Module 3 -medication safety Chapter 1-challenges during care transitions

Question 1

ADE

Answer 1

Adverse drug event

Question 2

ADR

Answer 2

Adverse drug reaction

Question 3

IV

Answer 3

intravenous

Question 4

RCT

Answer 4

Randomize control trial

Question 5

-harm resulting from medical intervention related to a drug
-all ADEs result in harm
-AEDs may be preventable or non-preventable

Answer 5

Adverse drug event (ADE)

Question 6

ADEs may be preventable or non-preventable
- ??? : A non-preventable ADE occurring with usual use of a medication,e.g. Nauseate and Quality secondary to chemotherapy

Answer 6

Adverse drug reaction (ADR)

Question 7

 in a context of ADE s
!?!!!: what is definition?
This refers to the impairment of physical,
The impairment of physical, emotional,
or psychological function,
or structure of the body, and resulting or injury

Answer 7

In the context of ADES : DEFINITIONS OF HARM

Question 8

The medication error:
1-(?) That may cause or lead to inappropriate medication use or patient harm
-if the medication error causes harm, then it is an (2). ???)
-If the medication error does not cause harm, but it has potential to do , then it is- (3) ??

Answer 8

1-PREVENTABLE ADEs

-2-an ADEs

-3- potential ADE

Question 9

A preventable event that may cause or lead to an inappropriate medication use or patient harm

Answer 9

Medication error
1-if the medication cause harm, then it is an adverse drug event
2-If the medication error does not cause harm, but it has potential to do so is it potential ADE

Question 10

What is preventable adverse drug event?

Answer 10

Medication history and ADE
It is a serious medication error
Error actually harm andhas potential to cause harm

A preventable Event that might cause or lead to inappropriate medication use or patient harm

Question 11

If the medication errors
does not cause harm, but has potential to do so

Answer 11

What is potential adverse drug event (ADE)?

Question 12

?
- a non-preventable AE occur with usual use of a medication, example :nausea, vomiting, secondary of chemotherapy

Answer 12

What is non-preventable (ADE)?

It is ADR (adverse drug reaction.

Question 13

MEDICATION ERRORS:
- IT CAN HAPPEN ANY STEP 1-May occur at any step in medication they delivery
— history taking, prescribing, transcribing, dispensing, and administering, taking, or monitoring,

2-most often: history- taking or prescribing (dose)

3-incident of prescribing error median (interquartile range)
—7% (2-14)of admissions
—52 (8-227 error /100 admissions

Answer 13

MEDICATION ERRORS:

- IT  CAN HAPPEN ANY STEP  AND

Question 14

1- it has one preventable ADE

2- It has serious medication error:
-errors actually harm and -
has potential to cause harm
- It has serious medication error: error actually harm
has potential to cause harm

Answer 14

MEDICATION ERROR AND ADVERSE DRUG EVENT

Question 15

POST-DISCHARGE ADVERSE EVENTS : 4 things
1-occurred in 19 to 23% of patient within 30 days of discharge.
2-Severity of adverse event: symptoms 65 to 68%, non-permanent disability( 25 to 30%,), permanent disability, (3%), death (0-3%)
3- Type of ADE 66 to 72% of all adverse events.
4- 50-62% preventable or ameliorable-
-better communication and coordination of care

Answer 15

POST-DISCHARGE ADE RISK FACTORS

1-medication-specific and medication regiment factors number of…t
2-patient factors
3-disease factors
4-health system factors

Question 16

????? Whah risk factors for post discharge ADEs ?
4 examples
1-Medication-specific and medication regiment factors :number of…
2-patient factors.
3-disease factors
4-health system factors

:warfarin, anagesics, benzodiazepines, anti-effective
4-health system, safety, safeguarding processes, established such as medication, reconciliation, appropriate monitoring and follow up

Answer 16

RISK FACTORS FOR POST-DISCHARGE ADEs

Question 17

1-????
-medication(10+)
-medication changed
-High risk medication example warfarins, analgesic , and benzodiazepine, corticosteroid , and anti- infective
2-???
-+/- age, female gender.
-fairly weak predictors

Answer 17

1-medication specific and medication regiment factors number of…

2-Patient factors

Question 18

3- ????factors
-chronic kidney disease
-Condition requiring treatment with high risk medication

Answer 18

3-Disease factors

Question 19

4-????factors
-Not having medication safely safeguarding process establish such as medication, reconciliation, appropriate monitor, and follow up

Answer 19

4- Health system factors

Question 20

-care transitions is a fraught time for medication safety
-patient have complex care

1-high risk time for medication management

2-complex care needs requiring coordination like:
a-medication reconciliation
b-formulary and insurance-issue
c-Home health,IV antibiotic

3-lack of continuity among healthcare provider

4-patients are still recovering
-Significant self-care
Requirements
-many medication for
chronic conditions
-stresses their social
support network

5-Information overload
-written instructions are not
to follow
-verbal instructions are often complex and delivery rapidly
-little confirmation of understanding

6-Post discharge follow up varies:

-Whent o see primary care providers?
-Who to call a problems?

A

Answer 20

Medication safety and care transitions involves:

Question 21

1-inappropriate prescribing.
2-Medication discrepancies:
—type 1: unexplained differences among documented regiment across
different side of care ( the
- -type. 2 - differences between what patient think they should be taking -
and the regiment collectively order by the medical provider.

3-non-adherent
-differences between what patient think they should be taking and what they actually take

4-in adequate monitoring and follow

Answer 21

Medication Errors At care Transitions : types

Question 22

TYPE 1 medication discrepancies
-type 1: ???
unexplained differences among documented regiment across different sites of care.
-Type 2: differences between what patients think they should be taking, and the regiments collectively order by their medical provider

Answer 22

TYPE1
Medication discrepancy
1- medication history errors
2-medication reconciliation error

Question 23

-3-???_ differences between the patient think they should be taking and what they actually taking
-4-
e.g: side-effect, medication not working enough

Answer 23

3-Non-adherence
4- inadequate monitoring and follow up
Eg: side-effect, medication not working enough

Question 24

-example do not know the patient was on aspirin so not documented or order during hospitalizations
-sources of information are inaccurate, out of date, un
-lack of time to access available sources of information

Answer 24

Medication history errors

Question 25

-example: new patient was taking aspirin at home, held it on admission, but forgot to restart it at discharge.
-lack of access to pre-admission medication list ,clerical error
-problem more common at discharge

Answer 25

Medication reconciliation error

Question 26

MEDICATION DISCREPANCIES:
Type 1- And Type 2-

Answer 26

Type1

1-pharmacist review of medication list at Brigham and Wonen’s hospital
TYPE 1:
-Discrepancy between PRE-ADMISSION and DISCHARGED meds in 49%
-Most of discrepancy due to ERRORS with taking the MEDICATION HISTORY .
-Half of the discrepancy were potential harmful 
-Type (2) -
POST-DISCHARGED phone call
-unexplained discrepancy - - between discharge and - - home in 29%

Question 27

????
1-do not know the patient was on aspirin so not documented or ordered during hospitalizing.
Sources of information are in accurate, out update, unavailable,
Lack of time to access available sources of information
2-Example: new patient was taking aspirin at home, held it on admission but forgot to restart it at discharge.
-lack of access to pre-admission medication list, clerical error
-Problem more than common at discharge

Answer 27

TYPE 1 Medication Discrepancies
- medication history errors 
- medication reconciliation errors

Question 28

In medication discrepancy: Type1?

what type 1?discrepancy

Type 2: Post-discharge phone call:

Answer 28

MEDICATION DISCREPANCIES

Type1
-discrepancies between preadmission and discharge med 49%
-Most discomforted due to errors with taking the medication history
-Half of the discrepancy were potentially harmful
Type 2:
-unexplained discrepancy between discharge and home at in 29%

Question 29

Intentional include:

Answer 29

1- documented
2-undocumented

Question 30

Unintentional include: (2)

Answer 30

1-potential for harms 27%
2-no potential for harm 73%

Question 31

Potential for harms include: 2

Answer 31

1-History error
2-reconciliation error

Question 32

Reconciliation error include: (2)

Answer 32

1-admission 4%
2-discharge 26%

Question 33

History Error includes: (2

Answer 33

Admission 22%
Discharge 50%

Question 34

MEDICATION DISCREPANCIES

-Pharmacist review of medication list at Brigham and Women’s Hospital : (Type 1)

Answer 34

-discrepancies between

 —Pre-admission and discharge meds  in 49%
 —-most discrepancies due to errors with taking the medication history
—Half of the discrepancy were potentially harmful

Question 35

MEDICATION DISCREPANCIES
-Post-discharge phone call :(type 2)

Answer 35

-unexplained discrepancy between discharge and home meds in 29%

Question 36

Baseline result from Marquis 1
Discrepancy type: (3)

Answer 36

-total discrepancies per patient all types: (3.8)
admission and discharge
-History discrepancy : (2.4) admission and discharge
-reconciliation discrepancy : (1.4) lladmission discharge:

Question 37

MARQUIS 1 ADJUDICATED RESULTS: (3)

Answer 37

-Potentially harmful discrepancy :
-potential severity : admission
-Potential severely discharge

Question 38

(9)
1-information systems that don’t share information.
2-lack of single” source of truth”
3-fragmented healthcare system
4-many transition of care.
5-lack of communication between patients and healthcare providers.
6-lack of communication among healthcare providers
7-polypharmacy.
8-frequent changes in medication regimens
9-lack of value placed of medication reconciliation

Answer 38

WHY SO MANY DISCREPANCIES!

1-information systems that don’t share information.
2-lack of single” source of truth”
3-fragmented healthcare system
4-many transition of care.
5-lack of communication between patients and healthcare providers.
6-lack of communication among healthcare providers
7-polypharmacy.
8-frequent changes in medication regimens
9-lack of value placed of medication reconciliation

Question 39

DISCREPANCIES:
- ????? (6 factors) 1-patient may have difficulty providing information during the medication history taking process. Including:
Thinking
Vision
Hearing
Physical functioning
Level of alertness
Limited English language proficiency

2-poor understanding of their medication due in park low health literacy
3-not keeping a medication with them at all times.
4-caring a medication list with them at our time, but not updating the list has changes to the regimen are made
5-not bringing pill bottles and other medication containers with them to the emergency department and clinic visit.
Patient are not familiar with their medication regiment because they rely on 6: caregiver in the home or facility to organize and administer the medication

Answer 39

PATIENT FACTORS

Question 40

Conclusions
-“ADE” refer to harms suffered secondary to use of a drug.
-medication error are ADE if they result in harm
-The risk of medication errors is high during transition of care.
-The causes of medication discrepancy are multi fractional. They include factors related to the healthcare system, as well as difficulty patient experience when communicating their home medication Richmond to healthcare professional notes.
— medication discrepancy can originate from Error/admissions in medication histories, and/or during medication reconciliation

Question 41

Inpatient ADEs: 3 factors involved

Answer 41

1-incidence : 6-15 per 100 admissions

2-consequences:
-Serious (39%)
-Live threatening (12%)
-Fatal (1 %)
3-preventability (20-75%)

Question 42

INPATIENT
1-incident: 6 to 15 per 100
admissions
2-consequences.
-Serious 39%, life
- life-threatening 12% ,fatal
- 1%
- -extended length of days- (O.5 days)

3-preventable

Answer 42

INPATIENT ADEs

Question 43

POST-discharge adverse event
(4) 1-occurs in 19 to 23% of patient within 30 days of discharge
2-severity of adverse event: symptoms only 65 to 68 event, non-permanent Disability 25 to 30%, permanent disability, 3%, 3%
3-type ADE (66 to 72% of all adverse events
4-52 to 62% preventable or AMELIORABLE) (severity wouldn’t be won’t be left. If have a clear communication.)

Answer 43

POST-Discharge Adverse Event

Question 44

(

1- patient is still recovering
2-involve information overload
3-post this job follow up varies

Answer 44

MEDICATION SAFETY AND CARE TRANSITIONS;

Question 45

6- Some patient factors that impact the list of medication non-adherence are modifiable (i.e, we can help to change it). while some are not, which of the following list are those that healthcare team can influence?

Question 46

8-in which stage the medication history is taking process to medication error most often occurred?

Question 47

9. what is the most common post discharge adverse drug event??

Question 48

21-it is a particularly busy in the emergency department (ED) and the medication history taker is nearing the end of that. They realize they won’t be able to complete medication histories for everyone currently in the ED who will be admitted. After we view the home medication list in the electronic medical record (EMR) which of the following patient should be to work on next.?

Question 49

22-of the following medication orders. Which of the most likely to be misinterpret ?