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44 Cards in this Set
- Front
- Back
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What is a medication misadventure?
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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 |
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What is an Adverse Drug Even (ADE)?
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Includes all adverse drug reactions
Allergic or idiosyncratic reactions Medication errors that result in patient harm . |
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What is an Adverse Drug Reaction?
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Any Unexpected, unintended, undesired, or excessive response to a drug that results in action.
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What is a Side Effect?
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An expected, well known reaction that results in little to no change in patient management.
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What is a medication error?
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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
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What are the six steps in the Medication use process?
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Prescribing
Transcribing/Documenting Dispensing Administering Monitoring Systems/Management Control |
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What is polypharmacy?
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the use of many pharmacies by the patient.
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What is involved in Prescribing?
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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 |
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what is involved in the transcribing/documenting process?
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transcription of the prescription order
Transmission to the pharmacy |
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What is involved in the dispensing process?
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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 |
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What is involved in the process of Administration?
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admin of the correct medicine to the intended recipient
Admin of the medicine when indicated Review of warnings, interactions, and allergies |
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What is involved in the process of Drug Monitoring?
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Assessment of the patient's response
Reporting and documentation of results |
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What is the impact of ADRs?
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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 |
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How many, and what are the names of the different types of ADRs?
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6 types
Type A, B, C, D, E, and F |
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What is involved in a type A ADR?
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Predictable, common, related to pharmacological effects
ex: toxicity Management: reduce or withhold dose |
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What is a Type B ADR?
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Unpredicatable, uncommon, not related to pharmacological actions of medication
Immunological (Immune system) Idiosyncratic reactions Management: Discontinue and avoid in the future |
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What is a Type C ADR?
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Uncommon, Dose and Time related
Ex- chronic med use Management: Reduce dose or discontinue medication |
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What is a Type D ADR?
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Uncommon, Dose and time related, Delayed onset, associated with environmental and genetic factors
Ex. teratogenic effects Management: Often intractable |
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What is a Type E ADR?
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Uncommon, occurs following withdrawal of medication?
Ex- opioid withdrawal syndrome Management: Reduce and withdraw medication slowly |
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What is a Type F ADR?
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Common, dose-related, associated with drug interactions
Ex- inadequate dosage Management: increase or decrease dosage Consider effects or concomitant therapy |
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What are the three onset of ADR actions?
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Acute: within 60 minutes
Sub-acute: 1-48 hours Latent more than 2 days |
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what are the classification of severity of ADRs?
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Minor:
Moderate: Severe: Lethal: |
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What type of treatment does a Minor ADR require?
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no antidote, therapy, or prolongation of hospitalization required?
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What type of treatment does a Moderate ADR require?
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require change in drug therapy treatment or increase in hospitalization by 1 day
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What type of treatment does a Severe ADR require?
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potentially life threatening, causing permanent damage or requiring intensive medical care
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What type of treatment does a Lethal ADR require?
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directly or indirectly contributes to death
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What are some mechanisms of ADRs?
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Pharmacologic
Secondary pharmacologic side effect Drug toxicity Drug-Drug interaction Drug overdose Pseudoallergic Idiosyncratic Intolerance |
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What are the different mechanism types of ADR reactions?
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Type 1: IgE-mediated
Type 2: cytotoxic Type 3: immune complex of serum sickness Type 4: delayed, cell-mediated |
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How are causality and probability of ADRs determined?
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Using Algorithms:
Naranjo- most commonly used Jones- series of yes or no questions Kramer- scoring system similar to Naranjo |
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How is a Naranjo Algorithm interpreted?
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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 |
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What does an ADR interpretation of highly probable mean?
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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
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should ADRs be reported?
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all healthcare professionals have a responsibility to inform colleagues and health care agencies about clinically important ADRs
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Who can ADRs be reported to?
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National Centers: FDA, WHO
Medwatch JCAHO (requires all hospitals to have an internal ADR reporting program) ASHP |
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Who is an ideal resource for developing an ADR program?
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the pharmacy department
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What is a medication error?
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Any preventable event that may cause or lead to inappropriate medication use or patient harm.
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What are the different types of medications errors (12)
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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 |
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What are the four different types of results for medication errors?
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No Error
Error no harm Error harm Fatal |
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What is the definition of harm?
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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
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What is the definition of Monitoring?
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to observe or record relevant psychological or physiologic signs
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What is the definition of intervention?
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May include chance in therapy or active medical/surgical treatment
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What are different ways of reporting medication errors within an organization
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incident reports
anonymous reports observational reporting "near miss" reporting voluntary reporting mandatory reporting |
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What are some National reporting programs for reporting medication errors?
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USP-ISMP program (anonymous)
MedMarx (fee based, site specific) JCAHO: review's organization response |
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What is involved in the people approach to medication error prevention strategies?
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improve patient communication
improve intra-professional communication improve education and training improve reporting |
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What is involved in the system approach to medication error prevention strategies?
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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 |
