Unit II : MEDICATION SAFETY IN HIGH-RISK SITUATION Flashcards
T/F: many medication errors may not result in harm
True
medication-related
harm can be reduced with:
appropriate ____________
responsible _____________
implementing ___________ that minimize risks
appropriate prescribing
responsible use
implementing strategies that minimize risks
highest prevalence rates are in
children
commonest type of prescribing error
dosage error
Meaning of A PINCH
Anti-infectives
Potassium and electrolytes
Insulin
Narcotics
Chemoterapeutic agents
Heparin and anti-coagulants
Others
Amphotericin, aminoglycosides
Anti-infectives
may cause damage to hearing or the kidneys in a dose-related, type A adverse drug reaction
ANTI-INFECTIVE AGENTS
pre-existing renal impairment, older
persons, obese individuals, patients with cystic fibrosis,
neonates and children
anti-infectives
reduce their renal clearance that will result in renal damage
ANTI-INFECTIVE AGENTS
rapid intravenous infusion of __________ increases the risk of anaphylactic-like reactions
vancomycin
Amphotericin B’s _________-based form have less severe toxicity
lipid
Amphotercin B form that may be inadvertently substituted at an
inappropriate dose, risking possible severe cardiotoxicity,
including cardiorespiratory arrest
conventional form
How to reduce harm for aminoglycosides:doses (e.g. gentamicin) should be calculated based patient’s _____ and ______
doses (e.g. gentamicin) should be calculated based patient’s
weight and renal function
How to reduce harm for vancomycin
improve safe use by providing monographs
How to reduce harm for Amphotericin B:
________________________ in the fridge for different formulations of amphotericin (lipid-based and non-lipid based)
use of _____________________ to remind staff about the
differences
**segregatie storage areas **in the fridge for different formulations of amphotericin (lipid-based and non-lipid based)
use of cautionary labels or warning signs to remind staff about the
differences
POTASSIUM AND OTHER SALTS OR ELECTROLYTES FOR IV
INJECTION examples
Potassium chloride, Potassium phosphate, magnesium and calcium salts and
hypertonic sodium chloride
_____________ solution of Potassium chloride: used treat hypokalemia (to avoid serious
sequelae - cardiac arrest)
diluted
____________ solution of KCl: occasionally administered in error,
concentrated
also used mistakenly for sodium chloride
concentrated solution
How to reduce harm in areas where high
concentrations of salts/electrolytes are necessary: a ____________ for safe ________, _________ and _________ should be
developed
a protocol for safe storage, preparation and use should be
developed
How to reduce harm of salts/electrolytes in general ward:stock may be _________ if not necessary, replacement with
_____________ solutions could also be considered
stock may be removed if not necessary, replacement with
premixed solutions could also be considered
How to reduce harm where potassium chloride ampoules and premixed solutions
should be stored separately
readily identifiable from preparations with similar
packaging
insulin-related harm are due to:
- complexity of dosing
- variety of available products
- pharmacology of the medicine
ACTIONS TO REDUCE HARM for prescribing insulin
Abbreviations, unclear instructions and ambiguous doses should be avoided.
Insulin syringes and well-titrated doses should be used.
Prescribing by “brand name” and device could reduce error.
ACTIONS TO REDUCE HARM for insulin storage
physically separating insulin from vaccines or LASA products
nausea, vomiting, constipation and in severe cases
respiratory depression or respiratory arrest which may result
in death
NARCOTICS AND SEDATIVES
T/F: wide range of alternative opioids (some short-acting and
others long-acting) make the possibility of an error
True
ACTIONS TO REDUCE HARM for morphine and diamorphine
select correct product in the correct dose
ACTIONS TO REDUCE HARM for IV morphine (neonatal units)
clear and easy protocols in preparation and administration
use of prefilled syringes from a central intravenous additive
service and** smart pumps** could be considered
CHEMOTHERAPEUTIC AND IMMUNOSUPPRESIVE AGENTS examples
Etoposide, Vincristine, Methotrexate, an anticancer agent
alkylating agent
Etoposide
Etoposide is availble in what forms
- etoposide base
- etoposide phosphate salt
used to treat certain leukemia, lymphomas, and some solid
tumors, such as breast and lung cancer
Vincristine
intrathecal administration of _______________ has caused severe ascending
radiculomyeloencephalopathy, which is almost always fatal
Vincristine
used in the treatment of rheumatoid arthritis and other
autoimmune conditions due to its immunosuppressive
properties
Methotrexate
Methotrexate is administered ________ rather than _____ dose
weekly; daily
resulted in bone marrow suppression, pulmonary
complications and, in some cases, even death
Methotrexate
ACTIONS TO REDUCE HARM in chemotherapeutic administration
processes should be in place to avoid wrong medication, dose, route,
concentration, duration or frequency
ACTIONS TO REDUCE HARM in chemotherapeutic prescription
should be carried out to the same standard as parenteral anticancer
therapy and should be monitored in the same way
used with monitoring of the blood using the activated partial
thromboplastin time (aPTT)
UFH
there is a ________________(non-linear/linear) relationship between the dose of UFH
infused and the aPTT
non-linear
overdosing of ____________ is associated with an increased risk of
hemorrhage
UFH
administered subcutaneously, excreted unchanged in the
urine
LMWH
LMWH’s safe and effective dose is determined by the patient’s ________ and ___________
weight
and renal function
LWMH underdosing risks ___________ while overdosing may increase
the risk of _________________
inefficacy; hemorrhage
orally active vitamin K antagonists, for the treatment and
prevention of thrombosis, cause hemorrhage
Warfarin, phenindione, acenocoumarol (nicoumalone) and
phenprocoumon
should be monitored throughout treatment using the
international normalized ratio (INR)
Warfarin, phenindione, acenocoumarol (nicoumalone) and
phenprocoumon
one of the 10 medications most frequently related to
dispensing errors
Warfarin
agents acting directly on clotting factor II or X
Newer oral anticoagulats (NOACs), also known as Direct-acting
oral anticoagulants (DOACS):
ACTIONS TO REDUCE HARM for UFH:
all patients should have a baseline _________ performed before initiation of therapy
_________ should also be measured just before therapy
regular monitoring of platelet counts may be required if administered for longer
than ________
all patients should have a baseline aPTT performed before initiation of therapy
platelet counts should also be measured just before therapy
regular monitoring of platelet counts may be required if administered for longer
than four days
ACTIONS TO REDUCE HARM for LMWH
weight of the patient is used to calculate the treatment dose required
renal function should be taken into account
ACTIONS TO REDUCE HARM FOR Vitamin K
antagonists
baseline prothrombin time (or INR) should be determined and
measured regularly
ACTIONS TO REDUCE HARM FOR NOACs/DOACs
before prescribing, creatinine clearance should be calculated (e.g.
using the Cockcroft Gault equation and ideal body weight)
OTHER MEDICATIONS include
NSAIDs, Paracetamol, Lithium salts, Penicillin, diuretics, cardiac glycosides and neuroleptics
- may cause gastrointestinal effects (e.g. ulceration) and
cardiotoxicity (including exacerbation of heart failure,
worsening of hypertension and myocardial infarction due to
increased thrombotic risk
NSAIDs
responsible for a high rate of medication errors in children,
including several instances of dose-related liver failure
Paracetamol
used in the treatment of psychiatric disorders, including the
treatment and prevention of mania, bipolar disorder and
recurrent depression
Lithium salts
T/F: Lithium salts have a narrow therapeut
T
may cause gastrointestinal and central nervous system
disturbances, and cardiac conduction disturbances
Lithium salts
Lithium salts may interfere with ______ and ______ fx
interfere with kidney and thyroid function
special consideration is required for women of childbearing
age, so a pregnancy test should also be performed
- Lithium salts
most severe allergic reaction iin Penicillin is
anaphylaxis
included in the Screening Tool of Older Person’s
Prescriptions (STOPP) criteria
diuretics, cardiac glycosides and neuroleptics
To reduce the harm for nsaids use _________ or __________ if needed
ibuprofen/naproxen
To reduce the harm for nsaids consider co-prescribing ____________ in those with risk of gastric bleeding
or when used for long-term treatment of osteoarthritis, rheumatoid arthritis and
lower back pain
co-prescribing proton pump inhibitors
T/F: prescribing error rates were higher in hospitalized patients
than in the community
True
T/F: anticoagulant-related adverse events still occurred during
hospitalization, despite mostly being preventable, since
they were often related to dosage errors
True
prescribing assessment tools for potentially inappropriate medication use
in older adults
Beers Criteria
prescribing assessment tools for potentially inappropriate medications
STOPP criteria
prescribing assessment tools for potentially beneficial treatments in
older people
START (Screening Tool to Alert Doctors to Right
Treatment)
