Medication error- Etiology and strategic methods to reduce the incidence of M...Dr. Jibin Mathew
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
Medication error- Etiology and strategic methods to reduce the incidence of M...Dr. Jibin Mathew
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
At the end of the session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to advance patient engagement in medication safety as a result of their increased understanding of:
. the role and responsibilities of patients/ families in medication safety
. different approaches to patient engagement in medication safety
. influencing factors (e.g. health literacy, culture, organizational and public policy)
. supporting resources and leading practices
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
Dr. Arjun Srinivasan - In-Patient Antimicrobial Resistance (AMR) IssuesJohn Blue
In-Patient Antimicrobial Resistance (AMR) Issues - Dr. Arjun Srinivasan, Associate Director for Healthcare-Associated Infection Prevention Programs, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Dr. Steve Solomon - Metrics and Decision-Making for Antibiotic Stewardship in...John Blue
Metrics and Decision-Making for Antibiotic Stewardship in Human Medicine - Dr. Steve Solomon, Centers for Disease Control & Prevention, Currently serves as Director of the Office of Antimicrobial Resistance in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, in the Office of Infectious Diseases at CDC., from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Scope on medicatio error in a sample of iraqi two cities samawa and diwania.Ali Al Samawy
Summery
Introduction:
The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations and teratogenicity etc.
Methodology:
A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Al Sammawah & Al Diwania) during October, 2016.
A formal was used to collect data included the name of pregnant, age, trimester, doctor diagnosis, the drug dispensed and their dose, rout, duration, frequency, strength and notes section. The formal filled during visits of the research team to pharmacies that most of the prescriptions they dispense are for pregnant women prescribed by a nearby gynecology &obstruct doctors.
Then the data analyzed to identify the medication errors that includes; inappropriate and irrational, ineffective, over and under prescribing and drug interactions using available literature and drugs.com drug interaction checker.
Result:
Total number of prescriptions involved in the study is 100 prescriptions, they contain 487 medication dispensed to the patients. The total number of medication errors identified were 364(74.7%), included 110 irrational & inappropriate prescribing, 47 over prescribing. 19 under prescribing, and 8 ineffective prescribing. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions were recorded. 0.8 % of all drug-drug interactions were major, 76 % moderate and 23% mild. Phenobarbital (luminal) is the drug that caused the most of medication error that identified as it dispensed 23 times but in all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions were caused by luminal.
While Dydrogesterone was prescribed as a tocolytic 21 times, and this considered as irrational & inappropriate prescribing. Isoxsuprine prescribed irrationally 17 times. The parenteral iron administered without calculating the dose depending on the body weight and blood Hb. Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration, dose, and indication errors.
Conclusion:
Percentage of medication errors was high. Types of medication errors were mostly drug-drug interaction, irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.
Recommendations:
Adherence to the treatment guidelines and further studies to assess the impact of medications errors on pregnant women and her fetus.
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.
Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.
a presentation in CME activities by Saad Specialist Hospital, KSA
COMMON ERRORS IN DISPENSING by Mrs omorodion 3.pptxAnijuKenechukwu
a presentation on the common dispensing error encountered in a pharmacy and the role of pharmacy technicians in curbing or reducing the rate of these common errors
This was my last presentation in academics (Pharm.D Internship as Clinical Pharmacist Intern).
It consists of the summary of cases analyzed, ADR reported, and drug-drug interactions noted during my internship at Government Cuddalore Medical College Hospital (RMMCH).
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Background Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients BMJ. 2004; 329:15-19
3.
4. Background Prevalence, Incidence and Nature of Prescribing Errors in Hospital Inpatients: A Systematic Review . Drug Safety 2009; 32(5):379-389 7% 93%
25. “ A man suffered irreversible brain damage after a pharmacist misread his doctor’s prescription. The patient had been prescribed the antibiotic Amoxil® (amoxicillin) for a chest infection. The prescription was badly written and the pharmacist misread the drug name as Daonil® (glibenclamide) a drug used to lower blood sugar in people with diabetes. As a result of taking the wrong medicine the patient went into a coma and was hospitalised for 5 months…”
31. “ A man suffered irreversible brain damage after a pharmacist misread his doctor’s prescription. The patient had been prescribed the antibiotic Amoxil® (amoxicillin) for a chest infection. The prescription was badly written and the pharmacist misread the drug name as Daonil® (glibenclamide) a drug used to lower blood sugar in people with diabetes. As a result of taking the wrong medicine the patient went into a coma and was hospitalised for 5 months…”
41. Post-operative pain VOTE: A 50MG ORAL DICLOFENAC B 25 MICROGRAM TOPICAL FENTANYL PATCH C 10MG INTRAMUSCULAR MORPHINE D 1000MG RECTAL PARACETAMOL
42. A 50MG ORAL DICLOFENAC B 25 MICROGRAM TOPICAL FENTANYL PATCH C 10MG INTRAMUSCULAR MORPHINE D 1000MG RECTAL PARACETAMOL
43. Here are some further details you will need: A 50MG ORAL DICLOFENAC B 25 MICROGRAM TOPICAL FENTANYL PATCH C 10MG INTRAMUSCULAR MORPHINE D 1000MG RECTAL PARACETAMOL Patient name: Anne Smith Patient hospital number: 135852 Patient date of birth: 01/08/72 Patient weight: 66Kg Ward: Day case unit Consultant: BJH
44. Post-operative pain HIS CHOICE: A 50MG ORAL DICLOFENAC B 25 MICROGRAM TOPICAL FENTANYL PATCH C 10MG INTRAMUSCULAR MORPHINE D 1000MG RECTAL PARACETAMOL
50. System changes? VOTE: A DEVELOP AN ALGORITHM FOR POST-OPERATIVE PAIN B ENSURE ALLERGY BOX ON PRESCRIPTION FORM IS MORE VISIBLE C ORGANISE TEACHING SESSIONS FOR JUNIOR DOCTORS REGARDING PAIN MANAGEMENT D TRAIN NURSES TO PRESCRIBE AND ADMINISTER POST-OPERATIVE ANALGESIA
We’re students– why do we need to know? The use of medicines is the most common health care intervention (almost every patient will receive a medicine at some point in their care). GMC tomorrow’s doctors: Prescribe drugs safely, effectively and economically. (a) Establish an accurate drug history, covering both prescribed and other medication. (b) Plan appropriate drug therapy for common indications, including pain and distress. (c) Provide a safe and legal prescription. (d) Calculate appropriate drug doses and record the outcome accurately. (e) Provide patients with appropriate information about their medicines. (f) Access reliable information about medicines. (g) Detect and report adverse drug reactions. (h) Demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving.
BMJ 2004 Two large general hospitals in Merseyside, England Over 18000 patients aged > 16 years were admitted over six a month period These were all assessed for cause of admission There were more that 1200 admissions related to an adverse drug reaction The projected annual cost of such admissions to the NHS is £466m (706m, $847m). Most reactions were either definitely or possibly avoidable. Most ADRs were predictable from the known pharmacology of the drugs and many represented known interactions and are therefore likely to be preventable. Over 2% of patients admitted with an adverse drug reaction died.
Famous fatal medication errors have included: Chemotherapy given intrathecally rather than IV route (vincristine) BBC report 2001
As mentioned in the advertising for this course, medication error is still a big problem at the moment. A recent systematic review was carried out by senior members of the schools of Pharmacy and Medicine here at the University and was published at the beginning of 2009. They looked at and summarised studies which investigated the prevalence, incidence and nature of prescribing errors in hospital inpatients. Overall, studies show that prescribing errors are a common occurrence, affecting around 1 in 14 of all hospital prescriptions. Foot note
Overall, around half of all hospital admissions will be affected in some way by some kind of prescribing error. Click 1 - Nightingale ward half affected. Click 2 - Lets affect the lady sitting down as well, just for fun.
Minimum standard for prescribing safely: Prescription should not endanger patient care either because of inappropriate prescribing or poor communication. Most errors in hospital involve a small number of “high risk” or “problem” drugs. We will have a think about this in a moment.
As part of this lecture series we want you to feel included, and not just be passive participants that we feed information to. So we are going to get you involved in the presentation, get you to think about cases, make some decisions and think about how confident about things. All of this will be completely anonymous and will not put anyone on the spot. We are not even going to ask any of you to put your hands up! In your packs in front of you, you will find some voting sheets. Can you all take them out and have a look at them?
We need to get some voting sheets designed and then add an example here. You will see on the voting sheets that there are X numbers of votes to be cast. You may vote for one option on each occasion, and this you must do by marking the option letter with a cross. Do not mark more than one option. So think about which option you want to go for before marking the paper. Also, you will be asked to rate your confidence in your vote each time. We want to know how sure you are that you have made the right decision. You should score your confidence in the vote you have cast by ringing the confidence score you feel fits best with the confidence you have in your decision. Have a read through the 4 confidence statements now.
Some things that we are asked about are easy for us to answer with confidence. For example, think of this problem: A glass is being filled from the tap. Unfortunately, the glass is left under the tap and the water starts to overflow in to the sink. In your opinion, which of the following options would be best to deal with this situation effectively and keep your hands dry whilst doing so?
Most people would go for option A, and be pretty sure they had made the right decision. So what if I was to also ask you to rate your confidence in the answer you had given? Would you be very confident you had made the right decision, or maybe very unconfident and would always seek advice before acting if confronted by this in the real world? I hope that all of you would be very confident to deal with this and would be confident you had voted for the best option from those presented to you.
But things aren’t always that simple. What if I was to request that you think about something more complex or unfamiliar? For example, what if I told you that one part of this piping system was liable to leak due to the plumbing design? Say I outlined some problem points with handy arrows and then asked you to vote which arrowed area you felt was the most likely to leak first. Now unless you happen to be a plumber, or have a strange and rather specialist interest in your spare time, you are likely to be pretty unsure as to which area may be most likely to leak. You can vote, but overall your confidence that you have selected the correct area most prone to leaks is likely to be low. We will be putting some problems forward to you during this lecture series, and presenting some possible courses of action to you. We will be asking you to vote on your preferred course of action throughout the lecture series, and to have a think about your confidence levels in selecting which option to vote for. All of this will be completely confidential and private, provided you do not look over each other’s shoulders! The results from the voting and confidence scoring will be presented to you during the next two lectures. Everything will be completely anonymous, including to us as presenters. It will hopefully make things more interactive, and fun.
As well as voting on things, we also want you to discuss a few questions with your colleagues at certain points in the seminar. Discussing things with those around you for a few minutes will help you establish what you do and don’t know, what you are confident about and what you are not so sure of. We will give you a few minutes each time. Make sure that you just talk to the people next to you, otherwise we won’t be able to hear each other due to shouting.
Types of medicines most likely involved in admissions So lets start with this question: Which medications are the most likely to lead to a hospital admission due to an adverse drug reaction? Have a think about it and discuss this with the people sitting next to you.
Drugs most commonly implicated in causing these admissions included low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding. Conclusion: The burden of ADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs. Although many of the implicated drugs have proved benefit, measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit:harm ratio of the drugs.
Types of medicines most likely involved in hospital medication errors
Medication errors by class of medication at a local (unnamed) hospital over 6 months
For doctors, prescribing (some administration); For pharmacists, ordering and dispensing (some prescribing); For nurses administration (some ordering and prescribing)
I presume the 1000 bed hospital represents Hope/Wythenshawe/MRI/Preston? Can you confirm that I am correct about this point ?
The students will be reminded that we will look at a controlled drug prescription next session.
Use slides to demonstrate
Drugs with similar names
Drugs with similar packaging (manufacturer branding)
Photos
Photos
Please ring the number which corresponds to your confidence that you have voted for the best option. Do not ring more than one number. When considering your confidence, think about how you would feel if confronted with the situation as a recently qualified professional. Think whether you would be happy to proceed or whether you think you would need more help before acting. Description of options 1 I am not at all confident that I have voted for the most appropriate option. If I were confronted by this situation I would need to ask for advice and help before making a decision. 2 I am not overly confident that I have voted for the most appropriate option. If I were confronted by this situation I would usually ask for advice and help before making a decision, unless it was very difficult and inconvenient to do so. 3 I am quite confident that I have voted for the most appropriate option. If I were confronted by this situation I would not usually ask for advice and help before making a decision, unless it was very easy and convenient to do so. 4 I am very confident that I have voted for the most appropriate option. If I were confronted by this situation I would not need to ask for advice and help before making a decision. Remember: Cast your vote and confidence rating by circling one letter and one number. Fold your voting slip over so that it cannot be viewed by anyone during the collection process. Pass it to the end of your row and it will be placed in the collection box. These votes are completely anonymous; you will not receive individual feedback following your vote. Group results will be shared with everyone at following seminars.
RING A NUMBER- DON”T DO THIS!
Patient with learning difficulties has been admitted to hospital. She has undergone a routine operation of some sort e.g. arthroscopy. No relatives have arrived. Notes brief- learning difficulties, knee pain, no other relevant medical history. Nursing staff on day care unit. Patient is complaining of pain 1 hour post operatively. The patient has received some morphine and 1000mg intravenous paracetamol in theatre 1 hour ago. The patient is still quite drowsy, but has had a few sips of water. The nurse tells you that her observations are fine, except that her respiratory rate is only 8 breaths per minute.
The nurse tells you that her observations are fine, except that her respiratory rate is only 8 breaths per minute. The patient is still quite drowsy, but has had a few sips of water.
The junior doctor decides to prescribe some pain relief for this patient. Vote for medication that you would select from the above four options. How confident are you that you have selected the an appropriate medication? Ring your level of confidence from 1-4. Remember to ring a number- you cannot vote in between numbers!
Okay, we have collected the votes in. It’s your turn to do some prescribing. What would you write on the drug chart? Where? Why not have a go at prescribing the medication you picked? Feel free to talk to those around you, also have a look at the BNF.
Okay, we have collected the votes in. It’s your turn to do some prescribing. What would you write on the drug chart? Where? Why not have a go at prescribing the medication you picked? Feel free to talk to those around you, also have a look at the BNF.
The junior doctor decides to prescribe a Non steroidal anti-inflammatory drug (NSAID).
New info- relative rings- patient experienced a rash and became wheezy when previously when received ibuprofen. Nurse has withheld the NSAID but is concerned because the patient still is in pain. What now?
The nurse adds this to the drug chart and asks for your advice.
What would be the best option out of the following that are going through our doctor’s mind? You can discuss this with the person next to you and look at the BNF text.
What now- vote 2 You may feel there are advantages and disadvantages with all the options To outline one that comes to mind for each- A Nursing staff are concerned about this option as they have already contacted you regarding Ibuprofen and are querying this. Are risks (if any) lower, the same or higher for the patient if they receive THIS NSAID? B Will this relieve the patient’s pain without endangering patient due to any opiate side effects? C Should further paracetamol be used instead? The patient had some in theatre, but that was over an hour ago D The patient is in pain- why are you delaying things? Have a go, pick an option to vote for, and then think about how confident you are that this is the best option of those above. Remember, this is all anonymous.
Final vote- how change system to prevent in future. Could anything help here? Few options, nothing clearly best option… real life, confidence etc.
Final vote- how change system to prevent in future. Could anything help here? Few options, nothing clearly best option… real life, confidence etc. Which would be the best one to go for as a first option? (Prof Pollard, Anaesthetics at MRI- he is happiest with first option as this encompasses many staff, and least happiest with second as it is irrelevant, but this will not be revealed until next lecture).
Need to reflect on activities and learning during first session (reflection on action)
Need to inform students about future sessions (Anticipatory reflection) They will receive the results of their voting next week (Feedback) They will also see how the pharmacists/medics voted when confronted with the same dilemmas (Inter-professional communication) They will look at a more complex case and have the opportunity to vote again (Interaction and discussion) They will think about some small group work which follows this lecture series (Future aims)
