L9. Improving Medication Safety.pdf

Improving Medication Safety Patient Safety Lecture no. 9 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  To provide an overview of Medication Safety Or patient safety (same term). To encourage studen...

Improving Medication Safety Patient Safety Lecture no. 9 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  To provide an overview of Medication Safety Or patient safety (same term). To encourage students to learn and practice ways to improve the safety of medication use. Knowledge requirement 1 Understand the scale of medication error. 2 Understand the steps involved in a patient using medication. 3 Identify factors that contribute to medication error. 4 Learn how to make medication use safer. 5 Understand the benefits of a multidisciplinary approach to medication safety. Dr said most of questions from this lecture will come as cases This lecture was presented by Dr. Afraa Alsafadi. For the required reading from Blackboard click here  Medication Error Medication use has become increasingly complex in recent times. Medication errors are a major cause of preventable patient harm. As future health-care workers, you will have an important role in making medication use safe. The drugs errors are the most common cause of medical errors in hospitals, affecting 3.7% of patients. Medication Error Very important keyword (Medication errors are preventable) Is any preventable event that may cause or led to inappropriate medication use or patient harm. Medication error may result in: 1 An adverse event if a patient is harmed 2 A near miss if a patient is nearly harmed Reached the patient Didn’t reach the patient A known effect, other than that primarily intended, relating to the Side effect of a pharmacological properties of a medication e.g. opiate analgesia often drug causes nausea. Adverse Unexpected harm arising from a justified action where the correct process was followed for the context in which the event occurred e.g. An unexpected reaction of a allergic reaction in a patient taking a medication for the first time. drug It’s neither a medication error or a side effect Adverse drug event An incident in which a patient is harmed. It includes both errors & side effects of the medication. Adverse drug event may: May not be preventable (e.g. the May be preventable (e.g. 1 Or 2 result of an adverse drug reaction the result of an error) or side-effect) So Adverse drug event is like an umbrella that underneath it is 1. Medication error 2. Side effect  Medication Prescription Steps in Using Medication: 1) Prescribing 2) Preparing & Dispensing 3) Administration 4) Monitoring Medication Use Process in The Institutional Setting Medication prescription is physician related Medication Prescription Choosing an appropriate medication ○ for a given clinical situation, taking individual patient factors into account, such as allergies. Selecting the administration ○ route, dose, time and regimen. Documentation Very important Communicating details of the plan with The administer is most likely the nurses ○ Whoever will administer the medication (written-transcribing and/or verbal) and the patient. Sources of Error in Prescribing 1) Inadequate knowledge about drug indications and contraindications. 2) Not considering individual patient factors such as allergies, pregnancy, comorbidities, other medications. Example for prescribing error Illegible Handwriting 3) Wrong patient, wrong dose, wrong time, wrong drug, wrong route. Mostly in 4) Mathematical error when calculating dosage. children & infants 5) Documentation: incomplete, ambiguous & dangerous abbreviation. 6) Inadequate communication (written, verbal). 7) Incorrect data entry when using computerized prescribing e.g. duplication, omission, wrong number.  Strategies to Reduce Prescribing Errors Avoid Illegible ○ Write/Print More Carefully Handwriting ○ Use Computers Depends on the hospital ○ Patient’s Name ○ Amount ○ Patient-Specific Data ○ Directions for Use Write Complete ○ Generic and Brand Name ○ Purpose Information ○ Drug Strength ○ Refills ○ Dosage Form ○ Age ○ Concurrent Medications Look at ○ Weight ○ Allergies Patient-Specific ○ Renal and Hepatic Function ○ Medical/Surgical/Family History Information ○ Laboratory Test Results ○ Pregnancy/Lactation Status ○ Drug names ○ “µg” for microgram (use mcg) Do Not Use ○ “QOD” for every other day ○ “QD” or “OD” for the word daily Abbreviations ○ Letter “U” for unit Example for Error Prone Abbreviations:  Strategies to Reduce Prescribing Errors Avoid whenever possible Never use a terminal zero Decimals ○ Use 500 mg for 0.5 g ○ Colchicine 1 mg not 1.0 mg ○ Use 125 mcg for 0.125 mg Space between name and dose ○ Inderal40 mg arrow → Inderal 40 mg Be alert to drug name ○ “Look-Alike” or “Sound-Alike” Drug Names: (use generic name. 1. Celebrex (celecoxib, anti-inflammatory) Rather than trade 2. Cerebyx (fosphenytoin, anticonvulsant) names) 3. Celexa (Citalopram, antidepressant) Learn and practice thorough medication history taking: ○ Include name, dose, route, frequency Write the Medication ○ Duration of every drug the patient is taking; Reconciliation ○ Enquire about recently ceased medications; ○ Ask about over-the-counter medications ○ Dietary supplements and complementary medicines; Need double check Examples: ○ Oral anticoagulants ○ Insulin Know the High ○ Chemotherapeutic agents Alert Medications ○ Neuromuscular blocking agents ○ Concentrated electrolytes ○ Emergency medications (potent and used in high pressure situations) More Attention to Use patient specific information Dosage Calculations ○ Height ○ Weight ○ Age ○ Body system function We need to know the patient’s height to calculate chemotherapy dosage ○ Avoid when possible ○ Pronouns slowly and distinctively Verbal Orders ○ State numbers like pilots (i.e., “one-five mg” for 15mg) ○ Spell out difficult drug names ○ Specify concentrations  Medication reconciliation form Extra medication reconciliation form is a document used to record and document an accurate and up-to-date list of all the medications a patient is taking Strategies to Reduce Dispensing Error Dispensing is related to pharmacist Note: Doctor went through it fast as it’s not related to physicians Standardized concentrations for all Use commercially Dispense a IV medication prepared solutions unit of use. Administration Obtaining the medication in a ready-to-use form; may involve counting, calculating, mixing, labeling or preparing in some way (inpatient). Checking for allergies The nurse is the 1st person to notice allergic reactions, and they have to be sure & continuously checking. Giving the right medication to the right patient, in the right dose, via the right route, at the right time. Documentation Everything should be documented so the physician need to be aware about it. How can drug administration go wrong? Wrong patient Wrong route Wrong time Wrong dose Wrong drug Omission, failure to administer Inadequate documentation  When prescribing & administering Remember the 5 Rs Nowadays it’s updates to the 7 Rs Check the name in the order & the patient, use two identifier & 1 Right Patient ask the patient to identify himself/herself. 2 Right Medication Check the medication label & order. Confirm that the patient can take or receive the medication 3 Right Route by the ordered route. Check the frequency of the ordered medication & Confirm 4 Right Time when the last dose was given. 5 Right Dose Confirm appropriateness of the dose using a current drug reference & calculation. Strategies to Reduce Administration Errors Administration is related to nurses Infusion tubing Be familiar with Preprinted and Use programmable should be traced from the institution standardized infusion device. the infusion bag to the policy. infusion rate charts point of delivery. Medication monitoring Monitoring involves:k Observing the patient to determine if the medication is working, being used appropriately and not harming the Patient. Documentation  How can monitoring go wrong? Lack of monitoring for side-effects Drug levels not measured, or measured but not checked or acted upon. Drug not ceased if not working, or Communication failures: course completed this is a risk if the care provider changes, for example, if the patient moves from the Drug ceased before course completed hospital setting to the Community setting or vice versa Which patients are most at risk of medication errors? Dr said there will be questions on this topic Children and babies (dose calculations required?) Patients on multiple medications Patients who have more than one doctor Patients with another condition e.g. renal impairment, pregnancy Patients who cannot communicate well Factors for Medication Errors Staff factors: Inexperience & Doing two things at the same time Interruptions Rushing Fatigue, boredom, or Lack of checking and Poor teamwork and/or stress communication double checking habits between colleagues  How can workplace design contribute to medication errors? Workplace: Absence of a safety culture in the workplace e.g. poor reporting systems and failure to learn from past near misses and adverse events Inadequate staff Absence of memory numbers aids for staff Ways to make medication use safer 1 2 3 Use generic Tailor Learn and practice prescribing names where collecting complete for individual appropriate patients medication histories 4 5 6 Be very familiar Use memory Know the high-risk with the aids & medications and medications you Communicate take precautions prescribe clearly 7 8 9 Remember the Develop checking Encourage patients 5 Rs when habits & Report to be actively prescribing and and learn from involved administering errors Summary ◎ Medications can greatly improve health when used wisely and correctly. ◎ Yet, medication error is common and is causing preventable human suffering and financial cost. ◎ Remember that using medications to help patients is not a risk-free activity. ◎ Know your responsibilities and work hard to make medication use safe for your patients.  Case studies Case 1 Recommended actions: Pharmacists/Technician should READ / CHECK carefully the label of each medication they prepare. DOUBLE CHECKING is essential tool to avoid such mistakes Look Alike medications should be stored separately with proper labeling to avoid such mistakes Case 2 A 38-year-old woman comes to the hospital with 20 minutes of itchy red rash and facial swelling; she has a history of serious allergic reactions A nurse draws up 10 mls of 1:10,000 adrenaline (epinephrine) into a 10 ml syringe and leaves it at the bedside ready to use (1 mg in total) just in case the doctor requests it Meanwhile the doctor inserts an intravenous cannula The doctor sees the 10 ml syringe of clear fluid that the nurse has drawn up and assumes it is normal saline. There is no communication between the doctor and the nurse at this time The doctor gives all 10 mls of adrenaline (epinephrine) through the intravenous cannula thinking he is using saline to flush the line. The patient suddenly feels terrible, anxious, becomes tachycardia and then becomes unconscious with no pulse She is discovered to be in ventricular tachycardia, is resuscitated and fortunately makes a good recovery Recommended dose of adrenaline (epinephrine) in anaphylaxis is 0.3-0.5 mg IM, this patient received 1mg IV. Can you identify the contributing factors to this error? 1. Assumptions 2. Lack of communication 3. Inadequate labeling of syringe 4. Giving a substance without checking and double checking what it is 5. Lack of care with a potent medication  MCQs Q1. Steps of using medications? A. Prescription- B. Presentation - C. Preparation - D. closure - Preparation dispensing- preparation dispensing- preparation administration - closure - administration - - administration - administration - prevention prevention Q2. Which types of medications should be included in the medication reconciliation? B. Prescription drugs , over the counter drugs C. Prescribed D. Oral medication A. Current medication and natural medication only supplements Q3. Which one from the following is considered a good way to make medication usage safer? D. Using the 5 Rs when A. Not considering C. Using abbreviations B. Using decimals prescribing and individual factors where appropriate administering Q4. Which ONE of the following goals in patient safety is for medication reconciliation? A. The reconciliation C. The resolution of B. The reconciliation of D. The clarification of of duplicated dosage, medication medications throughout patient’s medication to frequency and discrepancies in dose the patient’s stay the relatives description frequency Q5. A nurse transcribed an order for lisinopril 2.5mg P.O. for a patient who was transitioning from the ED (Emergency) to an inpatient area by copying the prescriber’s order as lisinopril 12.5mg P.O. daily. This event is considered as which of the following? A. Never event B. Sentinel event C. Late effect D. Medication error Q6. When do you have to fill medication reconciliation? A. At the time of B. At the time of C. At the time of D. At the time of admission, transfer, transfer to another receive patient in OR transfer to the ICU discharge hospital A1. A A2. B A3. D A4. B A5. D A6. A Click here For Anki cards Made by Nazmi A Alqutub  Team Leaders Aroub Almahmoud Remaz Almahmoud Lama Almutairi Team Members Farah Abukhalaf Nazmi M Alqutub Aljoharah Alkhalifah Areej Alquraini Aleen Alkulyah Moath Alhudaif Aryam Almsari Rahaf Alshowihi Mohammed Alqutub Sarah Alshahrani Aishah Boureggah Raghad Alqhatani Sultan Albaqami Lama Alotaibi Lama Alrushid Sarah Alajaji Haya Alzeer Faris Alzahrani [email protected]