Lecture 18 Flashcards
define adverse drug event
harm caused from medical
intervention relating to a drug
define adverse drug reaction
any response to a drug which is harmful and unintended
define drug allergy
Distinct subgroup of an adverse drug reaction
what is an adverse drug reaction - type A (augmented)
• 80% of ADRs in the hospital setting or causing admission
• Pharmacological effects that are predictable and dose dependent. The ADR is an exaggeration of the
normal effects of the drug
• Should be readily recognised by prescribers
• Can manage through dose
reduction, changing drug etc.
what is an adverse drug reaction - type B (Biazarre)
Account for ~10% of reactions
• High mortality
• Small population affected individual patient host factors are important
• Management requires stopping the offending drug and avoiding in the future
Adverese drug events in Australia
Medication related hospital admissions are estimated to comprise 2-3% of all Australian hospital admissions
• 230,000 hospital admissions in Australia annually
• $1.2 billion annual cost
• 20-30% of all admissions in those aged > 65 years are
estimated to be medication related
• ¾ are preventable
- Errors occur in 15-20% of drug administrations on hospital wards
what do medication errors result in?
- An adverse drug event if a patient is harmed
- A near miss if a patient is nearly harmed or
- Neither harm nor potential for harm
what do medication errors occur due to ?
- Failure at an individual (person) level
- Failure at a system level
- Combination of the two
when do medication errors occur?
- on admission
- 60-80% of patients have a medication discrepancy with their medication history
- prescribing errors (2.5%)
- adminstartion errors (5-10% of errors).
what patients are most at risk of medicaton errors?
• Patients on multiple medications
• Patients with another condition, e.g. renal
impairment, pregnancy
• Patients who cannot communicate well
• Patients who have more than one doctor
• Patients who do not take an active role in their own medication use
• Children and babies (dose calculations required)
what are the risk factors contributing to medication error
- Inexperience
- Rushing
- Doing two things at once
- Interruptions
- Fatigue, boredom, being on “automatic pilot”
- Lack of checking and double checking habits
- Poor teamwork and/or communication between colleagues
how can prescribing go wrong?
- inadquate knowledge
- not considering individual patient factors
- Wrong patient, wrong dose, wrong time, wrong drug, wrong route
- inadequate communication
- documentation (illegible)
- mathematical error
- incorrect data
What case study got prescribed the wrong medication?
- Mrs A
- methotrexate for arthritis
how to improve medication safety?
- improving prescribing
- electronic prescrbing
- tall man lettering
- standardised medical charts
