PHARMACOLOGY > 05- Medication Safety > Flashcards

05- Medication Safety Flashcards

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1
Q

Medication Error

A

Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm.

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2
Q

Adverse Drug Event

A

Any event of injury/harm from using a drug or the lack of use of a drug. An error may or may not have occurred.

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3
Q

Adverse Drug Reaction

A

Any type of ADE that occurs at NORMAL doses, resulting in an unexpected reaction to a medication. Includes side effects & allergies.

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4
Q

Vanessa’s Law

A

Mandated reporting of ADR to Health Canada (drug is recalled).

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5
Q

Near Miss

A

Medication errors that are stopped before harm can occur to patient - error is cauught beforehand. Is a potential ADE (error has the potential to cause harm).

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6
Q

T or F: Medication errors can occur when prescribing, transcribing, dispensing, administering & monitoring.

A

true

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7
Q

Most medication errors occur during which 2 processess?

A

Prescribing & administering

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8
Q

Swiss Cheese Model

A

Shows that errors can bypass lines of defense to reach the patient. There may be multiple levels of defense, but latent conditions such as poor design, procedures, management decisions, etc allows for active errors that can compromise the patient’s safety.

Errors are to be expected even in the best opportunities & the holes (latent conditions) represent opportunities for the process to fail.

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9
Q

What are some human/environmental factors that contribute to med errors?

A
  • poor lighting
  • fatigue
  • stress
  • distractions
  • messy work area
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10
Q

High alert medications

A

Medications that have a high risk of causing patient harm when used in error. Includes heparin & concentrated electrolytes.

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11
Q

What are the 8 rights?

A
  1. Patient
  2. Med
  3. Reason
  4. Dose
  5. Frequency
  6. Route
  7. Site
  8. Time
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12
Q

When a medication is ordered to be on hold, the order should have what 2 things?

A
  1. Reason for hold

2. Restart date/time OR reassessment date/time

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13
Q

Narcotics & controlled substances are…

A
  • high risk meds
  • can have serious consequences
  • are prone to misuse
  • must be wasted in irretrievable containers
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14
Q

Which drug is stronger: morphine or hydromorphone? By how much?

A

Hydromorphone; is 5x stronger (bc it has 5 more letters)

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15
Q

T or F: You should compare the patient’s medications at admission, transfer, dischange, with what the organization is providing in order to avoid errors.

A

true

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16
Q

Institution IV Monographs

A

Provides information on IV drug (reconstitution, how to administer, monitoring parameters, IV solution compatibility, etc.)

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17
Q

What are IV guardrails?

A
  • min & max limits

- makes sure IV drug is at the right dose, not running too fast & is not overly concentrated

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18
Q

When should you use IV guardrails?

A

For all IV meds, IV infusions, TPN

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19
Q

What is methadone?

A

A long acting opioid

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20
Q

What is naloxone?

A

Antidote for opioid overdose

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21
Q

Why is medication safety important?

A
  • Its a frequent problem (1 med error per hospitalized patient per day)
  • We end up using a lot of health care resources in treatment of drug overdoses
  • Its a major cause of death (7000 per year)
  • Its very costly ($3.5 billion spent each year on extra medical costs associated with adverse drug events)
  • Preventable (1.5 million preventable events each year)
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22
Q

What part of medication safety is the nurses responsibility?

A
  • Ensuring the order is complete, appropriate and clear
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23
Q

What is a medication error?

A
  • Preventable

- Event that may cause or lead to inappropriate medication use or patient harm

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24
Q

What is an example of a medication error?

A

Physician prescribes amoxicillin to a patient with a history of anaphylactic reaction to penicillin. The patient takes the amoxicillin which results in a severe reaction requiring hospitalization

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25
What is an adverse drug event?
Harm resulting from medication or lack of medication (error may or may not have occurred)
26
What is an example of an adverse drug event?
Patient with depression overdoses on amitriptyline (anti-depressant)
27
What is an adverse drug reaction?
Type of adverse drug event that occurs at normal doses that results in an undesired, unintended or unexpected reaction to a medication
28
What is an example of an adverse drug reaction?
Patient experiences hepatoxicity after taking methotrexate for rheumatoid arthritis
29
What is a near miss?
Event that could have resulted in harm but did not reach the patient as a result of chance or timely intervention
30
What is an example of a near miss?
Pharmacy dispenses dimenhyDRINATE 25 mg instead of diphenhyDRAMINE 25 mg as ordered. However the dispensing error is noted by the nurse and the incorrect medication is not administered to the patient
31
What is the medication use process?
Prescribing, transcribing, dispensing, administering
32
At what part of the process do medication errors occur the most?
38% of the time at administration, as a health care provider you are the most responsible
33
What are nurses considered with respect to medication administration?
The last line of defense in preventing medication errors before they reach the patient
34
What are the types of errors that can occur during prescribing?
- Inadequate knowledge of indication, contraindication, or drug interaction - Patient factors such as allergies, pregnancy, renal impairment not taken into account - Inappropriate drug, dose (including calculation), route or administration time
35
What are the types of errors that can occur during transcribing?
Prescribed medication transcribed incorrectly or not transcribed at all
36
What are the type of errors that can occur during dispensing?
- Incorrect medication, dose (including calculation), route or quantity dispensed - Dispensed medications labelled inappropriately
37
What are the type of errors that can occur during administration?
- Incorrect patient, medication, dose (including calculation) route or time - Administration omission
38
What are the type of errors that can occur during monitoring?
- Inadequate monitoring for effectiveness or side effects | - Drug levels not ordered or followed up
39
What is a systems approach?
- Focusing on the flaws associated with the system that cause errors, not the person - Preventable adverse events are caused by the interaction between flaws in the working environment and unavoidably imperfect human beings
40
How can adverse events be prevented?
By creating a system that reduces errors and prevents errors from causing harm
41
What is the order of medication error reduction strategies in order from most effective to least effective?
- Fail safe constraints (prevent clerk from ringing up medication thats not checked by the pharmacist) - Forcing functions (profile with all medications prescribed, medications selected and scanned if it does not match a warning comes up) - Automation and computerization - Standardization (preprinted prescription blanks, insulin regimens, frequently prescribed medications, etc.) - Redundancies (Independent double check for high alert medications before administration) - Reminders and checklists - Rules and policies (Nurses check vitals at certain times after the administration of medications) - Education and information - Suggestions to be more careful or vigilant (Email sent out to staff to remind them to be more careful)
42
What are some environmental/human factors that may contribute to medication errors?
- Inadequate lighting - Messy work area - Distractions (noise, telephone, interruptions) - Stress - Fatigue
43
What is the definition of a high alert medication?
- Medication which may result in an increased risk of patient harm if used inappropriately
44
What are some examples of high alert medications?
Insulin, opioids/narcotics, anticoagulants, chemotherapy, and potassium chloride
45
What is an independent double check?
- Important for high alert medications and high alert routes of administration (ex. epidural/intrathecal administration) - If they are done correctly they can detect up to 95% of errors - Must be done independently - Nurse administering medications checks her medication, and then asks another nurse to check it without influencing her
46
What is an example of an incorrect double check?
Holding up a syringe and vial of insulin and saying "this is 10 units of insulin glargine, is this correct?"
47
What is an example of correct double check?
Providing a second health care professional with the syringe, vial of insulin and the order or MAR and saying "would you check this for me?"
48
Why is qod no longer allowed to be used?
Can be mistaken for qid, which means 4 times daily and can cause a huge overdose
49
Why is lack of a leading zero problematic
Makes it hard to distinguish between 0.5 mg and 5 mg
50
How can we reduce error with look alike, sound alike medications?
By similar sounding medications from different manufacturers
51
What does tallman lettering do?
Highlights the part of the word that is different
52
What is confirmation bias?
- Accepting information that agrees with our hypothesis while rejecting information that does not - Clinicians see the name or dose with which they are most familiar and often don't question the order Ex. dimenhydrinate vs diphenhydramine - Results in medication errors
53
What is the CPOE?
Computerized prescriber order entry, prescribers put the order right into the electronic medical system
54
How does the CPOE eliminate errors?
- Addresses illegible orders - Avoids transcription errors - Alerts prescriber to allergies, inappropriate doses/frequency/route, drug interactions, etc.
55
What is BCMA?
Bar code medication administration, nurse scans the patients wristband, followed by the medication to be administered
56
How does the BCMA eliminate errors?
- Confirms the five rights of medications - Can be linked with clinical decision support to alter the nurse to important information such as allergies, vital signs, critical lab value
57
What is a guardrail?
- Smart pump technology - IV medications are administered through this - Medication picked, dose, volume, rate inputted by the nurse - Specific guardrail for each med
58
Which types of guardrails can you override?
Soft min/max
59
Which types of guardrails can you not override?
Hard min/max
60
How do guardrails help to prevent medication errors?
- Programmed into pumps to ensure medications are administered safely - Ensure administration of appropriate concentration, dose and rate - Very important for high alert medications
61
What don't guardrails prevent?
the nurse from administering the wrong medication
62
What references can you look prior to administering an unfamiliar medication?
- Institutional IV monographs - Compendium of pharmaceuticals and specialties (CPS) {helpful to identify medications, also tells you how the medication is supplied} - Micromedex {online, more comprehensive than CPS, not CAD specific) - Lexi-comp {online} - Your pharmacist {call!}
63
What information is given to you by an IV monograph?
- Use - Dosage - How its supplied/reconstituted - How long its stable for - Can you push it? - Does it need to be hung? - Compatibility - Adverse effects - Guardrails - Soft minimum/maximum - Hard minimum/maximum
64
What is a best possible medication history?
Process of obtaining a list of a patients prescribed and non-prescribed medications using a systematic process of interviewing the patient/family and reviewing at least one additional reliable information source
65
What should occur after immediate actions have been taken to ensure the care and safety of the patient after a near miss, medication errors, or adverse drug event?
- Proper documentation! - Chart in patients record - Safety occurrences report at HHS - Institute for safe medication practices (ISMP) - Serious or unexpected medication reactions or reactions to recently marketed products should also be reported to Health Canada
66
What is a root cause analysis?
- Comprehensive, systems based retrospective review of a critical medication error - Goal: to determine what happened, why it happened and how it can be prevented in the future - Conducted with an interdisciplinary group including persons involved in the medication error, front line staff and management - Impartial and sensitive to conflicts of interest - Includes relevant literature
67
What is failure mode and effects analysis (FMEA)?
- Systematic proactive approach to evaluate a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process in the greatest need of change - Failure modes: what could go wrong? - Failure causes: why would the failure happen? - Failure effects: what would be the consequences of each failure?
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