Introduction to Prescribing Flashcards
How many deaths occur per year due to prescribing errors in the UK?
1100
What proportional of medical admissions are complicated with medication errors?
1 in 10
Give 6 factors that could increase the rate of medication errors
- More rapid throughput of patients
- New drug developments, extending medicines into new areas
- Increasing complexity of medical care
- Increased specialisation
- Increased use of medicines generally
- Sicker and older patients
Why does increasing numbers of elderly patients cause problems with prescribing?
- More likely to have co-morbidities
- More likely to be on multiple drugs
- Have an increased risk of side effects
Why does clinical evidence not always identify the negative aspects of drugs?
- Usually test the drug in isolation
- Test in relatively healthier patients, and/or young volunteers initially
- Some side effects only come to light during post-marketing surveillance
Why are drugs tested on relatively healthier and/or younger patients?
To make sure the untested drugs cause the least harm
Why is testing new drugs on relatively healthier/younger patients problematic?
It is hard to extrapolate to the general population, which in itself may do harm
Why do some side effects only come to light during post-marketing surveillance?
Because many trials are small to save money, and therefore don’t pick up adverse effects
What is the problem with blind adherence to prescription guidelines?
There may be contraindications or serious interactions that are not picked up on if you don’t look at the patient as a whole
In what respects may medical schools inadequately prepare students for prescribing?
- Inadequate level of teaching
- Inadequate level of examining
How does the nature of the medical profession lead to prescribing errors?
- Shift work and reduced hours
- Lack of pharmacology training
- Too many students
How does shift work contibute to prescription errors?
- Sleep-deprived doctors have more attentional failures, and make more clinical errors and incorrect diagnoses
- Exhausion erases recent learning
- Poorer morale
How does reduced hours contribute to prescription errors?
- Lower exposure to teaching
- Working alone more often
- Less ward teaching and feedback
- Lack of continuity of care
Give a reason why prescription errors are more likely to occur when a doctor is on call
Rarely know the patient
What does a person approach say is responsible for medication errors?
Aberrant mental processes - ‘bad things happen to bad people’
