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Fall 2018/P3 Year' > Safety Quiz 2 > Flashcards

Safety Quiz 2 Flashcards

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1
Q

what is BCMA?

A

Bar code medication administration

scanning stuff at pt bedside aka AT POINT OF ADMINISTRATION

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2
Q

what is CPOE?

A

computerized provider order entry

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3
Q

what is a PHR?

A

personal health record

an electronic app used by pts

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4
Q

subtypes of systems of PHRs?

A

standalone (ex: google health PHR)
tethered (tied into healthcare system - MyHealthvet from PHR)
or
networked (access data from multiple locations)

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5
Q

what is meaningful use?

A

goal: to increase EHR adoption and improving
quality of care!!
CMS gave out money for rewarding ppl to to do EHRs then after time they would penalize ppl

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6
Q

what is HIE?

A

health information exchange

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7
Q

ultimate goal of HIE?

A

NHIN (national health information network)

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8
Q

Hx of HIE:

what was the first initiative? and the problems with it?

A

in 1990 - Hartford foundation
grants given to different communities
endpoints to assess - quality and cost reduction

problems: technology wasnt good enough for this/slow internet etc

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9
Q

Hx of HIE:

what was the second initiative? main issue?

A

in mid- 1990s CHINs (community health information networks)
these were commercial endeavors
political groups against public health data

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10
Q

Hx of HIE:

what was published in 1999/2001 that said HIE’s could help pt safety

A

To Err is human

IOM reports on pt safety and quality

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11
Q

Hx of HIE:

what was the initiative in 2000? what was the downfall?

A

RHIOs! (regional health information organizations)
downfall: getting everyone on board/funds/political/competitive

all RHIO’s across the country were SOOO different

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12
Q

Hx of HIE:
In 2004 the DHHS began developing ______

*DHHS - department of health and human services

A

NHIN (national health information network)

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13
Q

Hx of HIE:

in 2006 - the prominent RHIO located in ______ closed after 8 years

A

Santa barbara, CA

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14
Q

Hx of HIE:

In 2008: _________ specifies HIE as a component of “meaningful use” incentives

A

HITECH Act

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15
Q

Hx of HIE:

In 2009: the _____ assures stakeholders that NHIN will NOT exchange data with government angencies

A

ONC (office of the national coordinator for Health IT)

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16
Q

Definitions/Terms:

EMR?

A

electronic medical record

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17
Q

Definitions/Terms:

Formulary

A

medications approved for use by the pharmacy and therapeutics committee

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18
Q

Definitions/Terms:

ADC

A

automated dispensing cabinet

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19
Q

Definitions/Terms:

BCMA

A

barcode medication administration

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20
Q

Definitions/Terms:

CPOE

A

computerized prescriber order entry

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21
Q

Definitions/Terms:

CDS

A

clinical decision support - automated tools used to help assist with clinical decisions

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22
Q

Definitions/Terms:

Medication use process

A

Multistep process involved in getting a prescribed medication to the patient

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23
Q 
Which of the below are factors associated with effective implementation of pharmacy automation?
A. Usability 
B. Integration and interoperability
C. Stability and reliability
D. Adaptability and flexibility
E. All of the above
A

E

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24
Q

What dispensing technologies could have prevented these heparin errors?
A. Barcode scanning when removing the medication from the carousel
B. Barcode scanning prior to loading into the automated dispensing cabinets
C. Patient monitoring
D. A and B
E. All of the above

A

D

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25
Which of the below are reasons to implement Carousels? A. Better security of medications B. Reduces medication errors C. Maximizes floor space and storage capacity; improves space efficiency D. All of the above
D
26
Smart Pump = an infusion pump w/ | ______ of medications that provides _____ guidelines for concentrations and dose limits
library dosing....
27
different types of infusion pumps?
``` LVP - large volume pump PCA - pt controlled analgesia Syringe Elastomeric Enteral Insulin Pumps ```
28
Types of smart pump data?
``` drug libraries alerts DERS compliance rate alarms pump status (up to date?) ```
29
what is DERS?
dose error reduction software --- used in smart pumps! | this get measured for compliance
30
the the "medication use process" what is a part of the monitoring portion?
EHR documentation lab testing refill data
31
the the "medication use process" what is a part of the prescribing portion?
CPOE
32
the the "medication use process" what is a part of the transcribing portion?
e-prescribing
33
Medication alerts are one form of ______________ and are intended to improve medication decision-making and thereby improve patient safety.
computerized clinical decision support
34
Medication Alert challenges?
Alert Fatigue Wide variation in alert display Lack of alert clarity Barriers to prescriber-pharmacist communication
35
what does C-HIP model stand for and why is it related to med safety?
C-HIP = communication-human information processing model related to med safety because it is the process that ppl go thru while looking at warnings and is a way to see why a warning did not work
36
what is the C-HIP model process?
source --> channel --> delivery --> attention switch --> attention maintenance --> comprehensive memory (SCDAAC?)
37
Examples of portions of the C-HIP model process? | Source
Source - initial transmitter of warning info | hospital system, ISMP, FDA
38
Examples of portions of the C-HIP model process? | Channel
medium in which warning is presented | prescription label, sticker, EHR
39
Portions of the C-HIP model process: | Delivery
aka if the dr sees it | problems arise if a nurse puts it in and Dr just signs it
40
Portions of the C-HIP model process? Attention Switch what is considered a success and what is considered a challenge
success = dr sees alert... challenge = competing with other environmental stimuli
41
Portions of the C-HIP model process? Attention Maintenance what is considered a success and what is considered a challenge
Success: Prescriber views the alert; attention is sustained long enough to understand the information Challenges: stress, workload, competing demands
42
Alert components - what should be in the message content
a signal word the hazard itself instructions consequences
43
Workarounds in IT: | harmful if....
creates gaps in EHR documentation circumvents safety mechanisms reduces efficiency for individual or others
44
Workarounds in IT: | beneficial if...
assists with complex tasks and decisions tracks information reminds or prompts fills a gap in IT functionality
45
Public Health or Population Health informatics? promotes and protects the health of people and the communities where they live, learn, work and play
Public
46
Public Health or Population Health informatics? | Tends to focus on governmental PH
public
47
Public Health or Population Health informatics? | Tends to focus on clinical populations as well as payers
population
48
Public Health or Population Health informatics? | Health outcomes of a group of individuals, including the distribution of such outcomes within the group
population
49
Public Health or Population Health informatics? | Goals emphasize disease management, outreach, care coordination, and integration of services
population
50
Public Health or Population Health informatics? Goals emphasize assessment (surveillance) and prevention of disease; also pertains to other areas of PH like food safety, nutrition
public
51
Public Health or Population Health informatics? | Tends to emphasize outcomes and needs of a more narrow population
population
52
Public Health or Population Health informatics? | Tends to emphasize health needs and outcomes of the total population
public
53
what are the 5 V's of big Data
``` volume velocity variety variability veracity/value ```
54
Role of informatics (esp related to Big data)
``` data management (storing/maintaining) develop systems to make sense of big data Developing systems that can deliver the right data, derived from Big Data, to clinicians at the point-of-care ```
55
Analytics definition?
Analytics often involves studying past historical data to research potential trends, to analyze the effects of certain decisions or events, or to evaluate the performance of a given tool or scenario.
56
step by step process of BCMA?
``` scan nurse scan pt scan med respond to alerts administer and document ```
57
what are the 2 types of barcodes used with BCMA
linear | and 2D barcode (looks like QR code)
58
Linear Barcode: advantages? disadvantages?
advantage: easy to print! universally readable disadvantage: curvature (on pts wrist); limited amt of data
59
2D Barcode: advantages? disadvantages?
advantages: Compact; High data density; Less susceptible to curvature issues disadvantages: Require high quality printer (i.e. 600x600 resolution); Not universally scannable (requires imager)
60
what are some of the BCMA workarounds?
pt scan medication scan scan post administation
61
rationale and ways nurses do pt scan workarounds
"i know the pt" hard to scan wrist band/will disturb the pt print extra armband/remove armband/override
62
rationale and ways nurses do medication scan workarounds
hard to scan med/threw out packaging/ "its just saline" keep old packages/barcode stickers; override
63
rationale and ways nurses do BCMA workaround of scan post administration
aka give med now and scan later because it is time consuming
64
Required Readings: EHR article | article focuses on what 3 parts of EHR functions that pharmacists use?
documentation medication reconciliation pt evaluation and monitoring
65
Required Readings: EHR article T or F: pharmacists are currently not considered providers for CMS and do not receive incentive funds based on meaningful use
True
66
Required Readings: EHR article | T or F: There are a lot of pharmacists involved in informatics
false (there are not a lot and there should be more!)
67
Required Readings: 9/20 ISMP Article | Misconnections of __________ ports with IV infusions can result in fatal outcomes
tracheostomy pilot balloon ports
68
Required Readings: 9/20 ISMP Article | T or F: tubing misconnections are widely reported
false --- probably a lot are NOT reported
69
Required Readings: 9/20 ISMP Article | when a tracheostomy pilot balloon ports is connected to a fluid --- it will inflate with fluid and lead to what?
the lumen of the trachesotomy will collapse and the airway will be obstrcuted
70
Required Readings: 9/20 ISMP Article | what was a recent nebulizer mix up?
ipratropium and racepinephrine (v similar packaging) both are bronchodilators but act differently manufacturer was contacted
71
Required Readings: 9/06 ISMP Article | what were the 4 severe ADEs talked about?
rhabdomyolysis SS (serotonin syndrome) and NMS (neuroleptic malignant syndrome) SJS/TEN (steven johnson syndrome/Toxic epidermal necrolysis) PML (progressive multifocal leukoencephalopathy)
72
Required Readings: 9/06 ISMP Article Rhabdomyolysis: some drugs destroy skeletal muscle cells and lead to the contents of ______ and _____ being released
creatine kinase; myoglobin
73
Required Readings: 9/06 ISMP Article | If rhabdomyolysis is severe enough -- ____ failure is possible
renal
74
Required Readings: 9/06 ISMP Article | Signs and Symptoms of Rhabdomyolysis?
muscle pain dark urine (bc myoglobin) elevated creatine kinase arrhythmias (bc Ca2+/K+/Na+ release)
75
Required Readings: 9/06 ISMP Article | two most common drug classes to cause rhabdomyolysis
statins and antipsychotics for antipsychotics rhabdo was secondary to NMS
76
Required Readings: 9/06 ISMP Article | what 2 newer/novel drugs were found to cause rhabdoyolysis
nivolumab | entresto (sacubitril/valsartan)
77
Required Readings: 9/06 ISMP Article Serotonin Syndrome and NMS SS: happens within ______ and NMS happens within ______
SS: hours NMS: days
78
Required Readings: 9/06 ISMP Article | Symptoms of SS and NMS?
CNS disruptions irrgular heartbeats or breathing loss of body temperature CONTROL!! (fever) clonus (can be severe enough to CAUSE rhabdo)
79
Required Readings: 9/06 ISMP Article SS: caused by drugs that _________ NMS: caused by drugs that _______
SS: drugs that affect serotonin uptake NMS: drugs that block dopamine
80
Required Readings: 9/06 ISMP Article | Common drug classes that cause SS?
``` antidepressants (SSRI and SNRIs) opioids antipsychotics anti-emetics (aka drugs that also block serotonin receptors) ```
81
``` Required Readings: 9/06 ISMP Article NMS is caused by the drug class of ______ ``` which drug caused the most cases?
antipsychotics aripiprazole
82
Required Readings: 9/06 ISMP Article | why does SS and NMS diagnosis get messy?
polypharmacy pts on both antidepressants and antipsychotics aripiprazole affects both dopamine and serotonin
83
Required Readings: 9/06 ISMP Article | what drug classes are known to cause SJS/TEN?
anticonvulsants (lamotrigine, carbamazepine) antibiotics/antifungals analgesics (ibuprofen..)
84
Required Readings: 9/06 ISMP Article | what is SJS/TEN?
T cells attack/kill dermal cells - skin sloughs off
85
Required Readings: 9/06 ISMP Article PML - caused by a VIRAL infection of the brain - happens when immunosuppresive drugs or HIV cannot hold in check the _______ (that is common but also normally harmless in pts)
JCV (john cunningham virus)
86
Required Readings: 9/06 ISMP Article | what drugs can cause PML?
natalizuamab rituximab fingolimod mycophenolate
87
Required Readings: 9/06 ISMP Article | problem with Nucala?
the vial says 100 mg/vial 00 but it actually ahs 144 mg bc overfill!!! should say 100 mg/mL after reconstitution
88
Required Readings: 9/06 ISMP Article Suppository mix up? how found? and what to do?
one manufacturer makes APAP, bisacodyl, promethazine suppositories - look the same with packaging found by bar code scanning (good job nurse) to fix: buy each from different manufacturers... (manufacturer was contacted)
89
Required Readings: 9/06 ISMP Article | Drug Shortage - Pain Med case/issue?
Woman had pain - gave morphine - not enough relief could NOT do hydromorphone because out of stock Dr ordered fentanyl - option was 250 mcg (bc vial said 250 mcg/5 mL) got thru Dr, Rph, and nurse because no one familiar with fentanyl dosing Opioid pain conversion table was made for Drs and and high dose warning made if anything over 50 mcg

Fall 2018/P3 Year' (16 decks)

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