this case study and question o
this case study and question on it
Misr General Hospital has determined that its medicationmanagementsystem is “broken”. Costs are growing rapidly, doctors arecomplainingthat needed medicines are not available, while the pharmacypointsfingers at the internists saying that they use so many high priceantibioticsthat they don’t have the budget to buy other medications that arealsoneeded.The recently instituted measurement of medication errors disclosedalarge number of them, a significant percentage of which has to dowithadministration at the wrong time. Possibly related to the issueofmedication errors is the fact that post-hysterectomy infectionshaveincreased greatly; the nurses in the operating suite claiming thatpatientsare not receiving their antibiotic prophylaxis properly. Thequalitysteering committee developed the following set of measure todeterminethe extent of the problems and to help analyze their causes:Internal Medicine:Measure: The use of third generation cephalosporin as first linetreatmentfor the diagnosis of pneumonia.Numerator: The number of patients over the age of eighteen whowerediagnosed on admission with pneumonia and received one of thedesignated drugs within 24 hours of admission.Denominator: All patients over the age of eighteen with theadmissiondiagnosis of pneumonia.Frequency of measure: Monthly.
Obstetrics and Gynecology:Measure: Proper application of prophylactic antibiotics forabdominalhysterectomy.Numerator: All adult patients who received the first dose ofantibioticswithin one hour of the start of the operative procedure ofabdominalhysterectomy.Denominator: All adult patients who underwent the operationofabdominal hysterectomy.Frequency of measure: Every 3 months.
Nursing Service:Measure: Mis-timed administration of medications to patients.Numerator: Medications administered within 30 minutes (plus orminus)of the time ordered, or if the order is imprecise, such as 3 timesa day,within the time set by nursing policy.Denominator: All medications ordered.Frequency of measure: Sampling one day each week for eachnursingunit.
Pharmacy:Measure: Frequency of medications ordered by physician notbeingavailable for dispensing.Numerator: Each instance of a medication ordered by a physiciannotbeing in stock.Denominator: None-measure is simple number.Frequency: Monthly.
For each four measures, answer the followingquestions:1. Do the numerator and denominator actually measure what isbeingintended?2. If not, why not?3. Is the frequency of measurement appropriate?4. If not appropriate, what is the proper frequency?Do you have any other comment to make about any of the fourmeasures?
QUESTIONS ABOUT MEDICATION ERRORS
A. If the prescription is wrongly written but the right doseisadministered at the right time, is it a medication error? If not,is it anear miss?B. If the order is wrongly transcribed, but the right dose isadministered at the right time, is it a medication error? If not,is it anear miss?C. If the order neglects to note that the patient is reported tobeallergic, is it a medication error? If not, is it a nearmiss?D. If the order does not take drug-drug interactions into account,is it amedication error? If not, is it a near miss?E. If the prescription is correct, but the medication isadministered tothe wrong patient, who does not suffer any ill effect, is itamedication error? If not, is it a near miss?F. If the patient’s renal function necessitates a lower doseofmedication and this is not recognized, is it a medication error?Ifnot, is it a near miss?G. If the usual adult dose is administered to an 85-year oldpatientwho suffers a well described dose-related adverse reaction, is itamedication error? If not, is it a near miss?H. A patient unexpectedly suffers a convulsion. He has receivedtherecommended dose of a drug that is contraindicated in thepresenceof a seizure disorder, which he wasn’t known to have. Was thepatient the victim of a medication error? If not, is it a nearmiss?I. A diabetic patient has a renal arteriogram. Four days later, itisnoticed that her serum creatinine had increased three fold.Shereceived no medications known to cause kidney failure. Is itamedication error? If not, is it a near miss?J. A patient treated for pneumonia is found dead. He was lastcheckedthree hours ago. The antibiotic he should have received twohoursago was not given. Did he die as a result of a medicationerror?K. If the answer to J is “no”, was there a medication error? Ifnot, is ita near miss?
Answer:
MEDICATION ERROR IS DEFINED AS ANY PREVENTABLE EVENT THAT MAYCAUSE OR LEAD TO INAPPROPRIATE MEDICATION USE OR PATIENT HARM WHILETHE MEDICATION IS IN THE CONTROL OF THE HEALTHCARE PROFESSIONAL,PATIENT,OR CONSUMER.
TO SAFEQUARD AGAINST MEDICATION ERRORS,NURSES MUST IMPLEMENT THEPROPER PROCEDURES FOR MEDICATION ADMINISTRATION,INCLUDING AT LEASTTHESE FIVE RIGHTS
RIGHT PATIENT
RIGHT DRUG
RIGHT DOSE
RIGHT ROUTE
RIGHT TIME
RIGHT DOCUMENTATION ALSO IMPORTANT
failure to record the medication administered increases the riskthat the patient will receive another dose
THE NUMERATOR AND DENOMINATOR ARE NOT DOING THEIR WORKPROPERLY.NOT MEASURE THE MEDICATION BEING INTENDED.SO THE ABDOMINALHYSTERECTOMY INFECTION RATE INCREASE RAPIDLY.
ACCORDING TO THE INTERNAL MEDICINE THE ANTIBIOTICS GIVEN WITHIN24 HRS BUT THE FREQUENCY CHECKING MONTHLY.
THE FREQUENCY OF A MEDICINE REFERS TO HOW OFTEN IT IS TAKEN.WHENMEDICINES ARE TO BE GIVEN MORE THAN ONCE DAILY,IT IS IMPORTANT THATTHEY ARE SPACED OUT REGULARLY.
HERE THE MEDICINE ARE CHECKED I MONTHLY AND 3 MONTHLY SO THATINCREASES THE MEDICATION ERROR AND RISK FACTORS.
THE PHYSICIAN SHOULD INFORM THE MEDICAL AUTHORITY AND ARRANGETHE MEDICATION.NEARLY EVERY STATE HAS A PRESCRIPTION DRUGMONITORING PROGRAMTHAT TARACK ALL PRESCRIPTION AND ALSO THEMEDICATION RECORDS CAN BE VIEWED IN THE MY HEALTH RECORD SYSTEM AREDISPLAYED IN THE PRESCRIPTION AND DISPENSE VIEW,WHICH ALLOWSINDIVIDUALS AND THEIRNHEALTH CARE PROVIDERS TO EASILY VIEW DETAILSOF THEIR PRESCRIBED AND DIPENSED MEDICATION.
SO THE NOMINATOR AND DENOMINATOR CAN CHECK THE MEDICATION ANDSHOULD CHECK THE MEDICATION APPROPRIATELY
A. MEDICATION ERROR CAN OCCUR IN CHOOSING AMEDICINE-IRRATIONAL,INAPPROPRIATE ,IN EFFCTIVEPRESCRIBING,UNDERPRESCRIBING AND OVER PRESCRIBING.WRITING THEPRESCRIPTION -THAT IS PRESCRIPTION ERRORS THAT IS NOTMEDICATION ERRORS.
PRESCRIPTION ERRORS ARE TYPICALLY EVENTS THAT DERIVEFROM SLIPS ,LAPSES OR MISTAKES,WRITING A DOSE THAT IS ORDERS OFMAGNITUDE HIGHEROR LOWER THAN THE CORRECT ONE BECAUSE OF ERRONEOUSCALCULATION OR ERRONEOUS PRESCRIPTION DUE TO SIMILARITIES INDRUGBRAND NAMES OR PHARMACEUTICAL NAMES.
B, MEDICATION TRANSCRIPTION ERRORS (MTEs)ARE FREQUENT INHOSPITALIZED PATIENT SETTINGS .TRANSCRIPTION ERROR IS A SPECIFICTYPE OF MEDICATION ERRORS AND IS DUE TO DATA ENTRY ERROR THAT ISCOMMONLY MADE BY THE HUMAN PERATOR
C. RIGHT DRUG IS IMPORTANT.THE PHYSICIAN SHOULD NOTICETHE PATIENT CONDITION.
HERE WHERE IN A LACK OF COMMUNICATION EXISTS THE HEALTH CAREWORKERS NOT HAVE THE IDEA ABOUT PATIENT IT IS A MEDICATIONERROR
IT IS A PRESCRIBING ERROR WHEREIN THE SELECTION OF ADRUG IS INCORRECT BASED ON THE PATIENTS ALLERGIES.
D, IT IS WRONG ORDER ,THERE IS A RISK THAT THE DRUG MAYBE PRESCRIBED TOO LONG OR AN INADEQUATE AMOUT OF TIME IT ISMEDICATION ERROR .SO THE HEALTH CARE WORKERS SHOULD ARRANGE THEMEDICATION PROPERLY
E, IT IS MEDICATION ERROR
WRONG PATIENT AND WRONG MEDICATION IF ITS NO ANYT ILLEFFECTS EVENTHOUGH IT IS A MEDICATION ERROR
TOU HAVE TO INFORM THE CLIENT
NOTIFY THE REST OF THE CARE TEAM,
DOCUMENT THE ERROR AND REPORT IT TO THE HOSPITAL SAFETYCOMMITTEE.
F, IT IS A MEDICATION ERROR PATIENTS WITH RENAL ANDLIVER PROBLEMS SHOULD GIVEN LOWER DOSE.WRONG DOSE IS A MEDICATIONERROR.SOMETIMES THE PHYSICIAN IS NOT TAKING INTO ACCOUNT RENAL ANDLIVER FAILURE.
PATIENTS WITH RENAL AND LIVER DYSFUNCTION NEED LOWERDOSES.OTHERWISE ,TOXICITY CAN RESULT BECAUSE OF THE RENAL FAILURETO EXCRETE OR BREAK DOWN THE MEDICATION.
G, THIS INCLUDE THE MEDICATION ERROR IT IS A WRONG DOSETHE AGE IS IMPORTANT TO CHECK ALL PATIENT AND CALCULATE THE DOSEOTHERWISE IT AFFECT THE PATIENT LIFE.SO ITS IS A MEDICATIONERROR.
CONSIDER PATIENT AGE IS IMPORTANT,THE TWO POPULATIONSARE VERY SENSITIVE TO MEDICATIONS ARE THE ELDERLY ANDCHILDREN.ALWAYS CHECK THE PATIENTS AGE AND BODY WEIGHT TO ENSURETHAT THE DOSE ADMINISTERED IS CORRECT.
WHEN DEALING WITH ELDERLY PATIENTS,HEALTHCARE PROVIDERSSHOULD AVOID ORDERING DRUGS LISTED ON THE BEERS CRITERIA-THIS LISTOF DRUGS IS KNOWN TO HAVE THE POTENTIAL TO CAUSE ADVERSE REACTIONSIN ELDERLY INDIVIDUALS.
H, THE PATIENT UNEXPECTEDLY SUFFERS A CONVULSION THIS WECAN NOT TELL MEDICATION ERROR.PARTICULARLY THOSE WITH SOME DEGREEOF NEUROLOGIC DISEASE,ARE ESPECIALLY SUSCEPTIBLE TO THE ACTIONS OFMEDICATION.SEIZURES ARE A COMMON COMPLICATION OF DRUGINTOXICATION,AND UP TO 9% OF STATUS EPILETICUS CASES ARE CAUSED BYDRUG.WHILE THE SPECIFIC DRUG ASSOCIATED WITH DRUG INDUCED SEIZUREMAY VARY BY GEOGRAPHY AND CHANGE OVER TIME.
SO THIS WE CAN TELL NEAR MISS,THE DOCTOR SHOULD DEVELOPAPPROPRIATE MEDICATION REGIMENS AND ASSOCIATED MONITORINGPARAMETERS .
I, IT IS A MEDICATION ERROR,THAT MEANS MONITORING ERRORSUCH AS FAILING TO TAKE INTO ACCOUNT PATIENT LIVER AND RENALFUNCTION.
THE PHYSICIAN SHOULD EXAMINE THE PATIENT,AND ORDER THELABORATORY.HERE THE CAUSE OF MEDICATION ERROR IS DISTRACTION.THEPHYSICIAN DO NOT GIVE RIGHT MEDICINE .
J, WE CANT TELL PATIENT DEAD DUE TO THE MEDICATIONERROR.PNEUMONIA MAY OCCUR RESPIRATORY FAILURE.SO IT IS NOT OCCURMEDICATION ERROR
K, HERE THE MEDICATION ERROR WAS (WRONG TIME).THE HEALTHWORKER SHOULD GIVE MEDICATION RIGHT TIME THAT ISIMPORTANT.
TAKE THE ANTIBIOTICS ON TIME,TIMING IS CRITICAL WHEN ITCOMES TO ANTIBIOTICS,THATS BECAUSE A CERTAIN AMOUNT OF ANTIBIOTICSNEEDS TO BE INSIDE YOUR BODY FOR A CERTAIN LENGTH OF TIME IN ORDERTO GET RID OF THE BACTERIA THAT MAKING SICK. SO GIVEANTIBIOTIC AT THE RIGHT TIME.
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