Pharmacology, therapeutics and patient safety - Clinical Medicine Flashcards
What is meant by patient safety?
Prevention of avoidable harm, whether by an error (doing the wrong thing) or an omission (failure to do the right thing)
a) What are “never events”
b) Provide 2 examples of “never events”
a) Events that should never have been allowed
b)
- Surgical errors such as wrong site surgery
- Administration of medication by the wrong route
- Retained foreign object post-procedure
- Wrong implant/prosthesis
Name and briefly describe the checks involved in patient theatre
- First check - The Team Brief
- Second check - Patient checked on ward by theatre support worker
- Third check - Sign in & Time out
- Fourth check - Sign out
Describe the first check in surgical theatres
Team brief
- Meeting with all nursese, anaesthetists, theatre support workers
- All cases discussed any problem highlighted
Describe the second check in surgical theatres
Patient checked on ward by theatre support worker
- 4 essentail details on a name tag: full name, DOB, hospital no., NHS no.
- Consent form checked for name, DOB, operations an signature - any complication that occurs >1% is made aware to patient and limb is marked with non washable marker
- Pregnancy status recorded
- Keeping anesthetic room safe - anesthethetist left alone to draw up drugs, unclutter work surface, all syrings labelled (any without labellig cannot be usd and so discarded)
Describe the third check in surgical theatres
Sign in and time out
Sign in (before anaesthesia)
- Has the patient confirmed his/her identity, site, procedure, and consent?
- Is the surgical sit marked?
- Is the anaesthetic and medication complete?
- Does the patient have a known allergy?
- Difficult airway/aspiration allergy?
- Risk of bleeding >500ml?
Time out (before surgical intervention)
- ‘Time out’ shouted out activates WHO surgical checklist
- Have all the team members introduces themselves by name and role?
- Have the urgeon, anaesthetist, and registered practitioner verbally confirmed patient`s name, procedure, site, position?
- Anticipated critical events for surgeons, nurses, anaesthetists
- Anathetist e.g., are there any specific patient concerns, what is the patent’s ASA grade (ASA grades assess sickness of physical state prior to given anaesthetic) , what monitoring equipment and other specific level of support are required?
- Nurse/operating department personnel: Has the sterility of the instruments been confirmed? Are there any equipment issues or concerns?
- Has the surgical site infection (SSI) bundle been undertaken?
Describe the fourth check in surgical theatres
Sign out
- Sign out (to be read aloud) before any member of the team
- Registered practitoer verbally confirms with the team
- Has the name of the procedure been recorded?
- Has it been confirmed that the instruments, swabs, and sharps counts are complete (or not applicable)
- Have the specimens been labelled?
- Have any equipment problems been identified that need to be addressed
- What are the key concerns for recovery and management of this patient
What might go wrong causing mistakes in surgery
- Dysfunctional team work
- No consent forms
- No WHO checklist
- Poor consent
- Distraction
- Personal factors
- Human error and no checks
- Prosthesis kept in place
List how patient safety is maintained in surgical theatres
- Wrist bands - babies have 2, in case one falls off aka double labelling
- Consent
- Checklists
- Marking of site
- Labelling of meds
- Expected complications
- Allergies
- Sign ot
- Post op care plan
Define medication error
An unintended failure in the drug treatment process that leads to or has potential to lead to, harm to the present
Discuss why prescriptions/medications can go wrong, including human errors of prescribing, how to respond to and report it
Why prescriptions can go wrong
- Increasing complexity of drug therapy
- Patients with multiple problems, cared for by many different doctors
- More drugs, more interactions, more errors, and adverse reactions
Human errors
- Slips in attention
- Failure to apply relevant rules
- Organizational issues - lack of eductaion trainng, low percieved importance or prescribing, no self-awareness of erros
How to respond to medication errors
- Acknowledge your mistake to the patient or family
- Discuss the situation with a trusted colleague
- Seek professional advice
How to report medication erros
- Must be reported immediately to consultant
- Error appropriately documented
Describe the steps involved in good prescribing
- Make a diagnosis
- Consider factors that might influence the patient’s response to therapy (age, concomitant drug therapy, renal and liver function etc.)
- Establish the therapeutic goal * * These steps in particular take the patient’s views into consideration to establish a therapeutic partnership (shared decision-making to achieve ‘concordance’).
- Choose the therapeutic approach *
- Choose the drug and its formulation (the ‘medicine’)
- Choose the dose, route and frequency
- Choose the duration of therapy
- Write an unambiguous prescription (or ‘medication order’)
- Inform the patient about the treatment and its likely effects
- Monitor treatment effects, both beneficial and harmful
- Review/alter the prescription
Which sources of information could you obtain a drug history from?
- From patient or relatives
- From medical notes
- From clinical letter/discharge summaries
- From computer print-out or shared care record
- Checking the bottle/packet
- Nursng home drug charts
How can you ensure a drug history you’ve taken is reliable?
- Verify
- Cross-check
- Make sure drug history matches medical histry
- Do not multi-task when you’re recording history and then prescribing
Name 2 common drugs that are at high risk of errors
Insulin
Warafin
