Medication Safety ll Flashcards
Classification of risk mitigation strategies based on leverages/effectiveness (3)
- Low leverage
- least effective
- person-based - Medium leverage
- medium effective
- person-based & system-based - High leverage
- most effective
- system-based
Low leverage (2)
- rules & policies
- education & information
Medium leverage (2)
Person-based : Reminders, checklist & double checks
System-based : Simplification & standardisation
High leverage (2)
- forcing functions & constraints
- automation or computerisation
Steps to reduce errors (10)
- Reduce reliance on human memory
- Simplify
- Standardise
- Forcing & constraints function
- HAM - Use protocols & checklist wisely
- Improve access to information
- Decrease reliance on vigilance
- Reduce handoffs
- Differentiation
- eliminate look-alikes & sound-alikes - Automate carefully
- CPOE
HAM
High Alert Medications
CPOE
Computerised Provider Order Entry
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Reduce reliance on human memory (4)
- *
1. Use computerised order entry - avoid memorising medication orders
- Use bar-coding on drugs, containers, medication records, patient wristbands
- to help identify & verify drugs & patients - Use computerised patient information
- avoid memorising patient information - Use guided dose algorithms
- avoid memorising dosing algorithm
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Simplify (2)
- *
1. Simplify formulary in institution - limit choices of available drugs in pharmacy
- strengths & concentrations
- Automate dispensing on patient care unit
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Standardise (2)
- *
1. Standardise prescribing conventions - standardised abbreviations
- Use standard equipments
- reduce risk of using wrong equipments
eg 1 type of pump
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Standardised prescribing conventions (3)
- *
- 0.5mg with a leading zero
- 5.0mg with a trailing zero
- generic names > brand names
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Use forcing & constraints function
- forcing function
- constraints function
(2+3)
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Forcing functions
- eliminates reliance on memory, checklists & double check system
Constraints function
- prevent further action until conditions are met
- use equipments that have to match with each other before equipments can be used
eg special luer-locks syringes & indwelling lines have to match - use computerised order entry with dosage range checks
- special safeguards for HAM
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Special safeguards for HAM (7)
- *
- improve access to drug information
- limit access to HAM
- remove HAM from clinical areas
- reduce number of HAM stocked by hospitals
- use auxiliary labels & automated alerts
- employ automated or independent double checks when necessary
- close monitoring to detect errors early and institute prompt remedial action
Water for injections = normal saline?
No.
Water for injections for reconstitution
Normal saline is isotonic to body fluids hence can be used directly for IV infusion
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Use protocols & checklists wisely (2)
- *
- revisit the protocol or checklist regularly to evaluate & update
- shared consensus on the protocols & checklists among various HCPs
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Improve access to information (4)
- *
- have a pharmacist available & accessible on nursing units & at rounds
- place protocols & ordering information on patient’s charts & in medication room where they are easily accessible
- computerised lab data to alert abnormal values
- colour-code wristband tags for patients with allergies
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Decrease reliance on vigilance (4)
- *
- use automatic drug dose checking
- electronic monitors that raise alert when parameters are exceeded
- rotate staff when performing repetitive functions
- limit shift durations for HCPs
** Reduce handoff (4)
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- use automated drug dispensing / filling systems
- use computerised prescriber order entry
- use unit-dose systems (prepack them using machines)
eg syrups unit packs of 10mL
- provide ready-to-administer products
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Differentiation between look-alikes & sound-alikes (4)
- *
- store look-alikes in separate places
- repackage or relabel look-alikes to differentiate them
- use caution stickers on stock containers to alert staff
- use Tall Man letters to differentiate sound-alikes & look-alikes
Tall Man Letters
- caps the differentiating parts
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Automate carefully
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- use computerised order entry systems with range checks & override capacity
- use bar-code technology to identify drugs
- regular double checks on automation
eg right stock in the right dispensing machine
Advantages of CPOE (5)
- elimination of handwriting discrepancies / illegibility
- automated DDI & allergy checkings
- immediate error checking for dosage, frequency & route
- tool for documentation
eg administration by nurse - intelligent prescribing
eg automatic dose calculator based on patient’s weight inputs
ISMP key recommendation for safe electronic communication of medication orders (6)
- Use generic names
- unless the brand matters (eg cannot switch between brands) - Avoid including salts of chemicals
- unless got multiple salts for the same type of drug - Differentiate generic names from brand names
- brand names in upper case letters (all)
eg LANOXIN - Standardise inclusion of suffixes
eg SR, CR, LA - Standardise the use of mnemonics or short names
- Standardise fonts (size & style) & colours
CLMM
Closed Loop Medication Management system
- ensure the 4 rights (drug, dose, time & patient)
- review by pharmacists & automated checks
- 4 components
Advantages of CLMM
- reduce TAT for medication stock
- reduce time required to administer medications to patients
4 components of CLMM
- Electronic Inpatient Medication Record system (eIMR)
- prescription ordering system
- medication record - Clinical Decision Support System (CDSS)
- Inpatient Pharmacy Automated System (IPAS)
- automated tablet dispensing & packing system
- automated dispensing cabinets - Electronic Medication Administration Record System (eMARS)
RCA
Root Cause Analysis
- team of 4-6 people
- interprofessionals
- 3 key questions
3 key questions for RCA
- What happened? Describe the key steps
- What went wrong & why? Identify the failed process
- What to do to prevent incident recurrence? Suggest risk reduction strategies & their implementations
Recommended guidelines for HAM (3)
- Eliminate or reduce the possibility of error
- Make errors visible
- Minimise consequences of errors
Methods to eliminate or reduce the possibility of error (6)
- remove HAM from clinical areas
- reduce HAM stocked by the hospital
- limit the variance in conc & total volumes
- improve access to information about HAM medications
- restrict access to HAM medications
- automated dose checking system
Methods to eliminate or reduce the possibility of error (3)
- remove HAM from clinical areas
- reduce HAM stocked by the hospital
- limit the variance in conc & total volumes
Methods to minimise consequences of errors (1)
- close monitoring
Methods to minimise consequences of errors (1)
- close monitoring
Example of restriction function (2)
- restrict use for certain patients
- restrict access to the medication
Use of protocols
- provide guidance on medication use
- minimise variation in practices but need to use it wisely (error can arise if there is indiscriminate adherence)
Use of checklists (1)
- reminder on the various factors to consider during MUP
