Iatrogenesis Flashcards Preview

Geriatrics Exam 2 > Iatrogenesis > Flashcards

Flashcards in Iatrogenesis Deck (36):
1

Definition of Iatrogenesis

Harm caused by medicine or a physician
- Deleterious effects of therapy or diagnostic procedures independent of the condition they were used for

- Can have devastating psychomotor and social consequences

2

If ranked, Iatrogenesis would rank ____ in the leading cause of death

6th!

3

Adverse Drug Reaction (ADR)

Noxious response to drugs used in usual doses

4

Adverse Drug events (ADEs)

Any injury that occurs from a drug
- usually dose-related
- Noxious response
- Drug administration error
- Any other circumstance that leads to an injury

5

Prevalence of ADRs and ADEs

- 3-7% of all hospital admissions
- 88% preventable
- 100,000 emergency visits from ADEs
- 5-10% of hospital costs

6

How ADE's happen in.... nursing homes

-Inappropriate ordering
-Inadequate monitoring

7

How ADE's happen... in the community

Patient errors

8

Any new symptom in the elderly is _________ until excluded

Drug-related

9

Risk factors for PDE's

- Polypharmacy
- Multimorbidity
- No safety profile studies
- Multiple physicians
- Altered drug metabolism
- Cognitive impairment
- Functional deficits and disabilities
- Hospitalization for medical or surgical procedures

10

What percentage of people 57-85 have at least one prescription?

- 81%

11

On average, how many medications are nursing home residents on?

7-8, with 33% having 9 or more

12

How many people on medicare have 5 or more medications?

50%

13

What does polypharmacy and mutimorbidity increase the risk of?

- ADRs
- Drug-drug interactions
- Hip fractures
- "prescribing cascades"
- Non-adherence to medications

14

What is a prescribing cascade?

- Drug-related symptoms misinterpreted as new illness
- so then that provider adds another medication....

15

Tools to improve prescribing practices

- Beers criteria
- START/STOPP criteria
- FORTA list
- Medication appropriateness index (MAI)
- ACOVE project
- GerontoNet ADR risk score
- Comprehensive geriatric assessment

16

Beers criteria

- revised in 2015- originally designed for nursing homes
- List of inappropriate medications for older adults
- Most commonly found inappropriate drug used- NSAIDs

17

START/STOPP criteria

- Comparable to Beers
- Screening tool of older person's prescriptions

18

FORTA List

Fit for the Aged
4 Categories
- Clear benefit
- Proven but limited efficacy
- Questionable efficacy
- Clearly avoid

19

MAI

Instrument for pocket use
- 10 questions to improve dosage, check indication, and adapt medication list

20

Medicare/Medicaid DUR criteria

Targets 8 drug classes
- Digoxin
- ACEI
- NSAIDs
- Antipsycotics
- Antidepressants
- CCBs
- H2RB
- BDZs
and 4 problems
- Inappropriate dosage
- Inappropriate duration
- Duplication of Rx
- Drug-drug interactions

21

ACOVE Indicators

Assessing Care of Vulnerable Elders
- Document indication for new drug therapy
- Educate patients on benefits and risks associated with use
- Maintain a current medication list
- Document response to therapy
- Periodically review ongoing need for drug therapy

- All vulnerable elders should have annual medication reviews
- Education and monitoring is needed for warfarin therapy
- Check serum creatinine and potassium annually if on ACEI
- Check electrolytes annually if on loop diuretics

22

GerontoNet ADR Risk Score

will be test question

4 or more comorbidities- 1 pt
Congestive Heart Failure- 1 pt
Liver disease- 1 pt
Renal failure- 1 pt
Previous ADR- 2 pt
Number of drugs
- less than 5- 0 pts
- 5-7- 1 pt
- more than 8- 4 pts.

0-1 pts- low risk for ADR
2-4 pts- Moderate risk for ADR
5-8 pts- high risk for ADR- needs intervention
9-12 pts- Very high risk for ADR- needs urgent intervention

23

Strategies

- Review current medication list and maintain accurate list
- Brown bag checkups
- Discontinue unnecessary medication
- Substitute problematic medications with safer ones
- Reduce the dose and simplify dosing schedule and use organizers
- Educate patient of indications and side effects
- Consult community pharmacists
- Consider non-pharm interventions

24

Proven Interventions (proven to work)

- Facilitate communication among healthcare practitioners
- Reduce language barriers and disabilities
- Use of care managers
- Multidisciplinary approach to hospitalized elderly (ACE units)
- Appropriate prescribing
- Nursing education programs
- Pharmacist consultation

25

Iatrogenesis in Diagnostic and therpeutic procedures...

- Invasive procedures
- Use of contrast dye
- Radiation

ex. -colonic perforations from colonoscopy
- UTIs from cathetors
- CHF with too much IV fluids
- Pneumothorax from theracentesis

26

How to prevent Iatrogenesis events in diagnostic and therapeutic procedures

- Determine risk-benefit ratio proactively
- Err on the side of caution when assessing situation
- Timely diagnosis of surfical emergencies and optimal perioperative care
- Ensure patient has clear understanding of risk and benefits

27

Iatrogenesis- Nosocomial infections

- occurs in 6-17% of hospitalized older adults
- 33% are preventable
- Highest risk are the terminally ill and immunocompromised
- Most common or UTIs and Pneumonia
- Others are MRSA, C. Dif, Candidal infection

28

How to prevent nosacomial infections

- Hand washing
- Staff/Patient/Family education
- Reminders of infection control
- Active infection surveillance

29

Iatrogenesis- Delerium

- One of most common iatrogenic complications in hospitals
- High-risk in post-op hip fractures and thoracic surgery
- Increases morbidity, hospital stays and risk for more iatrogenic cascades

30

Preventing Delerium

- Target risk factors that may trigger episode- frequent room change, invasive procedures, loud noises, poor lighting
- Promote good sleep habits
- Help patient remain calm and well-oriented

31

Iatrogenesis- Urine Incontinence

- 33% acute care, up to 80% in Nursing homes
- Mostly functional
- Contributes to pressure ulcers, social isolation, and depression

32

Preventing Urinary incontinence

- Care plans for UI
- Use of absorbent products
- Fixed-interval toileting
- Containment
- Avoid bladder irritants, such as caffeine and acidic foods
- Prevent constipation

33

Pressure ulcer causes and prevention

Causes
- Malnutrition
- Inactivity
- Dehydration
- Skin changes

Prevention
- Repositioning
- Skin care
- Nutrition
- Exercise

34

Causes of fecal impaction

- Polypharmacy
- laxative abuse
- Immobility
- Reduced fluid intake
- Malnutrition and weakness
- Depression and dementia

35

Preventing fecal impaction

- Dulcolax
- Metmucil- bulk fiber laxatives
- Glycerin suppositories- (colace)
- Stool softeners (docusate)

36

Other causes of Iatrogenesis (misc)

- Malnutrition and dehydration
- Depression
- Falls and other accidents
- Harmful effects related to values, beliefs, prejudices, and attitudes of well intentioned but ignorant providers