prelim 2 - medication review

Defined as any preventable event that may cause or lead to inappropriate medication use or patient harm

Medication error

Are essential in combating medication risks and errors

Pharmacists

The __________ defined medication review (MR) as a “structured evaluation of patient’s medicines with the aim of optimizing medicine use and improving health outcomes” (PCNE)

Pharmaceutical Care Network Europe

The Pharmaceutical Care Network Europe (PCNE) defines __________ as a “‘structured evaluation of patient’s medicines with the aim of optimizing medicines use and improving health outcomes”

Medication review (MR)

Addresses issues relating to the prescription or medicines; the patient does not need to be present, nor access to full notes (Types of review)

Type 1 (Prescription review)

Addresses issues relating to the patient’s medicine taking behavior by community pharmacists (Types of MR)

Type 2 (Concordance and compliance review)

Addresses issues relating to the patient’s use of medicines in the context of their clinical condition (Types of MR)

Type 3 (Clinical medication review)

A subtype of MR; describes pharmacists partnering with patients to improve their medicine use, consider their preferences, and ultimately optimize medication adherence

Medication-use review (MUR)

__________ aims primarily at improving clinical outcomes

Medication review (MR)

__________ is a service exclusively designed to improve medication adherence

Medication-use review (MUR)

__________ is a structured assessment of a patient’s medication therapy

Medication review (MR)

To conduct an MR, adequate time, resource, logistics, and professional training are necessary (Conditions & requirements of medication review)

Resources & logistics

Interprofessional collaboration is essential to ensure beneficial outcomes of MR (Conditions & requirements of medication review)

Collaborative efforts

___________ processes must be established and embedded into practice

Privacy

__________ needs to be maintained through the use of secure files

Confidentiality

__________ of the patient must be obtained before comprehensive medication management review services are undertaken

Consent

Effective __________ is essential to maximize safety, quality, and efficiency

Documentation

Each year, in the United States alone, __________ to __________ people die due to a medication error

7,000-9,000

The __________ defines medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm” (NCCMERP)

National Coordinating Council for Medication Error Reporting and Prevention

The National Coordinating Council for Medication Error Reporting and Prevention defines ___________ as “any preventable event that may cause or lead to inappropriate medication use or patient harm”

Medication error

The __________ defines an adverse drug reaction as “any response that is noxious, unintended, or undesired, which occurs at doses normally used in humans”

World Health Organization (WHO)

The World Health Organization defines an ___________ as “any response that is noxious, unintended, or undesired, which occurs at doses normally used in humans”

Adverse drug reaction

__________ are expected negative outcomes that are inherent to the pharmacologic action of the drug and not always preventable

Adverse drug reactions

__________ is an injury from a medication or a missed or inappropriately dosed medication

Adverse drug event

__________ causes morbidity or mortality to a patient

Adverse drug event

__________ is an iatrogenic incident that is inherent to medication therapy

Medication misadventure

__________ includes medication errors, adverse drug reactions, and adverse drug events

Medication misadventure

__________ are always undesirable and unexpected

Medication misadventures

__________ defines a sentinel event as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof”

Joint Commission

Joint Commission defines a __________ as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof”

Sentinel event

The phrase __________ includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome

“Or the risk thereof”

__________ may include medication errors, adverse drug events, and medication misadventures

Sentinel events

__________ can occur at many steps in patient care, from ordering the medication to the time when the patient is administered the drug

Medication errors

__________ are grouped by different taxonomies by the Joint Commission, World Health Organization, and the National Coordinating Council for Medication Error Reporting and Prevention

Medication errors

Usually occurs due to improper storage of preparations resulting in deterioration or use of expired products (Causes of medication errors)

Expired product

Duration errors occur when medication is received for a longer or shorter period of time than prescribed (Causes of medication errors)

Incorrect duration

This error usually occurs with compounding or some other type of preparation before the final administration (Causes of medication errors)

Incorrect preparation

May potentially occur at many points in the medication process; it usually occurs due to human error when similar bottles or syringes with the incorrect strength is selected (Causes of medication errors)

Incorrect strength

Most often occurs with medications that are given as IV push or infusions; this is particularly dangerous with many drugs and may result in significant adverse drug reactions (Causes of medication errors)

Incorrect rate

In both home and institutional settings, it is challenging to be completely accurate with scheduled doses (Causes of medication errors)

Incorrect timing

This error includes overdose, underdose, and an extra dose (Causes of medication errors)

Incorrect dose

Occurs when an inappropriate or different medication dose is given other than what was ordered (Causes of medication errors)

Incorrect dose

This occurs when a patient receives a dosage form different than prescribed, such as immediate-release instead of extended-release (Causes of medication errors)

Incorrect dosage form

This occurs when a patient takes medication inappropriately (Causes of medication errors)

Incorrect patient action

__________ is the only way to prevent incorrect patient action

Patient education

Dispensing a drug that the patient has an allergy often due to failure to communicate with the patient (Causes of medication errors)

Known allergen

This occurs when medications are not vigilantly reviewed for drug-drug, drug-disease, or drug-nutrient interactions (Causes of medication errors)

Known contraindication

Their errors are usually judgmental or mechanical; most common causes involve workload, similar drug names, interruptions, etc. (Causes of medication errors)

Pharmacist

Include failure to detect drug interactions, inadequate drug utilization review, inappropriate screening, etc. (Causes of medication errors - pharmacists)

Judgmental errors

Is a mistake in dispensing or preparing a prescription such as administering an incorrect drug or dose, giving improper directions, or dispensing the incorrect dose, quantity, or strength (Causes of medication errors - pharmacists)

Mechanical error

One of the major causes of medication errors is __________; occurs when a lapse of judgment develops (Causes of medication errors)

Distraction

A prevalent cause of medication errors is __________; may originate from poor writing, misunderstood symbols, the use of abbreviations, or improper translation (Causes of medication errors)

Distortions

Has plagued both nurses and pharmacists for decades; when physicians are often in a hurry and frequently scribble down orders that are not legible (Causes of medication errors)

Illegible writing

Bad writing by physicians has become such a major problem that the __________ has recommended the complete elimination of handwritten orders and prescriptions (ISMP)

Institute of Safe Medication Practices

It is best to spell out the quantity (Solutions to medication errors)

Write down the precise dosage

Use the universal metric measures that are preferred by pharmacists and practitioners (Solutions to medication errors)

Use metric measures

The two populations that are very sensitive to medications are the __________ and __________ (EC)

Elderly, Children

Always check the patient’s age and body weight to ensure that the dose administered is correct (Solutions to medication errors)

Consider patient age

Patients with renal and liver dysfunction need lower doses (Solutions to medication errors)

Liver and kidney function

Provide clear instructions on doses, the number of pills, and how and when the medication is to be taken (Solutions to medication errors)

Provide directions

One widespread cause of medication errors; these can have several other meanings that can be misinterpreted (Solutions to medication errors)

Use of abbreviations

It is vital to specify the duration of treatment and that the duration of treatment matches the number of pills prescribed (Solutions to medication errors)

Duration of treatment

For example, if a patient has deep vein thrombosis or a prosthetic heart valve and requires warfarin, only prescribe for 4 weeks at a time and reassess the patient on each visit (Solutions to medication errors)

Remain alert for high-risk medications

Writing the indication for the drug is highly recommended because many drugs have multiple uses (Solutions to medication errors)

Always specify the indication for the drug

When dealing with elderly patients, healthcare providers should avoid ordering drugs listed on the Beers criteria (Solutions to medication errors)

Choose the appropriate drug for the patient population

Always add extra precautions when necessary (Solutions to medication errors)

Add supplemental instructions

Refers to a list of drugs that are known to have the potential to cause adverse reactions in elderly individuals

Beers criteria

When prescribing ___________, the patient should be warned about sun exposure

Tetracyclines

When taking __________, the patient should be told to take the medication with food

Ibuprofen

Develop a reporting system and then make changes to prevent similar errors from reoccuring (Solutions to medication errors)

Adopt a reporting system

Considering the many drugs available to treat the same disorder, involve the patient in decision-making (Solutions to medication errors)

Discuss the patient’s preferences

Many healthcare providers write prescriptions or orders in the chart and often do not leave a contact number (Solutions to medication errors)

Write your contact number

In reference to the PCNE definition of MR, type __________ comprises MUR

2a )