Drug information part II

Question 1

What are the differences between ADE and ME

Answer 1

ME: Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consume
ADE: An injury resulting from medical intervention related to a drug, which can be attributable to preventable and non-preventable causes
ALL MEs can be prevented, not all ADEs can be prevented.

Question 2

What is the prevalence of MEs and ADEs in the U.S.

Answer 2

6.7% of all patients admitted to the hospital will experience a ME. Of these, 3.1% will cause harm and 13% will die.
Preventable ADEs occur in 2% of hospitalized patients
MEs that result in harm contribute to 7,000 deaths per year.

Question 3

List the types of harm that can occur from ME and ADEs

Answer 3

ALL ADEs cause harm, but are not always preventable. NOT all ME cause harm, but they are always preventable. Harm is the impairment of the physical, emotional or psychological function or structure of the body and/or pain resulting therefrom.
Monitoring: Harm can occur by failing to monitor for signs of safety and efficacy
Intervention: Changes in therapy, active medical/surgical treatments, or other responses of healthcare team.
An intervention necessary to save life is: cardiovascular and respiratory support.

Question 4

Why are ME and ADEs a public health problem?

Answer 4

Causes harm to patients, huge economical burden to treat

Question 5

Causes of ME and ADE in procurement

Answer 5

Failure to order adequate stock to meet patient need, ordering of expired/adulterated products, confusion with appropriate substitutions during shortages/recalls, ordering incorrect product, strength or dilution

Question 6

Causes of ME and ADE in storage

Answer 6

Failure to refrigerate product that requires it and failure to protect product from light

Question 7

Causes of ME and ADE in ordering/transcribing

Answer 7

Dose, route, frequency, and duration are not appropriate for patients disease state. Failure to interpret med order correctly (illegible)

Question 8

Causes of ME and ADE in preparing/dispensing

Answer 8

Must obtain and package correct drug, dose, or dilution for correct patient, Dispensing errors are described as discrepancies between medication dispenses and the original prescribers order.

Question 9

Causes of ME and ADE in medication administration

Answer 9

Any discrepancy between how the medication was actually given and how the administration was supposed to be given according to physicians order or hospital protocol.
Right patient, Right drug, Right dose, Right route, Right time.

Question 10

Causes of ME and ADE in patient education

Answer 10

Making sure the patient knows their medication inside and out is key to preventing ME and ADEs. Use the repeat back method to make sure the patient understands.

Question 11

How can ME and ADEs be prevented

Answer 11

Always determine the root cause of ME/ADE. Strategies to reduce ME include Computerized Physician Order Entry (CPOE), automated drug-distribution cabinets with barcode scanning, Bar-Code Assisted Medication Administration (BCMA), and Smart IV infusion pumps

Question 12

Describe 3 quality improvement methods that can be employed to prevent ME and ADEs

Answer 12

Upgrade computer program, software or entire new system. Separate LASA drugs. Create preprinted orders based on guidelines to precent inappropriate drug, dose and monitoring.

Question 13

Describe the steps in the med reconciliation process and how they help reduce ME and ADEs

Answer 13

1. Determine a current list of medications
2. Develop list of medications to be prescribed
3. Compare the 2 lists
4. Make clinical decisions based on the 2 lists
5. Finalize and communicate the list of medications to the patient and other clinicians.

Question 14

Define just culture

Answer 14

Focuses on the sequence of events that led to the error rather than the person who made the error. This encourages internal risk transparency, coaching and counseling of employees, avoiding negative retribution for errors, and gathering and then using information to prevent recurrence of ME.

Question 15

Produce which types of ME are likely, possible and unlikely to be intercepted by CPOE

Answer 15

Likely (most likely to be caught): Wrong dose/overdose, wrong route, wrong dosage form
Possible: Duplicate therapy, contraindicated drug, drug-drug interaction
Unlikely (least likely to be caught by CPOE): Wrong patient, wrong drug, dose omission

Question 16

Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in patient information

Answer 16

Make sure all patient information is well documented, make allergy information mandatory, 2 patient identifiers, accurately capture comorbid conditions

Question 17

Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in drug information

Answer 17

Have an expedited med rec process for high alert meds, perform a med review every time the patient moves from one unit to another, create and reinforce therapy-specific dosage limits, enable an automatic stop policy for high alert meds

Question 18

Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors when communicating drug information

Answer 18

Limit verbal orders unless emergency, use the JC error prone abbreviations

Question 19

Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in standardization

Answer 19

Use carefully developed standard order sets to minimize ME, prescribers should be encouraged to dose opioids based on patients age and tolerance.

Question 20

Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors based on environmental factors

Answer 20

Limit distractions during tasks, enhance font size, enable CPOE system to make prescriber choose patient name from list rather than typing patient name each time.

Question 21

What type of errors occur in the community pharmacy setting that are specific to eprescribing and strategies to prevent such errors

Answer 21

Detecting eRx errors: Double check eRx info, print eRx to paper handout and compare with computer screenshot, highlight important patient and DI on the printed eRx.
Detecting and explaining eRx errors: Consult other pharmacy team members, review patient med history, consult with the patient, use online DI resources
Explaining and correcting eRx errors: Make educated guesses of prescribers intention, contact provider for clarification