Patient Safety In Older Adults Flashcards

1
Q

What is DIAE

A

Drug induced adverse events

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2
Q

5 criteria used to identify DIAE

A
Drug Burden Index
Anticholinergic Scales
Beer's criteria
FORTA ( Fit for The Age)
STOPP ( screening tool of Older Person's Prescription) criteri
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3
Q

The outcomes of Drug-induced adverse events are most commonly related to what?

A

MOA -mechanism of action

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4
Q

Are the outcomes of drug induced adverse events well documented

A

May or may not be documented

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5
Q

4 Factors that increase risk of drug induced adverse events

A

1- frailty
2- coexisting medical problems
3-memory issues
4-use of multiple-prescribed and non-prescribed MEDICATIONS

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6
Q

2 limitations to identifying DIAE

A

1- incomplete medical records

  • Thought process of DR. may not be in notes
  • Medical records may be filed away

2-patients’ inability to describe issues
* patients complaints may NOT be documented or issues may lead to hospitalizations

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7
Q

Best way to identify DIAE regarding patients involvement

A

A patient complaint AFTER starting a NEW medication

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8
Q

Transition of care include what

A

1- Setting
2-Service
3-Practitioner
4-Level of care

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9
Q

What is Medication reconciliation

A

Process of comparing a patient’s medication orders to ALL medications that a patient has been taking

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10
Q

What is MR ROSS

A

Medication reconciliation- review of subject’s systems

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11
Q

Prescribing cascade

A

Occurs when a new(chronic) drug is prescribed to treat the SYMPTOMS arising from an UNRECOGNIZED ADVERSE EVENT related to an EXISTING MEDICATION

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12
Q

With prescribing cascade the unrecognized adverse event is thought to be WHAT to the patient and provider

A

1-The event is thought to due to NORMAL AGING

2-Misinterpreted as a NEW diagnosis common in older adults

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13
Q

3 Factors which increases the risk for prescribing cascade

A

1- age
2-multiple co-morbid conditions
3-multiple drug therapies

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14
Q

Broad spectrum antibiotics cause C. Difficile are treated with what 2 possible

A

Vancomycin

Metronidazole

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15
Q

Acceptable prescribing cascade

A

Standard of care dictates the treatment of one medication with another medication to PREVENT NEGATIVE OUTCOMES

Example: furosemide ➡️ KCL

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16
Q

Not quite prescribing cascade

A

Treatment of one medication adverse outcomes that require SHORT TERM TREATMENT and IF NOT harm may occur

Ex broad spectrum antibiotics requiring Vancomycin or Metronidazole

17
Q

What is used to determine a Prescribing cascade?

A

Bradford-Hill Criteria of Causation

18
Q

6 thing Bradford-Hill look at

A

1) Plausibility- DIAE/PC make sense based on MOA
2) Temporal( timing) Relationship- patient get initial medication and THEN comes DIAE/PC
3) Dose - Response Relationship- the HIGHER the dose the MORE DIAE/PC
4) Consistency- DIAE/ PC is confirmed in MULTIPLE previous trials
5) Consider ALTERNATIVE EXPLANATIONS - DIAE maybe due to another cause
6) EXPERIMENT- DIAE occurs after withdrawal and re-challenge

19
Q

What is PSSA

A

Prescription sequence symmetry analysis is a detection method for adverse drug events. It assess risk, temporality and consistency of ADE

20
Q

Cholinesterase inhibitors used to treat what and can cause what DIAE? This is an example of what in determining prescribing cascade?

A

Cholinesterase inhibitors used to treat Dementia , but can cause ⬆️urination.

If the ⬆️ urination is thought to be related to aging or progression of Dementia then DR may prescribe an anticholinergic medication WHICH CAN BLOCK POTENTIAL BENEFITS OF CHOLINESTERASE INHIBITORS AND CONTRIBUTE TO WORSENING DECLINE

An example of Retrospective Medication Claims Cohort Example