Medication Safety and Error Prevention, Exams of Medicine

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patient safety and quality assurance

What is the term for "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer"? knowledge deficit performance deficit medication error prescription drug abuse - ✔Medication errors may be the result of patient misuse, practitioner error, or an error in the pharmacy. Deficits in knowledge or performance may be underlying causes of medication errors. Prescription drug abuse implies that a person is taking a medication with the express purpose of getting high. To avoid transcription errors in the pharmacy, which of these procedures is recommended? Repeat back all phone orders before hanging up. Require indications for all high-risk drugs. Always include a zero after a decimal point. Require an independent dose double check. - ✔Transcription errors result from incorrect data entry on the part of a human operator. Therefore, repeating back phone orders to the caller before hanging up would be the best approach to avoid this specific type of medication error. An additional precaution is always including a zero before, not after, a decimal point. Note: In most states, technicians are not allowed to take over-the-phone prescriptions, but 17 states do allow this function by a pharmacy technician, with various restrictions. Therefore, knowledge of the procedure is important in case your job location changes. Which of these is an example of unintentional medication misuse?

The patient uses someone else's prescription to self-medicate. The patient takes a benzodiazepine three times a day every day instead of just "as needed" before flying. The patient takes his opioid pain medication after it is no longer needed. The patient uses his rescue asthma inhaler multiple times per day when the drug is only indicated for emergent shortness of breath. - ✔In the case of an asthma inhaler, perhaps the patient's asthma is undertreated and he is therefore experiencing shortness of breath more than expected. He is not necessarily dependent on the medication, but a referral to a prescriber would be appropriate so the necessary control medications can be ordered. On the other hand, when a patient intentionally continues drug therapy following discontinuation, uses another person's medications, or takes a medication with addiction potential more often than prescribed, it may indicate that the patient is dependent on the medication and/or requires a larger dose than prescribed; this is considered intentional misuse. What organization is the authority on high-alert medications across different healthcare settings? Food and Drug Administration Institute for Safe Medication Practices Drug Enforcement Administration Substance Abuse and Mental Health Administration Center for Behavioral Health Statistics and Quality - ✔The Institute for Safe Medication Practices identifies high-alert medications and strategies to reduce errors and minimize harm. They are also responsible for maintaining lists of common look-alike/sound-alike drugs, error-prone abbreviations, and medications to avoid crushing. What is the term used to describe "drugs that can cause significant and considerable harm when used in error"? prescription drug abuse

Tk 1 tab PO QD. Take one tab qd. 1 tab per os qd. - ✔The Institute for Safe Medication Practices maintains a list of error-prone abbreviations, symbols, and dose designations, which includes Latin like "per os" and shorthand like "QD." To minimize the risk of errors, it is best to avoid abbreviations altogether whenever possible in all medication communications. Which of these includes a trailing zero?

500 - ✔For whole numbers, trailing zeros (e.g., 5.0) should be avoided because it could result in a 10-fold increase in the dose if the period is mistakenly overlooked. Instead, this should have been written simply as "5." The other options are examples of appropriate use of zeros and/or decimal points. Which of these medication orders is most appropriate to use? Take 10 mg per os twice daily. Take 10.0 mg PO BID. 10 mg twice daily. Take 10 mg by mouth twice daily. - ✔The Institute for Safe Medication Practices maintains a list of error-prone abbreviations, symbols, and dose designations, which includes Latin like "per os" and shorthand like "BID." To minimize the risk of errors, it is best to avoid abbreviations altogether whenever possible in all medication communications. Which of these notations is on the Institute for Safe Medication Practice's list of error-prone abbreviations, symbols, and dose designations?

PO

un HS daily - ✔"HS" may be interpreted to mean "half strength" or "bedtime"; as such, it is most appropriate to write out the term intended. "PO" is one of the few abbreviations supported by the Institute for Safe Medication Practice. Other options for "PO" include "by mouth" or "orally," but not "per os." Which of these notations is on the Institute for Safe Medication Practice's list of error-prone abbreviations, symbols, and dose designations? units mcg cc mL - ✔Cubic centimeters or "cc" may be mistaken for "u" as in "unit"; as such, it is most appropriate to write out the term intended. The notations "mL," "mcg," and "unit" are supported by the Institute for Safe Medication Practice. The hospital Pharmacy and Therapeutics Committee determines that Drug X and Drug Y are equally effective, but Drug X is preferred because of cost. If a patient is admitted to the hospital on Drug Y and switched to Drug X, what is this an example of? therapeutic interchange adverse drug event misuse over-the-counter recommendation - ✔Therapeutic interchanges allow for the substitution of one medication to an alternative, more preferred medication. Patients should be informed if their medications are interchanged or substituted in this way.

✔CQI is a set of methods to help improve pharmacy practices and should occur on a regular and continual basis. While important for accreditation, the focus is on the safe practice of pharmacy, not to just make sure all the correct boxes are checked. And while it may satisfy several pharmacy requirements, it is not centered on punishment. What is the first step to complete when a quality-related event occurs such as a medication error? Quality assurance should be used to identify what went wrong. The error should be documented. Treat the patient for any adverse effects. The error should be reported to a district manager. - ✔Any problem or medical condition resulting from a quality-related event should be treated immediately. Treatment may be as simple as changing the prescription or giving a reversal agent but, since results can be severe in some cases, it may require emergency care. Which safety organization provides a list of inappropriate abbreviations for medication orders to help prevent medication errors? USP State Board of Pharmacy ISMP The Joint Commission - ✔The Institute for Safe Medical Practices (ISMP) is a national organization that supports a medication error reporting program and reviews reported errors in some states, such as Pennsylvania. They also provide lists of healthcare words and abbreviations to avoid, as well as a list of look-alike/sound-alike drugs. The Joint Commission uses this list, but the ISMP actually creates it. When it comes to quality assurance, what is the most important aspect of PPE related to compounding?

appropriate hand washing recapping your needle after compounding taking off jewelry after donning PPE starting with the facemask when donning PPE - ✔PPE stands for personal protective equipment and hand-washing is one of the easiest, yet most important, aspects of infection control. Always wash your hands prior to any compounding procedure or pharmacy process that involves direct contact with the drug product. This includes washing your hands prior to donning PPE in accordance with USP 795 and 797. What is the benefit of using a barcode system in the pharmacy? to optimize the data entry process to keep an accurate inventory of medications to verify drug products before they reach the patient to improve workflow efficiency - ✔Each drug's barcode is also unique and can be used to verify that the correct product is chosen. It is impossible to do this with the naked eye. Instead, a scanner may be used to scan the individual drug product into the system and to verify the correct drug is chosen in the filling process. Which of the following will not improve medication safety? automation and computerization punishing staff who make a medication error personal health and hygiene standardization of pharmacy workflow - ✔A punishment culture will reduce the number of errors reported (not the number that occur) and will keep the CQI process from improving on areas in the system that need help. As a result, more medication errors are likely to occur. Which of these is appropriate regarding the use of PPE?

requires counseling by the pharmacist for all new prescriptions and no other staff member may ask the patient about this. So, be sure to verify this regulation for the state in which you plan to work. Which of these can be performed by the pharmacist only? maintaining medication inventory transferring a prescription via an unshared network entering new prescriptions into the computer compounding a prescription product - ✔Pharmacy technicians are able to perform all tasks in the pharmacy except: drug utilization review, patient counseling, transferring prescriptions (unless using a shared network), ordering and record keeping (all need pharmacist signature), and prescription verification (some states do allow tech-check-tech on a limited basis, however). In which of these scenarios would you report information to the FDA MedWatch website? A doctor prescribes a medication that is dangerous for a patient to take. A patient brings you a prescription that appears forged. A patient requests a refill too soon. A patient reports an unusual or dangerous side effect from a medication. - ✔MedWatch is a program used to report adverse events and side effects of medications to the FDA. A technician using a pharmacy computer system can perform all of the following except ____. request a refill from a doctor's office verify a prescription is correct send a prior authorization request to a doctor's office bill an insurance company -

✔Only a pharmacist can verify a prescription. Neither a computer system nor a technician can perform this function. A patient reports to a pharmacy technician that he or she is allergic to a food or medication. What step should the technician take? Enter the allergy into the patient's profile. Dispense an Epipen® to the patient. Alert the pharmacist about the patient's allergy. Nothing needs to be done because the doctor is responsible for avoiding prescribing anything to which the patient may be allergic. - ✔A patient's profile should include all food and medication to which a patient is allergic. Which of the following can be performed by a pharmacy technician and does not require pharmacist intervention? prescription data entry OTC recommendation adverse drug event reporting drug utilization review (DUR) - ✔Data entry of prescription information into a pharmacy's computer system is one of the many duties of a pharmacy technician, which does not require pharmacist intervention. OTC recommendations, DUR, and ADE reporting are not duties of the pharmacy technician and require pharmacist intervention. Where should an adverse event to a vaccine be reported to? REMS VAERS RCA MedWatch -