Pharm final: medication errors

for pharm section of Nurs 207.

for which type of medications is there a higher risk for medication errors?

high alert medications.

what are drugs that are commonly involved in medication errors?

-Central nervous system drugs
-anticoagulants
-chemotherapeutic drugs

define adverse drug event (ADE) and what are the 2 broad categories of them?

-any undesirable occurrence involving medications
-the outcomes of these can range from no effect/complication to permanent disability, disfigurement, or even death.

1. medication errors
2.adverse drug reactions

what is a impending ADE (adverse drug event) that is picked up before it actually happens?

a potential ADE or a "near miss"

define medication error (medication incident)

it is a mistake with a medication, or a problem that could cause a mistake with medication. often include receiving the wrong medication or using the wrong route of admin.
-preventable

-common cause of adverse healthcare outcomes
-the reason why high alert meds are most at risk for this is not because more events have happened, but because more potential for pt harm with these meds is greater, potentially toxic nature.

Define adverse drug reaction (ADRs)

-an allergic reaction (hypersensitivity reaction)
-involves the immune system
-range from mild to life-threatening

idiosyncratic reaction: not the result of a known pharmacological property of a drug or client allergy
happens unexpectedly.
*can happen due to fillers in other forms such as
generic vs brand name

what do nurses have the responibility to do in terms of adverse drug reactions

nurses are responsible to report them to health Canada through MedEffect.

what are the issues contributing to medication errors?

-procuring
-prescribing
-transcribing
-dispensing
-administering
-monitoring

-organizational issues
-educational system issues
-sociological factors
-use of abbreviations

causes of medication errors?

human factors such as performance deficits, knowledge deficits, miscalculation of dose

communication mistakes such as unreadable handwriting
inaccurate or omissions in client hand off or report
verbal/telephone orders

name confusion:
lookalike and sound-alike names

what is Tallman lettering

changes the shape of similar med drug names to prevent medication errors.

ex: DOPamine

what are the types of medication errors?

near miss: circumstances or events happened that could have led to an error

no harm error: medication error that causes no harm

medication error: that causes harm

critical incident: medication error that results in serious harm

what are the 5 most common causes of med errors?

1. incomplete client info
2.unavailable drug info
3.miscommunication of drug orders
4. lack of appropriate drug labeling
5. environmental distractions

what are the ways to prevent medication errors?

1.perform patient assessment before preparing/administering medications
2. always have TWO patient identifiers, check allergies and identification
3. do not admin if you didn't draw up the med yourself
4. never leave meds unattended
5. avoid abbreviations
6. never assume anything about items not specified in a drug order
7. check 10 rights 3 times
8. do not hesitate to ask questions
9. do not try to decipher bad hand writing, contact the prescriber for clarification

what to remember with verbal or telephone orders

1.repeat order back to the doctor
2. spell the drug name out-loud
3.speak slowly and clearly
4. document on the actual order form

*telephone orders must be signed by prescriber within 24h or according to the policy.

what should clients know about their medications to keep them safe?

Know names of all medications
Know what side effects may occur
Use appropriate administration devices
Read label prior to each drug administration
Carry list of all medications, including OTC and herbals
Ask questions

how do clients contribute to medication errors that they are taking on their own?

Taking drugs prescribed by several practitioners
Getting prescriptions filled at more than one pharmacy
Not filling or refilling prescriptions
Taking medications incorrectly
Taking medications that may be left over from a previous illness
Taking medications prescribed for something else

what is medication reconciliation?

the continuous assessment and updating of patient medication info.

process where medications are reconciled at all points of entry and exit in a health care setting

the patient. lists all medications they are on and the doctor assesses and decides if they should be continued according to their situation.

critical incident disclosure loop.

INCIDENT
1. immediate care: provide support to the patient family and staff involved. apologize and disclose facts as known

2. investigation: listen to pov of patient and family. keep them in the loop of any updates.

3. follow up meeting: share investigation findings, including new facts and suggested system improvements

4. closure: share learning implement improvements and evaluate change.

incident reports are a part of a clients hospital records, true or false

false. they are not

what does CNA's code of ethics do for nurses?

provides us with guidance for ethical decision making and evaluating ethical nursing practice.

requires nurses to practice and admin medications according to what's in the code.

what are the CRNNs standards of practice?

are defined by the provincial and territorial professional nursing associations

require nurses to admin meds as specified in the standards of care

standards of care are defined as reasonable and prudent action.

polypharmacy: geriatric consideration

-taking a lot of medications at the same time especially when multiple meds are in the same class for the treatment of one or more chronic diseases.

concerns with this include: increased risk for drug interactions

what are BEERs drugs?

a listing of drug and drug classes to be avoided or used with caution in older adults