Pharm Foundations II Flashcards
error of omission
something was LEFT OUT that is needed for safety
ex: failing to warn a patient about an important side effect with a new medication
error of commission
something was done INCORRECTLY
ex: prescribing bupropion to a patient with a history of seizures
evaluation and quality improvement: prospective
failure mode and effects analysis (FMEA) is a proactive method used to reduce the frequency and consequences of errors
evaluation and quality improvement: retrospective
a root cause analysis (RCA) is a retrospective investigation of an event that has already occurred, which includes reviewing the sequence of events that led to the error
evaluation and quality improvement: continuous
continuous quality improvement (CQI) is the goal for most health care settings
-lean and six sigmas
“do not use” abbreviations
U, IU, QD, QOD, trailing 0, lack of leading 0, MS, MSO4, MgSO4
high alert medications
- anesthetics IV, inhaled (propofol)
- antiarrhythmics IV (amiodarone)
- anticoagulants. antithrombotics (heparin, warfarin)
- chemotherapeutics (methotrexate)
- epidural/ intrathecal drugs
- hypertonic saline (> 0.9%)
- immunosuppressants (cyclosporin)
- inotropics (digoxin)
- insulin
- magnesium sulfate injection
- neuromuscular blocking agents (vecuronium)
- opioids
- oral hypoglycemics (sulfonylureas)
- parenteral nutrition
- potassium chloride and phosphates for injection
- sterile water for injection
code blue
patient requiring emergency medical care (typically for cardiac or respiratory arrest)
Common methods to reduce medication errors
- avoid “do not use” abbreviations
- tall man lettering
- high alert medications
- MTMs
- med recs
- indications and proper instructions on prescriptions
- use metric system
- do not identify meds based on packaging alone
- avoid multiple dose vials
- safe practices for emergency medications/crash carts
- dedicate pharmacists to high risk areas
- monitor for drug-food interactions
- education
- five rights of medication administration
use of technology and automated systems
- computerized prescriber order entry and clinical decision support (CPOE)
- barcoding
- automated dispensing cabinets
- patient controlled analgesia devices (PCA)
common types of hospital acquired infections
- UTIs from indwelling catheters
- bloodstream infections from IV lines (central lines highest risk) and catheters
- surgical site infection
- decubitus ulcers
- hepatitis
- c difficile
- pneumonia (mostly due to ventilator use) and bronchitis
when to use soap and water (not alcohol based rubs)
- before eating
- after using the restroom
- visible soil
- caring for patient with c. diff or spore forming organisms
- before caring for patient with food allergies
risk evaluation and mitigation strategies (REMS)
–> required by the FDA for some drugs
- developed by manufacture
- approved by FDA
- ensures the benefits outweigh the risk of drug
medication guides
–> present important adverse events
- FDA approved handouts
- written in non technical language
- part of the drugs labeling
- dispense with original prescription and each refill
- not necessary to dispense in hospital since pt is being monitored but should be available upon patient/family request
where to report side effects, adverse events and allergies
FDAs MedWatch program: FDA adverse event reporting system (FAERS)
