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 Name confusion: ● ● Confusion between brand names Celebrex and Celexa, resulting in wrong drug administration. Confusion between generic names Rifampin and rifaximin, leading to wrong drug administration. Packaging, formulations, and delivery devices: ● ● ● Topical product in sterile intravenous multidose vial caused confusion. Confusion due to similarities in color, shape, or size of tablets or capsules. Malfunction or selection of wrong delivery devices. Labeling and reference materials: ● ● Wrong patient name, drug name, strength, or directions on the label of dispensed product. Inaccurate, incomplete, misleading, or outdated information in reference materials. Institutional culture change: ● ● Focus on preventing errors through system and process design rather than blaming individuals. Encouragement of active participation by patients and their families in healthcare decisions. Action goals for medication safety: ● ● ● Institutional commitment to a culture of safety. Medication safety education for all employees. Ongoing recognition of safety innovation. Strategies to improve patient safety in medication management: ● ● ● ● ● ● ● ● ● ● ● ● Designate a medication safety coordinator/officer and identify physician champions Promote greater use of clinical pharmacists in high-risk areas Establish area-specific guidelines for unit-stocked medications Ensure availability of critical medication information to all members of the patient's care team Eliminate dangerous abbreviations and dose designations Implement safety checklists for high-alert medications and infusion pumps Develop limitations and safeguards for verbal orders Perform failure-mode analysis during the procurement process Implement triggers and markers to indicate potential adverse medication events Eliminate the use of infusion pumps without free-flow protection Implement computerized prescriber order entry systems Adapt strategies to meet individual institutional needs Successful measures implemented to reduce medication errors: ● ● ● ● Replacing handwritten medication orders with computerized order entry systems Having a senior clinical pharmacist accompany physicians in ICUs Using bar-code systems to match patient and drug information Incorporating medication reconciliation Reporting a medication error: ● ● ● Report through the Medication Error Reporting (MER) Program by phone or online Reporting is confidential and encouraged from healthcare providers Focus is on improving patient safety by increasing knowledge of medication errors Note: This text contains additional information not mentioned in the initial request Medication Reconciliation ● ● Medication reconciliation is the process of comparing a patient's current medication list with new medications that may be provided during a transition in care. Transitions in care include hospital admission, discharge, moving to a different level of care, transfer to another facility, or discharge home. Steps for Conducting Medication Reconciliation ● ● ● ● ● Create a list of current medications, including name, indication, route, dosage size, and dosing interval. Create a list of all medications to be prescribed in the new setting. Compare the medications on both lists. Adjust medications based on the comparison, discontinuing duplicates or inappropriate drugs and avoiding drugs that can interact adversely. Provide the updated, reconciled list to the patient and the new provider during the next transition in care.