Drug information part II Flashcards
What are the differences between ADE and ME
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.
What is the prevalence of MEs and ADEs in the U.S.
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.
List the types of harm that can occur from ME and ADEs
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.
Why are ME and ADEs a public health problem?
Causes harm to patients, huge economical burden to treat
Causes of ME and ADE in procurement
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
Causes of ME and ADE in storage
Failure to refrigerate product that requires it and failure to protect product from light
Causes of ME and ADE in ordering/transcribing
Dose, route, frequency, and duration are not appropriate for patients disease state. Failure to interpret med order correctly (illegible)
Causes of ME and ADE in preparing/dispensing
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.
Causes of ME and ADE in medication administration
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.
Causes of ME and ADE in patient education
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.
How can ME and ADEs be prevented
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
Describe 3 quality improvement methods that can be employed to prevent ME and ADEs
Upgrade computer program, software or entire new system. Separate LASA drugs. Create preprinted orders based on guidelines to precent inappropriate drug, dose and monitoring.
Describe the steps in the med reconciliation process and how they help reduce ME and ADEs
- Determine a current list of medications
- Develop list of medications to be prescribed
- Compare the 2 lists
- Make clinical decisions based on the 2 lists
- Finalize and communicate the list of medications to the patient and other clinicians.
Define just culture
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.
Produce which types of ME are likely, possible and unlikely to be intercepted by CPOE
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
Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in patient information
Make sure all patient information is well documented, make allergy information mandatory, 2 patient identifiers, accurately capture comorbid conditions
Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in drug information
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
Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors when communicating drug information
Limit verbal orders unless emergency, use the JC error prone abbreviations
Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors in standardization
Use carefully developed standard order sets to minimize ME, prescribers should be encouraged to dose opioids based on patients age and tolerance.
Identify and assess risk reduction strategies that can be implemented to help prevent prescribing errors based on environmental factors
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.
What type of errors occur in the community pharmacy setting that are specific to eprescribing and strategies to prevent such errors
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
