LESSON 5: Medication Safety

Question 1

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.”

Answer 1

Medication Errors

Question 2

According to National Coordinating Council for Medication Error Reporting and Prevention, such events (Medication Error) may be related to:

Answer 2

professional practice, healthcare products, procedures, and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring and use

Question 3

It has been reported that __________ are among the commonly encountered medical problems in clinical practice, one of these is medication error.

Answer 3

Adverse drug effects

Question 4

Medication errors can lead to _________ if not recognized or managed accordingly.

Answer 4

Fatalities

Question 5

Generally occur as unsafe acts which are committed in the background of a potential hazard. This is a result of __________

Answer 5

System failure

Question 6

Proposed by James Reason in 2000. He said that ideal system is analogous to a stack of slices of swiss
cheese.

Answer 6

Swiss Cheese Model of Accident Causation

Question 7

In the swiss cheese model, these are considered as opportunities for a process to fail.

Answer 7

Holes

Question 8

In the swiss cheese model, these are defensive layers in the process. It is a defense against potential error impacting the outcome

Answer 8

Each slices

Question 9

In the swiss cheese model, this may allow a problem to pass through a whole in one layer.

Answer 9

Error

Question 10

In the swiss cheese model, in the succeeding layers, holes are in _________ such that the problem is caught and addressed.

Answer 10

different places

Question 11

In the swiss cheese model, if a hole in one layer coincides with the holes in the next layers, the problem is allowed to _______ and can eventually lead to an adverse outcome.

Answer 11

pass through

Question 12

A general type of error that involves administering a drug without having established whether a potential adverse event or reaction will occur.

Ex. When one gives penicillin without checking whether the patient has a history of allergy or not.

Answer 12

Knowledge-based errors

Question 13

A general type of error that involves using a bad rule or misapplying a good rule.

Ex. Injecting diclofenac in lateral thigh rather than in buttocks.

Answer 13

Rule-based errors

Question 14

A general type of error that involves slips in which certain practices were done incorrectly.

Ex. Dispensing a drug Leponex (Generic: Clozapine), an
atypical antipsychotic medication, instead of Ceporex (Generic: Cefalexin), a cephalosporin antibiotic, or picking up a bottle of Gabapentin, an anticonvulsant for Gemfibrozil, a lipid-regulating drug.

Answer 14

Action-based errors

Question 15

Medication errors can occur in every of the ____________.

Answer 15

Medication process

Question 16

A general type of error that involves lapses in which steps in the medication process are missed.

Ex. Failure to administer antibiotics prior to surgical operation.

Answer 16

Memory-based errors

Question 17

A specific type of error that includes Incorrect drug selection (based on indications, contraindications, known allergies, existing drug therapy, and other factors), dose, dosage form, quantity, route, concentration, rate of administration, or instructions for use of a drug product ordered or authorized by physician (or other legitimate prescriber); illegible prescriptions or medication orders that lead to errors that reach the patient.

Ex. [Case Study 1] Patient received a total of 16,000 mg/m2 instead of a 4000 mg/m2, an incorrect drug dose.

Answer 17

Prescribing errors

Question 18

A specific type of error that includes an error in drug dispensing (type and dose) as a result of outdated or incorrect drug reference information, poor work environment, suboptimal packaging, labeling of products, interpretation of prescriptions, failure to double-check orders.

Ex. [Case Study 2] The prescription drug name Avandia (Rosiglitazone maleate) was incorrectly interpreted as Coumadin (Warfarin) by the pharmacist.

Answer 18

Dispensing errors

Question 19

A specific type of error that involves a medication administration error which includes administration to the patient of a dose that is greater than or less than the amount ordered by the prescriber or administration of duplicate doses to the patient, i.e., one or more dosage units in addition to those that were ordered.

Answer 19

Improper dose error

Question 20

A specific type of error that involves a medication administration error which includes failure to administer an ordered dose to a patient before the next scheduled dose, if any.

Answer 20

Omission error

Question 21

A specific type of error that involves a medication administration error which includes administration of medication outside a predefined time interval from its scheduled administration time (this interval should be established by each individual health care facility)

Answer 21

Wrong time error

Question 22

A specific type of error that involves a medication administration error which includes inappropriate procedure or improper technique in the administration of a drug.

Ex. Giving Vitamin K1 as a bolus instead of as a push

Answer 22

Wrong administration-technique error

Question 23

A specific type of error that involves a medication administration error which includes administration to the patient of medication not authorized by a legitimate prescriber for the patient.

Ex. Administration of an over-the-counter medication which was not previously approved by the attending physician or a drug which has no proven therapeutic indication.

Answer 23

Unauthorized drug error

Question 24

A specific type of error that involves a medication administration error which includes administration to the patient of a drug product in a different dosage form than ordered by the prescriber.

EX. Giving the drug through parenteral form rather than in oral preparation.

Answer 24

Wrong dosage-form error

Question 25

A specific type of error that involves a medication administration error which includes incorrectly formulated drug product or manipulated before administration and incorrect dilution or reconstitution, mixing drugs that are physically or chemically incompatible.

Answer 25

Wrong drug-preparation error

Question 26

A specific type of error that involves a medication administration error which includes administration of a drug that has expired or for which the physical or chemical dosage-form integrity has been compromised. Ex. Administration of a drug 3 months after expiration date.

Answer 26

Deteriorated drug error

Question 27

It’s very important that patients are provided with appropriate information and advice because if they are not given so, ___________ may happen. Ex. Case 4: 45-year old female on methotrexate stopped taking the medication because of vomiting and diarrhea Case 5: 54-year old male, maintained on warfarin, developed bleeding. Protimedetermination showed an INR of 7 which is prolonged.

Answer 27

Patient adherence errors

Question 28

A specific type of error that involves a patient adherence error which includes inappropriate patient behavior regarding adherence to a prescribed medication regimen.

Answer 28

Compliance error

Question 29

A specific type of error that involves a patient adherence error which includes failure to review a prescribed regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.

Answer 29

Monitoring error

Question 30

Most ME occur but do not cause harm. These are labeled as __________.

Answer 30

Potential errors or Potential ADEs.

Question 31

Some cause harm and they are either potential ADEs or ___________ depending on whether an injury has occurred.

Answer 31

preventable ADES

Question 32

An end effect medication error that includes no harm happened because intervention may have been done to prevent an error to happen. Also known as near misses.

Answer 32

Potential ADE–ME occurred but no harm

Question 33

An end effect medication error that take for instance BL from Case 1, a breast cancer patient who developed a drug overdose as a result of prescribing error. The end result is death which is a serious adverse event.

Answer 33

Preventable ADE–ME occurred and adverse reaction or harm was observed

Question 34

An end effect medication error that includes an injury of which the severity or duration could have been substantially reduced if different actions had been taken. Ex. Patient who was prescribed furosemide, which is a diuretic, for congestive heart failure and advised a follow-up visit with a cardiologist in 4 weeks, but no instructions for earlier follow-up or laboratory tests to be done. 10 days later, the patient presents to the emergency department with acute kidney injury and critically low potassium. These adverse effects of diuresis are not preventable because these are adverse reactions of the drugs, but the severity could have been reduced by planning to have the patient come in for a laboratory testing within a week of discharge and while the patient is on furosemide for that first week.

Answer 34

Ameliorable ADE-ME

Question 35

A factor that cause medication errors that involves the following: ● Inaccurate dosage calculation ● Inadequately trained personnel ● Excessive workload ● Lapses in individual performance ● Inadequate number of personnel ● Poor handwriting of prescribers

Answer 35

Provider

Question 36

A factor that cause medication errors that involves the following: Miscommunication of drug order ○ Improper transcription ○ Misuse of zeros and decimal points ○ Confusion of metric and other dosing units ○ Inappropriate abbreviations used in prescribing ○ Lack of appropriate labeling

Answer 36

Procedure

Question 37

A factor that causes medication errors that involves an environment that is not conducive and safe to work in e.g., lighting, heat, noise, and interruptions can distract health professionals from their medical tasks, and stress.

Answer 37

Place (enviromental)

Question 38

A factor that causes medication errors that involves the following: ● Unavailability or ambiguity of drug information ● Ambiguous strength designation on labels ● Unavailability of medication ● Confusion between drugs with look-alike or sound- alike names Ex. Look-alike or sound-alike names - Zantac (Ranitidine) vs Xanax (Alprazolam) Same brand names but with different ingredients - Tylenol contains Paracetamol vs Tylenol PM which consists of paracetamol and diphenhydramine

Answer 38

Product (drug itself)

Question 39

A factor that causes medication errors that involves use of devices such as infusion pumps and equipment failure or malfunction.

Answer 39

Peripherals

Question 40

A factor that causes medication errors that involves the following: ● Incomplete patient information ● Failure to elicit from patient the history of allergies and other adverse drug reactions ● Previous diagnoses ● Maintenance medications ● Laboratory results

Answer 40

Patient

Question 41

A factor that causes medication errors that involves administration of non-formulary drugs and lack of standardized use of abbreviations.

Answer 41

Policies

Question 42

A safety net that made use of: ● Patient-specific identifiers (name and date of birth; “name alert”; may include mother’s maiden name) ● Verification of allergies and reactions ● Highlighting critical diagnoses and conditions ● Updating current medications ● Standardizing height and weight measurements ● Taking note of patient’s occupation (guides doctor on drug selection and timing of intake)

Answer 42

Correct patient information

Question 43

A safety net that made use of: ● Maintaining drug references (know the drug carefully:dose, route, rate, etc.) ● Establishing guidelines ● Identifying high-alert medications (warfarin, low molecular weight heparins, insulin,etc.) ● Knowing the drug manufacturer (quality and bioavailability) ● Checking for expiration dates

Answer 43

Correct drug information

Question 44

Drugs that bear a heightened risk of causing significant patient harm when they are used in error (ISMP definition). Such harm can be DEVASTATING to a patient's health!

Answer 44

High-alert medications

Question 45

The following are: ○ Narrow therapeutic ranges ○ Low toxic-therapeutic ratios ○ Potential serious adverse effects (E.g. bleeding, hypoglycemia, arrhythmias, allergies) ○ Need frequent calculation of doses ○ Require specific rates of administration ○ Require specific diluents/IV fluids

Answer 45

Characteristics of High Alert Medication

Question 46

A safety net that made use of: ● Separating problematic drugs ● Keeping the storage area well organized ● Avoiding over prescribing and overstocking (accidents, sharing, reselling) ● Not using if you cannot read the label (name, strength, expiration date)

Answer 46

Proper drug labeling and storage

Question 47

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Is there an indication for the drug?

Answer 47

Indication

Question 48

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Is the medication effective for the condition?

Answer 48

Effectiveness

Question 49

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Are there important comorbidities that could affect the response to the drug?

Answer 49

Diseases

Question 50

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Is the patient already taking another drug with the same action?

Answer 50

Other similar drugs

Question 51

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Are there clinically important drug-drug interactions with other drugs that the patient is taking?

Answer 51

Interactions

Question 52

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing What is the correct dosage regimen (dose, frequency, route, formulation)?

Answer 52

Dosage

Question 53

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing What are the correct directions for giving the drug and are they practical?

Answer 53

Orders

Question 54

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing What is the appropriate duration of therapy?

Answer 54

Period

Question 55

One of the nine questions before writing a prescription that is included in the safety net: appropriate drug prescribing Is the drug cost-effective?

Answer 55

Economics

Question 56

This is an example of error prone abbreviation that is mistaken for zero, number 4, or cc. The alternative is to write it as it is.

Answer 56

U (unit)

Question 57

This is an example of error prone abbreviation that is mistaken for IV or number 10. The alternative is to write it as it is.

Answer 57

IU (international unit)

Question 58

This is an example of error prone abbreviation that is mistaken for QID. The alternative is to write “daily.”

Answer 58

QD (daily)

Question 59

This is an example of error prone abbreviation that is mistaken for QID and QD. The alternative is to write “every other day.”

Answer 59

QOD (every other day)

Question 60

This is an example of error prone abbreviation that includes a missing decimal point. The alternative is to write X mg.

Answer 60

Trailing zero (X.0 mg)

Question 61

This is an example of error prone abbreviation that includes a missing decimal point. The alternative is to write 0.X mg.

Answer 61

Lack of leading zero (.X mg)

Question 62

A safety net that made use of: ● Assessing the performance of your practice ● Making it easy to learn from errors ● Looking for system changes that will help prevent future errors

Answer 62

Culture change

Question 63

A feature of cultural safety under safety net: cultural change that involves the leader considers themself as a member of the team.

Answer 63

Active leadership

Question 64

A feature of cultural safety under safety net: cultural change that involves people knowing that their concerns will be openly received and treated with respect.

Answer 64

Psychological safety

Question 65

A feature of cultural safety under safety net: cultural change that involves members being comfortable speaking about safety concerns with confidence that the organization will learn from problems and use them to improve the system.

Answer 65

Transparency

Question 66

A feature of cultural safety under safety net: cultural change that involves people knowing that they will not be punished or blamed for system-based errors.

Answer 66

Fairness

Question 67

T/F: Medication errors have the potential for adverse drug events/preventable adverse drug events/ameliorable ADEs.

Answer 67

T

Question 68

T/F: Medication errors don't result from problems in systems rather than exclusively from staff performance or environmental factors.

Answer 68

F

Question 69

T/F: Medication errors are avoided if medication error prevention strategies are established.

Answer 69

T

Question 70

T/F: Medication errors cannot be reduced by following the 6 rights of safe medication administration (right drug, right patient, right dose, right route, right time and right documentation.

Answer 70

F