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44 Cards in this Set

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What is a medication misadventure?
Any medication related hazard or incident.

May involve omission or administration of one or more medications that could result in patient harm.
Range of effect (mild to fatal)
Outcome may or may not be independent of preexisting disease.
Attributable to error, immunologic, or idiosyncratic
What is an Adverse Drug Even (ADE)?
Includes all adverse drug reactions

Allergic or idiosyncratic reactions

Medication errors that result in patient harm .
What is an Adverse Drug Reaction?
Any Unexpected, unintended, undesired, or excessive response to a drug that results in action.
What is a Side Effect?
An expected, well known reaction that results in little to no change in patient management.
What is a medication error?
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the med is in control of the patient, professional, or consumer
What are the six steps in the Medication use process?
Prescribing
Transcribing/Documenting
Dispensing
Administering
Monitoring
Systems/Management Control
What is polypharmacy?
the use of many pharmacies by the patient.
What is involved in Prescribing?
Evaluation of the patient
establishing a need for medicine
Selection of the right medicine
Determining if a drug-drug interaction or allergic reaction could occur
Prescribing the medicine
what is involved in the transcribing/documenting process?
transcription of the prescription order
Transmission to the pharmacy
What is involved in the dispensing process?
the review of the prescription order
Confirmation of the transcription
contacting the prescriber to resolve discrepancies
Preparing the medicine
Distribution of the medicine
Educating the patient and/or healthcare professional about the medicine
What is involved in the process of Administration?
admin of the correct medicine to the intended recipient
Admin of the medicine when indicated
Review of warnings, interactions, and allergies
What is involved in the process of Drug Monitoring?
Assessment of the patient's response
Reporting and documentation of results
What is the impact of ADRs?
Accounts for 15% of hospital admissions

6.7%(2 million) have serious ADRs with a fatality rate of 0.32%

4th leading cause of death in hospitals
How many, and what are the names of the different types of ADRs?
6 types
Type A, B, C, D, E, and F
What is involved in a type A ADR?
Predictable, common, related to pharmacological effects

ex: toxicity

Management: reduce or withhold dose
What is a Type B ADR?
Unpredicatable, uncommon, not related to pharmacological actions of medication

Immunological (Immune system)

Idiosyncratic reactions

Management: Discontinue and avoid in the future
What is a Type C ADR?
Uncommon, Dose and Time related

Ex- chronic med use

Management: Reduce dose or discontinue medication
What is a Type D ADR?
Uncommon, Dose and time related, Delayed onset, associated with environmental and genetic factors

Ex. teratogenic effects

Management: Often intractable
What is a Type E ADR?
Uncommon, occurs following withdrawal of medication?

Ex- opioid withdrawal syndrome

Management: Reduce and withdraw medication slowly
What is a Type F ADR?
Common, dose-related, associated with drug interactions

Ex- inadequate dosage

Management: increase or decrease dosage
Consider effects or concomitant therapy
What are the three onset of ADR actions?
Acute: within 60 minutes
Sub-acute: 1-48 hours
Latent more than 2 days
what are the classification of severity of ADRs?
Minor:
Moderate:
Severe:
Lethal:
What type of treatment does a Minor ADR require?
no antidote, therapy, or prolongation of hospitalization required?
What type of treatment does a Moderate ADR require?
require change in drug therapy treatment or increase in hospitalization by 1 day
What type of treatment does a Severe ADR require?
potentially life threatening, causing permanent damage or requiring intensive medical care
What type of treatment does a Lethal ADR require?
directly or indirectly contributes to death
What are some mechanisms of ADRs?
Pharmacologic
Secondary pharmacologic side effect
Drug toxicity
Drug-Drug interaction
Drug overdose
Pseudoallergic
Idiosyncratic
Intolerance
What are the different mechanism types of ADR reactions?
Type 1: IgE-mediated
Type 2: cytotoxic
Type 3: immune complex of serum sickness
Type 4: delayed, cell-mediated
How are causality and probability of ADRs determined?
Using Algorithms:
Naranjo- most commonly used
Jones- series of yes or no questions
Kramer- scoring system similar to Naranjo
How is a Naranjo Algorithm interpreted?
9 or more: ADR is highly probable
5 to 8 mean: an ADR is probable
1 to 4: and ADR is possible
0 or less: an ADR is doubtful
What does an ADR interpretation of highly probable mean?
a clinical event that occurs in a plausible time relation to drug administration and which cannot be explained by concurrent disease or other drugs or chemicals
should ADRs be reported?
all healthcare professionals have a responsibility to inform colleagues and health care agencies about clinically important ADRs
Who can ADRs be reported to?
National Centers: FDA, WHO
Medwatch
JCAHO (requires all hospitals to have an internal ADR reporting program)
ASHP
Who is an ideal resource for developing an ADR program?
the pharmacy department
What is a medication error?
Any preventable event that may cause or lead to inappropriate medication use or patient harm.
What are the different types of medications errors (12)
1-Prescribing error
2-Omission error
3-Wrong time error
4-Unauthorized Drug error
5-Improper dose error
6-Wrong Dosage form error
7-Wrong drug preparation error
8-wrong administration technique error
9-Deteriorated Drug Error
10-Monitoring Error
11-Compliance Error
12-Other Medication Error
What are the four different types of results for medication errors?
No Error
Error no harm
Error harm
Fatal
What is the definition of harm?
temporary or permanent impairment if the physical, emotional, or psychological function or structure of the body and/or pain resulting from the use of a drug and requiring intervention
What is the definition of Monitoring?
to observe or record relevant psychological or physiologic signs
What is the definition of intervention?
May include chance in therapy or active medical/surgical treatment
What are different ways of reporting medication errors within an organization
incident reports
anonymous reports
observational reporting
"near miss" reporting
voluntary reporting
mandatory reporting
What are some National reporting programs for reporting medication errors?
USP-ISMP program (anonymous)
MedMarx (fee based, site specific)
JCAHO: review's organization response
What is involved in the people approach to medication error prevention strategies?
improve patient communication
improve intra-professional communication
improve education and training
improve reporting
What is involved in the system approach to medication error prevention strategies?
Reduce environmental factors that may contribute to performance lapses
Implement policies that support efforts to minimize medication errors
develop a system for identifying potential errors
improve technology
implement systems to foster reporting