CPP Flashcards
is any preventable event that
may cause or lead to inappropriate medication use or
patient harm while the medication is in the control of
the health care professional, patient, or consumer.”
MEDICATION ERROR
A medication error that took place but has
been captured before reaching the patient
is termed as
NEAR MISS
FACTORS CONTRIBUTING TO
MEDICATION ERROR
HUMAN RELATED
SYSTEM RELATED
MEDICATION RELATED
HUMAN RELATED ERRORS
PROVIDER
PATIENT
over worked
under trainedcompetence
distracted
illness
stress PROVIDER
PROVIDER
health literacy level
in a hurry
patient compliance
trust providers to not make mistakes
PATIENT
lack of communication
poor workflow
no proper policy or guideline in place
disorganized workspace
inadequate tools to complete work
lack of supervision
SYSTEM RELATED ERRORS
look alike or sound alike medications
multiple dosage forms and strenghts
MEDICATION RELATED ERRORS
look alike or sound alike medications
multiple dosage forms and strenghts
TYPES OF MEDICATION
ERROR
PRESCRIBING ERROR
DISPENSING ERROR
ADMINISTRATION ERROR
TRANSCRIPTION ERROR
DOCUMENTATION ERROR
INDENT ERROR
as a result of a
prescribing decision or prescription writing process, there is an unintentional
significant (1) reduction in the probability of treatment being timely and effective
or (2) increase in the risk of harm when compared with generally accepted
practice”.
PRESCRIBING ERROR
PRESCRIBING ERROR Includes:
Incorrect Prescription
Illegible Handwriting
Drug allergy not identified
Irrational combinations
Out of list abbreviations
DISPENSING ERROR Includes:
Dispensing incorrect medication, dosage strength, or dosage form
Dosage miscalculations
Failure to identify drug interactions or contraindications
is a discrepancy between a prescription and the medicine that
the pharmacy delivers to the patient or distributes to the ward on the basis of this
prescription, including the dispensing of a medicine with inferior pharmaceutical
or informational quality
DISPENSING ERROR
This type of medication error involves a discrepancy between the drug therapy
received by the patient and the drug therapy intended by the prescriber.
ADMINISTRATION ERROR
Common causes of dispensing error includes:
Work environment
Outdated or incorrect drug references
Sound Alike and Look Alike Drugs (SALADs)
ADMINISTRATION ERROR Inncludes:
Errors of omission
Incorrect administration technique
Administration of incorrect or expired medication
Deliberate violation of guidelines
An error in the process of making an identical copy of prescription in the medical
records is called a transcription error.
TRANSCRIPTION ERROR
TRANSCRIPTION ERROR Includes:
Wrong drug
Wrong drug preparation
Wrong dose
Wrong time
Wrong frequency
Wrong route
DOCUMENTATION ERROR Includes:
Documentation before administration
No documentation
involves inconsistencies between the documented
medication and the actual medication that was given to the patient.
DOCUMENTATION ERROR
INDENT ERROR Includes:
Wrong dose
Wrong drug
Wrong strength
Wrong route
Wrong frequency
10 WAYS TO MINIMIZE MEDICATION
ERRORS
- Ensure correct entry of the prescription.
- Confirm that the prescription is correct and complete.
- Beware of look-alike, soundalike drugs.
- Be careful with zeros and abbreviations.
- Organize the workplace.
- Reduce distraction when possible.
- Focus on reducing stress and balancing heavy workloads.
- Take the time to store drugs properly.
- Thoroughly check all prescriptions.
- Always provide thorough patient counseling.
An error that occurs during the process of indenting, ordering of drugs, may be
classified as an indent error.
INDENT ERROR
are routinely encountered but remain underreported.
Medication errors
