Module 1 Flashcards
Are events associated with drug therapies that can or do hamper optimal patient health outcomes.
This includes:
•medication errors,
•adverse drug reactions, and
•side effects.
Also similar to the term medication misadventures.
MEDICATION-RELATED PROBLEMS
CLASSIFICATION OF MEDICATION ERRORS:
ADPMT
ADMINISTRATION ERROR
DISPENSING ERROR
PRESCRIBING ERROR
MONITORING ERROR
TRANSCRIPTION AND/OR INTERPRETATION ERRORS
FACTORS CONTRIBUTING TO THE OCCURRENCE OF MEDICATION-RELATED PROBLEMS:
SOUND-ALIKE AND LOOK-ALIKE DRUGS (SALAD)
SLOPPY COMMUNICATION PRACTICES
-Illegible handwriting, incorrect transcription and verbal communications
DISTRACTIONS AND OVERWORK
POOR DESIGNED LABELS
POOR PERSONNEL MANAGEMENT PRACTICES
-Inadequate performance feedback
LACK OF A QUALITY IMPROVEMENT SYSTEM
EQUIPMENT FAILURES
Are DRPs that are unexpected, unintended, undesired, or excessive responses to a drug that require some type of medical response (discontinuing the drug, changing therapy, making major dose modifications)
ADVERSE DRUG REACTIONS
resulting in a negative outcome (hospital admissions, prolonged treatment, harm, disability or death).
ADVERSE DRUG REACTIONS
ADVERSE DRUG REACTIONS:
ALLERGIC REACTIONS
IDIOSYNCRATIC REACTIONS
ADVERSE DRUG EVENTS (ADE)
DRUG-RELATED MORBIDITY
SENTINEL EVENTS
Immunologic hypersensitivities to drugs.
ALLERGIC REACTIONS
Abnormal responses drugs that are peculiar to individuals.
IDIOSYNCRATIC REACTIONS
Result in injury, expected (drug withdrawal symptoms, drug-abuse symptoms, accidental poisonings and drug-overdose management).
ADVERSE DRUG EVENTS (ADE)
Failure of drug to achieve intended outcomes
DRUG-RELATED MORBIDITY
Unexpected incidents resulting in death or potential serious physical and psychological injury
SENTINEL EVENTS
Expected, unavoidable reactions of the appropriate use of many drugs.
Example: Potential upset stomach associated with NSAIDS.
SIDE EFFECTS
MEDICATION-RELATED PROBLEMS:
LATENT INJURIES
POTENTIAL INJURIES
ERROR OF COMMISSION
ERROR OF OMISSION
Propensity or predisposition for harm during process of care.
Does not result in patient injury.
LATENT INJURIES
Results from errors in prescribing, dispensing, or medication administration.
Potential to cause an injury but did not, either by luck or because they were intercepted.
POTENTIAL INJURIES
Patient receives either correct or incorrect drug.
ERROR OF COMMISSION
Patient failing to receive drugs that can be beneficial.
Receiving no drug occur.
ERROR OF OMISSION
PREVENTION OF MEDICATION ERRORS:
Improvement of health information technology
Pharmacovigilance
Active health workers and organizations.
Pharmacist must keep with medication literature
Pharmacist should verify the accuracy of new prescription
Patient education
PHARMACISTS ROLE IN RESOLVING MEDICATION ERRORS
Patient engagement in their medication regimens.
Prescription filling technology must be assessed and improved.
Pharmacists monitoring of ADRs and high risk of side effects.
Pharmacists should routinely review patient medication records.
WHO defines _____ as an unintended noxious response occurring after the normally used in man for the prophylaxis. Diagnosis or therapy of disease, for the modification of physiological function (WHO, 1972).
ADR
CLASSIFICATION OF ADRS
RAWLINS-THOMPSON CLASSIFICATION
DoTS System
based on the type of ADR occurred
RAWLINS-THOMPSON CLASSIFICATION
-Dose relatedness, Timing and patient Susceptibility (Aronson and Ferner, 2003).
-examine the various factors that both describe a reaction and influence an individual patient’s susceptibility.
-the dose of the drug
Example: Increasing the dose of a cardiac glycoside will increase the risk of digitalis toxicity.
DoTS System
FACTORS AFFECTING SUSCEPTIBILITY TO ADRS:
AGE
GENDER
CO-MORBIDITES AND CONCOMITANT
MEDICINE USE
ETHNICITY
-> CYTOCHROME P450 GENOTYPE
GENETIC VARIATION
ERYTHROCYTE GLUCOSE-G-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD)
PORPHYRIAS
PHARMACOVIGILANCE AND EPIDEMIOLOGICAL METHODS IN DETECTION OF ADR:
-Post-marketing surveillance of medicines
-Pharmacovigilance
1. Spontaneous Reporting
-Signal detection
-Causality assessment
Naranjo Algorithm
2. Yellow card Scheme
3. Direct Patient Reporting
ASSESSMENT OF ADR:
ASSESSMENT OF ADR
1. Analysis of each reported ADR
2. Identification of drugs and patients at high risk for being involved in ADRs.
3. Development of scope, policies and procedures for the ADR-monitoring and reporting program.
4. A description of the responsibilities and interactions of pharmacists, physicians, nurses, risk managers, and other health professionals in the ADR program
5. Use of the ADR program for educational purposes.
6. Development, maintenance, and routine evaluation of ADR records within the organization, including the use of standardized reporting rate and incidence of onsite ADRs occurrence.
7. The organizational dissemination and use of information obtained through the ADR program.
8. Facilitating the reporting of serious or unexpected ADRs as outlined in program features and presentation of important ADRs in the medical community.
GOALS OF AN ADR PROGRAM:
Primary goal is to raise awareness of the risks associated with ADRs, identify ADR that have occurred and reduce their risk of associated harm.
Ongoing ADR program can provide benefits to the organization, patients, pharmacists and other healthcare professionals.
ROLES OF HEALTH PROFESSIONALS:
Medication safety
Identification, Assessment and prevention of ADRs in Clinical Practice
Assessment of pre-disposing factors.
Monitoring therapy
Risk identification and patient education
Therapeutically undesired but often unavoidable effect
Predicted from a drug pharmacological profile
SIDE EFFECT
INTERVENTIONS FOR COMMON SIDE EFFECTS:
- Allergic reactions-take antihistamines
- Bruising and bleeding-stop the medication and put pressure on bleeding area
- Constipation- increase water and fiber intake
- Dehydration-increase water intake
- Diarrhea-increase electrolyte intake
- Drowsiness and sedation-stop activities that may cause accident
- Dry Mouth (Xerostomia)-avoid caffeine; increase water intake
- Headache- analgesics
- Nausea and vomiting-antiemetic drugs; anti-motility
is defined by the World Health Organization as “the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider.”
MEDICATION ADHERENCE
Occurs when medication regimen is complex
Influenced by patient behavioral factors.
MEDICATION NON-ADHERENCE
FACTORS ASSOCIATED WITH NON-ADHERENCE:
- Disease
- Therapeutic regimen
-Multiple Drug therapy
- Frequency of administration
- Duration of therapy
- Adverse events
- Patients symptoms
- Cost of medication
- Administration of medication
- Taste of medication
- Patient/Health Professional Interaction
- Failure to comprehend the importance of therapy
- Poor understanding of the instructions
IMPROVING COMPLIANCE:
Health professionals commitment.
Improvement Physician-Pharmacist-Patient communication.
Pharmacist participation.
IDENTIFICATION OF RISKS:
All patients should be viewed as potential noncompliers.
Recognize non-compliant patients
Identification of predisposing factors
DEVELOPMENT OF TREATMENT PLAN:
- Individualized treatment plan
- Patient involvement
- Patient education
- Oral communication/Counseling
- Written communication
- Audio-visual Materials
- Patient motivation
COMPLIANCE AID:
Labeling
Medication Calendars and drug reminder charts
Special Medication containers, caps and systems
Compliance Packaging
Dosage form
MONITORING THERAPY:
Self-monitoring
Pharmacist monitoring
Directly Observed treatment (DOT)
IMPORTANT KEY POINT
Improvement of patient compliance
Pharmacist recognition
Pharmaceutical manufacturers benefits
Reduction costs of physician and hospitalization
