Day 7: Impoving Quality Flashcards
What is the incidence and impact of medical errors in the US?
8th leading cause of death in the US
Drug ADRs result in 4 million ER visits per year
Preventable ADE cost $3.5 billion in hospital admissions and ic LOS
What are the concerns about utilization and spending when it comes to Quality?
Americans using 5 or more RX has increased
Higher medical spending DOES NOT lead to higher quality RX use
Higher medical spending is NOT associated with better health care
Pts with chronic conditions may see up to 16 different docs a year
What are the concerns about the elderly when it comes to quality?
40% of OLDER American use more than 5 meds
Elderly are twice as likely as people under 65 to have adverse drug events
Quality of prescribing for elderly varies among localities
What are the concerns about “high alert” medications?
There are drugs used in outpatient setting that can cause serious harm
Chemo, antiretrovirals, immosuppresants
Insulin, hypoglycemic, opioids
Also for inpatient setting
Antiarrhymics, anthothrombo and sedatives
What are the recommendations for safe medication practices when it comes to “high alert” medications?
Standardize use for these drugs
Implement a “double-check” system for high alert drugs
What are the concerns when patients transition from out-patient care to in-patient care and back? Where is one area we can improve?
60% of all med errors occur during transitions of care
80% of serious medical errors involve miscommunication between medical providers during transition of care (big error of omission can occur because meds for chronic condition are accidentally not prescribed)
In medication histories
67% of RX medication histories have errors
What is the joint commission 5-step process for medication reconciliation?
- Develop a list of all current meds, vitamins etc
- Develop list of medications to be prescribed (make sure they comply with current guidelines)
- Compare med lists - do they match (are there differences between in and out pt formularies)
- Assess if there are opportunities to improve the pt drug treatment
- COMMUNICATE ANY CHANGES to anyone involved (pt, caregiver, other health professionals)
What is a medication error?
Any PREVENTABLE event that may cause or lead to inappropriate use or patient harm while the drug is in control of the health care professional or patient
**dont always cause injury
What makes it difficult to determine the “true” error rate?
Emphasis is on reporting can inc reports of errors
HOWEVER when emphasis goes away the reporting can dec
this will show over time like “false” improvement in quality but in reality they just aren’t reporting it
What are questions you can ask patient about drugs to increase error prevention?
TEACH-BACK method
1. Why are you taking it
- What benefits of taking the drug
- What side effects can happen
- Where do you store the drug at home
- When do you need to refill it
- How long should you take it for
What are the cause of system errors?
- Excessive workload
- Poor workflow (no 2nd checks, multiple interruptions)
- Poor use to tech
- Drug and drug-device problems
- Medication order and drug distribution system has flaws (what policies and processes prevent individuals from making errors)
What are the individual causes of errors?
- Lack of knowledge & “objective” info
- Poor or failed communication
- Dosage miscalculations
- Incorrect drug administration
- Poor pt education
What are some evidence-based solutions to prevent errors?
- Unit dose distribution
- Protocols for high-risk drugs
- Use computers ((CPOE) with decision support
- RPhs in pt care areas / rounds
- Car coding of unit-of-use meds
- Pt counseling about meds
What are some recommended guild lines to promote more conservative prescribing?
- Think beyond drugs (lifestyle changes, non drug treatment)
- Strategic evidence-based prescribing
- Increase vigilance about adverse effects (educate pts and make sure they know what to look for)
- Use caution when recommending new drugs (recommendation should be evidence based)
- Involve patients
- Consider long-term benefits and risks
How are OTC instructions and measuring devices a threat to quality of the system??
Caregiver dosing of liquid meds for children is usually inaccurate and can cause pain/death
Accurate measuring device not provided with drug
Poor dosin instruction and variation in the units (mL or teaspoon / tablespoons or even ounce)
