Medication error, ID, Reconciliation Flashcards
Explain 15 %/ >40%/ 60% in terms of scope of drug usage among patients > 65 yrs old
In Canada-15% of population is 65 or older
They represent >40 % Rx drug Sales
60% Public drug program spending
5 risk factors for Inappropriate Medication Use
1) #of RX and non RX drugs ( poly pharmacy 5+,9+)
2) # of co-morbidities
3) Prescribers without Training in Geriactrics
4) Higher level of patient care ( nursing home➡️acute hospital➡️primary care)
5) age
Which level of patient care have the highest level of risk?
Nursing home
True or false? More medications leads to greater risk of being prescribed something inappropriate
True
True or false: ANY symptom in an Elderly patient should be considered a drug side effect until proven otherwise
TRUE
Name 8 Poor Health Outcomes related to Inappropriate Medication Use:
1) adverse drug reactions or 2) Falls
⬇️
3) hospitalization or ➡️4)health care service utilization
-can lead to 5) mortality - can lead to 6)increased cost or 7) reduced quality of life 8) Medication Non adherence
Name 8 Medication Related Problems
1) untreated condition 2) failure to receive medication
3) sub therapeutic dose 4) overdose 5) drug use without indication 6) improper drug selection
7) drug interaction 8)adverse drug event
What % of ADE ARE considered Preventable and what is the most considered the most frequently preventable ADE
42%, Medication errors
Name 6 medications that are the most frequently associated with PREVENTABLE ADEs
1-warfarin 2-atypical antipsychotics 3-intermediate acting benzodiazepines 4-opioids 5- loop diuretics 6- Ace inhibitors
What is the acronym for looking at symptoms of Medicated-Related problems?
CLEAR
What does each letter stand for in CLEAR
COGNITIVE changes LOSS of bladder of bowel control EATING or appetite changes ACTIVITY or energy changes RECURRENT falls
Name 2 methods to assess Medication Appropiateness
Implicit methods
Explicit methods
Name 2 IMPLICIT methods to assess Medication Appropriateness
MAI- Medication appropriateness index
Drug Regimen Review checklist
The challenge with using MAI
1) You must know something about the drug to apply it
2) Must use it on each and every medication
6 categories for Drug Regimen Review Checklist
- indication
- effectiveness
- safety
- monitoring
- errors
- cost
Name 3 Explicit methods to assess Medication Appropriateness
STOPP( screening tools of older people’s potentially Inappropriate prescriptions)
START ( screening tool to alert doctors to RIGHT treatments)
BEERS
How many STOPP criteria to identify PIMs (potentially Inappropriate Medication)
80
START criteria identify OVERuse or UNDERuse of medication , what 2 other things it can identify and how many criterias are used
UNDERuse , prescribing omissions and under treated conditions
34
Where did START AND STOPP criteria originate
Ireland
Which 2 tools look at overuse of medication
STOPP and BEERS
When did BEERS start and year of most recent version
1991, 2015
How many PIM or medication classes do BEERS identify in 2015 update?
40+
Name 5 categories of BEERS
- Medications to avoid in older adults
- Medications to avoid in older adults w: Specific Diseases/ Syndromes
- Medications to be USED WITH CAUTION in older adults
- Clinically important drug-drug interactions
- Medications for which DOSAGE ADJUSTMENT is required based on RENAL IMPAIRMENT ( based on expert panel and not package inserts)
Name 2 LISTS in BEERS
List of drugs with ANTICHOLINERGIC properties
List of SAFER alternatives and Complete References
