The document discusses an ethical dilemma involving the improper administration of medications by a nurse. Specifically, the nurse pulled medications for multiple patients together, administered medications hours before or after the scheduled time, and signed off that treatments were given when they were not. This violates nursing ethics standards and can endanger patient safety. Proper reporting of such incidents helps ensure patient well-being and prevents future errors or diversion of drugs.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
This study evaluated the risk of opioid abuse in 202 chronic pain patients by addiction psychiatry fellows in an academic pain center. Most consultations were requested by less experienced pain practitioners and focused on assessing risk of continued opioid therapy. Abnormal toxicology results were found in 63% of patients referred, and only 2% were ultimately recommended for continued opioid therapy. The addiction psychiatry fellows found this rotation valuable for their training in evaluating prescription opioid risk. The study suggests supervised addiction psychiatry fellows can effectively conduct opioid risk assessments.
This study examined whether a psychological opioid-risk evaluation influenced physicians' opioid prescribing decisions for 151 chronic pain patients being considered for chronic opioid therapy. Patients underwent an evaluation that assigned them an opioid-risk level of low, moderate, or high. The evaluation report was made available to physicians before their follow-up appointment where prescribing decisions were made. Results found that risk level significantly predicted opioid prescribing, with lower risk patients more likely to be prescribed opioids. A history of substance abuse also predicted less likely opioid prescribing. Demographic factors did not significantly influence prescribing contrary to some previous research. This suggests providing additional information about patients' abuse risk aids prescribing decisions and may reduce bias.
This document summarizes a study on the predictive characteristics of users of alternative medicine. The study found that 6.6% of patients surveyed had visited an alternative practitioner in the previous year. These patients tended to be of middle age, have chronic conditions, have a lower quality of life, greater anxiety and depression, and were heavier users of primary and secondary healthcare. Three factors - self-care and visiting specialists, changing primary doctors, and younger age - explained 66.2% of the variance in alternative medicine use. The conclusions indicate that seeking alternative medicine seems driven by patient characteristics but was not due to dissatisfaction with their primary doctor.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
This study evaluated the risk of opioid abuse in 202 chronic pain patients by addiction psychiatry fellows in an academic pain center. Most consultations were requested by less experienced pain practitioners and focused on assessing risk of continued opioid therapy. Abnormal toxicology results were found in 63% of patients referred, and only 2% were ultimately recommended for continued opioid therapy. The addiction psychiatry fellows found this rotation valuable for their training in evaluating prescription opioid risk. The study suggests supervised addiction psychiatry fellows can effectively conduct opioid risk assessments.
This study examined whether a psychological opioid-risk evaluation influenced physicians' opioid prescribing decisions for 151 chronic pain patients being considered for chronic opioid therapy. Patients underwent an evaluation that assigned them an opioid-risk level of low, moderate, or high. The evaluation report was made available to physicians before their follow-up appointment where prescribing decisions were made. Results found that risk level significantly predicted opioid prescribing, with lower risk patients more likely to be prescribed opioids. A history of substance abuse also predicted less likely opioid prescribing. Demographic factors did not significantly influence prescribing contrary to some previous research. This suggests providing additional information about patients' abuse risk aids prescribing decisions and may reduce bias.
This document summarizes a study on the predictive characteristics of users of alternative medicine. The study found that 6.6% of patients surveyed had visited an alternative practitioner in the previous year. These patients tended to be of middle age, have chronic conditions, have a lower quality of life, greater anxiety and depression, and were heavier users of primary and secondary healthcare. Three factors - self-care and visiting specialists, changing primary doctors, and younger age - explained 66.2% of the variance in alternative medicine use. The conclusions indicate that seeking alternative medicine seems driven by patient characteristics but was not due to dissatisfaction with their primary doctor.
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
Evaluation of the Inpatient Hospital Experience while on PrecautionsKathryn Cannon
This study assessed patient satisfaction of those under contact/airborne isolation precautions versus those not under precautions at Yale-New Haven Hospital. 87 patients were interviewed using a survey measuring satisfaction with communication, treatment explanations, help from staff, pain control, and overall experience. Small variations were found between groups in nurse communication, timely help, pain control, and overall satisfaction. No significant difference was seen in doctor communication, but those under precautions expressed higher satisfaction with treatment explanations. The study aimed to understand differences to improve hospital processes and performance under new CMS reimbursement policies tied to patient satisfaction.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
The document discusses computer-based patient records for anesthesia. It notes that Cushing-Codman made the first ether chart for keeping anesthesia records. Computerization allows for easy retrieval of data which is an important advantage. Hospital information systems can have a monolithic or "best-in-breed" model. The monolithic system has smooth interoperability but some components may be inferior. Electronic health records provide tools for provider communication and access to population data for research. Specialty electronic health records have been developed including for anesthesia, emergency departments, and intensive care units.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Physicians have difficulty detecting when patients are lying or deceiving them. A literature review found that standardized patients, or actors trained to mimic real patients, were correctly identified as fake by physicians only about 10% of the time during office visits. Some real patients were even mistakenly identified as standardized patients. Deception is challenging for physicians given their tendency to assume patients are being truthful. The legal risks of prescribing opioids when deceived mean doctors must take precautions to minimize risks of abuse or diversion, but allowance must be made for the fact that honest physicians can still be misled by deceptive patients.
Concept of risk in pharmacoepidemiology PresentationMdshams244
This document discusses concepts of risk in pharmacoepidemiology. It defines risk as the likelihood of experiencing harm or loss, and risk factors as variables that increase the likelihood of developing a problem. Risk factors can be biological, environmental, or psychosocial. Risk is not certain - not everyone exposed will have an adverse outcome. Risk is also relative and depends on multiple interacting factors over time. In pharmacoepidemiology, risk refers to the probability of developing an outcome from drug exposure, which depends on factors like age, sex, and other medications. Risk is measured using metrics like attributable risk, relative risk, and odds ratio.
Comparisonof Clinical Diagnoses versus Computerized Test Diagnoses Using the ...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com was able to help the former Dean of Los Angeles Chiropractic College detect medical diagnoses which he had overlooked, and he later confirmed.
This paper examines the relationship between socioeconomic factors and prescription drug abuse. It reviews 7 studies that found higher rates of opioid misuse among low-income populations, including Medicaid patients and those with mental health or substance abuse disorders. While doctors often perceive younger and non-white patients to be at higher risk of abuse, studies have found no evidence to support these assumptions. The paper calls for reducing reliance on opioids for chronic pain and improving clinician training on cultural competence and implicit biases.
The document summarizes a study that reviewed charts of 86 patients discharged from an Opioid Renewal Clinic (ORC) over 22 months to examine outcomes two years after discharge. The most common reason for discharge was recurrent positive urine drug screens for illicit substances (47%). Only 17% received addiction treatment in the two years after discharge. 41% were prescribed opioids within two years of discharge, and those prescribed opioids tended to have longer stays in the ORC and more primary care visits after discharge. The outcomes reveal a need to improve addiction management for this patient population.
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It combines the fields of clinical pharmacology and epidemiology. Recent data shows that adverse drug reactions cause 100,000 deaths and 1.5 million hospitalizations in the US each year, yet 20-70% may be preventable. Pharmacoepidemiology aims to detect adverse drug reactions early through observational studies in order to educate healthcare providers and the public about safer medication use. Key study types include case series, case-control studies, cohort studies, cross-sectional studies, and experimental studies. Drug utilization studies also fall under pharmacoepidemiology and evaluate factors related to prescribing, dispensing, administering, and taking
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It applies epidemiological methods to issues in pharmacology. Descriptive studies examine disease and exposure rates, while analytic studies compare exposed and unexposed groups to test hypotheses. Pharmacoepidemiology aims to optimize drug use by quantifying known effects, discovering new effects, and informing safe and effective prescribing practices at a population level.
Expanding internationally allows companies to purchase raw materials in bulk at lower prices, spread administrative costs over a larger customer base, and potentially sell products at higher prices in some foreign markets. However, companies face challenges when going global such as not understanding local tastes, habits, and distribution networks. There are several methods for entering overseas markets like indirect export, direct export, licensing, joint ventures, and direct investment which involve working with local partners or directly investing in foreign companies and operations.
The document summarizes the scheme and syllabus for the 8th semester of Bachelor of Technology in Mechanical Engineering from the University of Calicut.
It includes the list of subjects for the 8th semester such as Quality Engineering and Management, Operations Management, Mechatronics and Machine Controls, along with two elective subjects and seminar, project work and viva voce.
It provides the course code, name, hours per week, sessional and university examination details for each subject. It also lists the elective subjects available for the two elective courses. The document concludes with providing sample university examination patterns for the subjects.
Expanding internationally allows companies to buy raw materials in bulk at lower prices, spread administrative costs over a larger customer base, and potentially sell products at higher prices in some foreign markets. However, companies face challenges like not understanding local customer tastes, habits, and distribution networks when entering new international markets. Companies can use methods like indirect exporting, direct exporting, licensing, joint ventures, and direct investment to enter overseas markets.
The document discusses the differences between should/shouldn't and must/mustn't. Should and shouldn't express duty, necessity, or advice, with should being weaker than must. Must and mustn't express obligation or prohibition, with mustn't prohibiting an action. The positive forms of should and must are used with he, she, it plus the base verb form. The negative forms are shouldn't and mustn't plus the base verb form. Questions are formed by placing should/shouldn't or must/mustn't before he, she, it plus the base verb form.
This document provides guidance on how to write a 200-word compare and contrast essay in 45 minutes. It recommends starting with an introduction noting the topics have similarities and differences. The body should then compare similarities, using phrases like "both...and..." It then contrasts differences using words like "whereas", "while", and comparatives. The conclusion restates the main similarities and differences between the topics in different words.
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
Evaluation of the Inpatient Hospital Experience while on PrecautionsKathryn Cannon
This study assessed patient satisfaction of those under contact/airborne isolation precautions versus those not under precautions at Yale-New Haven Hospital. 87 patients were interviewed using a survey measuring satisfaction with communication, treatment explanations, help from staff, pain control, and overall experience. Small variations were found between groups in nurse communication, timely help, pain control, and overall satisfaction. No significant difference was seen in doctor communication, but those under precautions expressed higher satisfaction with treatment explanations. The study aimed to understand differences to improve hospital processes and performance under new CMS reimbursement policies tied to patient satisfaction.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
The document discusses computer-based patient records for anesthesia. It notes that Cushing-Codman made the first ether chart for keeping anesthesia records. Computerization allows for easy retrieval of data which is an important advantage. Hospital information systems can have a monolithic or "best-in-breed" model. The monolithic system has smooth interoperability but some components may be inferior. Electronic health records provide tools for provider communication and access to population data for research. Specialty electronic health records have been developed including for anesthesia, emergency departments, and intensive care units.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Physicians have difficulty detecting when patients are lying or deceiving them. A literature review found that standardized patients, or actors trained to mimic real patients, were correctly identified as fake by physicians only about 10% of the time during office visits. Some real patients were even mistakenly identified as standardized patients. Deception is challenging for physicians given their tendency to assume patients are being truthful. The legal risks of prescribing opioids when deceived mean doctors must take precautions to minimize risks of abuse or diversion, but allowance must be made for the fact that honest physicians can still be misled by deceptive patients.
Concept of risk in pharmacoepidemiology PresentationMdshams244
This document discusses concepts of risk in pharmacoepidemiology. It defines risk as the likelihood of experiencing harm or loss, and risk factors as variables that increase the likelihood of developing a problem. Risk factors can be biological, environmental, or psychosocial. Risk is not certain - not everyone exposed will have an adverse outcome. Risk is also relative and depends on multiple interacting factors over time. In pharmacoepidemiology, risk refers to the probability of developing an outcome from drug exposure, which depends on factors like age, sex, and other medications. Risk is measured using metrics like attributable risk, relative risk, and odds ratio.
Comparisonof Clinical Diagnoses versus Computerized Test Diagnoses Using the ...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com was able to help the former Dean of Los Angeles Chiropractic College detect medical diagnoses which he had overlooked, and he later confirmed.
This paper examines the relationship between socioeconomic factors and prescription drug abuse. It reviews 7 studies that found higher rates of opioid misuse among low-income populations, including Medicaid patients and those with mental health or substance abuse disorders. While doctors often perceive younger and non-white patients to be at higher risk of abuse, studies have found no evidence to support these assumptions. The paper calls for reducing reliance on opioids for chronic pain and improving clinician training on cultural competence and implicit biases.
The document summarizes a study that reviewed charts of 86 patients discharged from an Opioid Renewal Clinic (ORC) over 22 months to examine outcomes two years after discharge. The most common reason for discharge was recurrent positive urine drug screens for illicit substances (47%). Only 17% received addiction treatment in the two years after discharge. 41% were prescribed opioids within two years of discharge, and those prescribed opioids tended to have longer stays in the ORC and more primary care visits after discharge. The outcomes reveal a need to improve addiction management for this patient population.
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It combines the fields of clinical pharmacology and epidemiology. Recent data shows that adverse drug reactions cause 100,000 deaths and 1.5 million hospitalizations in the US each year, yet 20-70% may be preventable. Pharmacoepidemiology aims to detect adverse drug reactions early through observational studies in order to educate healthcare providers and the public about safer medication use. Key study types include case series, case-control studies, cohort studies, cross-sectional studies, and experimental studies. Drug utilization studies also fall under pharmacoepidemiology and evaluate factors related to prescribing, dispensing, administering, and taking
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. It applies epidemiological methods to issues in pharmacology. Descriptive studies examine disease and exposure rates, while analytic studies compare exposed and unexposed groups to test hypotheses. Pharmacoepidemiology aims to optimize drug use by quantifying known effects, discovering new effects, and informing safe and effective prescribing practices at a population level.
Expanding internationally allows companies to purchase raw materials in bulk at lower prices, spread administrative costs over a larger customer base, and potentially sell products at higher prices in some foreign markets. However, companies face challenges when going global such as not understanding local tastes, habits, and distribution networks. There are several methods for entering overseas markets like indirect export, direct export, licensing, joint ventures, and direct investment which involve working with local partners or directly investing in foreign companies and operations.
The document summarizes the scheme and syllabus for the 8th semester of Bachelor of Technology in Mechanical Engineering from the University of Calicut.
It includes the list of subjects for the 8th semester such as Quality Engineering and Management, Operations Management, Mechatronics and Machine Controls, along with two elective subjects and seminar, project work and viva voce.
It provides the course code, name, hours per week, sessional and university examination details for each subject. It also lists the elective subjects available for the two elective courses. The document concludes with providing sample university examination patterns for the subjects.
Expanding internationally allows companies to buy raw materials in bulk at lower prices, spread administrative costs over a larger customer base, and potentially sell products at higher prices in some foreign markets. However, companies face challenges like not understanding local customer tastes, habits, and distribution networks when entering new international markets. Companies can use methods like indirect exporting, direct exporting, licensing, joint ventures, and direct investment to enter overseas markets.
The document discusses the differences between should/shouldn't and must/mustn't. Should and shouldn't express duty, necessity, or advice, with should being weaker than must. Must and mustn't express obligation or prohibition, with mustn't prohibiting an action. The positive forms of should and must are used with he, she, it plus the base verb form. The negative forms are shouldn't and mustn't plus the base verb form. Questions are formed by placing should/shouldn't or must/mustn't before he, she, it plus the base verb form.
This document provides guidance on how to write a 200-word compare and contrast essay in 45 minutes. It recommends starting with an introduction noting the topics have similarities and differences. The body should then compare similarities, using phrases like "both...and..." It then contrasts differences using words like "whereas", "while", and comparatives. The conclusion restates the main similarities and differences between the topics in different words.
The document summarizes upcoming events at Fort Meade from May 28 to June 10, including warehouse sales, career days, meet the author events, farmers markets, and the opening of a new AAFES exchange. It also previews summer camp beginning in June and thanks Child, Youth and School Services staff. The commander's column welcomes summer and thanks various organizations for Memorial Day events while looking forward to construction projects and events in June.
This is a shortened PowerPoint presentation of a one hour Social Media Workshop by More In Media of Myrtle Beach, SC about 'Online Engagement'. Examples and a few images were removed from the original presentation.
This document discusses animal rights and the arguments for and against recognizing animals as having rights. It notes that some arguments against animal rights are that animals don't think, feel, or behave morally like humans. Accepting animal rights would mean prohibiting experiments on animals, using animals for food/clothing/medicine, labor, selective breeding not for the animal's benefit, hunting, keeping animals in zoos/entertainment. Quotes are provided on non-violence and animal protection.
This document outlines the syllabus for the 8th semester of the Bachelor of Technology program in Mechanical Engineering at the University of Calicut. It includes details on 8 subjects to be covered: Quality Engineering and Management, Operations Management, Mechatronics and Machine Controls, two elective subjects, a seminar, project work, and viva voce. For each subject, it provides the course objectives, topics to be covered in each module, textbook references, and exam format. The semester aims to impart knowledge in areas such as quality management, statistical process control, operations research techniques, production planning, facilities planning, and a major project.
The document is an issue of the Fort Meade community newspaper Soundoff from April 16, 2015. It includes the following articles:
- A summary of upcoming community events at Fort Meade, including Earth Day celebrations and a youth fishing rodeo.
- A story about retired military officers' wives showcasing spring fashions and Gold Star Mothers and wives sharing memories and peer support.
- The main article profiles Master Sgt. Cedric King, an Army veteran who lost both legs to an IED in Afghanistan. He spoke at Fort Meade about overcoming adversity through faith, family and focus.
The document provides information about upcoming events on Fort Meade including cooking classes, Super Bowl parties, and a prayer breakfast. It also announces that the Fort Meade Joint Installation Tax Center has opened for the tax season to provide free tax preparation services to military members and their families. The commander's column discusses the importance of professional counseling between supervisors and subordinates.
The Fort Meade community honored 240 years of Army service at a breakfast event. The guest speaker was retired Lt. Col. Alfred Rascon, a Medal of Honor recipient for his actions in Vietnam. He recalled the day in 1966 when he risked his life under heavy fire to rescue wounded comrades. About 60 people attended the event to commemorate the Army's birthday and cut a ceremonial cake.
The document lists upcoming events at Fort Meade in February, including cooking and financial readiness classes and Black History Month observances. It also provides a brief summary of articles in the publication about support programs for military families and a visit by the new Maryland governor to tour the installation and honor the Defense Information School for its 50th anniversary.
The document summarizes an article from the Fort Meade newspaper Soundoff about the following topics:
1) Fort Meade's Army Emergency Relief campaign raised nearly $135,000, surpassing its goal of $55,000. Most of the donations came from active-duty service members.
2) The increased funds will help support Soldiers and their families during financial hardships. Donations are pooled with other installations to support wider Army and military communities.
3) The article highlights some of the top contributing units at Fort Meade and thanks the community for participating in the campaign. The fiscal year 2016 campaign will aim to increase donations by 15 percent.
This document provides an outline of Rhetorical Structure Theory (RST). It begins by defining RST as a theory of text organization that analyzes how parts of a text relate to each other functionally. The document then discusses key aspects of RST, including its principles, relation types (subject matter and presentational), graphical representations, and how to perform an RST analysis. It provides examples to illustrate various relation types like circumstance, motivation, and evidence. The document concludes by noting some issues with RST and implications for its applications in areas like writing research and natural language generation.
This document discusses words used to compare and contrast ideas such as coordinators, subordinators, and transition words. It provides examples of how to use coordinators like "and" and "but" between and within sentences. Subordinators like "although" and "while" are used to join dependent clauses. Transition words require a semicolon or new sentence when connecting two independent clauses. Similarities are signaled by words like "like" and "both" and differences by words such as "different from" and "but". The document ends by listing some practice websites on comparing and contrasting.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
This document discusses safety measures for using medication and outlines key factors that can lead to medication errors. It defines medication errors and adverse drug events, and identifies high-alert medications and black box drug warnings. The five stages of the medication process are described as well as common types of errors that can occur at each stage, particularly prescribing and administering. Working conditions like staffing shortages, distractions, and high workloads are highlighted as latent factors that can facilitate medication errors.
497 group #4 section 200 presentation.pptxpoindexk
A student nurse discovered a medication error involving a pregnant patient admitted to the hospital for high blood pressure. The patient was supposed to be taking Labetalol, a beta-blocker, but the pharmacy listed Tegretol, a seizure medication that is risky in pregnancy. After verifying with the patient's medication bottle, it was confirmed the pharmacy made a dispensing error. The nurse notified the doctor, who ordered the correct medication and said she would inform the patient.
This article discusses the problem of narcotic abuse among nurses, particularly in emergency departments. Research shows emergency department nurses are 3.5 times more likely to abuse drugs than nurses in other specialties. Risk factors for substance abuse among nurses include family history of abuse, work demands like overtime and shift work, and stress. The specialties with the highest rates of drug abuse are oncology, psychiatry, and emergency/critical care. An impaired nurse endangers patients, so programs provide education, monitoring, and treatment to address this issue and protect safety. Signs a nurse may be diverting drugs include frequent bathroom breaks and volunteering to administer medications. Around 10% of US nurses, or 300,000, are estimated to be
Please make a reply to this student post adding something.docx4934bk
The student post addresses several ethical issues in healthcare. The response provides additional context and perspectives to consider for each issue:
1. When abortion may be necessary to protect the mother's health or life.
2. Understanding different ethical frameworks like deontology and utilitarianism before making recommendations.
3. Disclosing poor prognoses compassionately while respecting patient beliefs and emotional state.
4. Engaging all stakeholders in collaborative decision making around family nondisclosure requests.
5. Addressing underlying factors for a nurse's improper narcotic seeking and supporting substance abuse prevention and treatment.
6. Following protocols to prevent errors and protect patient safety.
7. Involving family can
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
The document describes the process of medication reconciliation to ensure accurate medical information at care transitions. It involves obtaining a best possible medication history, comparing it to admission orders, and reconciling any discrepancies. Key steps include interviewing patients, comparing medication lists to orders, and resolving unintentional discrepancies. The goal is to mitigate errors from poor communication and improve safety during admissions, discharges, and transfers of care.
This study analyzed results from over 900,000 urine drug tests conducted between 2006-2009 on patients prescribed chronic opioids. The results showed:
- 11% tested positive for illicit drugs
- 29% tested positive for non-prescribed medications
- 38% did not detect the prescribed medication
- 15% had lower than expected levels of the prescribed medication
- 27% had higher than expected levels of the prescribed medication
These high rates of potential issues like non-compliance, abuse or diversion demonstrate the importance of periodic urine drug screening for patients on long-term opioid therapy to identify problems and ensure appropriate use of medications.
This project report summarizes a quantitative analysis of nursing practices related to medication management at XYZ Hospital in Ludhiana, India. The author observed medication administration practices on the hospital's 4th floor over 50 patient cases. The observation found an 18.75% non-compliance rate with best practices, mostly due to staff negligence. Overall, the analysis showed that nursing staff were well-oriented in medication practices, adhering to patients' medication management plans 81.25% of the time. The report recommends continued focus on reducing errors by strictly following medication administration safety guidelines and policies.
An Internet questionnaire to identify Drug seeking behavior in a patient in t...Nelson Hendler
Drug seeking behavior in patients with little or no real pain, has led to the opioid crisis. Until now, there was no reliable method for detecting drug seeking behavior. The Pain Validity Test from www.MarylandClinicalDiagnostics.com can predict with 95% accuracy who will have medical test abnormalities, i.e. who has a valid complaint of pain, and predicts with 85%-100% accuracy who will not have any medical test abnormalities, i.e. who is faking and drug seeking. The Pain Validity Test has been admitted as evidence in over 30 legal cases in 8 states.
Pain Validity Test to detect drug seeking behaviorNelson Hendler
The Pain Validity Test predicts which patient will have medical test abnormalities with 95% accuracy, thereby validating their complaint of pain. The Pain Validity Test also predicts with 85%-100% accuracy who will not have medical test abnormalities, thereby detecting drug seeking behavior, faking and malingering.
This study surveyed 36 patients in a residential addiction treatment program to understand the methods used to improperly obtain prescription medications from physicians. Key findings include:
- Patients obtained an average of 50 prescriptions over 3.8 years, seeing an average of 2 doctors in 1.2 different states and 5 pharmacies.
- The most common reasons for obtaining prescriptions from doctors rather than buying illegally were legal concerns and lower cost/increased comfort.
- The most obtained drug types were opioids (97% of patients) and sedative-hypnotics (47% of patients).
- The majority (75%) feigned symptoms to obtain prescriptions, with some using falsified medical records or
PHARMACOEPIDEMIOLOGY Edited by Abraham G. Hartzema, Miquel.docxmattjtoni51554
PHARMACOEPIDEMIOLOGY
Edited by Abraham G. Hartzema,
Miquel S. Porta, and Hugh H. Tilson
DRUG-RELATED PROBLEMS: THEIR STRUCTURE AND FUNCTION
Linda M. Strand, Peter C. Morley, RobertJ. Cipolle, Ruthanne Ramsey, and Grace D. Lamsam
ABSTRACf: In order to better focus the role of the pharmacist on
patient need and patient outcome, a means of categorizing drug-related
problems (DRPs) is presented. A DRP exists when a patient
experiences or is likely to experience either a disease or symptom
having an actual or suspected relationship With drug therapy. Eight
different categories of DRPs are described and examples of each
category are offered. This categorization serves a number of functions,
such as: (1) to illustrate how adverse drug reactions form but one
category of extant DRPs, (2) to make tangible the pharmacist's role for
the future, (3) to serve as a focus for developing a systematic process
whereby the pharmacist contributes significantly to the overall positive
outcome of patients, (4) to bring to pharmacy practice a vocabulary
consistent with that of other healthcare professionals, and (5) to aid
in the development of standards of practice for pharmacists.
DJCP Ann Pharmacother 1990;24:1093-7.
PATIENT-ORIENTED CLINICAL PHARMACY is coming of age at
a time when the healthcare system is characterized by
change, particularly in the form of powerful economic
forces. During this time when the healthcare system is
caught up in economic determinism and its impact on shap-
ing policy, there are increasing demands for pharmacists to
LINDA M. STRAND, Pharm.D., Ph.D., is an Associate Professor, Department of
Pharmacy Practice; PETER C. MORLEY, Ph.D., is a Professor, Deparbnent of Phar-
macy Practice; ROBERT J. CIPOLLE, Pharm.D., is the Associate Dean, College of
Pharmacy, University of Minnesota; RUTHANNE RAMSEY, Pharm.D., is a Profes-
sional Research Associate, School of Medicine, University of Colorado; and GRACE
D. LAMSAM, Pharm.D., is a Graduate Assistant, Deparbnent of Pharmacy Practice,
College of Pharmacy, University of Minnesota. Reprints: Linda M. Strand, Pharm.D.,
Ph.D., Department of Pharmacy Practice, College of Pharmacy, University of Min-
nesota, 5-130 Health Sciences Unit F, 308 Harvard St., SE, Minneapolis, MN 55455.
ABRAHAM G. HARTZEMA, Ph.D., M.S.P.H., is an Associate Professor, Phar-
macy Administration, School of Pharmacy, and a Clinical Associate Professor,
Health Policy and Administration, School of Public Health, University of North
Carolina, Chapel Hill, NC 27514; MIQUEL S. PORTA, M.D., M.P.H., is an
Adjunct Assistant Professor, Department of Epidemiology, School of Public Health,
University of North Carolina; an Associate Professor, Universitat Autonoma de
Barcelona; and the Director, Clinical Epidemiology Unit, lnstitut Municipal d'lnves-
tigacio Medica, Barcelona, Spain; and HUGH H. TILSON, M.D., M.P.H.,
Dr.P.H., is the Director, Division of Epidemiology, Information, and Surveillan.
This document discusses polypharmacy and medication errors. It begins by defining polypharmacy as the use of multiple medications where more are being used than clinically indicated. Polypharmacy can increase the risk of drug interactions and adverse events. Common risk factors for polypharmacy include the elderly, multiple comorbidities, recent hospitalization, and multiple physicians or pharmacies. Medication errors are also defined as any error in the medication use process and examples are provided. Reporting systems for medication errors and the most commonly implicated drug classes and individual drugs are outlined. Risk factors for errors and recommendations to reduce polypharmacy and errors are presented.
The dilemma to use drugs for treatment as the standard for care creates problems for drug side effects that cause harm and death of patients.
The problem of the drug side effects and prescription errors kill more patients, according to Lazarus et al (1998), an "estimated of 106,000 deaths occur annually due to adverse drug side effects" for standard of care for "practicing medicine".
In the case of prescription drug, the ethical issue is standard of care for treatment, and is complicated because of adverse drug effect.
The dilemma for standard of care by drugs is the problem for unexpected adverse reaction to drug that harms patients for medical law, ethics, and bioethics.
The standard of care for practicing medicine is a drug for a treatment can never be about ethics between a doctor and a patient.
To think health care coverage for vaccination and immunization is standard of care for introducing virus, bacteria and toxin cause sickness for practicing medicine (use of drugs) for treatment.
There are no medical ethics that said 'to treat patients right by giving advice' instead, the standard of care is prescribing drugs with side effect is practicing medicine "drug" for compliance with treatment that cannot apply to the doctrine "to do no harm".
According "to the ethical guidance in the Era of managed Care" by Higgins & Hackett (2000), an analysis of the American College of Healthcare Executives' (ACHE) Code of ethics suggests, "the managed care revolution undermining the medical ethics and that it does not adequately address several ethical concerns." Bioethics is the study of life, moral and ethical issues for debate as it relates to medical policy and practice that were appropriate for legal standard and standard of care, which can arise from the relationship between biology, technology, medicine, politics, law and philosophy, especially in the application for life and reproduction such as the recent event about plan parenthood.
Without a change to the current system for standard of care of practicing medicine by diagnose diseases to prescribe drugs for treatment for health care coverage, the answer is no.
The document discusses the ethical dilemma around using prescription drugs as the standard of care for treating patients. While the Hippocratic Oath states that doctors should first do no harm, prescription drugs can cause harmful side effects and even death for some patients. Studies have found that adverse drug reactions and medical errors kill over 100,000 patients annually in the US. Some doctors have also been found to unethically prescribe unnecessary treatments, like yearly flu shots that introduce viruses and bacteria, just to generate revenue from prescribing antibiotics. The current healthcare system prioritizes treating illnesses with drugs over preventing them, but changing to a preventative model and using telemedicine could help solve the healthcare crisis and better uphold medical ethics of first doing no harm.
The document summarizes key problems in healthcare, including medication errors and access to healthcare. It discusses types of medication errors, recommendations to prevent them, and defines access to healthcare. It notes that medication errors cause over 1.5 million preventable injuries annually in the US. Lack of access results in millions of unnecessary child deaths from preventable diseases due to inability to obtain treatment. The document was researched by three authors who divided topics and collaborated to create an informative presentation.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
This document discusses several key aspects of medication safety:
1. Medication errors are a major cause of preventable patient harm. Proper knowledge of pharmacology principles is important for safely administering and monitoring medications.
2. Several factors can contribute to medication errors, including lack of communication, assumptions, inadequate labeling, and lack of checking procedures. Errors can be prevented by developing safe habits like verifying medications and using memory aids.
3. Patients should be educated on their medication regimens and actively involved in their own care by maintaining accurate medication lists. Thorough medication histories are important to avoid unintended interactions or duplications.
This document discusses issues with patient misidentification in healthcare and proposes solutions. It notes that patient misidentification can lead to medical errors and harm patients. Interventions like using two patient identifiers, barcoding systems, and staff education on safety protocols may help reduce errors related to improper identification. The importance of ensuring patients receive the correct treatments and medications is emphasized.
1. University of South Carolina UpstateMary Black School of NursingProfessional Nursing IssuesSBSN 497 Nursing Ethical Dilemma Presentation: The Improper Administration/Handling of Medications Alisha Holmes, Erin Hunter, Brittany Jukes, Loren McClaflin
2.
3. Nursing Ethical Dilemma “My nursing dilemma occurred when I was training at my job at a local nursing home as an LPN. The nurse training me would pull medications for a patient and place them in her drawer to be given out hours later. This gave her more time to either talk or do nothing. She also gave medications hours prior to the scheduled time to save herself from constantly walking into the room. Another thing I noticed was that she signed off on treatments that were not given and used other patients medications if her patient did not have their medication regardless of the dose. I told her that this was wrong, but she insisted that this was an easier way to give medications and not be on the floor all night. She stated that there was a DHEC way to do things and an everyday way to do things. Needless to say I practice the DHEC way and not her way.” - Alisha Holmes
4.
5. Identification and Background Medical errors are not uncommon, and they may cause patient morbidity and mortality and significantly increase health care costs. In 1999, it was estimated that up to 98,000 Americans might have died annually as a result of medical errors. Drug administration errors are significant contributors to this problem. (Llewellyn, 2011)
6. Identification and Background continued Although most errors do not result in major morbidity or death, a significant number can potentially seriously harm patients, e.g. wrong site injections. Accidental administration of vasopressors may be the error with the greatest potential to contribute to morbidity and mortality. In a study, 4 errors (12.2%) were due to the inadvertent administration of adrenaline instead of atropine or fentanyl. Although no adverse consequences were reported, subtle organ damage cannot be excluded. Poor ampoule labeling remains a major cause of substitution errors. (Llewellyn, 2011)
7. Identification and Background continued People treated in hospitals in the United States for illnesses and injuries from taking the wrong medication or dose has increased by 52%, according to the Agency of Healthcare Research and Quality. A recent report indicated a jump in figures between 2004 and 2008 from 1.2 million to 1.9 million. The top categories of medications that people were treated and discharged from emergency departments with were painkillers, antibiotics, tranquillizers, antidepressants, corticosteroids and other hormones. (Wrong Medication or Dose, 2011)
8.
9. Identification and Background continued According to the Drug Enforcement Administration (DEA), nearly 7 million Americans are abusing prescription drugs--more than the combined number of those abusing cocaine, heroin, hallucinogens, ecstasy and inhalants--representing an 80 percent increase since 2000. According to the SAMHSA.gov Web site, substance abuse costs businesses $100 billion annually due to productivity loss, absenteeism and insurance premiums. However, it is surprising to note that prescription drug abuse reaches beyond patients and often affects the very practitioners entrusted with delivering the medication. Healthcare professionals are some of the most common abusers of prescription pharmaceuticals, which correlates with their easy access to the medications during the normal course of their duties. (Vrabel, 2010)
10. Identification and Background continued Drug diversion can occur in all clinical areas, including: falsification of medication administration documentation, replacement of a vial of a controlled drug (e.g., morphine) with saline, excessive wastage (without actual witnessing), shorting doses of patient medications, substitution of non-controlled drugs, discrepancies between actual vs. system medication counts and intentional miscounts (both re stocking on the floors and the central pharmacy and activities within stores and the vault). One study showed that drug diversion could be as high as 18 percent among nurses. However, diversion goes beyond nurses to include physicians, pharmacists and any other employee involved in handling controlled substances. (Vrabel, 2010)
11. Identification and Background continued No hospital is immune to drug diversion, but there are proactive steps that can help detect diversion before it becomes an issue of patient safety. In an effort to meet regulatory compliance and prevent diversion, most hospitals have implemented automated dispensing cabinets (ADCs) to provide physical control and limit authorized access using biometrics and bar coding. More recently, hospitals are increasingly using special software technology for medication surveillance. (Vrabel, 2010)
12.
13. Impact on Nursing The ANA has established Standards of Professional Performance that the nurse must incorporate and use as a guide to their nursing care. Included in these standards is ethics, which must be integrated in all areas of nursing practice. The ANA has also developed a Code of Ethics, which “is a guide for carrying out nursing responsibilities that provide quality nursing care and provides for the ethical obligations of the profession.” The Code of Ethics includes advocacy, responsibility, accountability, and confidentiality, not to mention autonomy, beneficence, nonmaleficence, justice, and fidelity, which are all basic health ethics that nurses should practice by. (Perry & Potter, 2009)
14. Impact on Nursing continued 6 Rights to Medication Administration: 1. The right medication 2. The right dose 3. The right client 4. The right route 5. The right time 6. The right documentation When a nurse fails to acknowledge the 6 Rights, there are ethical and legal ramifications to consider. (Perry & Potter, 2009); (Good, 2011)
15. Impact on Nursing continued If the nurse participates in behavior such as the improper administration/handling of patient medications, he/she does not abide by the Standards of Professional Performance or the Code of Ethics, which not only has an impact on patient safety but also has an impact on the nurse’s employment and/or licensure. The possibility of the nurse diverting drugs is also included in the improper administration/handling of patient medications. All health care providers should be aware of how to detect the behaviors of nurses participating in this behavior, how to report such behavior, and how to avoid such behavior, such as not signing off that the nurse witnessed medications being wasted when in fact they did not. (Perry & Potter, 2009); (Laven, 2006)
16.
17. Impact on Nursing continued “There are two aspects to drugdiversion: (1) the direct and indirect impact on a patient's care if the patient does not receive the medications that his or her physician intended, and (2) the impact on the healthcare worker who develops a pattern of drugdiversion. Hospitals want to keep their patients safe and eliminate the opportunities for employees to divert medications and potentially jeopardize their jobs. Early detection can allow hospitals to correct employee behavior before it becomes necessary to impact their employment.” (Vrabel, 2010)
18. When Healing Hands Harm: Drug Diversion in Vermont (Motion picture) Attorney General Sorrellstated, "Early detection and action preserves the integrity of patient care, removes a source of drugs for the offender, and may be the best chance for the offender to confront his or her addiction." “The film succeeds in emphasizing the value of prevention and detection and encouraging health care providers to seek substance abuse help for themselves or others. The film also succeeds in providing a sharp reminder that drugdiversion is a criminal offense for which offenders suffer criminal consequences, including incarceration and license sanctions.” (Attorney general releases…, 2007)
19. What Happened An LPN was training with a nurse, who later became the floor supervisor, and the nurse told the LPN that the easiest way to administer medication was to compile all of the medication together at one time instead of giving it at the time when it was scheduled to be given. She also stated that if there were patients that were alert and oriented, the medication could be pulled early and placed inside the locked cart until it was time to administer the medication. Since most of the patients had some type of dementia, they just took the medication when it was presented to them. This violated one of the six rights of medication administration: the right time. Since some of the medication was delivered at the wrong time, pain and certain chronic diseases may have not been managed as effectively as they should have been. (Perry & Potter, 2009)
20.
21. What Should Have Happened What should have happened was the nurse should have administered the medication at the right time (give or take an hour per institution protocol) because there can be therapeutic repercussions for not administering the medication at the correct time. The doctor prescribed the medication at the proper intervals to maximize efficiency. If this is not maintained, the patient could have adverse side effects, or worse, they may become resistant to the medication and may have to change their medication regimen altogether. (Perry & Potter, 2009)
22. In the ethical situation described, the nurse administering the medication violated the 6 Rights to Medication Administration by not giving the meds at the right time, giving one patient’s meds to another patient regardless of the dose, and also by signing off on treatments that were not given(documentation). The LPN acted as a patient advocate and did the responsible thing by confronting the nurse about her actions, as outlined by the Code of Ethics. One additional step the LPN could have taken was to report the incident to the immediate supervisor.
23.
24. Summary and Conclusion According to the CDC, adverse drug events can add 8-12 days to the length of hospitalization and account for 770,000 injuries and deaths each year. Medication errors and intentional diversion are becoming increasingly widespread and a serious problem affecting our industry, our jobs, and our patients’ care. As new nurses, we at some point may be witnesses to the mishandling of patient meds, and must be prepared to react professionally, ethically, and morally to those issues stemming from error and criminal intent alike.
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26. Alternatively, if the error was made without intent, a learning opportunity does exist.In either situation, it is our responsibility to immediately report the occurrence to the direct supervisor so that education or corrective actions may occur.
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28. The ANA has developed our code of ethics to guide us in the delivery of care practice that provides a framework for ethical decision-making.
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30. Remember: If you fail to report the act, then you, too, are a part of the problem!
32. References Attorney general releases film on drug diversion by health care providers. (2007, Feb-April). Vermont Nurse Connection, 10(1), 10. Retrieved September 26, 2011, from Nursing and Allied Health Collection via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC Center for Disease Control and Prevention. (2010, September 28). Medication Safety Program. Retrieved from http://www.cdc.gov/medicationsafety/ Good, B. (2011, Jan-Feb). Conference attendees given new insight. West Virginia Medical Journal, 107(1), 47-48. Retrieved September 26, 2011, from Nursing and Allied Health Collection via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC Laven, D. (2006, June). Introduction: drug diversion and counterfeiting, Part I. Journal of Pharmacy Practice, 19(3), 136-141. Retrieved September 26, 2011, from Nursing Resource Center via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC Llewellyn, R , Gordon, P , & Reed, A (2011, May). Drug administration errors--time for national action. South African Medical Journal, 101(5), 319-321. Retrieved September 27, 2011, from Nursing and Allied Health Collection via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC Perry, A.G., Potter, P.A. (2009). Fundamentals of Nursing. 7th ed. St. Louis Mo: Mosby Elsevier. Vrabel, R. (2010, Dec). Identifying and dealing with drug diversion: how hospitals can stay one step ahead. Health Management Technology, 31(12), 18-20. Retrieved September 26, 2011, from Nursing and Allied Health Collection via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC Wrong medication or dose. (2011, August). Australian Nursing Journal, 19(2), 17-18. Retrieved September 27, 2011, from Nursing and Allied Health Collection via Gale:http://find.galegroup.com/nrcx/start.do?prodId=NRC