Question

this case study and question on it

Misr General Hospital has determined that its medication management
system is "broken". Costs are growing rapidly, doctors are complaining
that needed medicines are not available, while the pharmacy points
fingers at the internists saying that they use so many high price antibiotics
that they don't have the budget to buy other medications that are also
needed.
The recently instituted measurement of medication errors disclosed a
large number of them, a significant percentage of which has to do with
administration at the wrong time. Possibly related to the issue of
medication errors is the fact that post-hysterectomy infections have
increased greatly; the nurses in the operating suite claiming that patients
are not receiving their antibiotic prophylaxis properly. The quality
steering committee developed the following set of measure to determine
the extent of the problems and to help analyze their causes:
Internal Medicine:
Measure: The use of third generation cephalosporin as first line treatment
for the diagnosis of pneumonia.
Numerator: The number of patients over the age of eighteen who were
diagnosed on admission with pneumonia and received one of the
designated drugs within 24 hours of admission.
Denominator: All patients over the age of eighteen with the admission
diagnosis of pneumonia.
Frequency of measure: Monthly.

^{Obstetrics and Gynecology:}
Measure: Proper application of prophylactic antibiotics for abdominal
hysterectomy.
Numerator: All adult patients who received the first dose of antibiotics
within one hour of the start of the operative procedure of abdominal
hysterectomy.
Denominator: All adult patients who underwent the operation of
abdominal hysterectomy.
Frequency of measure: Every 3 months.

_{Nursing Service:}
Measure: Mis-timed administration of medications to patients.
Numerator: Medications administered within 30 minutes (plus or minus)
of the time ordered, or if the order is imprecise, such as 3 times a day,
within the time set by nursing policy.
Denominator: All medications ordered.
Frequency of measure: Sampling one day each week for each nursing
unit.

Pharmacy:
Measure: Frequency of medications ordered by physician not being
available for dispensing.
Numerator: Each instance of a medication ordered by a physician not
being in stock.
Denominator: None-measure is simple number.
Frequency: Monthly.

For each four measures, answer the following questions:
1. Do the numerator and denominator actually measure what is being
intended?
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 four measures?

QUESTIONS ABOUT MEDICATION ERRORS

A. If the prescription is wrongly written but the right dose is
administered at the right time, is it a medication error? If not, is it a
near miss?
B. If the order is wrongly transcribed, but the right dose is
administered at the right time, is it a medication error? If not, is it a
near miss?
C. If the order neglects to note that the patient is reported to be
allergic, is it a medication error? If not, is it a near miss?
D. If the order does not take drug-drug interactions into account, is it a
medication error? If not, is it a near miss?
E. If the prescription is correct, but the medication is administered to
the wrong patient, who does not suffer any ill effect, is it a
medication error? If not, is it a near miss?
F. If the patient's renal function necessitates a lower dose of
medication and this is not recognized, is it a medication error? If
not, is it a near miss?
G. If the usual adult dose is administered to an 85-year old patient
who suffers a well described dose-related adverse reaction, is it a
medication error? If not, is it a near miss?
H. A patient unexpectedly suffers a convulsion. He has received the
recommended dose of a drug that is contraindicated in the presence
of a seizure disorder, which he wasn't known to have. Was the
patient the victim of a medication error? If not, is it a near miss?
I. A diabetic patient has a renal arteriogram. Four days later, it is
noticed that her serum creatinine had increased three fold. She
received no medications known to cause kidney failure. Is it a
medication error? If not, is it a near miss?
J. A patient treated for pneumonia is found dead. He was last checked
three hours ago. The antibiotic he should have received two hours
ago was not given. Did he die as a result of a medication error?
K. If the answer to J is "no", was there a medication error? If not, is it
a near miss?

Answer 1

MEDICATION ERROR IS DEFINED AS 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.

TO SAFEQUARD AGAINST MEDICATION ERRORS,NURSES MUST IMPLEMENT THE PROPER PROCEDURES FOR MEDICATION ADMINISTRATION,INCLUDING AT LEAST THESE FIVE RIGHTS

RIGHT PATIENT

RIGHT DRUG

RIGHT DOSE

RIGHT ROUTE

RIGHT TIME

RIGHT DOCUMENTATION ALSO IMPORTANT  

failure to record the medication administered increases the risk that the patient will receive another dose

THE NUMERATOR AND DENOMINATOR ARE NOT DOING THEIR WORK PROPERLY.NOT MEASURE THE MEDICATION BEING INTENDED.SO THE ABDOMINAL HYSTERECTOMY INFECTION RATE INCREASE RAPIDLY.

ACCORDING TO THE INTERNAL MEDICINE THE ANTIBIOTICS GIVEN WITHIN 24 HRS BUT THE FREQUENCY CHECKING MONTHLY.

THE FREQUENCY OF A MEDICINE REFERS TO HOW OFTEN IT IS TAKEN.WHEN MEDICINES ARE TO BE GIVEN MORE THAN ONCE DAILY,IT IS IMPORTANT THAT THEY ARE SPACED OUT REGULARLY.

HERE THE MEDICINE ARE CHECKED I MONTHLY AND 3 MONTHLY SO THAT INCREASES THE MEDICATION ERROR AND RISK FACTORS.

THE PHYSICIAN SHOULD INFORM THE MEDICAL AUTHORITY AND ARRANGE THE MEDICATION.NEARLY EVERY STATE HAS A PRESCRIPTION DRUG MONITORING PROGRAMTHAT TARACK ALL PRESCRIPTION AND ALSO THE MEDICATION RECORDS CAN BE VIEWED IN THE MY HEALTH RECORD SYSTEM ARE DISPLAYED IN THE PRESCRIPTION AND DISPENSE VIEW,WHICH ALLOWS INDIVIDUALS AND THEIRNHEALTH CARE PROVIDERS TO EASILY VIEW DETAILS OF THEIR PRESCRIBED AND DIPENSED MEDICATION.

SO THE NOMINATOR AND DENOMINATOR CAN CHECK THE MEDICATION AND SHOULD CHECK THE MEDICATION APPROPRIATELY

A. MEDICATION ERROR CAN OCCUR IN CHOOSING A MEDICINE-IRRATIONAL,INAPPROPRIATE ,IN EFFCTIVE PRESCRIBING,UNDERPRESCRIBING AND OVER PRESCRIBING.WRITING THE PRESCRIPTION -THAT IS PRESCRIPTION ERRORS THAT IS NOT MEDICATION ERRORS.

PRESCRIPTION ERRORS ARE TYPICALLY EVENTS THAT DERIVE FROM SLIPS ,LAPSES OR MISTAKES,WRITING A DOSE THAT IS ORDERS OF MAGNITUDE HIGHEROR LOWER THAN THE CORRECT ONE BECAUSE OF ERRONEOUS CALCULATION OR ERRONEOUS PRESCRIPTION DUE TO SIMILARITIES IN DRUGBRAND NAMES OR PHARMACEUTICAL NAMES.

B, MEDICATION TRANSCRIPTION ERRORS (MTEs)ARE FREQUENT IN HOSPITALIZED PATIENT SETTINGS .TRANSCRIPTION ERROR IS A SPECIFIC TYPE OF MEDICATION ERRORS AND IS DUE TO DATA ENTRY ERROR THAT IS COMMONLY MADE BY THE HUMAN PERATOR

C. RIGHT DRUG IS IMPORTANT.THE PHYSICIAN SHOULD NOTICE THE PATIENT CONDITION.

HERE WHERE IN A LACK OF COMMUNICATION EXISTS THE HEALTH CARE WORKERS NOT HAVE THE IDEA ABOUT PATIENT IT IS A MEDICATION ERROR

IT IS A PRESCRIBING ERROR WHEREIN THE SELECTION OF A DRUG IS INCORRECT BASED ON THE PATIENTS ALLERGIES.

D, IT IS WRONG ORDER ,THERE IS A RISK THAT THE DRUG MAY BE PRESCRIBED TOO LONG OR AN INADEQUATE AMOUT OF TIME IT IS MEDICATION ERROR .SO THE HEALTH CARE WORKERS SHOULD ARRANGE THE MEDICATION PROPERLY

E, IT IS MEDICATION ERROR

WRONG PATIENT AND WRONG MEDICATION IF ITS NO ANYT ILL EFFECTS 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 SAFETY COMMITTEE.

F, IT IS A MEDICATION ERROR PATIENTS WITH RENAL AND LIVER PROBLEMS SHOULD GIVEN LOWER DOSE.WRONG DOSE IS A MEDICATION ERROR.SOMETIMES THE PHYSICIAN IS NOT TAKING INTO ACCOUNT RENAL AND LIVER FAILURE.

PATIENTS WITH RENAL AND LIVER DYSFUNCTION NEED LOWER DOSES.OTHERWISE ,TOXICITY CAN RESULT BECAUSE OF THE RENAL FAILURE TO EXCRETE OR BREAK DOWN THE MEDICATION.

G, THIS INCLUDE THE MEDICATION ERROR IT IS A WRONG DOSE THE AGE IS IMPORTANT TO CHECK ALL PATIENT AND CALCULATE THE DOSE OTHERWISE IT AFFECT THE PATIENT LIFE.SO ITS IS A MEDICATION ERROR.

CONSIDER PATIENT AGE IS IMPORTANT,THE TWO POPULATIONS ARE VERY SENSITIVE TO MEDICATIONS ARE THE ELDERLY AND CHILDREN.ALWAYS CHECK THE PATIENTS AGE AND BODY WEIGHT TO ENSURE THAT THE DOSE ADMINISTERED IS CORRECT.

WHEN DEALING WITH ELDERLY PATIENTS,HEALTHCARE PROVIDERS SHOULD AVOID ORDERING DRUGS LISTED ON THE BEERS CRITERIA-THIS LIST OF DRUGS IS KNOWN TO HAVE THE POTENTIAL TO CAUSE ADVERSE REACTIONS IN ELDERLY INDIVIDUALS.

H, THE PATIENT UNEXPECTEDLY SUFFERS A CONVULSION THIS WE CAN NOT TELL MEDICATION ERROR.PARTICULARLY THOSE WITH SOME DEGREE OF NEUROLOGIC DISEASE,ARE ESPECIALLY SUSCEPTIBLE TO THE ACTIONS OF MEDICATION.SEIZURES ARE A COMMON COMPLICATION OF DRUG INTOXICATION,AND UP TO 9% OF STATUS EPILETICUS CASES ARE CAUSED BY DRUG.WHILE THE SPECIFIC DRUG ASSOCIATED WITH DRUG INDUCED SEIZURE MAY VARY BY GEOGRAPHY AND CHANGE OVER TIME.

SO THIS WE CAN TELL NEAR MISS,THE DOCTOR SHOULD DEVELOP APPROPRIATE MEDICATION REGIMENS AND ASSOCIATED MONITORING PARAMETERS .

I, IT IS A MEDICATION ERROR,THAT MEANS MONITORING ERROR SUCH AS FAILING TO TAKE INTO ACCOUNT PATIENT LIVER AND RENAL FUNCTION.

THE PHYSICIAN SHOULD EXAMINE THE PATIENT,AND ORDER THE LABORATORY.HERE THE CAUSE OF MEDICATION ERROR IS DISTRACTION.THE PHYSICIAN DO NOT GIVE RIGHT MEDICINE .

J, WE CANT TELL PATIENT DEAD DUE TO THE MEDICATION ERROR.PNEUMONIA MAY OCCUR RESPIRATORY FAILURE.SO IT IS NOT OCCUR MEDICATION ERROR

K, HERE THE MEDICATION ERROR WAS (WRONG TIME).THE HEALTH WORKER SHOULD GIVE MEDICATION RIGHT TIME THAT IS IMPORTANT.

TAKE THE ANTIBIOTICS ON TIME,TIMING IS CRITICAL WHEN IT COMES TO ANTIBIOTICS,THATS BECAUSE A CERTAIN AMOUNT OF ANTIBIOTICS NEEDS TO BE INSIDE YOUR BODY FOR A CERTAIN LENGTH OF TIME IN ORDER TO GET RID OF THE BACTERIA THAT MAKING SICK. SO GIVE ANTIBIOTIC AT THE RIGHT TIME.