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Flashcards in Medication Errors and Patient Safety Deck (18)

Methods used to reduce medication errors

Review of patient profiles, medication therapy management, DUR, medication reconciliation, medication guides, barcoding, look-alike sound alike medication list, and do not use error-prone abbreviations, avoid using the term as directed as the patient does not know what that means, avoid multiple dose vials, and do not rely on packaging for identification of products


Medication guides

By law this is part of the labeling and should be dispensed with any drug containing a medguide on its first fill and any subsequent refills


Unapproved abbreviations per the joint commission

U for units, QD for daily, Q OD for every other day, do not use trailing zeros and always put a zero before anything that is a decimal, MS and MS04 and MGS04 for magnesium products


High alert medications

Hypertonic saline, insulin, heparin, potassium chloride, and opioids


Safe practices with hypertonic saline

Allow only commercially available standard concentrations of sodium chloride outside the pharmacy, limit the options of hypertonic saline, develop a protocol for administering hypertonic saline, limit addition of sodium to enteral feedings to Pharmacy only, and stock only a single hypertonic saline and locked area in my dialysis clinic


Safe practices with insulin

Eliminate insulin pens from inpatient setting, if U-500 is stocked specify conditions under which it is to be used, standardize all insulin infusions to one concentration, have standard orders in place for hypoglycemia, do not use "u" for units, always label with units or units per ML but never just ML


Safe practices with potassium chloride

Remove all KCL files from the horse, use premixed containers, use protocols for KCl delivery including indications for KCL infusion next mom right of infusion maximum allowable concentration stipulation that all KCL infusions must be given via a pump, label all fluids containing potassium with a potassium added sticker


Safe practices with opioids

Use tools to screen patients for risk factors for oversedation and respiratory depression, use red flag alerts and E scribing systems for dosing limits, separate sound alike look-alike drugs, use conversion technology systems to calculate correct doses, use an infusion pump when administering IV


Other methods of reducing medication errors

Only trained personnel should operate crash carts, have dedicated pharmacist to the ICU pediatric units and emergency departments, develop standard protocols (joint commission requires this for anti-thrombotics), implement CPOE, educate patients and encourage them to ask questions, check for drug food Interactions, follow requirements for REMS drugs


REMS drugs

Clozapine, APRISE (for erythropoietin), ipledge (isotretinoin), many opioids including morphine extended release fentanyl patches hydromorphone oxycodone oxymorphone methadone and buprenorphine

This changes frequently


Patient controlled analgesic device or PCA

Should be carefully programmed, patient should have cognitive assessment prior to using the PCA, and friends and family members should not administer PCA doses per the joint commission

Other: limit high-dose opioids available in floor stock, educate staff about hydromorphone and morphine mixups, implement protocols, use barcoding and assess the patient's pain sedation and respiratory rate on a scheduled basis


Common types of hospital acquired infections

Urinary tract infections (especially from indwelling catheters), bloodstream infections from IV lines and catheters, surgical site infections, decubitis ulcers, hepatitis, see death, pneumonia


Precautions for the spread of infectious agents in the healthcare setting

Contact precautions (recommended for MRSA and VRE), Droplet precautions (recommended for pertussis influenza adenovirus rhinovirus meningitis and streptococcus), airborne precautions (recommended for rubella virus or measles, varicella virus or chickenpox, and tuberculosis)


When to use soap and water over alcohol-based rub

Before eating, after using the restroom, anytime there is a visible soil or anything noticed on the hands, after caring for a patient with diarrhea or known C. difficile as alcohol-based rub has poor activity against spores, and before caring for patients with food allergies


Safe injection practices

Never administer oral solution or suspension IV label all oral syringes "for oral use only", never insert used needles into a multidose vial and use single-dose vials when able, never touch the tip of a plunger of the syringe, throw the entire needle syringe assembly into the red plastic sharps container, do not recapped needles


Garb order

Shoes, hair/head, facial mask then wash hands dry and put on sterile powder free gloves


National patient safety goals set by the joint commission

1. Label all medications medication containers and other solutions ALWAYS
2. Reduce the likelihood of harm associated with anticoagulant therapy
3. Maintain and communicate accurate patient medication information
4. Report critical results of test and diagnostic procedures on a timely basis
5. Comply with the Centers for Disease Control hand hygiene guidelines
6. Implement evidence-based practices to reduce healthcare associated infections
7. Use at least two patient identifiers when providing care treatment and services to patients


Reducing harm associated with anticoagulant therapy

Use standardized dosing protocols, monitor INR's, use programmable pumps for heparin, and provide education to patients and families