Patient Safety / Quality Assurance (26.5%) Flashcards
What are High Alert Medications?
Drugs with heighten risk of causing significant patient harm when they used in error
- Errors w/these drugs may or may not be more common that w/other drugs
- However conseq. of errors can be SEVERE
High Alert Medications: Potential Safeguards
- MANDATORY Patient Counseling
- Standardized protocols
- Education regarding their safety and use
- Safeguards to limit access
- Appropriate labeling
- Use of IT tools
- Manual double-checks when feasible
Examples of High Alert Medications in Institutions (look at page 126 in PTCE book)
- IV drugs used for cardiovascular
- IV sedatives or anesthetic agents; inhaled volatile gases
- IV antiarrhythmic drugs
- Antithrombotic drugs: Reduce formation of blood clots
- Chemotherapeutic agents
- Hypertonic solutions
- Epidural and intrathecal preps (pain relief – anathesia, spine work, etc.)
- Insulin
- Sterile water bags or vials GREATER than 100ml
Examples of High Alert Medications in the Community
- Anticoagulants are classified as high-alert medications because they cause fatal bleeding.
- Neuromuscular blockers are classified as high-alert medications because they cause cessation of breathing.
- Opioids are classified as high-alert medications because they cause fatal respiratory suppression.
- Antiretroviral drugs
- Chemotherapeutic drugs
- Oral drugs that can cause hypoglycemia (blood glucose lower than normal)
- Immune suppressing agents
- Insulin
- Opiods
- Pediatric liquid medication
- Drugs contraindicated in pregnancy (a particular technique or drug should not be used in the case in question).
- Warfarin
Look-Alike Sound-Alike Medications (who publishes?)
• Institute for Safe Medication Practices (ISMP) publishes list of look-alike sound-alike (LASA) medications
o These meds are at risk for being confuse w/other meds
o Have tall man recommend lettering
How can differentiate drugs? (LASA)
- Require specific strats to differentiate drug from similar sounding and appearing drugs to reduce risk of errors.
- Use both brand and generic names on prescriptions and labels
- Include ID for drug on prescription
- Configure electronic health records and pharma info systems so that similar appear names not consecutive
- Use of tall man letter to draw attention to diffs in drug names, with TALL MAN lettering for different parts of names
* e.g. NovoLOG vs. NovoLIN
* DiazePAM vs DilTIAZem
* RaNITIdine vs riMANTAdine
What is a Medication Error?
- Any PREVENTABLE event that may cause or lead to inappropriate medication use or patient harm while the med is in control of health care professional, patient or consumer.
- Such events may be relate to profess practice, health care products, procedures, and systems, including prescribing, order commun, product labelling, packaging, nomenclature, compounding, dispensing, distribution, admin, education, monitoring and use.
Types of Adverse drug event (ADE)?
Adverse drug event (ADE): injury resulting from medical intervention related to drug
1) Preventable adverse drug event: An ADE that results from medication error that reaches patient and causes any degree of harm
2) Potential adverse drug event: Medication errors that do not do harm (either by chance or bs they were ID before reach patient)
What is the Medication Process?
1) Order/Prescribing: Prescriber must select the appropriate drug, at approp dose, frequency and duration
2) Transcribing: Written orders must be read, interpret and enter correctly. Verbal orders must be heard, interpret and enter correctly.
3) Preparation/Compound & Dispense: Includes pharmacist review of order for appropriateness, and provide correct drug formulation, quantity and instructs for use.
4) Administration: May be done by patient, caregiver, or healthcare provider.
What are the 5 Rights of Medication Administration?
- Right Drug
- Right Dose
- Right Patient
- Right Route
- Right Time
What are typical Ordering and prescribing errors?
- Wrong patient
- Omission (non-treat)
- Incomplete/unclear order
- Wrong drug
- Wrong time
- Wrong dose
- Wrong dosage form
- PATIENT ALLERGY
What is name of the SYSTEM to prevent errors?
Computerized Physician Order Entry (CPOE)
Computerized provider order entry (CPOE) is an application that allows health care providers to use a computer to directly enter medical orders electronically in inpatient and ambulatory settings, replacing the more traditional order methods of paper, verbal, telephone, and fax.
- Elims risk of incomplete or unclear written orders that may be misinterpret
- Most systems contain clinical decision support tools
- Algorithms and prompts that guide ordering provider to select approp drug, dose, frequency while checking for allergies and interactions
Other ways to prevent errors?
1) Preprinted order forms
2) Standardized forms will already contain many elements of appropriate order
o When take verbal or telephone orders: transcribe, read back, confirm
o Must follow these steps. Do NOT read back then transcribe
3) Tall Man lettering. Often built into systems
4) If ANY doubt about an order (written, verbal, electronic) CONFIRM w/prescriber
What is Medication Reconciliation and when needed?
Changes often occur when patients TRANSITION from one level of care to another. Creates environ that facilitates medication errors.
- Medication reconcile is process of review medication list against medical records
- Technicians should pay attention to prescription and nonprescription medications, alternative medics, dietary supps (herbs, vit/minerals)
Preventing errors during prescribe or order (common errors)
AD, AS, AU – confuse w/ OD, OS, OU CC for cubic centim. Use mL instead D/C - for discharge or discontinue HS – for half-strength or “at bedtime” IU – for international unit Ug – for micrograms MS, MSO4, MgSO4 – for morphine sulfate or magnesium sulfate Q.D – for every day Q.O.D. – for every other day SC or SQ – for subcutaneous T.I.W. – for 3x/week U – for units (spell word instead
