Safe prescribing Flashcards
Disadvantages of paper prescriptions
often illegible
manual calculations
transcription errors from protocols
incorrect/missing instructions
inconsistent/missing supportive care
goes ‘missing’
Disadvantages of electronic prescriptions
‘mouseclick’ errors
prescriber prescription review less vigorous
doses not learned
supportive medicines not appreciated
erroneous inputs (height, weight, creatinine)
using other users log-ins
old data
wrong patient selection
Benefits of electronic prescribing
legible
safer - less errors
‘live’ system
consistent prescribing
doses/administration linked to protocol
doses and routes set centrally
reduces variation in practice
calculation of patient variables (eg. GFR, BSA)
regimens linked to disease site
Is blood a drug?
no
therefore it is not actually ‘prescribed’, it is authorised by qualified practitioners
When should blood transfusion be considered?
if Hb <70g/L
When should blood transfusion be considered in cardiovascular disease?
if Hb <80g/L
When should blood transfusion be considered in sepsis of traumatic brain injury?
if Hb <90g/L
When are platelets not generally required?
not required if count above 10x10^9/L and there is no bleeding
What is a generally acceptable platelet count if an invasive procedure is to be carried out?
> 50x10^9/L
When is Fresh Frozen Plasma (FFP) used?
transfuse to replace clotting factors in major haemorrhage, DIC, liver disease
may be used for plasma exchange
When should FFP not be used?
do not use to replace volume
do not use to reverse warfarin (use prothrombin complex concentrate)
When is cryoprecipitate used?
usually only administered when the patient is actively bleeding and has low fibrinogen levels
What is MSBOS?
maximum surgical blood ordering schedule
blood use for common operations is audited and a tariff drawn up that gives the average number of units used for that operation
this is the amount of blood that should be ordered for that procedure pre-operatively
What are 3 reasons for increasing tariff for maximum surgical blood ordering schedule?
the patient has a red cell antibody that means blood cannot be provided rapidly should there be unexpected bleeding
the patient has a bleeding disorder
the patient is anaemic pre-surgery
What should be involved in consenting a patient for a blood transfusion?
explain the reason for the transfusion
risks and benefits
the actual process
ant specific needs for the patient
any available alternatives
explain that they are no longer eligible to be blood donors
encourage the patient to ask questions
document in the notes
3 potential transfusion transmitted infections
Hep B
HIV 1
vCJD
Risk factors for TACO
> 70
cardiac failure
renal failure
low albumin
pre-existing fluid overload
over-transfusion (due to belief that 1u of blood will raise Hb by 10g/L which is only true for 70-80kg man)
Alternatives to transfusion
Tranexamic acid (ue if estimated blood loss >500mls)
Cell salvage
Iron
Erythropoietin (if transfusion not possible eg. due to religious beliefs)
When should administration of a blood product be completed by?
within 4 hours of leaving blood fridge
Which patients should be given CMV negative components?
all neonates (up to 28 days post expected delivery date)
elective transfusions for all pregnant women (regardless of CMV serostatus)
intrauterine transfusions
Describe transfusion associated graft-versus-host disease (TA-GvHD)
donor lymphocytes recognise the recipient as a foreign body and so can attack it
What does irradiating a blood product do?
inactivates donor lymphocytes
