Medication Errors and Patient Safety Flashcards
Medication guides
By law this is part of the labeling and should be dispensed with any drug containing a medguide on its first fill and any subsequent refills
Methods used to reduce medication errors
Review of patient profiles, medication therapy management, DUR, medication reconciliation, medication guides, barcoding, look-alike sound alike medication list, and do not use error-prone abbreviations, avoid using the term as directed as the patient does not know what that means, avoid multiple dose vials, and do not rely on packaging for identification of products
Unapproved abbreviations per the joint commission
U for units, QD for daily, Q OD for every other day, do not use trailing zeros and always put a zero before anything that is a decimal, MS and MS04 and MGS04 for magnesium products
High alert medications
Hypertonic saline, insulin, heparin, potassium chloride, and opioids
Safe practices with hypertonic saline
Allow only commercially available standard concentrations of sodium chloride outside the pharmacy, limit the options of hypertonic saline, develop a protocol for administering hypertonic saline, limit addition of sodium to enteral feedings to Pharmacy only, and stock only a single hypertonic saline and locked area in my dialysis clinic
Safe practices with insulin
Eliminate insulin pens from inpatient setting, if U-500 is stocked specify conditions under which it is to be used, standardize all insulin infusions to one concentration, have standard orders in place for hypoglycemia, do not use “u” for units, always label with units or units per ML but never just ML
Safe practices with potassium chloride
Remove all KCL files from the horse, use premixed containers, use protocols for KCl delivery including indications for KCL infusion next mom right of infusion maximum allowable concentration stipulation that all KCL infusions must be given via a pump, label all fluids containing potassium with a potassium added sticker
Safe practices with opioids
Use tools to screen patients for risk factors for oversedation and respiratory depression, use red flag alerts and E scribing systems for dosing limits, separate sound alike look-alike drugs, use conversion technology systems to calculate correct doses, use an infusion pump when administering IV
Other methods of reducing medication errors
Only trained personnel should operate crash carts, have dedicated pharmacist to the ICU pediatric units and emergency departments, develop standard protocols (joint commission requires this for anti-thrombotics), implement CPOE, educate patients and encourage them to ask questions, check for drug food Interactions, follow requirements for REMS drugs
REMS drugs
Clozapine, APRISE (for erythropoietin), ipledge (isotretinoin), many opioids including morphine extended release fentanyl patches hydromorphone oxycodone oxymorphone methadone and buprenorphine
This changes frequently
Patient controlled analgesic device or PCA
Should be carefully programmed, patient should have cognitive assessment prior to using the PCA, and friends and family members should not administer PCA doses per the joint commission
Other: limit high-dose opioids available in floor stock, educate staff about hydromorphone and morphine mixups, implement protocols, use barcoding and assess the patient’s pain sedation and respiratory rate on a scheduled basis
Common types of hospital acquired infections
Urinary tract infections (especially from indwelling catheters), bloodstream infections from IV lines and catheters, surgical site infections, decubitis ulcers, hepatitis, see death, pneumonia
Precautions for the spread of infectious agents in the healthcare setting
Contact precautions (recommended for MRSA and VRE), Droplet precautions (recommended for pertussis influenza adenovirus rhinovirus meningitis and streptococcus), airborne precautions (recommended for rubella virus or measles, varicella virus or chickenpox, and tuberculosis)
When to use soap and water over alcohol-based rub
Before eating, after using the restroom, anytime there is a visible soil or anything noticed on the hands, after caring for a patient with diarrhea or known C. difficile as alcohol-based rub has poor activity against spores, and before caring for patients with food allergies
Safe injection practices
Never administer oral solution or suspension IV label all oral syringes “for oral use only”, never insert used needles into a multidose vial and use single-dose vials when able, never touch the tip of a plunger of the syringe, throw the entire needle syringe assembly into the red plastic sharps container, do not recapped needles
