Quiz #2 Flashcards
Six “aims for improvement”
Safe Effective Patient-Centered** Timely Efficient Equitable
Adverse Drug Event (ADE)
either preventable or non-preventable
(IOM) – “an injury resulting from medical intervention related to a drug, which can be attributable to preventable and non-preventable causes.”
Adverse Drug Reactions (ADR)
non-preventable & are ALWAYS undesirable
refers to any unexpected, unintended, undesired, or excessive response to a medication that require some type of medical response or resulting in a negative outcome (not side effects). “Nonpreventable ADEs are also often referred to as ADRs.”
Medication Error (ME) (preventable)
“any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.”
Side effects:
Negative or undesirable effects that occur with normal use of the medication, based on pharmacology
Administration errors
Wrong dose, omitted dose, additional dose, wrong time,
wrong handling, or wrong route
Dispensing errors
Wrong drug/dose/dosage form, or correct drug/wrong patient
Prescribing errors
Drug selection, dose, dosage form, quantity, route, concentration, rate of administration, instructions, or illegible handwriting.
Transcription errors
Abbreviations, illegible hand-written prescriptions, misinterpretation of verbal orders
Monitoring errors
Failure to review regimen for appropriateness or failure to use appropriate clinical/lab data for adequate assessment of patient response to drug therapy.
Sentinel Event
Defined by TJC “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.”
Root Cause Analysis
Retrospective review of the event that occurred.
Two types of errors exist in health care systems:
– Human Error-the failure of planned actions to achieve their desired ends, without the intervention of some unforeseeable event.
– System Error-the failure of interdependent elements that work together in a particular environment to prevent the human error.
National ADR Reporting
MedWatch (form 3500) – FDA required by the Kefauver-Harris Amendment to have a Spontaneous Reporting System for monitoring of ADRS of medical products marketed in the US
Patient Safety Organizations (PSOs)
Made possible by the Patient Safety and Quality Improvement Act of 2005.
Integrated Health System
Patient care under ONE umbrella of a central organization, and often include inpatient/acute care, primary care/outpatient care, long-term care, and home care
Definition of a Hospital
“A complex organization utilizing combination of intricate specialized scientific equipment, and functioning through a corps of trained people educated to the problem of modern medical science. These are all welded together in the common purpose of restoration and maintenance of good health.”
Definition of Hospital Pharmacy
“Department or service in a hospital which is under the direction of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to patient care areas……”
Pharmacy’s Role
Role of the Pharmacist is to lead and influence the Safety and Quality of ALL aspects of the Medication-Use Process
Privileging
the process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care provider’s credentials and performance and found them satisfactory, authorized the individual to perform a specific scope of patient care services within that setting
TRANSCRIBING:
The process by which a prescriber’s written order is copied and either manually or electronically entered into pharmacy records
DISPENSING:
The act of physically transferring the drug product following review and approval of the prescription.
ADMINISTRATION:
Typically Managed by Nurses in a Hospital Setting
“Five Rights” Medication Administration
1) Right Medication 2) Right Dose 3) Right Time 4) Right Route 5) Right Patient
