Medication Safety, Monitioring And Interactions Flashcards
What are adverse drug events? (ADE’s)
- Side effects (side effects does not mean error)
- The effects the drug had on the patient, not an error in the medication process
- All ADE cause patient harm
In which demographic are side effects most common?
- Extreme age (very young, very old)
- Women
What is a medication error? ME
- Any preventable event that ay cause or lead to inappropriate medication use or patient harm
- Some type of process error
EX: Samantha adams received Samuel Adams Rx
Are MEs preventable?
Yes ME are preventable, but do not always cause patient harm
What is a sentinel event?
- A patient safety event that results in death, permanent harm, or severe temporary harm
*debilitating to both patients and HCP - Includes
*medication error, adverse drug events, and medication misadventures (wrong patient got the wrong drug)
What does The Joint Commission (TJC) do?
Inspect the hospital, notes any sentinel events
True or false a medication error can broadly be described as a negative clinical outcome?
False
What are the impacts of ME?
- Emotional toll
- “Second victim”
- Trust
- Costs (direct and indirect)
What was implemented in 2007 to try and reduce medication errors?
- Computerized physician order entry (CPOE)
- Bar-code assisted medication administration (BCMA)
- Multidisciplinary communication
- Active patient involvement in treatment
What is the goal of medication therapy?
- Achieving defined therapeutic goals to improve a patients quality f life while minimizing harm
What are the steps to the medication use process?
- Selection and procurement
- Storage
- Ordering and transcribing
- Preparing and dispensing
- Administration
- Monitoring
What falls under the error, harm category?
Reached patient
1. Temporary harm, intervention
2. Temporary harm, hospitalizations
3. Permanent harm
4. Intervention to sustain life
What falls under the error, no harm category?
Error by omission
Reached patient
1. No harm
2. Monitoring/intervention to preclude harm
What are some examples of latent errors?
- Poor handwriting
- Incomplete information.
- Unclear labeling
- High workload
Definition of human error?
Inadvertently doing other than what should have been done; a slip, lapse, or mistake
What is the definition of at-risk behavior
A behavioral choice that increases risk where risk is not recognized, or is mistakenly believed to be justified
What is the definition of reckless behavior?
A behavioral choice to consciously disregard a substantial and unjustifiable risk
How to manage human error, at-risk behavior, reckless behavior?
Human: Choices, procedures, training, design, environment
At-risk: Removing incentives for at-risk behaviors, creating incentives for healthy behaviors, increasing situational awareness
Reckless: remedial action, punitive action
How to avoid Rx errors?
- Avoid abbreviations
- TALLman lettering
- Avoid verbal order unless in emergencies
What does A-PINCH stand for? (High risk medications)
A: Anti-infective
P: Potassium and other electrolytes
I: Insulin
N: Narcotics and other sedatives
C: chemotherapy
H: Heparin and other anticoagulants
What are the principles for medication monitoring?
- Administration
- Adherence (patient engagement)
- Disease related efficacy and safety
- Tolerability
What is efficacy and safety?
E: os the desired effect occurring
S: what adverse effects are being experienced
What is the definition of drug interactions?
When one drug modifies the action of another drug
What are pharmacokinetic alterations?
Changes in distribution, elimination
EX: lower the dose depending on the changes with the patient
What are pharmacodynamic changes?
Additive, synergistic, antagonistic
*2 BP meds can increase the risk of hypotension
What are drug incompatibilities?
Interactions between drugs in vitro
What is Cytochrome P450s (CYP)
Superfamily of enzymes responsible for the metabolism of a wide range of structurally diverse substrates
What is the Narrow therapeutic index? (NTI)
- Drug with a <2 fold difference in the median lethal dose and median effective dose between values
*Effective dose and lethal dose are close in values
What does TD50 stand for?
Dose require to produce a toxic effect in 50% of the population
What is the LD50
The dose of the drug that produces death in 50% of the animal population tested
What is ED50
The dose at which 50% of individual exhibit the specified therapeutic effect
What are examples are NTI drugs?
- Carbamazpine
- Digoxin
- Levothyroxine
- Lithium Carbonate
- Phenytoin
- Theophylline
- Warfarin
*Small increases in a dose or blood/serum concentration could lead to toxic effects
What are the DDI of antacids
Will decrease absorption
What are the DDI of beta blockers for insulin
- Masking symptoms of hypoglycemia
What are the DDI of beta blockers with insulin
Will make the symptoms of hypoglycemia
