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Therapeutics 4 Kappa Epsilon > Safety Quiz 2 > Flashcards

Safety Quiz 2 Flashcards

1
Q

what is BCMA?

A

Bar code medication administration

scanning stuff at pt bedside aka AT POINT OF ADMINISTRATION

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2
Q

what is CPOE?

A

computerized provider order entry

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3
Q

what is a PHR?

A

personal health record

an electronic app used by pts

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4
Q

subtypes of systems of PHRs?

A

standalone (ex: google health PHR)
tethered (tied into healthcare system - MyHealthvet from PHR)
or
networked (access data from multiple locations)

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5
Q

what is meaningful use?

A

goal: to increase EHR adoption and improving
quality of care!!
CMS gave out money for rewarding ppl to to do EHRs then after time they would penalize ppl

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6
Q

what is HIE?

A

health information exchange

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7
Q

ultimate goal of HIE?

A

NHIN (national health information network)

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8
Q

Hx of HIE:

what was the first initiative? and the problems with it?

A

in 1990 - Hartford foundation
grants given to different communities
endpoints to assess - quality and cost reduction

problems: technology wasnt good enough for this/slow internet etc

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9
Q

Hx of HIE:

what was the second initiative? main issue?

A

in mid- 1990s CHINs (community health information networks)
these were commercial endeavors
political groups against public health data

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10
Q

Hx of HIE:

what was published in 1999/2001 that said HIE’s could help pt safety

A

To Err is human

IOM reports on pt safety and quality

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11
Q

Hx of HIE:

what was the initiative in 2000? what was the downfall?

A

RHIOs! (regional health information organizations)
downfall: getting everyone on board/funds/political/competitive

all RHIO’s across the country were SOOO different

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12
Q

Hx of HIE:
In 2004 the DHHS began developing ______

*DHHS - department of health and human services

A

NHIN (national health information network)

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13
Q

Hx of HIE:

in 2006 - the prominent RHIO located in ______ closed after 8 years

A

Santa barbara, CA

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14
Q

Hx of HIE:

In 2008: _________ specifies HIE as a component of “meaningful use” incentives

A

HITECH Act

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15
Q

Hx of HIE:

In 2009: the _____ assures stakeholders that NHIN will NOT exchange data with government angencies

A

ONC (office of the national coordinator for Health IT)

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16
Q

Definitions/Terms:

EMR?

A

electronic medical record

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17
Q

Definitions/Terms:

Formulary

A

medications approved for use by the pharmacy and therapeutics committee

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18
Q

Definitions/Terms:

ADC

A

automated dispensing cabinet

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19
Q

Definitions/Terms:

BCMA

A

barcode medication administration

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20
Q

Definitions/Terms:

CPOE

A

computerized prescriber order entry

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21
Q

Definitions/Terms:

CDS

A

clinical decision support - automated tools used to help assist with clinical decisions

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22
Q

Definitions/Terms:

Medication use process

A

Multistep process involved in getting a prescribed medication to the patient

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23
Q 
Which of the below are factors associated with effective implementation of pharmacy automation?
A. Usability 
B. Integration and interoperability
C. Stability and reliability
D. Adaptability and flexibility
E. All of the above
A

E

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24
Q

What dispensing technologies could have prevented these heparin errors?
A. Barcode scanning when removing the medication from the carousel
B. Barcode scanning prior to loading into the automated dispensing cabinets
C. Patient monitoring
D. A and B
E. All of the above

A

D

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25
Q

Which of the below are reasons to implement Carousels?
A. Better security of medications
B. Reduces medication errors
C. Maximizes floor space and storage capacity; improves space efficiency
D. All of the above

A

D

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26
Q

Smart Pump = an infusion pump w/

______ of medications that provides _____ guidelines for concentrations and dose limits

A

library

dosing….

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27
Q

different types of infusion pumps?

A 
LVP - large volume pump
PCA - pt controlled analgesia
Syringe
Elastomeric
Enteral
Insulin Pumps
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28
Q

Types of smart pump data?

A 
drug libraries
alerts
DERS compliance rate
alarms
pump status (up to date?)
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29
Q

what is DERS?

A

dose error reduction software — used in smart pumps!

this get measured for compliance

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30
Q

the the “medication use process” what is a part of the monitoring portion?

A

EHR
documentation
lab testing
refill data

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31
Q

the the “medication use process” what is a part of the prescribing portion?

A

CPOE

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32
Q

the the “medication use process” what is a part of the transcribing portion?

A

e-prescribing

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33
Q

Medication alerts are one form of ______________ and are intended to improve medication decision-making and thereby improve patient safety.

A

computerized clinical decision support

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34
Q

Medication Alert challenges?

A

Alert Fatigue
Wide variation in alert display
Lack of alert clarity
Barriers to prescriber-pharmacist communication

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35
Q

what does C-HIP model stand for and why is it related to med safety?

A

C-HIP = communication-human information processing model

related to med safety because it is the process that ppl go thru while looking at warnings
and is a way to see why a warning did not work

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36
Q

what is the C-HIP model process?

A

source –> channel –> delivery –> attention switch –> attention maintenance –> comprehensive memory
(SCDAAC?)

37
Q

Examples of portions of the C-HIP model process?

Source

A

Source - initial transmitter of warning info

hospital system, ISMP, FDA

38
Q

Examples of portions of the C-HIP model process?

Channel

A

medium in which warning is presented

prescription label, sticker, EHR

39
Q

Portions of the C-HIP model process:

Delivery

A

aka if the dr sees it

problems arise if a nurse puts it in and Dr just signs it

40
Q

Portions of the C-HIP model process?
Attention Switch
what is considered a success and what is considered a challenge

A

success = dr sees alert…

challenge = competing with other environmental stimuli

41
Q

Portions of the C-HIP model process?
Attention Maintenance
what is considered a success and what is considered a challenge

A

Success: Prescriber views the alert; attention is sustained long enough to understand the information

Challenges: stress, workload, competing demands

42
Q

Alert components - what should be in the message content

A

a signal word
the hazard itself
instructions
consequences

43
Q

Workarounds in IT:

harmful if….

A

creates gaps in EHR documentation
circumvents safety mechanisms
reduces efficiency for individual or others

44
Q

Workarounds in IT:

beneficial if…

A

assists with complex tasks and decisions
tracks information
reminds or prompts
fills a gap in IT functionality

45
Q

Public Health or Population Health informatics?

promotes and protects the health of people and the communities where they live, learn, work and play

46
Q

Public Health or Population Health informatics?

Tends to focus on governmental PH

47
Q

Public Health or Population Health informatics?

Tends to focus on clinical populations as well as payers

A

population

48
Q

Public Health or Population Health informatics?

Health outcomes of a group of individuals, including the distribution of such outcomes within the group

A

population

49
Q

Public Health or Population Health informatics?

Goals emphasize disease management, outreach, care coordination, and integration of services

A

population

50
Q

Public Health or Population Health informatics?
Goals emphasize assessment (surveillance) and prevention of disease; also pertains to other areas of PH like food safety, nutrition

51
Q

Public Health or Population Health informatics?

Tends to emphasize outcomes and needs of a more narrow population

A

population

52
Q

Public Health or Population Health informatics?

Tends to emphasize health needs and outcomes of the total population

53
Q

what are the 5 V’s of big Data

A 
volume
velocity
variety
variability
veracity/value
54
Q

Role of informatics (esp related to Big data)

A 
data management (storing/maintaining)
develop systems to make sense of big data
Developing systems that can deliver the right data, derived from Big Data, to clinicians at the point-of-care
55
Q

Analytics definition?

A

Analytics often involves studying past historical data to research potential trends, to analyze the effects of certain decisions or events, or to evaluate the performance of a given tool or scenario.

56
Q

step by step process of BCMA?

A 
scan nurse
scan pt
scan med
respond to alerts
administer and document
57
Q

what are the 2 types of barcodes used with BCMA

A

linear

and 2D barcode (looks like QR code)

58
Q

Linear Barcode:
advantages?
disadvantages?

A

advantage: easy to print! universally readable
disadvantage: curvature (on pts wrist); limited amt of data

59
Q

2D Barcode:
advantages?
disadvantages?

A

advantages: Compact; High data density; Less susceptible to curvature issues
disadvantages: Require high quality printer (i.e. 600x600 resolution); Not universally scannable (requires imager)

60
Q

what are some of the BCMA workarounds?

A

pt scan
medication scan
scan post administation

61
Q

rationale and ways nurses do pt scan workarounds

A

“i know the pt” hard to scan wrist band/will disturb the pt

print extra armband/remove armband/override

62
Q

rationale and ways nurses do medication scan workarounds

A

hard to scan med/threw out packaging/ “its just saline”

keep old packages/barcode stickers; override

63
Q

rationale and ways nurses do BCMA workaround of scan post administration

A

aka give med now and scan later because it is time consuming

64
Q

Required Readings: EHR article

article focuses on what 3 parts of EHR functions that pharmacists use?

A

documentation
medication reconciliation
pt evaluation and monitoring

65
Q

Required Readings: EHR article
T or F: pharmacists are currently not considered providers for CMS and do not receive incentive funds based on meaningful use

66
Q

Required Readings: EHR article

T or F: There are a lot of pharmacists involved in informatics

A

false (there are not a lot and there should be more!)

67
Q

Required Readings: 9/20 ISMP Article

Misconnections of __________ ports with IV infusions can result in fatal outcomes

A

tracheostomy pilot balloon ports

68
Q

Required Readings: 9/20 ISMP Article

T or F: tubing misconnections are widely reported

A

false — probably a lot are NOT reported

69
Q

Required Readings: 9/20 ISMP Article

when a tracheostomy pilot balloon ports is connected to a fluid — it will inflate with fluid and lead to what?

A

the lumen of the trachesotomy will collapse and the airway will be obstrcuted

70
Q

Required Readings: 9/20 ISMP Article

what was a recent nebulizer mix up?

A

ipratropium and racepinephrine
(v similar packaging)
both are bronchodilators but act differently
manufacturer was contacted

71
Q

Required Readings: 9/06 ISMP Article

what were the 4 severe ADEs talked about?

A

rhabdomyolysis
SS (serotonin syndrome) and NMS (neuroleptic malignant syndrome)
SJS/TEN (steven johnson syndrome/Toxic epidermal necrolysis)
PML (progressive multifocal leukoencephalopathy)

72
Q

Required Readings: 9/06 ISMP Article
Rhabdomyolysis:
some drugs destroy skeletal muscle cells and lead to the contents of ______ and _____ being released

A

creatine kinase; myoglobin

73
Q

Required Readings: 9/06 ISMP Article

If rhabdomyolysis is severe enough – ____ failure is possible

74
Q

Required Readings: 9/06 ISMP Article

Signs and Symptoms of Rhabdomyolysis?

A

muscle pain
dark urine (bc myoglobin)
elevated creatine kinase
arrhythmias (bc Ca2+/K+/Na+ release)

75
Q

Required Readings: 9/06 ISMP Article

two most common drug classes to cause rhabdomyolysis

A

statins and antipsychotics

for antipsychotics rhabdo was secondary to NMS

76
Q

Required Readings: 9/06 ISMP Article

what 2 newer/novel drugs were found to cause rhabdoyolysis

A

nivolumab

entresto (sacubitril/valsartan)

77
Q

Required Readings: 9/06 ISMP Article
Serotonin Syndrome and NMS
SS: happens within ______

and NMS happens within ______

A

SS: hours

NMS: days

78
Q

Required Readings: 9/06 ISMP Article

Symptoms of SS and NMS?

A

CNS disruptions
irrgular heartbeats or breathing
loss of body temperature CONTROL!! (fever)
clonus (can be severe enough to CAUSE rhabdo)

79
Q

Required Readings: 9/06 ISMP Article
SS: caused by drugs that _________

NMS: caused by drugs that _______

A

SS: drugs that affect serotonin uptake

NMS: drugs that block dopamine

80
Q

Required Readings: 9/06 ISMP Article

Common drug classes that cause SS?

A 
antidepressants (SSRI and SNRIs)
opioids
antipsychotics
anti-emetics
(aka drugs that also block serotonin receptors)
81
Q 
Required Readings: 9/06 ISMP Article
NMS is caused by the drug class of \_\_\_\_\_\_

which drug caused the most cases?

A

antipsychotics

aripiprazole

82
Q

Required Readings: 9/06 ISMP Article

why does SS and NMS diagnosis get messy?

A

polypharmacy
pts on both antidepressants and antipsychotics
aripiprazole affects both dopamine and serotonin

83
Q

Required Readings: 9/06 ISMP Article

what drug classes are known to cause SJS/TEN?

A

anticonvulsants (lamotrigine, carbamazepine)
antibiotics/antifungals
analgesics (ibuprofen..)

84
Q

Required Readings: 9/06 ISMP Article

what is SJS/TEN?

A

T cells attack/kill dermal cells - skin sloughs off

85
Q

Required Readings: 9/06 ISMP Article
PML - caused by a VIRAL infection of the brain - happens when immunosuppresive drugs or HIV cannot hold in check the _______ (that is common but also normally harmless in pts)

A

JCV (john cunningham virus)

86
Q

Required Readings: 9/06 ISMP Article

what drugs can cause PML?

A

natalizuamab
rituximab
fingolimod
mycophenolate

87
Q

Required Readings: 9/06 ISMP Article

problem with Nucala?

A

the vial says 100 mg/vial 00 but it actually ahs 144 mg bc overfill!!!
should say 100 mg/mL after reconstitution

88
Q

Required Readings: 9/06 ISMP Article
Suppository mix up?
how found?
and what to do?

A

one manufacturer makes APAP, bisacodyl, promethazine suppositories - look the same with packaging

found by bar code scanning (good job nurse)

to fix: buy each from different manufacturers… (manufacturer was contacted)

89
Q

Required Readings: 9/06 ISMP Article

Drug Shortage - Pain Med case/issue?

A

Woman had pain - gave morphine - not enough relief could NOT do hydromorphone because out of stock

Dr ordered fentanyl - option was 250 mcg (bc vial said 250 mcg/5 mL)

got thru Dr, Rph, and nurse because no one familiar with fentanyl dosing

Opioid pain conversion table was made for Drs and and high dose warning made if anything over 50 mcg

Therapeutics 4 Kappa Epsilon (16 decks)

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