Abbreviations and Dose Designations

Chapter 7_ Adversed Drug Reactions and Medication Errors Learning Objectives 1. Describe types of medication errors, causes of medication errors, ways to reduce medication errors, and ways to report medication errors. ● Types of medication errors include mistakes in prescribing, dispensing, or administering medications. Causes of medication errors include confusion, lack of communication, and incorrect dosage calculations. Ways to reduce medication errors include implementing safety measures, improving communication, and using technology. Medication errors should be promptly reported to ensure proper action is taken. Chapter 7 Reading In Chapter 7, the significance of adverse drug reactions (ADRs) and medication errors is discussed. A rise in ADRs was observed, with over 800,000 outpatients and 1,735,500 hospitalized inpatients experiencing adverse outcomes. Medication errors, which can lead to ADRs, are also explored, including their definitions, causes, and ways to minimize them. Bullet points Medication Reconciliation at Discharge ● ● ● ● When patients leave a facility, they should receive a clear list of all medications they will be taking after discharge. The list should include medications ordered at discharge, as well as any other medications the patient will be taking, including over-the-counter drugs, vitamins, herbal products, and prescription/nonprescription drugs. The list should not include drugs used during the episode of care but no longer needed. The updated list should be provided to the patient and the new provider during the next transition in care. Abbreviations and Dose Designations That Increase Medication Errors ● ● Certain abbreviations, symbols, or dose designations can increase the risk of medication errors. Examples include: U or u mistaken as 0 or 4, IU mistaken as IV or 10, q.d. mistaken as q.i.d., q.o.d. mistaken as q.d. or q.i.d., MS mistaken for magnesium sulfate, MgSO4 mistaken for morphine sulfate, and trailing zero after decimal point mistaken as additional digits. ● Preferred alternatives should be used to avoid misinterpretation. Abbreviations and Dose Designations That Increase Risk for Medication Errors ● ● ● Leading decimal point: Mistaken as mg if the decimal point is missed Write "0" before a leading not preceded by a zero decimal point (e.g., .5 mg) Abbreviations and notations for which the alternative is recommended: ○ ug: Microgram mistaken as "mg", write "mcg" ○ cc: Cubic centimeters mistaken as "u" (units), write "mL" ○ IN: Intranasal mistaken as "IM" (intramuscular) or "IV", write "intranasal" or "NAS" ○ H.S.; hs: Half-strength; at bedtime mistaken as opposite, write "half-strength", "at bedtime" ○ qhs: At bedtime mistaken as qhr (every hour), write "at bedtime" ○ qld: Daily mistaken as q.i.d. (four times daily), write "daily" ○ q6PM, etc.: Nightly at 6PM mistaken as every 6hours, write "nightly at 6PM" ○ T.I.W.: Three times a week mistaken as three times a day or twice weekly, write "three times weekly" ○ SC, SQ, sub q: Subcutaneous SC mistaken as "SL" (sublingual), SQ mistaken as "5 every", write "subQ," "sub-Q," "subcutaneously" ○ D/C: Discharge or premature discontinuation of medications if D/C has been interpreted as "discontinued", write "discharge" or "discontinue" ○ AD, AS, AU: Right ear, left ear, each ear mistaken as OD, os, OU, write "right ear," "left ear," or each ear ○ OD, os, OU: Right eye, left eye, each eye mistaken as AD, AS, AU, write "right eye," "left eye," or each eye ○ Per os: By mouth, orally, the "os" can be mistaken as "left eye", write "PO," "by mouth," or "orally" ○ > or <: Greater than or less than mistaken for the opposite, write "greater than" or "less than" ○ AZT: Zidovudine [Retrovir] mistaken as azathioprine or aztreonam, write complete drug name ○ CPZ: Prochlorperazine mistaken as chlorpromazine, write complete drug name [Compazine] ○ ARA: Vidarabine mistaken as cytarabine (ARA C), write complete drug name ○ HCT: Hydrocortisone mistaken as hydrochlorothiazide, write complete drug name ○ HCTZ: Hydrochlorothiazide mistaken as hydrocortisone, write complete drug name Resources on Decreasing Medication Errors ● ● ● ● ● ● ● Agency for Healthcare Research and Quality's Patient Safety Network: https://psnet.ahrq.gov Institute for Safe Medication Practices: www.ismp.org Institute for Healthcare Improvement's Medication Reconciliation Information and Tools: www.ihi.org/topics/adesmedicationreconciliation/Pages/default.aspx National Coordinating Council for Medication Error Reporting and Prevention: www.nccmerp.org Preventing Medication Errors ("The IOM Report"): http://www.nationalacademies.org/hmd/Reports/2006/Preventing-Medication-ErrorsQuality-Chasm-Serie The Joint Commission's Resources Related to Medication Errors: www.jointcommission.org/topics/default.aspx?k=660 U.S. Food and Drug Administration Medication Error Resources: www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm Key Points ● ● An adverse drug reaction is any noxious, unintended, and undesired effect that occurs at normal drug doses A medication order in a hospital is processed by several people Patient at risk for adverse drug events: ● ● ● ● The very young Older adults The very ill Those taking multiple drugs Iatrogenic diseases: ● Diseases that occur as a result of medical care or treatment Idiosyncratic effect: ● An adverse drug reaction based on a genetic predisposition Paradoxical effect: ● The opposite of the intended drug effect Common types of fatal medication errors: ● ● ● Overdose Wrong drug Wrong route Common causes of fatal medication errors: ● ● ● Human factors (e.g., performance or knowledge deficits) Miscommunication (e.g., illegible prescriber handwriting) Confusion caused by similarities in drug names Drug-related risks: ● ● ● ● Drugs are the most common cause of acute liver failure Hepatotoxicity is the most common reason for removing drugs from the market Drugs that prolong the QT interval pose a risk of torsades de pointes, a potentially fatal dysrhythmia Some drugs can cause cancer (carcinogenic effect) or birth defects (teratogenic effect) Efforts to reduce medication errors: ● ● ● ● ● ● ● ● A change in institutional culture from a punitive system to a nonpunitive system Using safety checklists for high-alert drugs Replacing handwritten medication orders with a computerized order-entry system Involving a clinical pharmacist during ICU rounds Avoiding error-prone abbreviations Educating patients about adverse effects and monitoring for signs and symptoms Conducting medication reconciliation during patient transitions Using a computerized bar-code system to ensure medication administration accuracy Measures to minimize adverse drug events: ● ● ● ● Avoiding drugs that are likely to harm a particular patient Monitoring for signs and symptoms of likely adverse effects Education about possible adverse effects Monitoring vulnerable organs FDA requirements for certain drugs: ● ● ● Requiring MedGuides for patients Using boxed warnings to alert prescribers Implementing Risk Evaluation and Mitigation Strategies Impact of medication errors: ● Major cause of morbidity and mortality Possible people who can make medication errors: ● ● ● ● Pharmaceutical workers Pharmacists Prescribers Transcriptionists ● ● Nurses Patients and their families