MED SAFETY Flashcards
At which 6 points can errors occur
1) admission to hospital
2) prescribing during inpatient stay
3) dispensing medication
4) administering medication
5) monitoring medication
6) Upon discharge (transfer of care)
What errors occur upon admission to hospital
There are discrepancies in admission drug histories
These errors can occur when:
- determining the patients med history
- when transcribing these details onto the clinical record
- when prescribing these medications onto the inpatient drug chart
How to reduce errors on admission to hospital
- By obtaining accurate drug history and carrying out Med Rec ASAP when patient admitted
Why is obtaining an accurate drug history important (4 reasons)
Allows continuity of treatment
Identifies adverse drug reactions
Identifies drugs that may need to be modified during admission (e.g. stop warfarin before surgery)
Implications for any new medications prescribed
What does a Med Rec consist of
Involves collecting info on MHx using at least 2 of the most recent and accurate sources of info to create a full list of their current meds
Checking or verifying the list against the current drug chart in hospital to identify discrepancies
Documenting any changes, omissions and discrepancies
How do you carry out a Med Rec
Use at least 2 accurate sources which include:
- asking the patient/carer
- See if patient has PODs
- Phone GP
- Drug charts from recent admissions
- SCR
Ask about allergies, how they take meds, OTC, herbal, supplements, adherence, side effects
what 4 types of medication are used in hospital
-Can be the patient’s own drugs which they brought from home
-Can be from ward stock = available on ward for any patient
-Dispensed as inpatient supply = with patient’s name but no direction on use
-Dispensed for discharge with full instruction on use
Advantages of PODs
- Assists with medication history taking
- patients can continue the medication they are familiar with
- Less risk of dose omissions (missed dose)
- less waste
Disadvantages of PODs
May include medicines from other members of the family
What 4 criteria do HCP have to use to determine if a POD is suitable for use
Is it identifiable
Is it in date
Is it labelled with the patients name
Is it in good condition
What is ward stock
Medicines kept on the ward even if patient is not currently using it so that it is available when patient needs
What drugs would we avoid making ward stock
costly drugs
Dangerous drugs
Rarely used drugs
Drugs for which we record the patients name
What drugs would we keep in ward stock
Drugs likely needed in an emergency
(e.g. adrenaline, lorazepam)
When are meds dispensed for discharge and what considerations need to be made
if a med is required by an inpatient and likely to be taken home by the patient
- labelled with patient name and directions on use
- Sufficient quantity supplied to take home
when are meds dispensed for inpatient supply
Meds that are needed for inpatient that isn’t ward stock and is unlikely to be taken home
- these are simply labelled with the patient name and no directions for use
How common are dispensing errors
2% of all dispensed items have errors before final check
only 0.02% of items have errors after the final check
what are 3 examples of dispensing errors
similar drug name = wrong medication given
Similar packaging = wrong drug given
Error in the patients name
who administers medication in hospital
Nurses
Doctors
other HCPs
Self-administered by the patient
What is the incidence of administration errors in IV and non-IV doses
6% of non-IV doses
35% of IV doses (IV doses are complex to prepare and administer
What are the causes of Administration errors
Administering IV infusions too quickly
Dose omissions (over half of all administration errors)
Wrong dose given
Wrong formulation given
Wrong drug
How to prevent administration errors
Educate nursing staff on med safety
Have clear clarifications on prescriptions
Use of technology
what is needed for clear clarifications on prescriptions
always use generic name alongside brand name
Always write abbreviations in full
Clearly indicate formulation
Fix handwriting = and advise to always confirm with prescriber if unsure what is written
What technology is used to reduce administration errors
Barcode medication administration (BCMA)
- nurse has to scan barcode on the medicine and barcode on patients wrist and see if it matches up
What is the limitation of BCMA
it is not advanced enough to distinguish between (e.g. two 5mg tablets being the same as one 10mg tablet), so it may flag up and not let nurse give the medication
