Stats/QI/Ethics/Pharma Flashcards
Type I vs II errors
Type I:
- null hypothesis (no effect) is true, but is rejected
- found an effect when there is none (False positive)
Type II
- null hypothesis is false, but fails to be rejected
- miss; did not find the effect when there is one
Intention to Treat results in
increase in statistical power
minimizes Type I errors
Medication Administration Tools
Syringe > Cup
Use mLs
Physicians as 2nd victims
Providers involved in an adverse event resulting in harm to a patient may become second victims.
Counseling services should be offered to health-care providers after an adverse event to ensure healthy coping.
Debriefing sessions may offer a safe space in which members of the medical team can begin to process their feelings after an adverse event.
Medical errors
Act that has potential to harm patient, regardless of whether harm reaches the patient
Adverse drug event
- nonpreventable
- preventable
Potential adverse drug event - does not harm patient “near misses”
- intercepted - stopped before harm
- nonintercepted - not stopped, but no harm**
Commission - incorrect action taken
Omission - correct action not taken
Hand-offs
Elements that improve handoff quality
- face-to-face communication
- using a mnemonic
- having the receiving team summarize information provided by the team handing over care.
Using a mnemonic as a guide during patient handoffs decreases the risk of miscommunication, and helps to ensure that all important elements are included.
Printed patient summary documents can help with the transfer of information during the handoff process; however, these documents generally remain accurate for only a short period.
Alarm Fatigue
Is real. Change the lower limit to something worth action. Like pulse ox < 90
Swiss Cheese Model
Used to prevent errors
In this model, the health care system is viewed as a series of slices of Swiss cheese, each with strengths (areas of intact cheese) and weaknesses (holes). As such, each part of the health care system contributes differently to the risk of error. When a system is designed to prevent errors, the “holes” will not line up. Each layer of care has a unique role in identifying and averting medical errors. In this vignette, the receiving nurse placed the order under the wrong neonate. The bedside nurse recognized that Infant B did not need a platelet transfusion, providing a different line of defense (blocking the hole) and preventing the error from reaching the patient.
Principles of Ethics
Beneficence - act in the best interest of the patient
Capacity - ability of patients to participate in their MDM. Children do not have capacity, so they are dependent on their caregivers
Justice - medical care be provided in a similar manner to all
Nonmalefience - do no harm
Principle of autonomy - respecting the decision made by an individual. Parents have the authority to make medical decisions for their children. However, parents do not have complete autonomy over their children
Which ethical principle is utilized to give Jehovah witness’s neonate blood?
Beneficience - acting in the best interest of the patient.
When there is clear benefit, this overrides parental autonomy.
Brain Death
Brain death should be declared after 2 independent examinations, including a physical examination and apnea testing, are consistent with brain death.
Neonates up to 30 days of age = 24 hrs apart
Infants, Children = 12 hrs apart
When determining brain death, ancillary testing, (ie, cerebral blood flow scanning and electroencephalography), should be performed only if any component of the physical examination or apnea testing cannot be performed.
Signs of abuse
Any bruising on a nonmobile infant should raise concern for child physical abuse.
A skeletal survey is indicated in any child under 2 years of age when physical abuse of any kind is suspected.
Pediatric clinicians with expertise in child abuse and child protection teams at tertiary centers can be valuable resources when a clinician is uncertain whether a clinical presentation is suspicious for abuse.
Bioequivalence
similar rate and extent of absorption
Area under the curve of concentration as a function of time expresses the total amount of exposure of the body to a medication.
The concentration versus time curve is affected by the rate and extent of absorption and kinetics of elimination.
Beta-Blockers side effects
β-Blockers have side effects of bradycardia, hypotension, HYPOGLYCEMIA, hypoglycemia-induced seizures, and hyperkalemia.
Additionally, β-blockers can exacerbate bronchospasm and should be used with caution in children with asthma
Diuretic Side effects
Loop:
- Inhibit the Na K Cl channel in thick ascending loop
Thiazide:
- inhibit the Na Cl cotransporter in the distal tubule
Side effects:
- Hypokalemia
- Metabolic alkalosis (hypochloremia)
- Hyponatremia
- Hypomagnesemia
- HYPERuricemia (due to volume depletion)**
Thiazides: HYPERCAlcemia
