Lecture 8.1: BNF and Medication Errors

Question 1

What is the BNF?

Answer 1

• British National Formulary
• Reference text for prescribing and pharmacology in
  the UK NHS

Question 2

Why use the BNF? (5)

Answer 2

• You cannot possibly know in detail all the drugs you
  will need to prescribe
• Avoid prescription error
• Right drug for the right patient
• Correct dose at appropriate interval
• Knowledge of side effects, contraindications and
  cautions

Question 3

When should the BNF be used? (4)

Answer 3

• Come across a drug you are unfamiliar with
• Take a drug history
• Are considering an ADR / interaction may be
  responsible for someone’s symptoms
• Are doing a prescribing task or considering a
  prescription for a patient you have seen
• ALL THE TIME BASICALLY!

Question 4

What are Side-Effects of Medications?

Answer 4

A known effect, other than that primarily intended, relating to the pharmacological properties of a medication

Question 5

What is an Adverse Event?

Answer 5

An incident that results in harm to a patient

Question 6

What is an Adverse Reaction?

Answer 6

Unexpected harm arising from a justified action where the correct process was followed for the context in which the event occurred

Question 7

Prescribing Involves 3 Steps

Answer 7

• Choosing an appropriate medication for a given
  clinical situation (taking allergies into account)
• Selecting the administration route, dose, time and
  regimen
• Communicating details of the plan with patients, those
  administering drugs & documentation

Question 8

How can Prescribing go wrong? (7)

Answer 8

• Inadequate knowledge about drug indications and
  contraindications
• Not considering individual patient factors such as
  allergies, pregnancy, co-morbidities, other medications
• Wrong patient, wrong dose, wrong time, wrong drug,
  wrong route
• Inadequate communication (written, verbal)
• Documentation - illegible, incomplete, ambiguous
• Mathematical error when calculating dosage
• Incorrect data entry when using computerised
  prescribing

Question 9

What are the The 5 Rs of prescribing medications?

Answer 9

• Right Drug
• Right Route
• Right Time
• Right Dose
• Right Patient

Question 10

5 Moments for Medication Safety

Answer 10

• Starting a Medication
• Taking my Medication
• Adding a Medication
• Reviewing a Medication
• Stopping my Medication

Question 11

Which patients are most at risk of medication errors? (6)

Answer 11

• Patients on multiple medications
• Patients with another condition, e.g. renal impairment,
  pregnancy
• Patients who cannot communicate well
• Patients who have more than one doctor
• Patients who do not take an active role in their own
  medication use
• Children and babies (dose calculations required)

Question 12

In what situations are staff most likely to contribute to a medication error? (8)

Answer 12

• Inexperience
• Rushing
• Doing two things at once
• Interruptions
• Fatigue, boredom, being on “auto-pilot”
• Lack of checking and double checking habits
• Poor teamwork and/or communication between
  colleagues
• Reluctance to use memory aids

Question 13

Do some homework on every medication you prescribe, the suggested framework is..? (7 Steps)

Answer 13

⚬ Pharmacology
⚬ Indications
⚬ Contraindications
⚬ Side-effects
⚬ Special precautions
⚬ Dose and administration
⚬ Regimen

Question 14

What is the PSA exam?

Answer 14

Prescribing Safety Assessment

Question 15

Structure of PSA exam

Answer 15

• You may use either an unannotated paper BNF or the
  online BNF
• You may also use a calculator
• Pass/Fail assessment of knowledge and judgement
• 2 hour online exam
• 60 questions
• 200 marks
• 8 question types
• Set in 7 clinical domains