Exam 1 - Basic Error Prevention, Errors of Omission, & REMS Programs Flashcards

Question

What are errors of omission?

Answer 1

Leaving out crucial info

Answer 2

Prescribing Transcribing Med labels Pt charts

Answer 3

Potentially for the person writing the order On the other hand, it can be misinterpreted or cause confusion

Answer 4

Creating shortened versions of drug names that are easily misinterpreted

Answer 5

Abbreviations for drug names Anything for the word daily U µg sq or sc A/ or & cc D/C

Answer 6

The word and

Answer 7

Discontinue or discharge

Answer 8

Prescribers should use metric system USP doesn’t recognize apothecary system

Answer 9

Apothecary: - dram (mistaken for tbsp) - grain Metric: gram

Answer 10

Apothecary: minims Metric: mL

Answer 11

Apothecary: one-half (ss)

Answer 12

Major source of errors Easily missed, especially on lined order sheets, carbon copies, or faxes Avoid using decimal places when not mandatory

Answer 13

Use 500 mg instead of 0.5 g Use 125 mcg instead of 0.125 mg

Answer 14

ALWAYS use leading 0 for values less than 1 Ex. 0.1 not .1

Answer 15

NEVER use when not necessary Ex. 10 not 10.0

Answer 16

Route Strength Qty

Answer 17

Vagueness Ex. Continue all meds, resume all home meds

Answer 18

Poor communication of medical info at transaction points is responsible for up to 50% of all med errors and up to 20% of ADEs in hospitals

Answer 19

Requires hospitals to reconcile meds across the continuum of care

Answer 20

Hospitals Ambulatory care Assisted living Behavioral health Home care/long term care orgs

Answer 21

Errors are likely when orders are put on hold w/ no explicit directions for restarting If they don’t have resume instructions, discontinue them

Answer 22

May inadvertently not be resumed May be resumed too soon Easily forgotten about and not restarted when appropriate Some systems can generate daily summary of current prescribed therapies and recently discontinued meds

Answer 23

Delay of med admin Delay of overall care

Answer 24

Workflow is interrupted, increasing the chance of errors

Answer 25

Avoid illegible handwriting Reduce variation in how care is provided to pts

Answer 26

Should be based on institution/dept (NOT individual prescribers) Printed forms providing a list of meds to choose from should be avoided (easy to circle the wrong one) Often include meds that cover all possible scenarios and every pt may not need every med option

Answer 27

Errors are likely Person taking the order may assume whoever is calling it in heard the prescriber right and is pronouncing everything right

Answer 28

Lay person may attempt to call in rx for med (often controlled) Be suspicious when an unknown prescriber calls in an rx: - get call back # - verify # or call to verify rx if there is concern

Answer 29

Limit spoken orders to those for true emergencies Always read back order Confirm dose by expressing # as single digits Prohibit certain high alert meds from being verbal orders Have 2nd person listen when possible Require mg/kg for all neonatal/peds scrips Both prescriber & receiver should spell unfamiliar drug names w “t as in tom” Immediately transcribe spoken orders to rx or chart (scrap paper creates opportunity for error)

Answer 30

Usually dispensed prior to computerized safety checks such as drug interactions, duplicate therapies, allergies, contraindications Often dispensed by physicians without an independent double check by another HCP Pt might not get written instructions or instructions might not be near the med Packaging can be confusing Can be overlooked in recalls/exp date checks Unsecured storage allows unauthorized access

Answer 31

Phenomenon of a clinician becoming victimized by an unanticipated adverse medical event (pt is primary victim, clinician is secondary)

Answer 32

- Treatment that is just - Respect - Understanding and compassion - Supportive care - Transparency and the opportunity to contribute

Answer 33

Stage 1: emotional first aid provided by a trusted colleague or mentor Stage 2: support by trained peers Stage 3: support by mental health professionals

Answer 34

Post-incident immediate discussion to allow the involved to debrief in time following incident before returning to work Trusted colleague/mentor should strive to normalize the providers feelings by recognizing that all providers are human

Answer 35

Be in a private place away from the clinical event as soon as safely possible Use open ended questions like “how are you feeling” or “do you want to talk about it” Listen and allow them to control the conversation Give the provider time alone to collect their thoughts before returning to clinical duties — some providers may need to leave the worksite

Answer 36

Administered by specific coworkers who are trained in mentoring and supporting peers after an adverse/traumatic event Trained peer will follow up in the days and weeks following the incident to ensure providers wellbeing and referral for other support as needed

Answer 37

Should be available to ALL clinical employees and is encouraged if the providers 2nd victim symptoms interfere w/ professional/personal lives, or if symptoms fail to improve/worsen over time

Answer 38

Drop out Survive Thrive

Answer 39

Provider leaves current job, specialty, or clinical care altogether

Answer 40

Provider stays at current employment but is haunted by event and continues to have long lasting SVS symptoms

Answer 41

Provider adopts a growth mindset and uses the experience to better the systems process to benefit future pts

Answer 42

Drug safety program that the FDA can require for certain meds that have serious safety concerns Helps ensure the benefit outweighs risk

Answer 43

Reinforce med use behaviors/actions that support safe use of that med Focuses on preventing, monitoring, or managing a specific serious risk

Answer 44

NOT designed to mitigate all potential adverse risks of med

Answer 45

Can vary depending on REM type Pt can get specific counseling about risk, actions to mitigate risk, symptoms to watch for Some REMS have pt sign form saying they understand the risks — some make them to lab testing REMS provide access to meds w/ serious risk that would not otherwise be available

Answer 46

Prescriber requirements vary Mostly, prescribers get info from mfrs about REMS Some programs require prescribers to enroll in programs, train, and document pt counseling, enrollment, overall compliance

Answer 47

Some get REMS communications from mfrs Some REMS require pharmacy to be certified to dispense that med Individual pharmacists may be needed to complete training, verify safe use conditions, or provide counseling/education to pts

Answer 48

Designating an authorized rep to: - complete the training - ensure compliance w/ policies/procedures - ensure staff is trained appropriately

Answer 49

Approved REMS on fda.gov

Answer 50

Info on all past & currently active REMS programs REMS materials, med guides (as applicable), history of the med