Quiz #2 Flashcards Preview

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Flashcards in Quiz #2 Deck (54):
1

Six "aims for improvement"

Safe
Effective
Patient-Centered**
Timely
Efficient
Equitable

2

Adverse Drug Event (ADE)
(either preventable or non-preventable)

(IOM) -- “an injury resulting from medical intervention related to a drug, which can be attributable to preventable and non-preventable causes.”

3

Adverse Drug Reactions (ADR)
(non-preventable & are ALWAYS undesirable)

refers
to any unexpected, unintended,
undesired, or excessive response to a
medication that require some type of
medical response or resulting in a
negative outcome (not side effects).
“Nonpreventable ADEs are also often
referred to as ADRs.”

4

Medication Error (ME)
(preventable)

“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.”

5

Side effects:

Negative or undesirable effects that occur with normal use of the medication, based on pharmacology

6

Administration errors

Wrong dose, omitted dose, additional dose, wrong time,
wrong handling, or wrong route

7

Dispensing errors

Wrong drug/dose/dosage form, or correct drug/wrong patient

8

Prescribing errors

Drug selection, dose, dosage form, quantity, route, concentration, rate of administration, instructions, or illegible handwriting.

9

Transcription errors

Abbreviations, illegible hand-written prescriptions, misinterpretation of verbal orders

10

Monitoring errors

Failure to review regimen for appropriateness or failure to use appropriate clinical/lab data for adequate assessment of patient response to drug therapy.

11

Sentinel Event

Defined by TJC “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.”

12

Root Cause Analysis

Retrospective review of the event that occurred.

13

Two types of errors exist in health care systems:

– Human Error-the failure of planned actions to achieve their desired ends, without the intervention of some unforeseeable event.
– System Error-the failure of interdependent elements that work together in a particular environment to prevent the human error.

14

National ADR Reporting

MedWatch (form 3500) – FDA required by the Kefauver-Harris Amendment to have a Spontaneous Reporting System for monitoring of ADRS of medical products marketed in the US

15

Patient Safety Organizations (PSOs)

Made possible by the Patient Safety and Quality Improvement Act of 2005.

16

Integrated Health System

Patient care under ONE umbrella of a central organization, and often include inpatient/acute care, primary care/outpatient care, long-term care, and home care

17

Definition of a Hospital

“A complex organization utilizing combination of intricate specialized scientific equipment, and functioning through a corps of trained people educated to the problem of modern medical science. These are all welded together in the common purpose of restoration and maintenance of good health.”

18

Definition of Hospital Pharmacy

“Department or service in a hospital which is under the direction of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to patient care areas......”

19

Pharmacy’s Role

Role of the Pharmacist is to lead and influence the Safety and Quality of ALL aspects of the Medication-Use Process

20

Privileging

the process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care provider’s credentials and performance and found them satisfactory, authorized the individual to perform a specific scope of patient care services within that setting

21

TRANSCRIBING:

The process by which a prescriber’s written order is copied and either manually or electronically entered into pharmacy records

22

DISPENSING:

The act of physically transferring the drug product following review and approval of the prescription.

23

ADMINISTRATION:

Typically Managed by Nurses in a Hospital Setting

24

“Five Rights” Medication Administration

1) Right Medication
􏰀 2) Right Dose
􏰀 3) Right Time
􏰀 4) Right Route
􏰀 5) Right Patient

25

DRUG-DISTRIBUTION-CENTERED MODEL
(outdated)

Pharmacists primarily distribute drugs and process new medication order

Not actively involved with the health care team or development of therapeutic plans for the patient

26

CLINICAL-PHARMACIST-CENTERED MODEL
(Might still be around)

Two Primary Types of Pharmacist in the Pharmacy Department

Clinical Pharmacist: Chiefly involved in clinical activities on the nursing units

Distributive Pharmacists: Involved in drug distribution, reviewing orders, verifying accuracy of medication prepared by a technician

27

PATIENT-CENTERED INTEGRATED MODEL

All Pharmacist in the department accept responsibility for all elements of the medication-use process

Pharmacists spend time on both clinical and distributive functions

28

What do hospital pharmacist do?

􏰀 Ensure appropriate, safe, cost-effective care
􏰀 Check appropriateness of medication
􏰀 Check dose, dosage form, administration route/technique
􏰀 Patient-focused services
􏰀 Supervisor pharmacy technicians

29

INPATIENT CARE

􏰁CRITICAL CARE UNITS 􏰀 Surgical
􏰀 Medical
􏰀 Neurosurgery 􏰀 Pediatrics
􏰀 Coronary Care 􏰀 Burn Unit

30

INPATIENT CARE

GENERAL CARE UNITS 􏰀 Medical
􏰀 Surgical
􏰀 Pediatrics 􏰀 Orthopedics 􏰀 Obstetrics

31

OUTPATIENT CARE

􏰁OUTPATIENT DISPENSING PHARMACY 􏰁Surgery Pharmacy
􏰁Emergency Departments
􏰁Ambulatory Care Clinics (i.e. Coumadin Clinic) 􏰁Home Health Care/Home Infusion Services

32

Accreditation Organization

(i.e. Joint Commission)

33

The Joint Commission (TJC)

􏰀 Independent, not-for profit organization
􏰀 Accredits more that 15,000 health care organizations
􏰀 Unannounced onsite visits

34

National Patient Safety Goals

􏰁Goal #1 (01.01.01)
􏰀 Use at least two patient identifiers when providing
care, treatment, and services
􏰀 Acceptable identifiers include:
􏰁 Patient name
􏰁 Assigned ID numbers (i.e. hospital number)
􏰁 Telephone number
􏰁 DOB
􏰁 Other person-specific identifier

35

controlled substance

a drug which has been declared by federal or state law to
be illegal for sale or use, but may be dispensed under a physician's prescription.
The basis for control and regulation is the danger of addiction, abuse, physical
and mental harm (including death), the trafficking by illegal means, and the
dangers from actions of those who have used the substances

Includes precursors or
derivatives

36

The term "controlled substance" means:

a drug or other substance, or immediate precursor, included in schedule I, II, III, IV, or V of part B of this subchapter. The term does not include distilled spirits, wine, malt beverages, or tobacco, as those terms are defined or used in subtitle E of the Internal Revenue Code of 1986.

37

diversion

movement of drug in direction other
than intended use

38

Addiction

Craving , negative function , use in spite of known negative consequences , Compulsion

39

Addiction is...

a disease

40

misuse

not taking it as prescribed

41

Physiological Dependence & Physiological Addiction

substance on board for long period of time , abrupt discontinuation causes withdrawal

42

Schedule I

(a) The drug or other substance has a high potential for abuse.
(b) The drug or other substances has no currently accepted medical use in treatment in the United States. (c) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

43

Schedule II

(a) The drug or other substance has a high potential for abuse.
(b) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted use with severe
restrictions.
(c) Abuse of the drug or other substance may lead to severe psychological or physical dependence.

44

Schedule III

(a) The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.
(b) The drug or other substance has a currently accepted medical use in treatment in the United States.
(c) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

45

Schedule IV

(a) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.
(b) The drug or other substance has a currently accepted medical use in treatment in the United States.
(c) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other
substances in Schedule III.

46

Schedule V

(a) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule IV.
(b) The drug or other substance has a currently accepted medical use in treatment in the United States.
(c) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other
substances in Schedule IV.

47

How many controlled substances schedules
for the state of Tennessee?

VII

48

Controlled Substance Act of 1970

The Controlled Substances Act (CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970.[1] The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain substances is regulated.

49

State Boards of Pharmacy

helps regulate pharmacies or
possibly medial office that handles controlled substances

50

FDA

decides schedule

51

DEA

enforces

52

Law enforcement

Only involved when there is criminal behavior

53

Movement of Controlled Substances

Manufacturer/Processing
Distributor
Pharmacy, Physician, Dentist->RD
Patient -> D
Law Enforcement (approved) -> D

54

Reverse distributor

must be used to accept return of controlled substances