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a PR3145 > Medication Safety ll > Flashcards

Medication Safety ll Flashcards

1
Q

Classification of risk mitigation strategies based on leverages/effectiveness (3)

A
  1. Low leverage
    - least effective
    - person-based
  2. Medium leverage
    - medium effective
    - person-based & system-based
  3. High leverage
    - most effective
    - system-based
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2
Q

Low leverage (2)

A
  • rules & policies

- education & information

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3
Q

Medium leverage (2)

A

Person-based : Reminders, checklist & double checks

System-based : Simplification & standardisation

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4
Q

High leverage (2)

A
  • forcing functions & constraints

- automation or computerisation

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5
Q

Steps to reduce errors (10)

A
  1. Reduce reliance on human memory
  2. Simplify
  3. Standardise
  4. Forcing & constraints function
    - HAM
  5. Use protocols & checklist wisely
  6. Improve access to information
  7. Decrease reliance on vigilance
  8. Reduce handoffs
  9. Differentiation
    - eliminate look-alikes & sound-alikes
  10. Automate carefully
    - CPOE
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6
Q

HAM

A

High Alert Medications

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7
Q

CPOE

A

Computerised Provider Order Entry

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8
Q

**

Reduce reliance on human memory (4)

A
  • *
    1. Use computerised order entry
  • avoid memorising medication orders
  1. Use bar-coding on drugs, containers, medication records, patient wristbands
    - to help identify & verify drugs & patients
  2. Use computerised patient information
    - avoid memorising patient information
  3. Use guided dose algorithms
    - avoid memorising dosing algorithm
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9
Q

**

Simplify (2)

A
  • *
    1. Simplify formulary in institution
  • limit choices of available drugs in pharmacy
  • strengths & concentrations
  1. Automate dispensing on patient care unit
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10
Q

**

Standardise (2)

A
  • *
    1. Standardise prescribing conventions
  • standardised abbreviations
  1. Use standard equipments
    - reduce risk of using wrong equipments
    eg 1 type of pump
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11
Q

**

Standardised prescribing conventions (3)

A
  • *
  • 0.5mg with a leading zero
  • 5.0mg with a trailing zero
  • generic names > brand names
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12
Q

**
Use forcing & constraints function
- forcing function
- constraints function

(2+3)

A

**
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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13
Q

**

Special safeguards for HAM (7)

A
  • *
  • 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
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14
Q

Water for injections = normal saline?

A

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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15
Q

**

Use protocols & checklists wisely (2)

A
  • *
  • revisit the protocol or checklist regularly to evaluate & update
  • shared consensus on the protocols & checklists among various HCPs
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16
Q

**

Improve access to information (4)

A
  • *
  • 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
17
Q

**

Decrease reliance on vigilance (4)

A
  • *
  • 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
18
Q 
**
Reduce handoff (4)
A

**
- 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

19
Q

**

Differentiation between look-alikes & sound-alikes (4)

A
  • *
  • 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
20
Q

Tall Man Letters

A
  • caps the differentiating parts
21
Q

**

Automate carefully

A

**
- 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

22
Q

Advantages of CPOE (5)

A
  • 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
23
Q

ISMP key recommendation for safe electronic communication of medication orders (6)

A
  1. Use generic names
    - unless the brand matters (eg cannot switch between brands)
  2. Avoid including salts of chemicals
    - unless got multiple salts for the same type of drug
  3. Differentiate generic names from brand names
    - brand names in upper case letters (all)
    eg LANOXIN
  4. Standardise inclusion of suffixes
    eg SR, CR, LA
  5. Standardise the use of mnemonics or short names
  6. Standardise fonts (size & style) & colours
24
Q

CLMM

A

Closed Loop Medication Management system

  • ensure the 4 rights (drug, dose, time & patient)
  • review by pharmacists & automated checks
  • 4 components
25
Q

Advantages of CLMM

A
  • reduce TAT for medication stock

- reduce time required to administer medications to patients

26
Q

4 components of CLMM

A
  1. Electronic Inpatient Medication Record system (eIMR)
    - prescription ordering system
    - medication record
  2. Clinical Decision Support System (CDSS)
  3. Inpatient Pharmacy Automated System (IPAS)
    - automated tablet dispensing & packing system
    - automated dispensing cabinets
  4. Electronic Medication Administration Record System (eMARS)
27
Q

RCA

A

Root Cause Analysis

  • team of 4-6 people
  • interprofessionals
  • 3 key questions
28
Q

3 key questions for RCA

A
  1. What happened? Describe the key steps
  2. What went wrong & why? Identify the failed process
  3. What to do to prevent incident recurrence? Suggest risk reduction strategies & their implementations
29
Q

Recommended guidelines for HAM (3)

A
  1. Eliminate or reduce the possibility of error
  2. Make errors visible
  3. Minimise consequences of errors
30
Q

Methods to eliminate or reduce the possibility of error (6)

A
  • 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
31
Q

Methods to eliminate or reduce the possibility of error (3)

A
  • remove HAM from clinical areas
  • reduce HAM stocked by the hospital
  • limit the variance in conc & total volumes
32
Q

Methods to minimise consequences of errors (1)

A
  • close monitoring
33
Q

Methods to minimise consequences of errors (1)

A
  • close monitoring
34
Q

Example of restriction function (2)

A
  • restrict use for certain patients

- restrict access to the medication

35
Q

Use of protocols

A
  • provide guidance on medication use

- minimise variation in practices but need to use it wisely (error can arise if there is indiscriminate adherence)

36
Q

Use of checklists (1)

A
  • reminder on the various factors to consider during MUP

a PR3145 (14 decks)

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