Medical Safety

Question 1

What is any type of preventable error that occurs anywhere in the course of medication treatment from prescribing to patient receiving medication?

Answer 1

medication error

Question 2

What is any injury resulting from any use of a medication?

Answer 2

adverse drug event

Question 3

What is a subset of ADEs where a non-preventable injury occurs when using the correct drug at the correct dose for the correct purpose?

Answer 3

adverse drug reaction

Question 4

Will all medication errors cause harm to patients?

Answer 4

no, medication errors are more common but less likely to cause harm

Question 5

What are the most common medication errors in primary care practices?

Answer 5

prescribing errors

Question 6

What percentage of medication errors are due to prescribing errors?

Answer 6

70%

Question 7

What is the system that is put in place to help prevent ADEs?

Answer 7

1. ordering and prescribing
2. transcribing
3. dispensing
4. administration

Question 8

What does the clinician make sure when they are ordering and prescribing medication?

Answer 8

making sure what is being prescribed is the correct medication

Question 9

What happens when the prescription is being transcribed?

Answer 9

pharmacists, pharm techs, etc are making sure they transcribe the prescription correctly

Question 10

What occurs when medication is being dispensed?

Answer 10

person dispensing makes sure to check for any allergies, appropriate quantity, to the correct patient, ADEs, etc

Question 11

What are the top 3 causes of medication errors?

Answer 11

1. lack of drug knowledge
2. lack of patient information
3. rule violations

Question 12

What are other causes of medication errors other than the top 3?

Answer 12

-slips and memory lapses
-transcription errors
-faulty drug identity checking
-faulty interaction with other services
-faulty dose checking
-infusion pump and parenteral delivery problems
-inadequate patient monitoring
-drug stocking and delivery problems
-preparation errors
-lack of standardization

Question 13

What are some common problems associated with drug knowledge?

Answer 13

-deficient knowledge of doses
-incorrect calculations
-errors in measurements or concentration

Question 14

What can lead to a lack in drug knowledge?

Answer 14

-out of date references
-computer system failure (or heavy reliance on computers)
-no pharmacist access
-handwritten charts, prescriptions

Question 15

What should be easily accessible and understandable to the user?

Answer 15

patient information

Question 16

What are the key pieces of information that should be included in patient information?

Answer 16

-height
-weight
-age
-pregnancy, breastfeeding
-lab values
-allergies
-current medications
-comorbidities

Question 17

What can lead to rule violations?

Answer 17

-workarounds (knowing there is a system in place but working around them)
-increased demands on productivity-shortcuts
-too many red rules leading to “rule fatigue”
-unclear expectations

Question 18

What are some ADE risk factors?

Answer 18

-polypharmacy (lots of medications)
-elderly
-pediatric
-poor health literacy

Question 19

50% of ADE related ER visits in elderly are due to what?

Answer 19

-antidiabetic agents
-oral anticoagulants
-antiplatelet medications

Question 20

What are examples of medication misuse?

Answer 20

-improper use
-overuse
-underuse
(at this point it is the patents fault for medication misuse)

Question 21

What is the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen?

Answer 21

compliance/adherence

Question 22

Why wouldn’t a patient take their medication?

Answer 22

-forgetting
-not wanting to
-being uneducated
-price

Question 23

What do not correlate with likelihood of compliance?

Answer 23

isolated demographics

Question 24

What are the isolated demographics that do not correlate with the likelihood of compliance?

Answer 24

-age
-sex
-education level
-intelligence
-income
-personality

Question 25

What are some barriers to compliance?

Answer 25

-patient-provider relationship
-patient must perceive they are susceptible to a disease which might have serious effect (benefit>cost)
-physical or psychological illness
-social support
-health literacy
-language barriers
-elderly
-complexity, length of regimen
-stigma associated with illness/treatment
-side effects
-cost/access issues
-homelessness or unstable living situation

Question 26

As a patient, what questions would they be thinking that could impact the patient-provider relationship?

Answer 26

-do i think my provider is competent
-does my provider take time with me and care
-do i understand what my provider is saying

Question 27

As a provider, what questions would I be thinking that could impact the patient-provider relationship?

Answer 27

-do i understand my patient’s lifestyle
-does my patient have any physical or social barriers
-have i included my patient in decision making
-did i ask my patient if they are willing to adhere to this therapy

Question 28

What are the components associated with elderly patients being a barrier to compliance?

Answer 28

-changes in metabolism (side effects)
-finances
-dexterity, mobility
-polypharmacy

Question 29

What are some strategies to improve compliance?

Answer 29

-listen to patient and ask questions
-be sensitive to what you are asking your patient to do
-employ the help of caregivers or a third party if patient cannot mentally or physically care for themselves
-keep written directions/instructions at the 6th grade level or lower
-utilize interpreter services
-educate patient and involve them in decision making
-use open-ended questions to assess patient’s understanding
-provide simplest regiment for shortest duration possible
-use memory aids, pill boxes
-talk with patients about affordability of medications
-adjust care for religious beliefs, cultural differences, and access issures

Question 30

What is an order for medication that is dispensed to and for the ultimate user? (patient is in charge of it)

Answer 30

a prescription

Question 31

What is an order for medication that is dispensed for immediate administration to the ultimate user? (patient has to immediately take it)

Answer 31

medication order

Question 32

Who can issue a prescription?

Answer 32

1. physicians (MD/DO)
2. within the terms of collaborative/supervisory agreement:
   **nurse practitioners
   **physician assistants
   **pharmacists
3. limited scope of practice
   **dentists
   **optometrists
   **podiatrists
   **veterinarians

Question 33

A prescription, to be valid, must be issued for a ________________ by an individual prescriber ______________________

Answer 33

1. a legitimate medical purpose
2. acting in the usual course of his/her professional practice

Question 34

An order purporting to be a prescription issued not in the usual course of bona fide treatment of a patient is what?

Answer 34

not a prescription

Question 35

All outpatient prescriptions issued by a prescriber shall:

Answer 35

1. be dated on day when issues
2. contain full name, professional title, and address of prescriber
3. telephone number where prescriber can be contacted
4. full name and residential address of patient
5. drug name and strength
6. quantity to dispense
7. appropriate and explicit directions for use
8. number of times or period of time for which the prescription may be refilled
9. identify trade or generic name of drug(s) in compounded prescription

Question 36

All prescriptions issued on paper to a patient by a prescriber shall be:

Answer 36

manually signed on day issued by prescriber

Question 37

What is the anatomy of a prescription?

Answer 37

1. dated as of and on the date of issuance
2. full name, title, phone number, address of prescriber
3. full name and residential address of patient
4. drug name and strength
5. quantity to dispense
6. appropriate and explicit instructions
7. number of refills; if nothing is indicated, no refills given
8. signed as the prescriber would sign a check