Clinical skills Flashcards
Most common prescribing error
Dosage error
Followed by incomplete prescriptions, therapy omission, illegibility…
Stage in dispensing where most errors occur
Stock selection
Greatest impact on dispensing errors
Workload
Followed closely by similar drug names/packaging
Clinical governance is defined as…
the framework through NHS organisations are held accountable for continuous improvement of services and safeguarding excellent standards of care by creating an environment where excellence in clinical care will flourish
Ways in which clinical governance is implemented
Audits CPD Remedying under performance Accountability Clinical effectiveness Patient/public involvement
Methods of preventing errors
SOP’s to standardise methods in order to reduce errors
No blame culture and error reporting allows analysis of procedures to minimise errors
Use of dispensing robots to reduce human errors
Duty of candour definition
Legal duty on medical professionals to own up to and apologise for any mistakes that have been made which may have led to harm coming to them.
Contraindication definition
A condition which my make a treatment or procedure possibly inadvisable. Either relative or absolute.
Relative: Cation should be used but is acceptable if the benefit outweighs the risks
Absolute: an event or a substance that could cause a life threatening situation. Should be avoided
ADR definition
A noxious reaction that is unintended resulting from the use of a drug not only in the use of a product at normal doses but also outside of market authorisation, including the misuse, off label use and abuse of a medicinal product
Adverse drug event
An event that occurs while a person is on a drug but not necessarily caused by it
Most common adverse drug reaction
GI bleed
ABCDE ADR classification
A- augmented: due to dose/pharmacology
B- bizarre: weird and nobody knows why
C- chronic: due to long term use
D- Delayed: occurs some time after drug use has stopped
E- End of use: Occurs due to the cessation of a drug (withdrawal)
DoTS ADR classification
Do- Dose
T-Time
S-Susceptibility
Where are ADR’s reported to?
The MHRA yellowcard scheme
AssesSment of ADR
Nature/severity of ADR History of ADR Drug history ADR profile for the drug Further monitoring? Review/discuss with patient Management of symptoms Reporting?
Allergies definition
When immune system reacts to substances in the environment that are harmless to most people
With drugs it will occur at doses much lower than therapeutic
Drug intolerance definition
Lower threshold to the normal pharmacological action of a drug
Principles of medicines optimisation
Principle 1: Understand patient experience
Principle 2: Evidence based choice of medicines
Principle 3: Ensure meds are as safe as possible
Principle 4: Make M.O. part of routine practice
Max no. of MUR’s per year
400 per community pharmacy per fiscal year
Aims of an MUR
Establishing patient knowledge and experience of the medicine
Identifying poor use of medication
Identifying potential side effects and interactions
Improving clinical effectiveness of given medication thereby reducing wastage
Requirements to be able to provide MUR service
Higher education systems will provide courses which will assess a pharmacists ability to do MUR’s
Such places include, medway, manchester, keele and cardiff (Universities)
Target groups for MUR’s
70% of MUR’s must include:
High risk medicines (NSAIDS, Anticoagulants/platelets, diuretics)
Recent discharge from hospital where medication was changed
Respiratory disease
CVD and has >4 meds regularly prescribed
Requirements for respiratory MUR
Must be on 2 or more medicines 1 of which must be on COPD/asthma list for NMS
Requirements for hospital discharge patients
Within 4 weeks is preferable but up to weeks later is acceptable
Standards for a consultation area
Clearly designated and signed as a consultation area
Distinctly separate from public areas and public should not be able to over hear patient/pharmacist talking in normal tone
MUR must take place in pharmacy unless a suitable alternative is available
Patient requirements for an MUR
Patient must give consent both for the consult to take place and for the info to be shared
May only have 1 every year unless significant benefits
May not have 1 within 6 months of an NMS
May not have 1 if there is only one drug unless that drug is a high risk medicine
Difference between prescription intervention MUR and ordinary MUR
The prompt for the consult.
P.I.MUR is reactive in response to an significant adherence problem
NMS therapy areas
Hypertension
Asthma/COPD
Antiplatelets/Anticoagulants
Type 2 diabetics
Steps undertaken in an NMS
- Initial consult where patient is given info about new med
- Patient comes back 1-2weeks later at a time suitable for them and they will be given more advice
- Patient comes back 2-3 weeks later so pharmacist can find out about adherence and general experience
Money for NMS can only be claimed after steps 1-2 have been completed
To obtain consent the patient must..
4 things
Patient must be able to:
- Understand given info
- Believe the info
- Retain and weigh up info
- Be free from duress
Automatic blood pressure
Unsuitable for those with irregular heartbeats
Should be calibrated every year
Not as accurate as manual blood pressure monitor (unless the person is useless at taking blood pressure’s)
Normal glucose range for adults
4-7mmols/l
Should be highest after meals and lowest in the morning
