Introduction To Medication Safety PDF

INTRODUCTION TO MEDICATION SAFETY ○ Consider safeguards in promoting patient OUTLINE safety I. Patient Harm II. Patient Safety...

INTRODUCTION TO MEDICATION SAFETY ○ Consider safeguards in promoting patient OUTLINE safety I. Patient Harm II. Patient Safety THIRD WHO GLOBAL PATIENT SAFETY CHALLENGE III. Medication Without Harm IV. Strategic Framework of the Global Patient Safety MEDICATION WITHOUT HARM Challenge the goal is to reduce severe, avoidable V. Key Steps for Ensuring Medication Safety medication-related harm by 50% over the next five years (2017-2023), globally INTRODUCTION the challenge is to reduce their frequency and Health care interventions are intended to benefit patients, impact by tackling some of the inherent but they can also cause harm. weaknesses in the system Whatever intervention is provided by the ○ Swiss cheese model: identifies error and healthcare team, it will always be for the benefit of weakness the patient. prioritize three areas (based on most errors): However, we cannot go away with the harm in the ○ medication safety in high-risk situations hospital because we intervene or we do Emergency cases, uses HAM something about our patient and there will always ○ medication safety in polypharmacy be harmful effects. ○ medication safety in transitions of care PATIENT HARM STRATEGIC FRAMEWORK OF THE GLOBAL PATIENT most are preventable SAFETY adverse events is the 14th leading cause of morbidity and mortality in the world ○ Even if our intention is good, still, it can cause morbidity and mortality. same league as TB and malaria PATIENT SAFETY one of the most important components of health care delivery which is essential to achieve universal health coverage (UHC), and moving towards the UN Sustainable Development Goals ○ Promotes patient safety all over the world ○ all institutions have SGDs MEDICINE most common therapeutic intervention ○ Medication makers are at risk of having patient harm over half of which are prescribed, dispensed or sold inappropriately ensuring safe medication use and having the processes in place to improve medication safety should be considered 1. Healthcare Professionals HA, JA, AC, EC, RC, MC | 1 PHA6130 LEC: INTRODUCTION TO MEDICATION SAFETY ○ Education and training confirmed that the NSAID, which should have been ○ Communication and teamwork discontinued (deprescribed), had been continued by ○ Capability at point of care mistake. This time Mrs Garcia was given a medication ○ Incident reporting and learning list when she left the hospital which included all the 2. Medicines (plays a big role; responsibility of medications she needed to take and was advised about pharmacists) which medications had been discontinued and why. ○ Right product at point of care ○ Logistics, storage and disposal There was a lack of proper instructions ○ Naming, labelling, and packaging ○ Mrs. Garcia, 65 years old, requires a ○ Product quality, and safety caregiver due to her age and health 3. Systems and Practices of Medication conditions. ○ Leadership and governance ○ There is insufficient information regarding ○ Prescribing, preparation, and dispensing the prescription of the medication ○ Administration and patient monitoring ○ Even with existing safeguards in place, a ○ Monitoring and evaluation single error in medication or instruction 4. Patients and the Public can result in consequences for patient ○ Involvement of patient organization safety. ○ Reporting by patients ○ Patient engagement KEY STEPS FOR ENSURING MEDICATION SAFETY ○ Public awareness and medication literacy CASE SCENARIO Mrs Garcia, a 65-year-old woman, came to the outpatient clinic complaining of abdominal pain and dark stools. She had a heart attack five years ago. At her previous visit three weeks ago she was complaining of muscle pain, which she developed while working on her farm. She was given a non-steroidal antiinflammatory drug (NSAID), diclofenac. Her other medications included aspirin, and three medicines for her heart condition (simvastatin, a medicine to reduce her serum cholesterol; enalapril, an angiotensin-converting enzyme (ACE) inhibitor; and atenolol, a beta blocker). She was admitted to hospital as she developed symptoms of blood loss (such as 1. Appropriate Prescribing and Risk Assessment: fatigue and dark stools). She was provisionally ○ Involvement of pharmacists is crucial at diagnosed as having a bleeding peptic ulcer due to her this stage NSAID, and her doctor discontinued diclofenac and ○ It is recommended to suggest a proton prescribed omeprazole, a proton pump inhibitor. pump inhibitor from the start if asked. 2. Medication Review: Following her discharge, her son collected her ○ Conduct a thorough medication history to prescribed medicines from the pharmacy. Among the identify all current medications, including medicines, he noticed that omeprazole had been aspirin, that the patient is taking. started and that all her previous medicines had been 3. Dispensing, Preparation, and Administration: dispensed, including the NSAID. As his mother was ○ Ensure that during the dispensing process, slightly confused and could not remember exactly what the decision is made not to dispense the doctor had said, the son advised his mother that diclofenac if it poses a risk. she should take all the medications that had been 4. Communication and Patient Engagement: supplied. After a week, her abdominal pain continued and her son took her to the hospital. The clinic HA, JA, AC, EC, RC, MC | 2 PHA6130 LEC: INTRODUCTION TO MEDICATION SAFETY ○ Engage with the patient to prevent this was not adequately communicated either to confusion, especially if a caregiver is the other healthcare professionals (including the involved. nurse or the pharmacist) or to the patient 5. Medication Reconciliation and Care Transitions: initial presenting symptoms due to adverse effects ○ This step is important for patients being could have been identified earlier if she had been discharged from the hospital. warned about the risks ○ It involves coordinating care among ○ Communicate with the patient to avoid different healthcare providers, such as confusion, as well as with the caregiver if hospitals and clinics. the patient has one. APPROPRIATE PRESCRIBING AND RISK ASSESSMENT MEDICATION RECONCILIATION AT CARE Based on the case scenario of Mrs. Garcia TRANSITIONS Prophylactic aspirin and NSAID without a Medication Reconciliation - formal process in gastroprotective agent – gastrointestinal bleeding which health care professionals partner with NSAIDs - increase risk of cardiovascular events patients to ensure accurate and complete (the patient had heart attack 5 years ago) medication information transfer at interfaces of This is a good example of a high-risk situation care. requiring health care professionals to prescribe Diclofenac had led the patient to hospital responsibly after analysing the risks and benefits. admission, and was discontinued. ○ Prescribe responsibly to the patient Should have this been communicated at the time of discharge (in the form of a medication list or MEDICATION REVIEW patient-held medication record), this would have Polypharmacy can put the patient at risk of helped her and her caregivers adverse drug events and drug interactions when not used appropriately RELATIONSHIP BETWEEN MEDICATION ERRORS AND Based on the case scenario of Mrs. Garcia ADVERSE DRUG EVENTS Medication review was needed when aspirin and Medication-related harm is harm caused to a diclofenac was prescribed together patient due to failure in any of the various steps of The ACE inhibitor should be temporarily stopped the medication use process or due to adverse following blood loss and wait for it to be resolved drug reactions. before restarting ○ It is important to ask the patient what medicine s they are taking (take note all, whether OTC, prescription or supplements) ○ The more drugs the patient is taking, the more risk of adverse drug events DISPENSING, PREPARATION AND ADMINISTRATION This is a high-risk situation as the medication (diclofenac) has the potential to cause harm diclofenac was continued after discharge when the patient transitioned from hospital to home dispensing and its administration caused serious harm ○ Before the process of dispensing, we REFERENCES should have known that diclofenac PHA 6130 LEC MEDICATION SAFETY PPT & MA’AM shouldn’t have been dispensed. RAMOS’ DISCUSSION COMMUNICATION AND PATIENT ENGAGEMENT When Mrs. Garcia was severely ill due to gastric bleeding, the NSAID was discontinued HA, JA, AC, EC, RC, MC | 3  MEDICATION SAFETY IN HIGH-RISK SITUATIONS Medication harm can be reduced with OUTLINE appropriate prescribing, responsible use, and by implementing strategies I. High-risk Situations II. Medication Factors 3. System factors III. High-risk (High-alert) Medications May mga times na ang ginagamit ng A. Anti-infective agents doctors ay pounds instead of kilograms. B. Potassium and other salts or electrolytes of We should always double-check what is IV injection being prescribed and dispensed. C. Insulins Incorrect translation of prescriptions D. Narcotics and Sedatives E. Chemotherapeutic and Immunosuppressive MEDICATION FACTORS agents F. Heparins and other anticoagulants G. Other medications HIGH RISK (HIGH ALERT) MEDICATIONS IV. Provider and Patient Factor Drugs that bear heightened risk of causing V. Systems Factors (Work Environment) significant patient harm when they are used in error HIGH-RISK SITUATIONS The consequences of an error with these High-risk situations, in the context of medication safety, medications are clearly more devastating to relate to those circumstances which are associated with patients a significant risk of medication-related harm. In practice many medication errors may not result High-Risk situations are instances that causes in harm and although every medicine has risks significant risks of medication harm during use, medication-related harm can be The moment na uminom ka ng gamot, may times reduced with appropriate prescribing, responsible na magkakaroon ng ADR/ADE use, and by implementing strategies that minimize risks. Inherent risks of certain medications Highest prevalence rates are in children: with a Unsafe medication use processes child’s weight not recorded or incorrectly recorded ○ From prescribing, transcription, dispensing, being the most common error and administration, monitoring Commonest type of prescribing error: dosage Difficulty in complying with safe medication error practices in certain clinical scenarios (such as in Other prescribing errors: incorrect date of the case of emergencies) prescription and omissions of required May result in ADR or a medication error medications Warrant special mechanisms to prevent medication errors When they do occur, should include means of “A PINCH” identifying and intercepting them before they result in harm to the patient HIGH RISK MEDICINE EXAMPLES OF GROUP MEDICINES FACTORS THAT INFLUENCE MEDICATION SAFETY IN HIGH-RISK SITUATIONS A: Anti-infective Amphotericin Aminoglycosides 1. Medication factors There are medications that we categorize P: Potassium and other Injections of potassium, as high risks. Pag nagtatake yung patient electrolytes magnesium, calcium, mga high alert medications, may higher hypertonic sodium chance na at risk ang kanyang health. chloride 2. Provider and patient factors HA, JA, AC, EC, RC, MC | 1 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS C: Continuous I: Insulin All insulins Time-dependent - The more N: Narcotics (opioids) and Hydromorphone, you take the medication, other sedatives oxycodone, morphine higher risk of ADR D: Delayed Fentanyl, alfentanil, Delayed - Next generation remifentanil and analgesic ang maapektuhan patches Teratogenic E: End of Use Benzodiazepines, for Withdrawal effect example, diazepam, F: Failure midazolam Di effective ○ Risk factors: those with pre-existing renal Thiopentone, propofol and impairment, older persons, obese other short term individuals, patients with cystic fibrosis, anaesthetics neonates and children ○ Reduce their renal clearance that will result C: Chemotherapeutic Vincristine in renal damage agents Methotrexate ○ Rapid intravenous infusion of vancomycin Etoposide increases the risk of anaphylactic-like Azathioprine reactions ○ Anaphylaxis - shortness of breath, low H: Heparin and Warfarin blood pressure, namumutla anticoagulants Enoxaparin Rivaroxaban, dabigatran, Amphotericin B apixaban ○ Antifungal ○ Lipid-based form: have less severe toxicity Other High-risk medicines ○ Conventional form: may be inadvertently identified at local health substituted at an inappropriate dose, district/facility/unit level risking possible cardiotoxicity. Including which do not fit the above cardiorespiratory arrest categories ACTIONS TO REDUCE HARM ANTI-INFECTIVE AGENTS Aminoglycosides (amikacin, gentamicin, Aminoglycosides Doses (e.g. gentamicin) should streptomycin and tobramycin) and the be calculated based patient’s glycopeptide antibiotic (vancomycin) weight and renal function ○ May cause damage to hearing or the kidneys in a dose-related, type A adverse Vancomycin Improve safe use by providing drug reaction monographs ○ Aminoglycosides cause type A adverse drug reaction Amphotericin B Segregate storage areas ○ Types of adverse drug reactions: in the fridge for different A: Augmented formulations of Augmented means amphotericin dose-related ADR (lipid-based and Normal dose siya pero ang non-lipid based) effect ay overdose Use of cautionary labels B: Bizarre or warning signs to Bizarre means totally not remind staff about the related differences HA, JA, AC, EC, RC, MC | 2 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS - Insulin pens are more common POTASSIUM AND OTHER SALTS OR ELECTROLYTES nowadays compared to non-insulin FOR IV INJECTION syringes. Once the physician has Potassium chloride prescribed insulin, even if it’s the ○ diluted solution: used treat hypokalemia (to first time the patient takes insulin, avoid serious sequelae - cardiac arrest) the patient will already have an ○ concentrated solution: occasionally insulin pen. In the doctor’s clinic, administered in error, sometimes resulting the physician already informs the in fatal outcomes (death) due to severe patient on how to inject insulin. hyperkalaemia 2. use of abbreviations such as “U” or “IU” for ○ also used mistakenly for sodium chloride units, which when added to the (normal saline) solution prescription for the intended dose may ○ Ex: parenteral products like dextroses - cause it to be misread (e.g. “10U” misread their plastic bottles have similar as “100”) appearances/packaging and just vary in - Use "Units" in full instead of the color of their label so we have to be abbreviations careful in dispensing these products Potassium phosphate, magnesium and calcium ACTIONS TO REDUCE HARM salts and hypertonic sodium chloride ○ harm also occur as a result of prescribing Abbreviations, unclear instructions and administration of these electrolytes ambiguous doses should be avoided. Insulin syringes and well-titrated doses should be used. Prescribing by “brand ACTIONS TO REDUCE HARM name” and device could reduce error. In areas where high a protocol for safe storage, Some manufacturers produce concentrations are preparation and use should be insulin pens that differ from those necessary developed of other manufacturers, making the devices non-interchangeable. In general ward stock may be removed if not Once a patient starts using a necessary, replacement with specific insulin pen, they should premixed solutions could also be continue using it consistently until considered the regimen is completed. Potassium chloride should be stored storage physically separating insulin from ampoules and separately vaccines or LASA products premixed solutions readily identifiable from (Look-Alike-Sound-Alike Drugs) preparations with similar packaging counseling educate to identify symptoms of hyperglycemia and hypoglycemia encourage to take immediate corrective INSULINS measures or seek advice when needed Insulin-related harm is due to: Symptoms of Hypoglycemia: 1. complexity of dosing dizziness, weakness - often requires Insulin scales 2. variety of available products NARCOTICS AND SEDATIVES - cartridge, automatic insulin pen 3. pharmacology of the medicin buprenorphine, diamorphine, dipipanone, Two common errors: fentanyl, hydromorphone, meptazinol, 1. use of non-insulin syringes, which are methadone, morphine, oxycodone, papaveretum, marked in milliliters and not in insulin units, tramadol and pethidine to administer the dose - Not common HA, JA, AC, EC, RC, MC | 3 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS ○ nausea, vomiting, constipation and in Methotrexate, an anticancer agent severe cases respiratory depression or ○ Used in the treatment of rheumatoid respiratory arrest which may result in death arthritis and other autoimmune conditions ○ wide range of alternative opioids (some due to its immunosuppressive properties short-acting and others long-acting) make administered as a weekly rather the possibility of an error than daily dose ○ check that the intended dose of the resulted in bone marrow specific opioid is safe for the patient suppression, pulmonary ○ patients or caregivers should be educated complications and, in some cases, about how to use transdermal opioid even death medications (for cancer pain) correctly ACTIONS TO REDUCE HARM ACTIONS TO REDUCE HARM Administration processes should be in place to morphine and select correct product in the correct avoid wrong medication, dose, diamorphine dose route, concentration, duration or frequency IV morphine clear and easy protocols in Vincristine: IV administration (neonatal units) preparation and administration use Etoposide dose: when used of prefilled syringes from a central interchangeably, consider intravenous additive service and the weight smart pumps could be considered Prefilled syringes - already Prescription should be carried out to the same measured; less preparation standard as parenteral anticancer and dosing therapy and should be monitored in the same way opioid patches guidance for patients and caregivers HEPARINS AND ORAL ANTICOAGULANTS CHEMOTHERAPEUTIC AND IMMUNOSUPPRESSIVE Unfractionated heparin (UFH) AGENTS ○ Long chain heparin, high molecular weight Etoposide heparin ○ alkylating agent available in two different ○ used with monitoring of the blood using intravenous formulations the activated partial thromboplastin time etoposide base (aPTT) etoposide phosphate salt When heparin is used, the Take note when using these two monitoring parameter is aPTT interchangeably: These two have ○ There is a non-linear relationship between different weights the dose of UFH infused and the aPTT ○ 100 milligrams of the etoposide base is ○ overdosing is associated with an increased equivalent to 113.6 milligrams of etoposide risk of hemorrhage phosphate ○ most common medication associated with Vincristine prescription errors (in a Brazilian study) ○ used to treat certain leukemia, lymphomas, Low molecular weight heparins (LMWH) and some solid tumors, such as breast and ○ administered subcutaneously, excreted lung cancer unchanged in the urine ○ CAUTION: injections are intended for ○ Precaution: safe and effective dose is intravenous administration only determined by the patient’s weight and ○ intrathecal administration has caused renal function severe ascending ○ underdosing risks inefficacy while radiculomyeloencephalopathy, which is overdosing may increase the risk of almost always fatal hemorrhage HA, JA, AC, EC, RC, MC | 4 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS Warfarin, phenindione, acenocoumarol antagonists undertaken and (nicoumalone) and phenprocoumon documented, and repeated ○ orally active vitamin K antagonists, for the on an annual basis treatment and prevention of thrombosis, discuss the risks, benefits cause hemorrhage and implications of long-term ○ should be monitored throughout treatment warfarin treatment using the international normalized ratio baseline prothrombin time (INR) (or INR) should be ○ There is a difference in monitoring heparin determined and measured and warfarin regularly Warfarin: INR anticoagulant treatment Heparin: aPTT booklets may be issued to all patients, an alert card to be Warfarin carried at all times ○ one of the medications most commonly there should be a reliable associated with medication errors leading follow-up system to severe harm including death ○ one of the 10 medications most frequently NOACs/DOACs in-depth knowledge of its related to dispensing errors pharmacology and clinical Newer oral anticoagulants (NOACs), also known use is needed as Direct-acting oral anticoagulants (DOACS): risk assessment should be including apixaban, dabigatran, edoxaban and undertaken rivaroxaban before prescribing, ○ agents acting directly on clotting factor II or creatinine clearance should X be calculated (e.g. using the ○ cause hemorrhage Cockcroft Gault equation and ○ commonest error associated with all oral ideal body weight) renal anticoagulant therapy was the omission of function should be a dose (since the administration is oral, monitored at least annually hinahayaan na lang ang patients to take individual patient bleeding this at home– thus the omission) risks should be considered counsel patients and ACTIONS TO REDUCE HARM caregivers UFH all patients should have a OTHER MEDICATIONS baseline aPTT performed These medications have higher risk before initiation of therapy NSAIDs platelet counts should also be measured just before ○ may cause gastrointestinal effects (e.g. therapy ulceration) and cardiotoxicity (including exacerbation of heart failure, worsening of regular monitoring of platelet hypertension and myocardial infarction due counts may be required if to increased thrombotic risk administered for longer than four days ○ rarely precipitate renal failure Paracetamol LMWH weight of the patient is used to ○ one of the most widely used calculate the treatment dose over-the-counter medicines required renal function should be ○ responsible for a high rate of medication taken into account errors in children, including several instances of dose-related liver failure Vitamin K a risk assessment should be HA, JA, AC, EC, RC, MC | 5 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS ○ high risk due to its high accessibility, proton pump inhibitors in among teenagers, who may overdose; those with risk of gastric although fatal outcomes are rare, it can bleeding or when used for only lead to liver failure. long-term treatment of Lithium salts osteoarthritis, rheumatoid ○ used in the treatment of psychiatric arthritis andlower back pain disorders, including the treatment and prevention of mania, bipolar disorder and Paracetamol for pediatric liquid, extra recurrent depression attention should be paid to ○ have a narrow therapeutic index, serum the dosing instructions, use lithium concentrations can be regularly of the correct measuring monitored device and concentration ○ may cause gastrointestinal and central nervous system disturbances and cardiac Lithium should be monitored conduction disturbances blood test results should be ○ interfere with kidney and thyroid function communicated between ○ special consideration is required for laboratories and prescribers women of childbearing age, so a track serum lithium levels pregnancy test should also be performed blood tests are monitored can have congenital effects, regularly particularly when used during the first trimester Antibiotic For Penicillin previous adverse drug Penicillin allergy reactions should be elicited, ○ most severe allergic reaction is anaphylaxis documented and considered prior to prescribing, dispensing and diuretics, cardiac glycosides and neuroleptics administering ○ high-risk (high-alert), particularly in certain patient groups especially for elderly KEY STRATEGIES FOR MEDICATION SAFETY ○ included in the Screening Tool of Older Person’s Prescriptions (STOPP) criteria to enhance patient safety by recommending the discontinuation of inappropriate prescriptions for older patients. ACTIONS TO REDUCE HARM NSAIDs review the appropriateness especially in people who are at higher risk of gastrointestinal, renal and cardiovascular morbidity and mortality (e.g. older people). if needed, use ibuprofen (1200 milligrams a day or less) or naproxen (1000 milligrams a day or less) use the lowest effective dose and the shortest duration of treatment consider co-prescribing HA, JA, AC, EC, RC, MC | 6 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS PROVIDER AND PATIENT FACTOR benefit (overall or relative to another medication) in a HEALTH CARE PROFESSIONALS particular individual involved in prescribing, ensuring safe storage, preparation, dispensing, administration and Underprescribing when a medication is not monitoring of medications - different steps of the prescribed whose likely medication use process benefit greatly exceeds the vital that there is good communication between risk of harm different groups interprofessional education- may help healthcare Misprescribing when either the wrong professionals learn to work better together to medication is prescribed or promote patient safety the wrong dose, route, ○ collaboration frequency or duration of administration is chosen PRESCRIBING PARTNERSHIP 3 professionals involved: PRESCRIBING ERRORS 1. Physician reduced through training, experience and practice 2. Pharmacist there is no room for error during prescribing and 3. Nurse thus it is important to train future doctors in the act of prescribing, dispensing, and administering a science of prudent prescribing medicine, involving several health care professionals, with the patient necessarily being a MEDICATION HISTORY TAKING part of, and in the centre of achieved through proper training of workforce and use of appropriate tools physicians omitted medicines or doses more often in comparison with their pharmacist colleagues, probably because the latter used a structured form to collect the information differences may also occur between specialties within a single health care profession PATIENTS Major predictors of medication error risks: 1. Age 2. Polypharmacy 3. Multimorbidity 4. High-risk medical conditions Prescribing - physicians Storage, dispensing, and preparation - AGE pharmacists Administration - nurses These 3 professionals must communicate and Older People group of frail patients who are collaborate together with the patient likely to be receiving several medications concomitantly, THREE (3) FORMS OF POOR PRESCRIBING adding to the risk of adverse drug events the harm of some of Overprescribing when a medication is medication combinations may prescribed whose risk of sometimes be synergistic and harm exceeds its likely be greater than the sum of the HA, JA, AC, EC, RC, MC | 7 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS risks of harm of the individual agents HEALTHCARE PROFESSIONALS 1. Systems approach Neonates (particularly premature to counter the effects of human fallibility neonates) elimination routes concentrates on the conditions under through the kidney or liver which people work may not be fully developed build the defenses required to avert errors Outcomes involving high-risk or limit their effects (high-alert) medications will be more severe in these 2. Education groups. they should be made aware of the importance of establishing an accurate Children medication errors resulting medication history and allergies covering from miscalculations have both prescribed and non-prescribed been reported in a pediatric medications intensive care setting history of allergy to any previous the risk of medication errors medication should be elicited was greater in those below interprofessional education can be used to the age of 15 years and in improve communication within different those aged over 64 years professional teams training prescribing competency to meet a POLYPHARMACY similar basic prescribing standard before they begin clinical practice the risk of medication (prescribing or monitoring) prescribing, dispensing, administration and errors in the was related to the number of unique monitoring of medicines should be the medication items prescribed subject of audit and clinical review MULTIMORBIDITY 3. Medication Reconciliation mental-physical multimorbidity was associated pharmacy-led medication reconciliation on with an increased risk for “active patient safety hospital admission may also have incidents” and prescribing errors economic benefits ○ Cheaper HIGH-RISK MEDICAL CONDITIONS ○ Pharmacists are more thorough in reviewing medications Renal or Hepatic (where both kidney and liver can PATIENTS Dysfunction and be compromised together) Should be made aware of the purpose of all Cardiac Failure medications taken, their likely benefits and dose-related ADRs (type A potential risks reactions) may occur ○ Teach patients to be reflective and to ask chronic conditions in which question polypharmacy is common predispose patients to 5 MOMENTS FOR MEDICATION SAFETY drug–drug interactions or drug– disease interactions Each moment includes self-reflective questions 1. starting a medication Pregnancy and predispose people to a high 2. taking my medication Poor Hydration risk of medication-related 3. adding a medication Status harm 4. reviewing my medication 5. stopping my medication STRATEGIES TO REDUCE MEDICATION ERRORS HA, JA, AC, EC, RC, MC | 8 PHA6130 LEC: MEDICATION SAFETY IN HIGH-RISK SITUATIONS Medication plan - should be discussed with the STRATEGIES TO REDUCE MEDICATION ERRORS patient and the patient should agree to follow that reduce interruptions during prescribing, plan, with the emphasis on joint decision-making dispensing, preparing and/or administering ○ Pharmacist must review the medication medication plan of patients checking every stage of preparing and Recognize intellectual disabilities - limited administering IV medications language proficiency, lower levels of education, ○ most likely the reconstitution step and misperceptions of illness severity ○ provision of pre-prepared injections may reduce error SYSTEMS FACTORS INFLUENCING MEDICATION ○ Common mistakes of pharmacists are SAFETY during IV preparation standardization of chart design ENVIRONMENT ○ electronic prescribing (reduce prescribing prescribing error rates were higher in hospitalized errors, completely eliminated illegible patients than in the community prescriptions) ○ Because more medications are taken in the hospital and parenteral dosage form ACCESS TO HIGH-QUALITY PRESCRIBING ADVICE is very common 1. Prescribing assessment tools adverse drug events during hospitalization remain Beers Criteria (for potentially inappropriate common medication use in older adults) anticoagulant-related adverse events still occurred STOPP criteria (for potentially inappropriate during hospitalization, despite mostly being medications) preventable, since they were often related to ○ For stopping inappropriate medications dosage errors START (Screening Tool to Alert Doctors to Right Treatment) criteria (for potentially beneficial ENVIRONMENT treatments in older people) ○ For starting beneficial treatments in older Hospitals Error-provoking conditions: people busy or understaffed, contributing to inadequate 2. Tables or software on drug–drug interactions, and supervision or failure to interactions with traditional and complementary remember to check important medication information assist health care professionals to better address interruptions during critical problems related to complex polypharmacy and processes reduce risk to patients tiredness and the need to ○ Example of softwares: Lexicomp, multitask when busy or drugs.com flustered ○ Some doctors are REFERENCES complaining because PHA 6130 LEC MEDICATION SAFETY IN HIGH-RISK of their 24-hour duty SITUATIONS PPT & MA’AM RAMOS’ DISCUSSION problems may be compounded by poor chart design Certain anesthesia setting: specialties administration errors (omissions, incorrect doses, and substitutions) are a particular problem HA, JA, AC, EC, RC, MC | 9