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Principles of Disease 16 > Prescribing errors > Flashcards

Flashcards in Prescribing errors Deck (25)
1

Define a medication error

“any preventable event that may cause or lead to inappropriate medication use or patient harm”

2

When are medication errors more likely?

• Inexperienced
• Inattentive
• Rushed
• Distracted
• Tired
• Depressed
• Orthopaedic surgeons,
• Work in paediatrics
• Work in intensive care units
• With elderly people

3

What is a prescribing error?

A clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is either an unintentional significant:
o Reduction in the probability of treatment being timely and effective
o Increase in the risk of harm when compared with generally accepted practice.

4

What is a prescribing fault?

Prescribing Faults - failures in the process of deciding which drug to use and how

5

What is a prescription error?

Prescription Errors - failures in the prescription writing process that result in wrong instructions about one or more of the normal features of a prescription

6

Which tasks are intrinsically prone to error?

– Tasks that are unfamiliar to the operator or performed under pressure.
– Tasks that require the calculation of a dosage or dilution are especially susceptible to error.

7

Why do medication errors happen?

• Increase in numbers and variety of drugs
• Patients have co-morbidities
• Complexity of care process
– Specialists
– Care settings
– Care delivery paths/journeys
• Need for high risk medications
• Number of prescribers
• OTC usage
• Loss of the generalist in charge of the patient

8

Describe some causes of errors in prescription writing

Wrong drug (sound similar)
Illegibility
Inappropriate abbreviation use

9

What can cause errors in decision making?

Poor understanding of medical history
Poor knowledge of drug properties
Poor knowledge of DDIs

10

What are the current issues with ageing and pharmacotherapy?

• Under-representation in clinical trials
• Multiple co-morbidities
• Multiple prescribers
• Polypharmacy: Drug Interactions
• Prescribing cascade
• Altered pharmacokinetics and pharmacodynamics
• Adverse drug reactions

11

How can you minimise the risk of improper decision making?

• Before prescribing, consider:
– The patient’s medication history
– Other factors that might alter the benefits and risks of treatment
• Select effective, safe, and cost-effective medicines individualised for the patient
• Adhere to national guidelines and local formularies
• Monitor the beneficial and adverse effects of medicines
• Communicate and document prescribing decisions
• Prescribe within the limitations of your knowledge, skills and experience

12

What are the consequences of prescription errors?

• Patient & family grief
• Colleagues: Staff/ multidisciplinary team
• Professional consequences
• Legal consequences
• Media

13

What are the 5 Rs?

• The 5 Rs
– Right patient
– Right drug
– Right route
– Right time
– Right dose
• 6th R: Formulation?
– Sustained Release Preparations
– Drugs that must be prescribed by brand
– Changing between formulations

14

How can we enhance safe prescribing?

• Use of patient passports
• Medicines reconciliation
• Use of technology
• Use of simulation for rehearsal
– Drug history: allergies
• Development of standards of practice
– Five “rights” - Right patient, drug, dose, route and time
• Handover
• Reporting system
• Communication techniques
• Design of safe delivery systems

15

Name some common anti epileptic enzyme inducers

Phenytoin
Carbamazepine
Primidone

16

Name some common antidepressant enzyme inducers

St Johns wort

17

Name a GI drug enzyme inducers

Omeprazole

18

Name some common antibacterial enzyme inhibitors

Clarithromycin
Erythromycin
Ciprofloxacin
Isoniazid
Metronidazole

19

Name some common cardiovascular drug enzyme inducers

Amiodarone
Verapamil
Diltiazem
Quinidine

20

Name some common antidepressant enzyme inhibitors

Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

21

Name some common anti fungal enzyme inhibitors

Fluconazole
Ketaconazole
Miconazole
Itraconazole

22

How does smoking, rifampicin and isoniazid affect liver enzymes?

Inducers

23

Name some anti-rheumatic drugs that are enzyme inhibitors

Allopurinol
Azapropazone

24

Name some anti-viral enzyme inhibitors

Indinavir
Ritonavir
Saquinavir

25

How do disulfam and sodium valproate affect drug metabolising enzymes?

Inhibitors