Medication Error Flashcards
Medication Error
NCCMERP: “Any PREVENTABLE event that may lead to inappropriate medication use or patient harm while medication is in control of the healthcare professional, patient, or consumer”
Adverse drug event (ADE)
Patient harm from drug exposure (an ADE can occur in the absence of a medication error)
- Non preventable
Preventable ADE
Medication error that reach the patient and cause harm (50% of all ADE)
Potential ADE
Medication error that does not cause harm (did not reach the patient or just good luck)
Adverse drug reaction (ADR)
A non preventable ADE( no medication error occurred but patient still experienced harm from drug exposure)
- Called side effect
FDA classification for ADEs (IND safety reporting during clinical trials)
Life threatening ADE: Places the patient at immediate risk of death
Serious ADE: Result in
– Patient death
– life threatening ADE
– Hospitalization or prolongation of existing hospitalization
– Persistent or significant incapacity or substantial disruption of normal daily life
– Congenital anomaly or birth defect
Suspected ADE: There is a possibility that the drug caused adverse event
Unexpected ADE: Any ADE, regardless of severity that is
- Not included in the investigator Brochure (IB)
- Not described in the IB as occurring at the observed specificity or severity
- Not consistent with the risk information in IB or general investigational plan
Significant of ADEs
ADEs during Transitions of Care:
- Medication adherence may suffer
- Medication may have been stopped, replaced, or added during hospitalization
- Poor healthcare provider communication and follow up exacerbates these problem
- Hospital readmission: ADR-related 20%, ADE-related 13%
ADEs in children:
- Dosing errors most common (93.2%)-Wrong amount of liquid measured
If you decrease medical errors => 30 days readmission rates decrease
NCCMERP medication error classification
- Two third of ADEs are preventable
- 40% are the result of negligence
This is the fault of the system as most of the time they are understaffed and overworked
What causes medication errors
Medication selection and procurement
- Drug shortage or recall (get mixed up)
- Expired or adulterated drug(light get into drug)
- Ordered wrong product, strength or dilution
Improper drug storage
- Failure to refrigerate, protect from light
Ordering and transcribing
- Wrong drug, dose frequency of admistration or duration of therapy prescribed (18.5%)**
-Missed drug allergy or DDI
Transcribing
- Medication order interpreted incorrectly (25.5%)**
Preparation and dispensing
- Failure to select, package, label,….
Administration
- Failure to give the medication at all - Missed does (25.6%)**
- Failure to administer the drug to the right patient, at the right time, in the right dose
- Any discrepancy in administration from the prescriber direction or hospital guidelines
Monitoring
- No proper follow up for effect and potential ADEs
Pharmacist Patient Care Process Model
- Collect: medication/medical/social history
- Assess:
– Each medication, adherence, access
– Health and functional status, risk factors, cultural factors, health literacy
– Immunization status, need for preventive care - Plan: Develop individualized patient-centered care plan
- Implement: in collaboration with other healthcare professionals
- Monitor, evaluate and follow up
ISMP list of confused drug names
LASA medication
Tips:
- Use brand and generic name on prescription and label
- Include indication on prescription
- Prevent LASA medication from appearing consecutively on CPOE screens
- Change appearance of lookalike names to highlight dissimilarities
Personalized Medicine
- Pharmacogenetics: Focuses on individual genes
- Pharmacogenomics: Focuses on the individual patient entire genome and how it affect the patient response to a drug
- Genotype: Complete genetic make up of an individual: Knowledge of the genotype can be used to optimize pharmacotherapy in that individual patient
- Phenotype: Observable traits of an individual patient
– Largely determined by genotype, other traits by environment or a combination
Variability in drug metabolism
- Genetic factors: gene ployophism such as mutation, insertion, deletion, separation and gene duplication
- Epigenetic factors: chemical modification in gene activity that DO NOT change DNA sequence
- Age
- Gender
- Ethnicity
- Disease: Liver disease, Kidney disease, Acute viral infection
- Environmental factors
– Cigarette smoking(CYP450IA2), coffee, alcohol
– Drug administration(drug interaction) herbal - Exposure to DDT or gasoline fumes
- Dietary factors (charbroiled beef, grapefruit juice (inhibit drug metabolizing enzyme)
Drug metabolism
Introduces or expose a FG
- Most reaction catalyzed by CYP450 enzymes
Covalent linkage between FG on the parent compound with glucuronic acid, sulfate, glutathione
- Lead to more rapid excretion
Pgp (drug efflux pump)
- Active in liver and small intestine (ABCB1-drug transporter)
Example: 6-MP (mercaptopurine)
6-Mercaptopurine (6-MP) (Biomarker-TPMT): FDA approved labeling**
- Purine antagonist used to treat childhood acute lymphoblastic leukemia (ALL) and (off label adult or childhood inflammatory bowel disease)
- TPMT IMs and PMs are predisposed to severe 6-MP toxicity
- Consider alternative in known PMs due to risk fatal bone marrow suppression
