NAPLEX Questions: Medication Safety and Quality Improvement

What is a medication error?

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

What is a sentinel event?

An unexpected occurrence involving death or serious physical or psychological injury

Who do experts think is the problem of medication errors?

Design of medical system and NOT individual error

What is an error of omission?

Something was left out that is needed for safety;

Ex. Failing to warn a patient about a side effect

What is an error of commission?

Something that was done incorrectly

Ex. Prescribing buproprion to a patient with a history of seizures

What is a root cause analysis (RCA)?

A retrospective investigation of an event that has already occurred, which includes reviewing the sequence of events that led to the error

What is a failure mode and effects analysis (FMEA)?

A proactive method used to reduce the frequency and consequences of error; evaluates the potential for failures

Where can you report medication errors and close calls?

ISMP National Medication Errors Reporting Program (MERP) online website www.ismp.org

What is the name of the goals set by TJC that decrease injuries to patients?

National patient safety goals (NPSG)

What are the six NPSGs listed in the RxPrep book?

1. Use at least two patient identifiers when providing care

2. Report critical results of tests and diagnostic procedures on a timely basis

3. Label all medications, their containers, and other solutions

4. Reduce the likelihood of harm associated with anticoagulant therapy

5. Maintain and communicate accurate patient medication information

6. Comply with the CDC hand hygiene guidelines

What are the five Do Not Use Abbreviations listed in the RxPrep book?

1. U, u for unit - write it out

2. IU for international unit - write it out

3. QD for daily and QOD for every other day (write daily or every other day)

4. Trailing and lacking leading zeros (0.1 or 1.0)

5. MS and MSO4 for morphine sulfate and magnesium sulfate- write it out

What are the top three High-Alert Drugs listed in the RxPrep book?

1. Insulin and oral hypoglycemics (hypoglycemia)

2. Anticoagulants (bleeding or clot risk)

3. Concentrated electrolytes (injectable KCL, phosphate, magnesium, hypertonic saline)

Opioid (respiratory depression)

Sedatives

List the five safe practices for "crash carts"

1. Meds should be unit-dose and age specific

2. Weight base dosing chart should be in cart

3. Prefilled syringes and drips if possible

4. Replace as soon as possible after use

5. Monitor expiration dates closely

How can high alert medication be used more safely?

- Developing protocols or order sets (insulin and KCl)

- Using premixed products whenever possible (KCl)

- Limiting concentrations available in the institution

- Stocking high alert products in the pharmacy (not in ADCs or on nursing units)

What is a code blue?

A patient requiring emergency medical care, typically for cardiac or respiratory arrest

What is the most important medication error reduction tool available? Why?

Barcoding

Follows the drug through the medication use process to make sure it is being properly stocked, through compounding, and administered to the pt

When should medication reconciliation be done?

It should be done at each stage of health care delivery:

- Admission

- Status

- Patient transfer within or between facilities/provider teams

- Discharge

What is preferred to "use as directed"?

"Use per instructions on the dosing calendar" for warfarin

Why should multiple-dose vials be avoided?

- Risk for cross contamination (infection)

- Overdosing

If use, only use for a single patient until they are done. Discard the rest.

What are the five methods to improve automated dispensing cabinet safety?

1. Require that pharmacists must review orders before medications can be removed

2. LASA medications should be stored in different locations within the ADC (Barcode scanning improves ADC safety)

3. Look-alike and sound-alike medicaiton should be stored in different locations within the ADC

4. Certain medications should not be put into the ADCs, including insulin, warfarin, and high-dose narcotics

5. Nurses should not put medications back into the medication compartments

6. Place the machine in a quiet, not busy, and with great lighting

What is a very common infection from indwelling catheters?

UTIs

remove catheters as soon as possible

Which kind of line has the highest risk for blood stream infections?

Central lines

What might increase the risk of PNA in a hospital?

Ventilator use

Hydromorphone is ___ times more potent than morphine

six times

Contact precautions are recommended for which patients? How should healthcare professionals enter the room?

Those with MRSA, VRE, and/or C. difficile infections

Airborne precautions are recommended for which patients?

Those with active pulmonary tuberculosis, measles, or varicella virus (chickenpox)

What is more effective in healthcare settings: soap and water or hand sanitizer?

Alcohol based hand sanitizer

What are the five situations where soap and water is preferred over hand sanitizer?

1. Before eating

2. After using the restroom

3. Anytime there is visible soil

4. After caring for a patient with diarrhea or known C. diff or spore-forming organisms as alcohol based-hand rubs have poor activity against spores

5. Before caring for patients with food allergies

What are the safety injection practices for healthcare facilities?

- Never admin an oral solution/suspension IV (use oral syringes) and label syringes for oral use only

- Never reinsert used needles into a multiple-dose vial or solution (single are preferred)

- Never touch the tip or plunger of syringe

- Discard a disposable needle or sharp into container without recapping asap

What is CPOE and what are the advantages of CPOE?

Computerized physician/provider order entry

Clinical decision support (CDS) and patient labs can be built into CPOE and can notify prescriber for inappropriate drugs or lab indications.

What is Failure Modes and Effects Analysis (FMEA)?

Step-by-step approach for identifying all possible ways in which something might fail

What is the most common type of medication error?

Giving wrong drug or wrong dose to a pt

What drug does morphine get mixed up with in the hospital settings?

Hydromorphone (more potent)

Where can used sharps be disposed?

- Public drop boxes and mail boxes

- Hazardous waste pick-up days or collection sites

- Police and fire departments

- Pharmacies

What are drug use evaluation (DUE)?

Retrospective analyses of pt drug usage, or of physician prescribing habits.

Helpful in guiding therapy to guidelines, or in saving money, or BOTH