Term
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Definition
| injury resulting from medical intervention related to a drug |
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Term
| Adverse Drug Reaction (ADR) |
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Definition
| include hypersensitivity reactions (10-20%), idiosyncratic reactions (5%), and predictable reactions (70-80%) |
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Term
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Definition
any preventable event that may cause or lead to inappropriate medication use or patient harm
includes professional practice, products, procedures and systems, prescribing, order, communication, product labeling, packaging, dispensing, distribution, administration, education, monitoring and use |
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Term
| Institute for Safe Medication Practices (ISMP) Goals |
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Definition
| (1) encourage a non-punitive, system-based approach to medication error reduction; (2) encourage a voluntary reporting of medication errors; (3) gain knowledge about the causes of errors; (4) disseminate information for medication error prevention |
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Term
| More than 1 in 10 medication errors are directly related to?: |
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Definition
| (1) the use of incorrect drug names; (2) confusing expressions of dosage forms; (3) misunderstood abbreviations |
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Term
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Definition
| a constellation of factors have to line up for an error to occur and many of these factors are out of control of the person administering the dose |
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Term
| At what level do most medication errors occur? |
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Definition
| prescribing (56%), transcription (6%), dispensing (4%), administration (34%), monitoring |
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Term
| Unacceptable Abbreviations |
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Definition
U or u for unit
IU
cc
QD or QOD
MS or MS04
Pit
chemotherapy abbreviations
DC (discharge or discontinue) |
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Term
| Guidelines for the Use of Decimals |
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Definition
| always use a zero preceding a decimal and never use a zero following a decimal |
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Term
| What are the causes of most miscommunication? |
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Definition
| illegible handwriting, dangerous abbreviations and/or dose designations, verbal orders, ambiguous orders, fax-related problems |
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Term
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Definition
| acceptance of information that agrees with our hypothesis and rejection of information that does not |
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Term
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Definition
| oxycontin (MS contin), OxyIR (oxycontin), MSIR (MS Contin), morphine (hydroMorphone) |
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Term
| Error Reduction Strategies |
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Definition
| forcing functions and constraints, automation and computerization, standardization and protocols, checklists and double-check systems, rules and policies, education and information |
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Term
| Improvement Recommendations at the Prescribing Level |
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Definition
| computerized provider order entry (CPOE), limited drug inventory using generic names, predefined order sets, independent double-checks, avoid abbreviations and be familiar with dangerous abbreviations, minimize verbal orders |
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Term
| Improvement Recommendations at the Transcription Level |
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Definition
| question vague, incomplete, or illegible orders; fax order reviews |
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Term
| Improvement Recommendations at the Dispensing Level |
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Definition
| Robotics, automated drug distribution systems, physical environment, safe systems, be engaged and proactive |
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Term
| Improvement Recommendations at the Administration Level |
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Definition
| barcode technology, automated drug distribution systems, check patient ID |
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Term
| Improvement Recommendations at the Monitoring Level |
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Definition
| identify current systems and safeguards, develop policies and procedures, staff education and resources |
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Term
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Definition
the receiver of the verbal order should WRITE down the complete order or enter it into a computer then the receiver should READ it back AFTER it is written down
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