Patient Safety Flashcards
NDC stands for?
National Drug Codes
how many digits is the NDC of a drug
10
how many segments in an NDC
3
what does each segment of NDC mean
first: manufacturer, second: drug formulation, third: package size
bar code scanning
help prevent medication errors
what are LASA medications
lookalike-soundalike drugs
which Institute came up with LASA?
Institute for Safe Medication Practices (ISMP)
what does LASA prevent?
choosing the wrong medication
Tall-Man Lettering
uses capital letters on part of a drug name
how many types of Tall Man lettering are there?
2
the first type of tall man lettering is recommended by what?
the FDA
who recommends the second type of tall man lettering
Institute for Safe Medication Practices (ISMP)
what does leading and trailing zeroes prevent?
dosage errors
what is a lead zero
used before the decimal
what is a trailing zero?
used after a decimal
when does a trailing zero not be applied
to whole numbers
ISMP Error Prone Abbreviations
list of abbreviations that are misinterpreted and should be avoided
spacing dose and units
space between the number and the unit should be added
drug name and dose
should never be ran together as it can be mistaken
should abbreviated drug names be used
no
which act introduced the DURs in 1990?
Omnibus Budget Reconciliation Act (OBRA)
what does a DUR stand for?
Drug Utilization Reviews
what does a DUR increase?
adherence and compliance
what is a DUR?
a review of the patient profile, where past medications are checked by the RPh
what protocol must be followed while preparing for a DUR?
identifying a target therapeutic goal
what are the 3 kinds of DUR?
prospective, concurrent, and retrospective
what does the prospective DUR do?
it attempts to identify potential errors beforehand such as drug-drug interactions, drug-disease interactions, changes in dosing, over/underuse of medication.
when does a prospective DUR occur?
before dispensing
when does a concurrent DUR occur?
at the same time as being dispensed
what are problems identified in a concurrent DUR?
inapproprate dose changes, abuse, potential of drug-disease interaction, and drug to drug interaction
what is a disadvantage of a concurrent DUR?
the pharmacist might not have complete patient data causing multiple reviews that are time-consuming and expensive
what does a retrospective DUR examine?
the impact of medication after being dispensed
what is a con of retrospective DUR?
harm or death may already have occurred to the patient
what does PIL stand for
patient information leaflet
what is a PIL
document that answers basic questions of a drug like trade/generic name, drug indication, mechanism, clinical pharmacology, side effects, rare adverse effects, warning, and dosing times
do all meds require PIL ?
yes
what is a MedGuide?
document that contains specific risks of certain medications
what are some examples of drugs that require a medguide?
isotretinoin, NSAIDs, antidepressants, fentanyl, metformin, amphetamine, immunosuppressants
what is the name of the FDA’s reporting system for an adverse reaction?
MedWatch, founded in 1993
adverse reactions are?
unexpected reactions
which two categories are not covered by MedWatch?
vaccines and vet stuff
what is the reporting system for vaccines?
VAERS: Vaccine Adverse Event Reporting System
benefits of MedWatch?
it can detect unexpected reactions for which FDA issues an alert notice to professionals and the public
what is the Beer’s Criteria?
an important list of meds with caution for elders. these meds have added risk
why elders?
they metabolize drugs to a lesser extent causing drug to accumulate
what are the 4 objectives with Beer’s Criteria?
- Deprescribing meds that are no longer necessary
- Reducing polypharmacy as much as possible
- Reducing drug-drug and drug-disease interactions
- Increasing risk benefit ratio of med to patient
what events are sentinel events?
events that cause death or permanent/temporary harm in the healthcare (to patients, staff, or both)
are sentinel events common
no, but constitute medical emergencies that may involve law enforcement
what are examples of sentinel events?
- patient committing suicide
- unexpected death of an infant brought to full term
- infant discharged to the wrong person or family
- rape/assault of a patient/staff
all sentinel events must be recorded for?
analysis
root cause analysis, RCA
analyzing the cause of the incident and implement preventive measures
polypharmacy
patient taking at least 5 medications at the same time
who does polypharmacy affect the most?
elders
prescription cascade
side effect of a medicine is assumed as a new problem, requiring additional medication
what does polypharmacy increase?
risk of med error, drug-disease interaction, and loss of compliance
compliance
patient following medical advice
is compliance same as adherence?
yes
concordance
patient and doctor relationship where they work together for the treatment
placebo
what a patient believes about the medication
positive mental states about a drug can impact how the drug affects the patient
nocebo
patients have negative expectations of a drug
crash cart medication
crash cart contains equipment and meds that needed for the first 30 minutes of a medical emergency
how often is the crash cart maintained
monthly
what is the crash cart maintenance checked for
batteries and expired medications
auxiliary labels
caution labels for safe administration, use, and storage
