Clinical Skills - Pharmacology and Prescribing Flashcards
Patient safety
Prevention of available harm, whether by an a error or an omission
Never events
Existing national guidance or safety recommendations if followed would’ve prevented this event e.g. retained foreign body
Easily identified, defined and measured
Results in permanent harm or death
Examples of never events
Surgical errors e.g. wrong site surgery
Placement of wrong implant
Administration of med by the wrong route
Mis-selection of solution e.g. strong K is lethal
First check on WHO checklist
The team brief
Meeting w/ all staff and all cases discussed and problems highlighted
Second check on WHO checklist
Pt checked on Ward by TSW
Details on name tag
Consent form checked
Pregnancy status recorded
Third check on WHO checklist
Sign in
Time out
Wtonmg site surgery
Wrong knee, hip, limb, organ, pt
Incl biopsy, radiological procedure and drain insertion
What is excluded when classifying wrong site surgery
Excludes wrong site because of abnormal patient anatomy, documented in note
Why do we mark digits
Naming digits helps avoid error
Drug errors
IV administration of epidural med
Wrong route administration of oral/enteral treatment
Maladministration of insulin
Opioid overdose in an opioid naive patient
Inappropriate administration of oral Methotrexate
Misplaced naso- or orogastric tubes
Measure pH of aspirate, not just litmus paper turning red as many factors influence acidity e.g. foods, drugs. X-ray abdomen most accurate Check before feeding Medical administration Flush
Patient safety during COVID-19
Mortality of GA whilst COVID+ is v. high
Therefore postpone surgery if safe to do so
Patient streams during COVID-19
Green (elective) – confirmed -ve COVID test
Yellow – no symptoms; test awaited
Red – confirmed test/ +ve symptoms awaiting test
Non-pharmalogical pain management
Physical and occupational therapy Self-help Wt loss Surgery CBT
Hydrotherapy
Relaxes muscles; can help to build strength in a warm, pain-relieving environment without pressure induced by gravity + weight-bearing
Splints/ orthoses
Temporary rest and support; shouldn’t be used for long so as to avoid muscle wasting
Can prevent further damage whilst sleeping
Useful for people who are severely disabled but can’t have surgery
Often custom-made
Aids and appliances
Provide dignity + independence for daily tasks, e.g. raised toilet seats
Self-help
For patients with incurable chronic pain- aims to help patients manage the controllable aspects of their disease, esp the emotional aspect i.e. coming to terms with how their life has been affected
Wt loss as pain management
Obesity often makes pain much worse as it causes more pressure on the joints and is a risk factor for many diseases
Surgery as pain management
Provide pain relief and increase function
Depends on cause of pain
May include soft tissue release (e.g. in carpal tunnel syndrome), synovectomy, arthroplasty, arthrodesis, tendon repairs, etc
CBT as pain management
Not successful or suitable for everyone with chronic pain
Helps treat the psychological aspects of pain
Believed to reduce stress, depression, and anxiety by challenging unhelpful/negative thoughts
Types of errors causing harm to patients
Medication errors Surgical/ procedural errors Diagnstic errors Transition of care errors Teamwork/ communication errors Healthcare-associated infections Device-related errors
Diagnostic errors
The failure to establish an accurate and timely explanation of the patient’s health problem(s) or communicate that explanation to the patient.”
Dealing with transition of care issues
Use a checklist for handover such as I-PASS
Provides clear expectation for both the provider and recipient of patient information
Key never events
Wrong site surgery
Wrong implant prosthesis
Retained foreign object post procedure
Administration of medication by wrong route
Overdose of methotrexate for non-cancer treatment
