Clinical Pharmacology - Safe Prescribing Flashcards
what is involved in the prescribing saftey assessment?
online assessment
what is the definition of a medicaiton error?
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
medicaiton errors may be related to what factors?
- professional practice
- health care products
- procedures and systems
- product labeling, packaging, and nomenclature
- dispensing
- distribution
- administration
- education
- monitoring
Medical error is the ___ commonest cause of death in the US
3rd
how is the number of deaths form emdication errors changing?
aduit commission report:
Just under 11% of patients on hospital medical wards experience an adverse event, such as being given the wrong ____ or having an adverse ________ to a drug
On average leads to an additional stay in hospital of ___ days
Costs the NHS as much as £1.1bn ($1.5bn; 1.8bn) - NHS budget is around 13/14 billion so it’s a fair proportion of that
1 in 10 patients coming into hospital potentially being harmed by what has been given to them
drug
reaction
8.5
nearly half of medicaiton errors are _________
preventable
what is the incidence of medication errors in europe and where do they occur?
Rare in dispensing in ambulatory care as pharmacists are careful about dispensing drugs
Wards where pharmacists come to check daily its much safer
Model for reducing patient harm from individual and system errors in healthcare
how much diagnosis does a patient on average have?
how does the average spending on prescribed drugs change in the different age groups?
is Insulin and diabetes an area where prescribing errors can easily occur?
yes
Insulin and diabetes is an area where prescribing errors can easily occur
69 y old female:
CAVG and MVR (tissue) 2010
On warfarin and aspirin
15/4/11 10pm Mild headache
16/4/11 0130 Slurred speech and dense left sided weakness.
INR >11 (INR should be 2.5-3, INR is a measure of your warfarin activation)
Management?
Cause?
Cytochrome P450:
Antifungals are very potent cytochrome P450 inhibitors so warfarin wasn’t being metabolised so it was more bale to act and INR went through the roof and she had a haemorrhage
Types of erorr:
About half of the adverse events occurring among inpatients resulted from ________
Next most frequent:
- complications from drug _______
- __________ mishaps
- ________ errors were the most common non-operative events
surgery
treatment
therapeutic
diagnostic
what is a cognative error?
E.g. incorrect diagnosis or choosing the wrong medication are more likely to have been preventable and more likely to result in permanent disability than technical errors
which patients are most at risk?
Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
Those with complex conditions
Those in the emergency room (in a rush)
Those looked after by inexperienced doctors
Older patients
how does the number of adverse events differer between age groups?
what are some factors that could increase the rate of medication errors?
More rapid throughput of patients (length of stay shorter)
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 are some people related causes of medication incidents?
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
As many ______ and balances to ensure _____ doesn’t happen
checks
error
at each stage, how many medication incidents occur?
A lot of issues occur in administration of the drug
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 (may be written once a day by accident)
Multiple dose changes
what are the commonest drugs with a prescribing problem in ARI?
Paracetamol
Gentamicin
Warfarin
Oxycontin
Methadone
Insulin
what is wrong with this?
illegible
Illegible Handwriting: Error Prevention - how is errors prevented?
Prescribers’ Obligation
Write/Print more carefully
Computers (can still be errors)
Verbal communication
Always check the patient information - what information is this?
Age
Weight
Renal and hepatic function
Concurrent diseases
Laboratory test results
Concurrent medications
Allergies
Medical/Surgical/Family History
Pregnancy
should you use abbreviations?
Don’t use abbreviations
Drug names (CBZ for example)
QD or OD for the word daily
Letter U for unit (insulin)
mg for microgram (probably not mcg either)
Sc for subcutaneous
(6 units but looks like 60)
how do you write the dose when prescribing?
Avoid decimal points if possible:
- Use 500 mg for 0.5 g
- Use 125 microgrammes for 0.125 mg
Never leave a decimal point ‘naked’:
- Haolperidol .5 mg – Haloperidol 0.5 mg
Never use a terminal zero:
- Colchicine 1 mg not 1.0 mg
Leave a space between name and dose:
- Atenolol50mg - Atenolol 50mg
Don’t use trade names unless you have to
Look alike drugs contribute to _________ ______
medication errors
Prevention of Medication Errors - what are the 5 Rs?
Right Patient
Right Drug
Right Dose
Right Route
Right Time
Formularies & ‘Essential’ Drugs
National formularies (e.g. the BNF) provide an independent source of advice
Grampian joint formulary reflects hospital/primary care choices (As there is so many drugs on the market, each health board will define which drug should be used within each class)
WHO provide a ‘model’ list of essential drugs (~300 items); some controversial!
