162 lab_Lesson 3: Medication Use Process (Answer with Term)

1. Prescribing

2. Transcribing

3. Dispensing

4. Administration

5. Monitoring

Look at it as a cycle

Medication Use Process

To Prescribe

• To advise and authorize the use of a medicine or treatment for someone, especially in writing (Oxford University Press, 2014)

  • Deciding on the medication

  • Preparing the prescription for dispensing and/or administration

Prescribing Error

• Failure to review a prescribed regimen for appropriateness and detection of problems

• Failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy

1. Prescribing Factors

2. Patient Factors

3. Medication Factors

4. Patient Preferences

5. Organizational Factors

Influences on a prescribing decision [5]

1. Previous experience

2. Clinical knowledge and skills

3. Values and beliefs

Influences on a prescribing decision - Prescribing Factors [3]

1. Medical history

2. Physiological parameters

3. Comorbidities

4. Concurrent medications

Influences on a prescribing decision - Patient Factors [4]

1. Research evidence

2. National guidelines

3. Side-effect profile

4. Cost

5. Monitoring requirements

Influences on a prescribing decision - Medication Factors [5]

1. Acceptability (Side effects, regime, formulation)

2. Previous experience

3. Values and beliefs

Influences on a prescribing decision - Patient Preferences [3]

1. Local guidelines and protocols

2. Formularies

3. Prescribing norms

4. Cost

Influences on a prescribing decision - Organizational Factors [4]

1. Decision-making errors (clinical errors)

2. Prescription writing errors (clerical or technical errors)

Two main types of Prescribing Errors

Decision-making errors (clinical errors)

[Type of Prescribing Error]

• E.g., errors in choice, dose or frequency of medication to be prescribed

• Dosing errors are the most common and more serious type of this error

Prescription writing errors (clerical or technical errors)

[Type of Prescribing Error]

 E.g., omission of the route of medication, illegibility of the prescription

1. Cardiovascular drugs 

2. Analgesics 

3. Hypoglycemic agents

Three categories of medication responsible for over four-fifths of preventable ADEs in ambulatory care (Thomsen, et. al., 2007):

1. Superscription: age (72.44%), gender (32.66%), date (18%) 

2. Inscription: dose (22%), dosage form (23%) 

3. Signa: directions for use (46%)

Types of omission errors in handwritten outpatient prescriptions (Shahaibi, et. al., 2012):

1. Individual Factors

2. Team Factors

3. Latent conditions

4. Patient Factors

5. Work Environment Factors

Causes of Prescribing Errors [5]

Dispensing Error

Deviations from a written prescription occurring during the dispensing process of selecting and assembling medication, generating and affixing of dispensing labels, and issue of the dispensed products to patients

1. Receipt of prescription

2. Legal check of prescription

3. Clinical check of prescription

4. Label generation

5. Stock selection

6. Medication assembly

7. Product labeling

8. Final accuracy check

9. Patient counseling

Typical steps involved in dispensing medication to individual patients in community and hospital pharmacies [9]

1. Technical errors

2. Clinical judgement errors

Types of Dispensing Errors

Technical error

• These are the errors usually experienced in a pharmacy

Dispensing error that may occur during the process of checking prescriptions for legal validity, product assembly or preparation, labeling, and completion of appropriate documentation or registers

Clinical judgement error

Dispensing error that may occur during screening of prescriptions for clinical appropriateness or during patient counseling

1. External errors

2. Internal errors

Two kinds of technical error

External Errors

Detected and reported after medication left the pharmacy

• Harm can happen

• After dispensing error, we could have communicated with the patient or not

Internal Errors

• Detected during dispensing before the medication has been issued

  • E.g. Near miss

  • Umabot kay patient yung error pero no harm

Drug Content Errors

Labeling Errors

Issue Errors

Documentation Errors

1. Workload

2. Look Alike, Sound Alike Drugs (SALAD’s)

3. Work Environment

Causes of Dispensing Error

Administration

Composed of: 

• Preparation 

• Actual drug administration

Medication administration error (MAE):

the administration of a dose of medication that deviates from the prescription, as written on the patient medication chart, or from standard hospital policy and procedures

1. Right patient

2. Right drug

3. Right time

4. Right dose

5. Right route

During administration, we usually check 5 rights of medication administration:

1. Omission 

2. Wrong dose/improper dose 

3. Wrong dosage form 

4. Deteriorated drug 

5. extra/ dose/unordered dose 

6. Wrong drug 

7. Unordered/non-prescribed drug 

8. Wrong route 

9. Wrong dose preparation/preparation technique 

10. Wrong patient 

11. Wrong rate of administration 

12. Drug incompatibility 

13. Wrong time 

14. Wrong administration technique 

15. Fast IV bolus 

16. Wrong diluent

Examples of Administration Error

1. Patient

2. Staff

3. Working Environment

4. Medication

Causes of Administration Error