Pharmacovigilance in the hospital setting: Safe prescribing

Question 1

what is a medication error?

Answer 1

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to:

professional practice
health care products
procedures and systems
product labeling, packaging, and nomenclature
dispensing
distribution
administration
education
monitoring

Question 2

Which patients are most at risk from medication errors?

Answer 2

Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
Those with complex conditions
Those in the emergency room
Those looked after by inexperienced doctors
Older patients

Question 3

Top ten prescribing errors

Answer 3

1. Prescriptions for medicines were omitted or delayed e.g. discharge meds, antibiotics
2. Anticoagulants e.g. warfarin
3. Opioid analgesics
4. Insulin
5. Nonsteroidal anti-inflammatory drugs
6. Drugs that require regular blood test monitoring e.g. digoxin, diuretics, antiepileptics
7. Known allergy to medicine, including antibiotics
8. Drug interactions
9. Loading doses e.g amiodarone, warfarin
10. Oxygen therapy

Question 4

People related causes of medication incidents

Answer 4

Fatigue: Sleep deprivation

Hunger: Long lapses between food/drink

Concentration: Lapses

Stress: Loss of control/cutting corners

Distraction

Lack of training

Lack of access to information (not timely)

Other factors: Alcohol, drugs & illness

Question 5

Common Prescribing Errors

Answer 5

Wrong drug (e.g. drugs that sound alike)
Wrong dose
Inappropriate Units
Poor/illegible prescriptions
Failure to take account of drug interactions
Omission
Wrong route/multiple routes (IV/SC?PO)
Calculation errors (important in Paediatrics)
Poor cross referencing
Infusions with not enough details of diluent, rate etc. Poor cross-referencing between charts
Once weekly drugs
Multiple dose changes

Question 6

Illegible Handwriting: Error Prevention

Answer 6

Prescribers’ Obligation
Write/Print more carefully
Computers
Verbal communication

Avoid decimal points if possible
Never leave a decimal point ‘naked’
Never use a terminal zero
Leave a space between name and dose

Question 7

The Five R’s

Answer 7

Right Patient
Right Drug
Right Dose
Right Route
Right Time

Question 8

National formularies

Answer 8

(e.g. the BNF)
provide an independent source of advice

Question 9

Grampian joint formulary

Answer 9

reflects hospital/primary care choices

Question 10

WHO

Answer 10

provide a ‘model’ list of essential drugs (~300 items); some controversial!