Med safety

Question 1

Define side effects

Answer 1

A known effect, other than that primarily intended, that is related to pharmacological property of medication

Question 2

Define adverse drug reactions

Answer 2

Reaction to drug that is noxious & unintended
Includes injuries judged to be caused by the drug
Excludes medication error

Question 3

Define medication error

Answer 3

Any preventable event that may cause/lead to inappropriate medication use and/or patient harm while the medication is in the control of HCP, patient or consumer 
Medication error can result in:
- Patient harm
- Near misses
- Neither harm nor potential to harm

Question 4

Define near miss

Answer 4

Event/Situation that could have resulted in medication error, but did not

Question 5

Types of medication error

Answer 5

1) Dose omission
2) Improper dose
3) Wrong drug
4) Wrong strength/concentration
5) Wrong dosage form
6) Wrong technique
7) Wrong route of administration
8) Wrong rate
9) Wrong duration
10) Wrong time
11) Wrong patient
12) Deteriorated drug error
13) Monitoring error
14) Others

Question 6

Steps in Medication Use Process

Answer 6

1) Prescribing
2) Preparing & dispensing
3) Administration
4) Monitoring

Question 7

Steps in medication use process

Answer 7

1) Prescribing
2) Preparing & dispensing
3) Administration
4) Monitoring

Question 8

Steps in medication use process - Prescribing

Answer 8

1) Choose appropriate drug, depending on individual patient factors
2) Select route, dose, time, regimen
3) Communication
- Communicate plan to HCP who will administer drug & patient
- Via written-transcribing, verbal
4) Documentation

Question 9

Types of errors that occur during prescription

Answer 9

1) Inadequate knowledge about indication & C/I
2) Fail to consider individual patient factors
3) Inadequate communication
4) Illegal, incomplete, ambiguous documentation
5) Wrong data entry when using computerized system
6) Wrong patient, route, dose, time, drug
7) Mathematical errors when calculating dose

Question 10

Steps in medication use process - Dispensing

Answer 10

1) Transcribe prescription
2) Review & confirm prescription
3) Prepare &/or packing drug
4) Distribute to patient location
5) Dispense drug & patient counselling
6) Documentation

Question 11

Types of errors that occur during dispensing

Answer 11

1) Transcribing error
2) Fail to consider individual patient factors
3) Mathematical errors when calculating dose/quantities
4) Labeling/Packaging mixed up
5) Poor inventory control
6) Illegal, incomplete, ambiguous documentation
7) Miscommunication

Question 12

Steps in medication use process - Administration

Answer 12

1) Obtain medication in ready-to-use form
2) Check for allergies
3) Give right drug to right patient, at right dose, via right route at right time
4) Documentation

Question 13

Types of errors that occur during administration

Answer 13

1) Wrong drug
2) Wrong patient
3) Wrong dose
4) Wrong route
5) Wrong time
6) Failure to administer/Omission
7) Inadequate documentation / communication

Question 14

Steps in medication use process - Monitoring

Answer 14

1) Monitor to ensure medication is
- Working properly
- Used appropriately
- Not harming patient
2) Monitor for ADRs & therapeutic effect
3) Documentation

Question 15

Types of errors that occur during monitoring

Answer 15

1) Lack of monitoring of ADRs
2) Drug not stopped when course completed/not working
3) Drug stopped before course completed
4) Drug levels not measured/followed up
5) Communication failures

Question 16

Factors contributing to medication error - Patient factors

Answer 16

1) Multiple medications/comorbidities
2) More than one doctor
3) Certain specific conditions
4) Children/Infants
5) Patients who do not take active role in managing medications
6) Patients who cannot communicate well

Question 17

Factors contributing to medication error - Medication / Technology Design Factors

Answer 17

Poor drug manufacturing / distribution practices:

1) Inappropriate packaging / Design leading to form confusion
2) Look-alike, sound-alike
3) Looks similar to another manufacturer / within same company’s product line
4) Inaccurate/Incomplete labeling
5) Misleading/Confusing information
6) Distracting symbols/logos
7) Similar size, shape, colour to another product/same product of different strength

Complex / Poorly designed technology :

1) Malfunction
2) Wrong device selected
3) Adapter
4) Automated distribution / Vending system / Automated counting machine / compounder
5) Oral measuring devices
6) Infusion

Question 18

Factors contributing to medication error - Staff/Human factors

Answer 18

1) Knowledge deficit
2) Rushing
3) Distracted
4) Inexperience
5) Fatigue, boredom, autopilot
6) Interruptions
7) Lack checking & double checking habits
8) Poor teamwork/communication due to:
- Written/Oral communication
- Drugs with similar names
- Drugs with different formulations / concentrations
- Misplaced/Missing zeroes/decimal points
- Confusion over units
- Ambiguous/Incomplete orders
- Non-standard abbreviations
9) Violations of SOPs/procedures
10) Reluctance to use memory aids

Question 19

Factors contributing to medication error - System / Workplace Factors

Answer 19

1) Lighting/Noise level
2) Frequent interruptions/distractions
3) Inappropriate storage
4) Lack of safety culture in workplace
5) Inadequate training/supervision
6) Absence of readily available medication & patient information
7) Inadequate staff
8) Breakdown of information system

Question 20

Root cause analysis steps

Answer 20

1) Describe key steps (what happened)
2) Describe failure processes (what went wrong & why)
3) Suggest risk reduction strategies & their implementation

Question 21

List of high alert medications

Answer 21

1) Intrathecal/epidural route
2) Hypoglycemic agents
3) Insulin
3) Anesthetics agents
4) Sedatives
5) Opiates
6) Neuromuscular agents
7) Vasopressors
8) Highly concentrated electrolytes
9) Inotropes
10) Chemotherapy
11) Radio-contrast agents
12) Anticoagulants & thrombolytics

Question 22

Strategies to reduce errors

Answer 22

1) Reduce reliance on human memory
2) Simplify
3) Standardize
4) Forcing & constraints function
5) Use protocols & checklists wisely
6) Improve access to information
7) Decrease reliance on vigilance
8) Reduce handoffs
9) Differentiate (eliminate LASAs)
10) Automate carefully

Question 23

Strategies to reduce errors - Reduce reliance on human memory

Answer 23

1) DDI checking systems
2) Computerized order entry
3) Computerized patient information
4) Bar-coding
5) Guided dose algorithm

Question 24

Strategies to reduce errors - Simplify

Answer 24

1) Limit choices of available drugs
2) Limit strengths/concentrations available
3) Mix IVs in pharmacy
4) Automated dispensing in patient care unit
5) Eliminate transcription of orders

Question 25

Strategies to reduce errors - Standardize

Answer 25

1) Standard prescribing conventions
- Generic name
- Avoid error-prone abbreviations
2) Use protocols for complex medication administration
3) Standardize time of administration
4) Store medications in same place in each medication room
5) Standardize equipment

Question 26

Strategies to reduce errors - Forcing & constraints function

Answer 26

1) Special luer-lock syringes & indwelling lines that have to be matched before fluid can be infused
2) Remove dangerous IV drugs from ward stock
3) Computerized order entry with dosage range checks
4) Special safeguards for high risk medications

Question 27

Preventing errors with high risk medications

Answer 27

Safeguards:

1) Improve access to information
2) Limit access to such drugs
3) Standardize ordering, storage, preparation, administration
4) Auxiliary labels & automated alerts
5) Automated/Independent double checks

Guidelines:

1) Remove from clinical areas
2) Reduce no. of high risk medications stocked
3) Limit available strengths & volumes
4) Make errors visible (e.g. independent double checking)
5) Minimize consequences of errors
- Close monitoring
- Change practices to reduce adverse effects

Question 28

Strategies to reduce errors - Use protocols & checklists wisely

Answer 28

1) Reduce inter-individual variation but may cause errors if followed blindly
2) Avoid statements containing double negatives
3) Multi-disciplinary consensus

Question 29

Strategies to reduce errors - Improve access to information

Answer 29

1) Computerized order entry system
2) Computerized laboratory data to alert abnormal lab values
3) Place lab report & medical records at bedside
4) Place protocols & ordering information in patient chart & in medication room
5) Color coding
6) Provide patient with list of medications, dosage, frequency
7) Track errors & near misses, provide regular feedback
8) Pharmacist available on nursing units & at rounds

Question 30

Strategies to reduce errors - Decrease reliance on vigilance

Answer 30

1) Limit shift duration
2) Rotate staff
3) Use automated dose checking system for high risk situations
4) Use electronic monitors to issue alerts when parameters are exceeded
5) Double checking system

Question 31

Strategies to reduce errors - Reduce handoffs

Answer 31

1) Reduce transcription
2) Provide ready-to-administer medications
3) Automated dispensing/filling systems
4) Computerized prescription order entry
5) Unit-dose system

Question 32

Strategies to reduce errors - Differentiate

Answer 32

1) Store similar looking medications at different areas
2) Re-label / Repackage
3) Use striking caution stickers
4) Avoid stocking look-alike packages
5) Alert staff and post information on medications with similar names
- E.g. Tall man lettering

Question 33

Strategies to reduce errors - Automate carefully

Answer 33

1) Computerized prescription order entry system with range checks & override capacity
2) Train staff to double check automation regularly
3) Bar-coding to identify drugs