chapter 14

Question 1

Institute for Safe Medication Practices (ISMP):

Answer 1

A nonprofit organization devoted entirely to promoting safe medication use and preventing medication errors; it gathers information on drug errors and suggests new, safer standards to avoid such errors.

Question 2

MedMARx:

Answer 2

A national Internet-accessible database that hospitals and health care systems use to track adverse drug reactions and medication errors.

Question 3

MedWatch:

Answer 3

A program established by the US Food and Drug Administration (FDA) for reporting drug and medical product safety alerts and label changes; the program also provides a voluntary adverse event reporting system for medications, medical products, and devices.

Question 4

National Academy of Medicine (NAM):

Answer 4

Previously known as the Institute of Medicine (IOM), established under the National Academies, and a part of the National Academy of Sciences, this nonprofit organization provides scientifically informed analysis and guidance regarding health and health policy; projects include studies of drug safety systems in the United States and recommendations for patient safety.

Question 5

Risk evaluation and mitigation strategy (REMS):

Answer 5

A strategy for managing a known or potential serious risk associated with a drug or biological product.

Question 6

Society for the Education of Pharmacy Technicians (SEPhT):

Answer 6

A national pharmacy technician organization that promotes the education and training of pharmacy technicians; it provides links to medication safety and quality practices for technicians.

Question 7

United States Pharmacopeial (USP) Convention:

Answer 7

An independent organization that strives to ensure the quality, safety, and benefit of medicines and dietary supplements by setting standards and certification processes.

Question 8

(High-Alert Medications)
Acute care settings:

Answer 8

• Epinephrine, subcutaneous
• Epoprostenol (Flolan), IV
• Insulin U-500 (special emphasis)*
• Magnesium sulfate injection
• Methotrexate, oral, nononcological use
• Nitroprusside sodium for injection
• Opium tincture
• Oxytocin, IV
• Potassium chloride injection concentrate
• Potassium phosphates injection
• Promethazine, IV
• Vasopressin, IV or intraosseous

Question 9

(High-Alert Medications)
Community and ambulatory health care settings:

Answer 9

• Carbamazepine
• Chloral hydrate liquid, for sedation of children
• Heparin, including unfractionated and low-molecular-weight heparin
• Metformin
• Methotrexate, nononcological use
• Midazolam liquid, for sedation of children
• Propylthiouracil
• Warfarin

Question 10

Five rights of medication safety:

Answer 10

1.The right patient,
2. The right medication,
3. The right dose,
4. The right route,
5. The right time.

Question 11

What constitutes an error?

Answer 11

An error is any type of preventable event that may cause or lead to inappropriate medication use or patient harm. Patients themselves cause many drug errors when taking their own medications at home. They may take their medications at the wrong time, in the wrong amount, in the wrong combination, or with an improper administration technique.

Question 12

Types of Medication error:

Answer 12

1. Compliance error,
   2.Deteriorated drug error,
   3.Improper dose error,
   4.Monitoring error,
   5.Omission error,
   6.Prescribing error,
   7.Unauthorized drug error,
   8.Wrong administration,
   9.Wrong dosage form,
   10.Wrong drug preparation,
   11.Wrong time error.

Question 13

(NOTE):
Medication errors can be broken down into three main categories: prescribing errors, dispensing errors, and administration errors.

Question 14

(NOTE):
An alternative to a handwritten prescription is a new technology called e-prescribing. Prescriptions can be sent by computer or mobile device directly to the pharmacy, where they can be easily and quickly interpreted.

Question 15

(NOTE):Each year, in an effort to reduce confusion between drug names that look alike or sound alike (LASA), the US Food and Drug Administration (FDA) reviews approximately 300 drug names before they are allowed to enter the market.

Question 16

(NOTE):The ISMP and The Joint Commission (TJC) promote the use of tall man lettering as one means of reducing confusion between similar drug names. Tall man lettering uses mixed case letters to draw attention to the dissimilarities in look-alike drug names.

Question 17

(NOTE):
Drug companies are urged to make changes in the labeling of any type of medication that can be confusing or misinterpreted. The use of color coding, tall man lettering, and boldface lettering can help make drug selection errors less likely.

Question 18

(NOTE): The probability of drug-drug interactions is increased in seniors and severely ill patients because of the multiple medications they often receive. Seniors may have multiple conditions that are treated concurrently.

Question 19

(NOTE):
Anticoagulants, such as warfarin, have the potential for many interactions with drugs, food, and dietary or herbal supplements. Certain warfarin interactions can be deadly. Warfarin is given to prevent clots that can cause strokes or heart attacks; the prothrombin time (PT) and the international normalized ratio (INR) must be maintained at a specific level to ensure that blood clots do not form and that the patient does not bleed internally.