect diagnosis or choosing the wrong medication more likely to have been preventable and more likely to result in permanent disability than technical errors.
Which patients are at most risk from errors?
- Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
- Those with complex conditions
- Those in the emergency room
- Those looked after by inexperienced doctors
- Older patients
What factors may increase the rate of medication errors?
- More rapid throughput of patients
- New drug developments, extending medicines into new areas
- Increasing complexity of medical care
- Increased specialisation
- Increased use of medicines generally
- Sicker and older patients, more vulnerable to adverse effects
What people related causes of medication incidents are there?
- Fatigue: Sleep deprivation
- Hunger: Long lapses between food/drink
- Concentration: Lapses
- Stress: Loss of control/cutting corners
- Distraction
- Lack of training
- Lack of access to information (not timely)
- Other factors: Alcohol, drugs & illness
Where in the process can errors occur?
- Prescribing
- Transcribing
- Dispensing
- Administering
What are some common prescribing errors?
- Wrong drug (e.g. drugs that sound alike)
- Wrong dose
- Inappropriate Units
- Poor/illegible prescriptions
- Failure to take account of drug interactions
- Omission
- Wrong route/multiple routes (IV/SC?PO)
- Calculation errors (important in Paediatrics)
- Poor cross referencing
- Infusions with not enough details of diluent, rate etc. Poor cross-referencing between charts
- Once weekly drugs
- Multiple dose changes
How can errors by illegible handwriting be prevented?
- Prescriber’s obligation
- Write/print more carefully
- Computers
- Verbal communications
What should always be checked when prescribing?
- Age
- Weight
- Renal and hepatic function
- Concurrent diseases
- Laboratory test results
- Concurrent medications
- Allergies
- Medical/Surgical/Family History
- Pregnancy
What abbreviations should you definitely ot use?
- Drug names
- QD or OD for daily
- Letter U for unit
- ug for microgram (or mcg)
- Sc for subcutaneous
How should numbers be written on prescriptions?
- Avoid decimal points if possible
- Never leave a decimal point naked
- Never use a terminal 0
- Leave as space between the name and dose
- Don’t use trade name unless you have to
