medication-related problems Flashcards by jo shibiwol

any undesirable event experienced by a patient that involves or is suspected to involve drug therapy and actually or potentially interferes with a desired patient outcome

medication-related problems

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all circumstances that involve a patient’s drug treatment that actually, or potentially, interfere with the achievement of optimal outcome

medication-related problems

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why geriatric patients are at higher risk for medication-related problems?

polypharmacy

↑ no. of drugs = ↑ risk for medication-related problems

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classification of mediation-related problems

dosing
ADR
drug interactions
non-adherence
medication errors
choice of drug

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TRUE OR FALSE

medication-related problem is brought about by human errors

true

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types of medication-related problems under “choice of drug”

need for additional drug
unnecessary drug
inappropriate drug choice

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means not given reason for deviation from concordance between drug and diagnosis or indication or absolute or relative contraindication because of for example age or comorbidity

inappropriate drug choice

choice of drug

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TRUE OR FALSE

deviations from guidelines that are based on the patient’s individual treatment goals and risk factors are not considered to be DRPs

true

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any noxious, unintended, and undesired effect of a drug which occurs at doses in humans for prophylaxis, diagnosis or therapy (WHO)

adverse drug reactions

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drug, chemical or food causing the interaction in a drug interaction

precipitant drug

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drug affected by the interaction in a drug interaction

object drug

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TRUE OR FALSE

all drug interactions are dangerous and not beneficial

false

some are beneficial; can increase effetivity

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patients’ real drug use deviate from the doctor’s prescription with respect to type of drug, dose or scheme

noncompliance

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any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of human

medication error

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the single most preventable cause of patient harm

medication error

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classification of medication errors

based on psychological approach
based on stage of medication cycle

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can be related to any type of knowledge (general, specific, or expert)

knowledge-based errors

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errors due to the** choice of the wrong rule** due to an erroneous perception of the situation, or omissions in the application of a rul

rule-based errors

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defined as performance of an action that was not intended

action-based errors

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IDENTIFY THE ERROR

slip of the pen, when a doctor intends to write diltiazem but writes diazepam
technical errors- addition to an infusion bottle of the wrong amount of drug
wrong dispensing

action-based errors

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the most difficult medication error to prevent

memory-based errors

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IDENTIFY THE ERROR

giving penicillin, knowing that the patient to be allergic, but forgetting

memory-based errors

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how to prevent action-based errors?

training can help prevent technical errors

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how to prevent memory-based errors?

putting in place systems that detect errors
checking lists and computerized systems

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defined as the** incorrect drug selection** for a patient

prescribing errors

defined as the **incorrect format** of writing the generic and brand name of the drug in the prescription or medication order

prescription error

# IDENTIFY THE PRESCRIPTION ORDER **no generic name** written

violative

# IDENTIFY THE PRESCRIPTION ORDER the brand name **precedes** the generic name

erroneous

# IDENTIFY THE PRESCRIPTION ORDER the generic name **does not match** the brand name

impossible

it **occur at any stage of the dispensing process**, from the receipt of the prescription in the pharmacy to the supply of a dispensed medicine to the patient

dispensing errors

most common cause of dispensing errors

S.A.L.A.D

**5R's** in medication

1. right **drug** 2. right **patient** 3. right **dose** 4. right **route** 5. right **time**

H.E.L.P meaning

* **How** much has been dispensed * **Expiry** date check * **Label** check * **Product** check

RA 6675

Generic Act of 1988

RA 3720

Food, Drug, and Cosmetic Act

example of SALAD drugs

* methylprednisolone = hydrocortisone

drugs that bear a **heightened risk** of causing significant patient harm when they are used in error

high alet medicines | HAM

although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more **devastating** to patients

high alert medicines | HAM

examples of HAM

* **A** - antimicrobials * **P** - potassium and other electrolytes, psychotropic medications * **I** - insulin * **N** - narcotics, opiois, sedatives * **C** - chemotherapeutic agents * **H** - heparin, other coagulant

# CATEGORY OF ERRORS **no error**, capacity to cause error

# CATEGORY OF ERRORS error that **did not reach** the patient

# CATEGORY OF ERRORS error that reach the patient but **unlikely to cause harm** (omissions considered to reach patient)

C | multivitamins was not ordered on admission

# CATEGORY OF ERRORS error that reached the patient & **could have necessitated** monitoring and or intervention to preclude harm

D | regular release metoprolol instead of extended-release

# CATEGORY OF ERRORS error that could have caused **temporary harm** --- **needs treatment or intervention**

E | inadvertently omitted antihypertensives

# CATEGORY OF ERRORS error that could have cause **temporary harm requiring initial prolonged hospitalization**

F | anticoagulant ordered daily but taken every other day

# CATEGORY OF ERRORS error that could have resulted into **permanent harm**

G | immunosupressant medication ordered at 1/4 dose

# CATEGORY OF ERRORS error that could have necessitated intervention to **sustain life**

H | anticonvulsant inadvertently omitted

# CATEGORY OF ERRORS error that could have resulted in **death**

I | beta blocker not re-ordered post-operatively

allows the person who commits the error or the person who discover the error to report it **without being associated** with the error

anonymous self report

this is the **official written legal reports** of a medication error as documented by the hospital staff

incident reports

this **results to underreporting** of the errors due to punitive action that might occur due to the report

incident report

involves **in-depth analysis** of a large number of individual errors or the purpose of identifying a common cause

critical incident techniques

it **involves an observer** accompanying the person who will give the medication and witnessing the administration of each dose

disguised observations

**outlines** in step by step process, the care the patient received and serves as a form of communication among health care providers, **so that each practitioner involved knows** what evaluation has occurred, what the plan for the patient’s treatment is, and who will provide it

documentation

the **most common and universally recognized format** of documenting patient information

SOAP note

obtained directly from patient given by the patient, family members or significant others or caregivers - typically **cannot be directly measured**

subjective

**measurable and not influenced** by memory, emotions, or prejudice

objective

**outlines** what the practitioner thinks the **patient’s problem** is, based upon the subjective and objective information acquired

assessment

involves the **action that needs to be taken** to resolve any problems that have been identified

plan

parameters that will be used to determine whether the desired therapeutic outcome is being achieved and to detect or prevent drug-related adverse event

plan

an important component of plan **to ensure** that problems were actually corrected, future problems were avoided and drug therapy goals are met

follow-up

clearly state the nature of the drug-related problem(s) --- will include medical information **both subjective and objective** findings

findings

this should **reflect the actions proposed** (or already performed) to resolve the drug-related problem based upon the preceding analysis

resolution

# FARM NOTE INDICATORS can be measured to determine the impact of therapy and include reports of **symptoms**, laboratory values, and the results of **quality-of-life assessments**

patient factors

# FARM NOTE INDICATORS describe the **degree of improvement** in patient variables that can reasonably be expected to result from the pharmacotherapy

progress factors

# FARM NOTE INDICATORS the **time frame** in which the pharmacotherapy should have achieved the desired degree of improvement

time factors

**objective measures** of a particular variable and include

quantitative assessments

**subjective determinations** of change in a particular variable

qualitative assessments

the practice of **monitoring the effects** of medical drugs **after they have been licensed** for use, especially in order to identify and evaluate previously unreported adverse reactions

pharmacovigilance

defined as **the science** and activities relating to the **detection, understanding, response and prevention of ADR** (adverse drug reactions) and other medication-related problems- including AEFI (adverse events following immunization)

pharmacovigilance

**the person who has taken** or been administered the product (age, gender, etc.) in compliance with local privacy laws

identifiable patient

**the source that reported** the event (health care provider, patient, legal representative of the patient) in compliance with local privacy laws

identifiable reporter

refers to activities in safety, efficacy, and **quality monitoring of health products**, including drug products --- this shall also include among others adverse events reporting, product safety update reporting, **collection and testing of health products in the market**

post-marketing surveillance | PMS