Medication errors

Question 1

Who are generally at fault when errors occur

Answer 1

The systems

Question 2

How to prevent system flaws in med errors

Answer 2

Need for accountability, reexamine workplace culture, reporting structure, management behaviour

Question 3

Adverse drug event

Answer 3

All types of clinicals problems resulting from medication including medication errors and adverse reactions

Question 4

Types of adverse drug reactions (ADRs)

Answer 4

Allergic reaction and idiosyncratic reaction

Question 5

Medication errors

Answer 5

is a preventable common cause of adverse health care outcomes

Question 6

Which type of drug has more potential for harm

Answer 6

High alert medications

Question 7

Which step of medication administration can errors occur

Answer 7

Any step
Procuring
Prescribing
Transcribing
Dispensing
Administering
Monitoring

Question 8

Issues contributing to errors

Answer 8

Organizational issues
Educational system issues
Sociological factors
Use of abbreviations

Question 9

Types of medication

Answer 9

SALAD: sound alike, look alike drugs
LASA: look alike sound alike
Near miss
No harm event
Medication error
Critical incident

Question 10

Near miss

Answer 10

Did not reach the patient and results in no harm

Question 11

No harm event

Answer 11

Reaches patient but results in no harm

Question 12

Medication error

Answer 12

Reaches patent and causes harm

Question 13

Critical incident

Answer 13

Results in serious harm

Question 14

Preventing medications errors

Answer 14

• Having multiple checks and balances
• Prescribes must write legible orders that are correct info entered in electronically
• Use resources (pharmacists or drug references)
• three checks
• ten rights
• do not use others people words as student resources

Question 15

type of orders to minimize

Answer 15

Verbal or telephone orders

Question 16

How to give a telephone/verbal order

Answer 16

Repeat order to prescribers, spell drug aloud, speak slow and clearly, have the indication next order

Question 17

What to do if written orders are illegible

Answer 17

contact prescriber

Question 18

Should you use trailing zeros

Answer 18

no

Question 19

Should you have leading zeros for decimal dosage

Answer 19

yes

Question 20

What to do if patients do not speak english

Answer 20

Provide a translator

Question 21

When to use tall man lettering

Answer 21

When look alike drug names come

Question 22

How to respond/report/document to a med error

Answer 22

Follow facility policy,
follow up procedures/tests
complete all necessary forms,
avoid using judgemental words,
take responsibility,
nurse with the highest priority is patient’s physiological status and safety,
document that the prescriber was notified and any follow up action or orders that were implemented
The Institute for Safe Medication Practices Canada

Question 23

Ensuring Accuracy in Patient Medication Information through

Answer 23

Continuous assessment and updating patient medication info
- Verification
- Clarification
- Reconciliation

Question 24

where should medication reconciliation occur

Answer 24

Entry into the facility
Transfer into the facility
Into or out of the ICU
Discharge

Question 25

Why do prescribers assess medications upon hospitalization

Answer 25

To ensure there are no discrepancies between what the patient was taking at home and hospital

Question 26

At what level should reconciliation be done

Answer 26

At every level
- Admission
- Status change
- Patient transferred between facilities/teams
- Dishcharge

Question 27

Preventing peds medication errors

Answer 27

• Know the weight and double check med calc
• communicate with everyone (parent/caregiver)