Iatrogenic diseases

Question 1

What is iatrogenic illness?

Answer 1

• Describing a condition or disease that has resulted from treatment and/or the actions of health-care professionals

Question 2

How is it that not all iatrogenic illnesses result from error?

Answer 2

• Some treatments carry an inherent risk of harm, e.g.
  > radiotherapy
  > cancer chemotherapy

Question 3

How may clinicians make errors in diagnosis?

Answer 3

• Errors may be:
  1- overdiagnosis (diagnosis where illness does not exist)
  2- incorrect or delayed diagnosis (diagnosis too late or of wrong illness)

> ordering tests that are not indicated might lead to error of diagnosis

Question 4

How can iatrogenic illness be a result of improper performance?

Answer 4

• Surgical “never events”
  wrong site surgery
  wrong implant/prosthesis
  retained foreign objects
• Other technical errors
  damaging blood vessels, nerves, etc.
  anaesthetic errors

-Failure to obtain informed consent

• Poor technique (e.g.endoscopy) resulting in injury
• Poor communication between members of healthcare team

Question 5

How can iatrogenic illness occur as a result of failure to supervise or monitor?

Answer 5

• Many drugs have specific monitoring requirements, e.g.
  clozapine
  > Failure to ensure monitoring may result in avoidable adverse effects
• Staff require clear instructions and appropriate supervision
• Junior doctors must not act beyond their competence or without required supervision

Question 6

How can failure to recognise complications cause iatrogenic illness?

Answer 6

• Procedures may have obvious possible complications (e.g.transplant rejection)
• Most drugs have common adverse effects
  doctor has responsibility to recognise possible medical cause of symptoms

Question 7

How can medication errors cause iatrogenic illness?

Answer 7

Question 7

What is Pharmacovigilance?

Answer 7

• Process and science of monitoring the safety of medicines and taking action to reduce the risks and increase the benefits of medicines

Question 8

What does pharmacovigilance require awareness of?

Answer 8

• Drug adverse effects (“side-effects”) and requirements for reporting
• Risks and how to manage them
  > detecting possible drug-related events
  > monitoring risk-benefit profile (additional to clinical trials)
  > pharmacoepidemiology
• Relevant national regulatory authority

Question 9

What do we a responsibility to be aware of in terms of adverse effects of drugs?

Answer 9

• known adverse effects of drugs
• interindividual variability in response (including allergies)
• known interactions with disease (contraindications), other drugs, foodstuffs and/or environmental factors (e.g. sunlight)
• risks of accidental overdose (e.g. once-weekly drugs taken daily)
• monitoring requirements before you prescribe or recommend a medication
• respond to any suspected adverse effects
  check correct drug/dose/frequency/route
  identify likely allergy and treat as appropriate, check for possible interactants,
  withdraw/change medication as per guidelines

Question 10

What do we use to report any suspected unknown adverse reactions?

Answer 10

• Yellow card
  > Vital for identifying possible harmful effects of drugs and other therapeutic substances/devices
  > Suspected adverse drug reactions to any therapeutic agent should be reported
  > reports should clearly state the brand name and the batch number of the suspected medicine or vaccine

Question 11

What does black trinagle mean?

Answer 11

• Black triangle
  > “This medicinal product is subject to additional monitoring”
  > new medicines undergoing post-marketing surveillance
  > medicines that have been relicensed for new indications
  > all adverse events experienced by patients taking these medications MUST be reported