Medical Safety Flashcards
What is any type of preventable error that occurs anywhere in the course of medication treatment from prescribing to patient receiving medication?
medication error
What is any injury resulting from any use of a medication?
adverse drug event
What is a subset of ADEs where a non-preventable injury occurs when using the correct drug at the correct dose for the correct purpose?
adverse drug reaction
Will all medication errors cause harm to patients?
no, medication errors are more common but less likely to cause harm
What are the most common medication errors in primary care practices?
prescribing errors
What percentage of medication errors are due to prescribing errors?
70%
What is the system that is put in place to help prevent ADEs?
- ordering and prescribing
- transcribing
- dispensing
- administration
What does the clinician make sure when they are ordering and prescribing medication?
making sure what is being prescribed is the correct medication
What happens when the prescription is being transcribed?
pharmacists, pharm techs, etc are making sure they transcribe the prescription correctly
What occurs when medication is being dispensed?
person dispensing makes sure to check for any allergies, appropriate quantity, to the correct patient, ADEs, etc
What are the top 3 causes of medication errors?
- lack of drug knowledge
- lack of patient information
- rule violations
What are other causes of medication errors other than the top 3?
-slips and memory lapses
-transcription errors
-faulty drug identity checking
-faulty interaction with other services
-faulty dose checking
-infusion pump and parenteral delivery problems
-inadequate patient monitoring
-drug stocking and delivery problems
-preparation errors
-lack of standardization
What are some common problems associated with drug knowledge?
-deficient knowledge of doses
-incorrect calculations
-errors in measurements or concentration
What can lead to a lack in drug knowledge?
-out of date references
-computer system failure (or heavy reliance on computers)
-no pharmacist access
-handwritten charts, prescriptions
What should be easily accessible and understandable to the user?
patient information
What are the key pieces of information that should be included in patient information?
-height
-weight
-age
-pregnancy, breastfeeding
-lab values
-allergies
-current medications
-comorbidities
What can lead to rule violations?
-workarounds (knowing there is a system in place but working around them)
-increased demands on productivity-shortcuts
-too many red rules leading to “rule fatigue”
-unclear expectations
What are some ADE risk factors?
-polypharmacy (lots of medications)
-elderly
-pediatric
-poor health literacy
50% of ADE related ER visits in elderly are due to what?
-antidiabetic agents
-oral anticoagulants
-antiplatelet medications
What are examples of medication misuse?
-improper use
-overuse
-underuse
(at this point it is the patents fault for medication misuse)
What is the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen?
compliance/adherence
Why wouldn’t a patient take their medication?
-forgetting
-not wanting to
-being uneducated
-price
What do not correlate with likelihood of compliance?
isolated demographics
What are the isolated demographics that do not correlate with the likelihood of compliance?
-age
-sex
-education level
-intelligence
-income
-personality
What are some barriers to compliance?
-patient-provider relationship
-patient must perceive they are susceptible to a disease which might have serious effect (benefit>cost)
-physical or psychological illness
-social support
-health literacy
-language barriers
-elderly
-complexity, length of regimen
-stigma associated with illness/treatment
-side effects
-cost/access issues
-homelessness or unstable living situation
As a patient, what questions would they be thinking that could impact the patient-provider relationship?
-do i think my provider is competent
-does my provider take time with me and care
-do i understand what my provider is saying
As a provider, what questions would I be thinking that could impact the patient-provider relationship?
-do i understand my patient’s lifestyle
-does my patient have any physical or social barriers
-have i included my patient in decision making
-did i ask my patient if they are willing to adhere to this therapy
What are the components associated with elderly patients being a barrier to compliance?
-changes in metabolism (side effects)
-finances
-dexterity, mobility
-polypharmacy
What are some strategies to improve compliance?
-listen to patient and ask questions
-be sensitive to what you are asking your patient to do
-employ the help of caregivers or a third party if patient cannot mentally or physically care for themselves
-keep written directions/instructions at the 6th grade level or lower
-utilize interpreter services
-educate patient and involve them in decision making
-use open-ended questions to assess patient’s understanding
-provide simplest regiment for shortest duration possible
-use memory aids, pill boxes
-talk with patients about affordability of medications
-adjust care for religious beliefs, cultural differences, and access issures
What is an order for medication that is dispensed to and for the ultimate user? (patient is in charge of it)
a prescription
What is an order for medication that is dispensed for immediate administration to the ultimate user? (patient has to immediately take it)
medication order
Who can issue a prescription?
- physicians (MD/DO)
- within the terms of collaborative/supervisory agreement:
**nurse practitioners
**physician assistants
**pharmacists - limited scope of practice
**dentists
**optometrists
**podiatrists
**veterinarians
A prescription, to be valid, must be issued for a ________________ by an individual prescriber ______________________
- a legitimate medical purpose
- acting in the usual course of his/her professional practice
An order purporting to be a prescription issued not in the usual course of bona fide treatment of a patient is what?
not a prescription
All outpatient prescriptions issued by a prescriber shall:
- be dated on day when issues
- contain full name, professional title, and address of prescriber
- telephone number where prescriber can be contacted
- full name and residential address of patient
- drug name and strength
- quantity to dispense
- appropriate and explicit directions for use
- number of times or period of time for which the prescription may be refilled
- identify trade or generic name of drug(s) in compounded prescription
All prescriptions issued on paper to a patient by a prescriber shall be:
manually signed on day issued by prescriber
What is the anatomy of a prescription?
- dated as of and on the date of issuance
- full name, title, phone number, address of prescriber
- full name and residential address of patient
- drug name and strength
- quantity to dispense
- appropriate and explicit instructions
- number of refills; if nothing is indicated, no refills given
- signed as the prescriber would sign a check
