Patient safety Flashcards
1
Q
NCCMERP med error categories
A
A - events with capacity for error
B - error occurred but did not each patient
C - error reached patient, did not result in harm
D - error reached patient, required monitoring to rule out harm
E - error reached patient, temporary harm that required intervention
F - error reached patient, temporary harm required hospitalisation
G - error reached patient, permanent harm
H - error reached patient, required intervention to sustain life
I - error, death
2
Q
WHO medication safety definition
A
- Freedom from unnecessary / potential harm
- Freedom from accidental injuries during care
- Actions undertaken to protect patients from harm
- Reduction & mitigation of unsafe acts
- Use of best practices for optimal outcomes
3
Q
Medication management process
A
- Selection & procurement
- Storage & labelling
- Prescribing & transcribing
- Preparing & dispensing
- Administration
- Monitoring
4
Q
HFACS framework
A
- Organisational influences
- Organisational culture
- Organisational process
- Resource management - Supervisory factors
- Inadequate supervision
- Planned inappropriate operations
- Failure to correct known problem
- Supervisory violation - Preconditions for unsafe acts
- Situational factors
- Individual factors
- Team factors - Unsafe acts
- Errors
- Violations
5
Q
Error reduction
A
- Eliminate opportunity for error
- Make it harder to do wrong
- Make it easier to do right
- Make errors more visible
- Minimise injury
- Policies, training, inspection
6
Q
Roles of medication safety leaders
A
- Responsibility for leadership
- Medication safety expertise
- Influence practice changes
- Education & research
7
Q
Categories of DRP
A
- Drug selection
- Drug regimen
- Drug preparation & administration
- Monitoring
- Adherence & education
- Operational
8
Q
Hierarchical system for classifying DRP
A
- Categorisation of DRP
- Actions taken to address IASE
- Process-related causes
- Sub-categorisation into error / recommendations
- Documentation
