Introduction to Prescribing

Question 1

How many deaths occur per year due to prescribing errors in the UK?

Answer 1

1100

Question 2

What proportional of medical admissions are complicated with medication errors?

Answer 2

1 in 10

Question 3

Give 6 factors that could increase the rate of medication errors

Answer 3

• 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

Question 4

Why does increasing numbers of elderly patients cause problems with prescribing?

Answer 4

• More likely to have co-morbidities
• More likely to be on multiple drugs
• Have an increased risk of side effects

Question 5

Why does clinical evidence not always identify the negative aspects of drugs?

Answer 5

• 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

Question 6

Why are drugs tested on relatively healthier and/or younger patients?

Answer 6

To make sure the untested drugs cause the least harm

Question 7

Why is testing new drugs on relatively healthier/younger patients problematic?

Answer 7

It is hard to extrapolate to the general population, which in itself may do harm

Question 8

Why do some side effects only come to light during post-marketing surveillance?

Answer 8

Because many trials are small to save money, and therefore don’t pick up adverse effects

Question 9

What is the problem with blind adherence to prescription guidelines?

Answer 9

There may be contraindications or serious interactions that are not picked up on if you don’t look at the patient as a whole

Question 10

In what respects may medical schools inadequately prepare students for prescribing?

Answer 10

• Inadequate level of teaching
• Inadequate level of examining

Question 11

How does the nature of the medical profession lead to prescribing errors?

Answer 11

• Shift work and reduced hours
• Lack of pharmacology training
• Too many students

Question 12

How does shift work contibute to prescription errors?

Answer 12

• Sleep-deprived doctors have more attentional failures, and make more clinical errors and incorrect diagnoses
• Exhausion erases recent learning
• Poorer morale

Question 13

How does reduced hours contribute to prescription errors?

Answer 13

• Lower exposure to teaching
• Working alone more often
• Less ward teaching and feedback
• Lack of continuity of care

Question 14

Give a reason why prescription errors are more likely to occur when a doctor is on call

Answer 14

Rarely know the patient

Question 15

What does a person approach say is responsible for medication errors?

Answer 15

Aberrant mental processes - ‘bad things happen to bad people’

Question 16

What are countermeasures centered on in the person approach to medication errors?

Answer 16

On the person

Question 17

Give 4 examples of countermeasures used in the person approach to medication errors

Answer 17

• Fear
• Retraining
• Litigation
• Naming and shaming

Question 18

What does a systems approach say is responsible for medication errors?

Answer 18

• Errors seen as consequences
• Unable to change human condition

Question 19

What are countermeasures centered on in the systems approach to medication errors?

Answer 19

Barriers and safeguards

Question 20

What are the types of medication errors?

Answer 20

• Slips
• Lapses
• Technical errors
• Mistakes
• Violations

Question 21

What is a slip?

Answer 21

A lack of concentration leading to the error - you would know the answer when thinking about it

Question 22

What is a lapse?

Answer 22

A lapse in concentration and memory, resulting in you forgetting something

Question 23

When do mistakeas occur?

Answer 23

When you;

• Confuse rules
• Don’t have the knowledge base

Question 24

What is a violation?

Answer 24

A deliberate error to harm people

Question 25

When can rule based errors occur?

Answer 25

* When good rules are not applied, or misapplied * When rules are bad

Question 26

What should you confirm before writing a prescription?

Answer 26

* Name of drug * Dose * Strength of drug * Frequency of administration * Duration of treatment * Allergies and adverse effects the patient has suffered * Indiciations * Adherence

Question 27

What are the legal requirements regarding prescription forms?

Answer 27

* Must be written in indelible ink * Patient identification must be provided- name and address, and DOB if under 12 * Signed * Dated * Name and address of practitoner * *Additional requirements for controlled drugs*

Question 28

What are the requirements for a **safe** prescription?

Answer 28

* The right drug * The right dose * The right route * The right site * The right frequency * The right patient * *All while considering contraindications, interactions, adverse effects and allergies*

Question 29

Why should the generic drug name be prescribed, rather than the brand name?

Answer 29

* Brand prescribing increases the likelihood of missed doses * Brand name may be misinterpreted - *the brand name changes in different countries* * Can produce substitution errors if the names are too similar * If you put a brand name, the pharmacist has to supply that specific one, whereas if prescribe generic, can just prescribe the cheapest/whatevers available

Question 30

Why is it important to specify the route when prescribing?

Answer 30

* Some drugs can only be given by one route, otherwise are fatal * Helps pharmacist/nurse see if dose is appropriate

Question 31

What should be reported on the yellow card scheme?

Answer 31

* With black triangle drugs and unlicensed herbal preparations, report **all** suspected reactions, *however trivial* * With established products and vaccines, report all suspected serious reactions, *even if the reaction is well-known and recognised* * All paediatric reactions

Question 32

What are black triangle drugs?

Answer 32

Drugs that are being intensively monitored, usually because it has; * Been newly released * Changed indiciations * Changed formulations * Combination product

Question 33

What is considered to be a 'serious' drug reaction?

Answer 33

* Any reaction which results in, or prolongs, hospitalisation * Fatal or life-threatening * Disabilng or incapacitating

Question 34

What steps should be taken with electronic prescribing?

Answer 34

* Ensure you are trained * Beware of decision support aids * Avoid 'work arounds' * Read the prescription before sending * Avoid hand-written alterations