Chapter 14 - Medication Safety and Error Prevention

A delayed-release drug may be substituted for an extended-release drug.

False; a delayed-release drug has a coating that delays the release of the drug until it has passed the stomach while an extended-release drug is designed to deliver the medication through a longer period of time.

All drug errors cause harm to the patient.

False; not all drug errors are harmful or caused by the pharmacy.

A drug error cannot be reported anonymously.

False; reporting can be done anonymously and voluntarily without fear of retribution.

The ability to catch mistakes before they occur will always be the responsibility of the personnel involved in the prescribing, ____, and dosing of medications.

Filling

The most important aspect of dealing with errors is the reporting process.

True

Medication administered in a dosage form other than what was ordered.

Wrong dosage form

The FDA has recommended new labeling on over-the-counter (OTC) cough and cold medications for children. What does the new label say?

"Do not dose children under the age of 4 years" as well as the new label states that a physician should be consulted for children ages 4 to 6 years.

Drug is incorrectly formulated or manipulated, and medication is administered to patient

Wrong drug preparation error

Medication administered outside scheduled time frame

Wrong time error

Anticoagulants such as warfarin have the potential for many interactions with:

-Dietary/herbal supplements -other drugs -food

Life expectancy in the United States has risen in the past century as a result of:

-Improved health care -Increased activity -Better dietary intake

List six strategies a pharmacy technician can use to help reduce errors.

1. Dispense vincristine (and other vinca alkaloids) in a minibag of a compatible solution and not in a syringe 2. Use a weekly dosage regimen default for oral methotrexate. If the prescription is changed to a daily regimen, require a hard stop verification of an appropriate oncological indication and provide patient education by a pharmacist for all weekly oral methotrexate discharge orders 3. Measure and express patient weighs in metric units only. Ensure that scales used for weighing patients are set and measure only in metric units 4. Ensure that all oral liquids are not commercially available as unit dose are dispensed by the pharmacy in an oral syringe 5. Purchase oral liquid dosing devices (oral syringes/cups/droppers) that display only the metric scale 6. Eliminate glacial acetic acid from all areas of the hospital.

List the five guidelines used to share information with health care professionals about potentially dangerous events.

1. Knowledge 2. Analysis (the evaluation of data) 3. Education 4. Cooperation 5. Communication.

List five safety standards outlined by the Joint Commission to improve patient quality and safety.

1. Leadership process and accountability 2. Competent and capable workforce 3. Safe environment for staff and patients 4. Clinical care of patients 5. Improving quality and safety

List three forms of identification provided by bar codes.

1. National Drug Code 2. Lot number of the drug 3. Expiration date of the drug

List five basic rights involving medication safety.

1. The Right Patient 2. The Right Medication 3. The Right Dose 4. The Right Route 5. The Right Time

According to a Health and Human Services report, bad hospital care contributes to the deaths of _______ patients on Medicare in a given year.

180,000

Many pharmacies fill upwards of :

300 to 400 prescriptions per day

The Institute for Safe Medication Practices (ISMP) estimates that around _______ deaths per year are linked to actual medication errors.

7,000

The Institute for Healthcare Improvement has reported that more than _____ of all errors in hospitals are caused by poor communication of medication orders.

50%

Which drug is NOT an example of an ISMP high-alert medication?

Amoxicillin; *examples of high-alert medications: -Warfarin -Methotrexate -Potassium chloride (KCI)

Patient does not adhere to prescribed medication regimen

Compliance error

Which of the following is a category that USP defines for a modified release formulation?

Delayed release

Medication is administered that has expired or integrity of ingredients has been compromised

Deteriorated drug

Errors are always caught before they can possibly hurt someone.

False

Medication errors only occur in hospital settings.

False

One of the best ways that errors are decreased is through trial and error.

False

Which of the following drugs is of great concern as a cause of error because it is commonly used to flush IV lines?

Heparin

Most reported medication errors are made in what type of setting?

Hospital pharmacies and retail pharmacies

Patient administered a dose that is greater or less than prescribed amount

Improper dose error

Receiving care in the home also carries the risk of:

Improper dosing and contamination of IV sets

Failure to review a prescribed medication for proper regimen, appropriateness, and dosage, or failure in using laboratory results to correctly adjust dose

Monitoring error

Failure to administer an ordered dose to a patient before the next dose is due, without an apparent reason or appropriate documentation.

Omission error

Prescriber orders a medication that is incorrect or is selected incorrectly based on indications or contraindications, and medication reaches patient

Prescribing error

One of the most serious types of errors is with parenteral medications.

True

Pharmacy technicians are at the forefront in the effort to prevent drug errors.

True

What three steps are involved in medication reconciliation?

Three steps are: 1. Verification 2. Certification 3. Reconciliation

Why would a patient try to use medical supplies intended for a single use more than once, and what risks are associated with this practice?

To save money because some insurances may not cover the medical supplies and only cover the medication and the risk associated with this practice is it may increase the risk of infection.

Combined sources suggest that more than 400,000 people per year suffer some type of preventable adverse event while in the hospital that contributes to their death.

True

Even the most highly skilled person will make errors at one time or another.

True

It is imperative that every health care worker view drug error prevention as a priority.

True

Many physicians use e-prescribing or computerized physician order entry to circumvent pharmacies having to decipher poor handwriting.

True

Misinterpreted abbreviations have resulted in drug errors and are an area of concern.

True

One common cause of medication error is illegible handwriting.

True

Medication administered to a patient from an unauthorized prescriber; physician not licensed in that state or not an authorized prescriber.

Unauthorized drug error

Which of the following is NOT an example of the daily obstructions encountered by pharmacy personnel?

When their lunch hour is; *examples of daily obstructions: -stress -hard to read labels because of small print -medication names that sound alike

Drug is given using wrong procedure or technique

Wrong administration

Pharmacy technicians should always check each prescription _____ throughout the filling process.

three times