Topic 11: Improving medication safety

1 229 Topic 11: Improving medication safety Why focus on medications? Medicines have proven to be verybeneficial for treating illness and preventingdisease. This success has resulted in a dramaticincrease in medication use in recent , this increase in use and expansionof the pharmaceutical industry has also broughtwith it an increase in hazards, error and adverseevents associated with medication use. medication has also become increasinglycomplex: There has been a massive increase in thenumber and variety of medications may have different routes of delivery,variable actions (long acting, short acting) andthere are drugs with the same action andformulation but with different trade names.

2 Although there are better treatments forchronic disease, more patients take multiplemedications and there are more patients withmultiple co-morbidities. This increases thelikelihood of drug interactions, side-effectsand mistakes in administration . The process of delivering medications topatients is often shared by a number ofhealth-care professionals. Communicationfailures can lead to gaps in the continuity ofthe process. Doctors are prescribing a larger range ofmedications so there are more medicinesthey need to be familiar with. There is just toomuch information for a doctor to be able toremember in a reliable way. Doctors look after patients who are takingmedications prescribed by other doctors(often specialized doctors) and hence maynot be familiar with the effects of all themedications a patient is have a major role in the use of role includes prescribing, administration ,monitoring for side-effects, working in a team and potentially a leadership role in the workplacein relation to medication use and Improving patient future doctors, medical students need tounderstand the nature of medication error, learnwhat the hazards are in relation to usingmedication and what can be done to makemedication use safer.

3 All staff involved in the useof medication have a responsibility to worktogether to minimize patient harm caused bymedication , adverse reaction, error, adverse event,adverse drug event, medication error, prescribing, administration and objectives: to provide an overview of medicationsafety; to encourage students to continue to learnand practise ways to improve the safety ofmedication outcomes: knowledge andperformanceWhat a student needs to know (knowledgerequirements): understand the scale of medicationerror; understand that using medications hasassociated risks; understand common sources of error; understand where in the process errors can occur; understand a doctors responsibilities whenprescribing and administering medication ; recognize common hazardous situations; learn ways to make medication use safer; understand the benefits of a multidisciplinaryapproach to medication 11: Improving medication safety What a student needs to do (performancerequirements) Acknowledge that medication safety is a vasttopic and an understanding of the area will affecthow a clinician performs in the following tasks: use generic names; tailor prescribing for each patient; learn and practise thorough medicationhistory taking; know the high-risk medications.

4 Be very familiar with the medications youprescribe; use memory aids; communicate clearly; develop checking habits; encourage patients to be actively involved inthe medication process; report and learn from errors; learn and practise drug STUDENTS NEED TO KNOW(KNOWLEDGE REQUIREMENTS)Definitions: Side-effect A known effect, other than that primarily intended,relating to the pharmacological properties of themedication [1]. For example, a common sideeffect of opiate analgesia is reactionUnexpected harm arising from a justified actionwhere the correct process was followed for thecontext in which the process occurred [1]. Forexample, an unexpected allergic reaction in apatient taking a medication for the first to carry out a planned action as intendedor application of an incorrect plan.

5 [1]Adverse event An incident that results in harm to a patient.[1]Adverse drug event An incident that may be preventable (usually theresult of an error) or not errorMay result in: an adverse event if a patient is harmed; a near miss if a patient is nearly harmed; neither harm nor potential for the scale of medicationerror medication error is a common cause ofpreventable patient Institute of Medicine in the United Statesestimates: 1 medication error per hospitalized patientper day in the United States; [2] million preventable adverse drug eventsper year in the United States; [2] 7000 deaths per year from medication error inUS hospitals. [3]Other countries around the world that haveresearched the incidence of medication error andadverse drug events have similarly worryingstatistics [4].

6 Steps in using medication There are a number of discrete steps in usingmedication: prescribing, administration andmonitoring are the main three. Doctors, patientsand other health professionals can all have a rolein these steps. For example, a patient may self-prescribe over-the-counter medication , administertheir own medication and monitor themself to seeif there has been any therapeutic , for example, in the hospital setting,98675231 Topic 11: Improving medication safety one doctor may prescribe a medication , a nursewill administer the medication and a differentdoctor may end up monitoring the patient sprogress and make decisions about the ongoingdrug main components of each step are : choosing an appropriate medication for agiven clinical situation, taking individualpatient factors into account such as allergies.

7 Selecting an administration route, dose, timeand regimen; communicating the plan with whoever willadminister the medication . Thiscommunication may be written, verbal or both; : obtaining the medication and having it in aready-to-use form. This may involve counting,calculating, mixing, labelling or preparing insome way; checking for allergies; giving the right medication to the right patient,in the right dose, via the right route, at theright time; : observing the patient to determine if themedication is working, being used correctlyand not harming the patient; is potential for error at every step of theprocess. There are a variety of ways that error canoccur at each that using medications hasassociated risksPrescribing Sources of error in prescribing: Inadequate knowledge about drugindications, contraindications and druginteractions.

8 This has become an increasingproblem as the number of medicines in usehas increased. It is not possible for a doctorto remember all the relevant details necessaryfor safe prescribing. Alternative ways ofaccessing drug information are required. Not considering individual patient factors thatwould alter prescribing such as allergies,pregnancy, co-morbidities like renalimpairment and other medications the patientmay be taking. Prescribing for the wrong patient, prescribingthe wrong dose, prescribing the wrong drug,prescribing the wrong route or the wrongtime. These errors can sometimes occur dueto lack of knowledge, but more commonly area result of a silly mistake or simplemistake , referred to as a slip or a are the sorts of errors that are morelikely to occur at 04:00, or if the doctor isrushing or bored and not concentrating onthe task at hand.

9 Inadequate communication can result inprescribing errors. Communication that isambiguous can be misinterpreted. This maybe a result of illegible writing or simplemisunderstanding in verbal communication. Mathematical error when calculating dosescan cause errors. This can be a result ofcarelessness, but could also be due to lack oftraining and unfamiliarity with how tomanipulate volumes, amounts,concentrations and units. Calculation errorsinvolving medications with narrow therapeuticwindow can cause major adverse events. Not1011121314232 Topic 11: Improving medication safety uncommonly, a calculation error can occurwhen transposing units ( from microgramsto milligrams) and may result in a 1000 timeserror.

10 Competence with dose calculations isparticularly important in paediatrics wheremost doses are determined according to theweight of the Types of administration errors: Classic administration errors are a drug beinggiven to the wrong patient, by the wrongroute, at the wrong time, in the wrong dose orthe wrong drug used. Not giving a prescribeddrug is another form of administration errors can result from inadequatecommunication, slips or lapses, lack ofchecking procedures, lack of vigilance,calculation errors and suboptimal workplaceand medication packaging design. There isoften a combination of contributory factors. Inadequate documentation. For example, if amedication is administered but has not beenrecorded as being given, another staff membermay also give the patient the medicationthinking that it had not yet been Types of errors in monitoring: inadequate monitoring for side-effects; medication not ceased once course iscomplete or clearly not helping the patient; course of prescribed medication notcompleted; drug levels not measured, or measured butnot checked or acted upon.