The document discusses medication reconciliation and errors. It notes that adverse drug events are common in hospitals and can result in harm or death. A study found over 50% of patients had at least one unintentional medication discrepancy upon admission. The challenges include a lack of standardized processes and clear ownership when patients transition between care settings. The document proposes interventions like education, standardized workflows, technology solutions, and policies to fully implement a medication reconciliation program across nursing, pharmacy, physicians, and patients to reduce errors and discrepancies.
This document describes a pilot study that evaluated the impact of including a pharmacist in the transitions of care process for patients discharged from an inpatient family medicine service. Key findings include:
- A pharmacist called patients within 2-7 days of discharge and documented any interventions in the electronic medical record. This reduced medication errors and delays in initiating new medications.
- A physician questionnaire found that including the pharmacist improved quality of care, reduced medication errors and prior authorization delays, and saved physician time with medication reconciliation.
- The readmission and emergency department visit rates during the 6 month pilot period were lower than the previous 6 months, suggesting the pharmacist interventions may have prevented readmissions.
This document discusses admitting a patient to the hospital. It provides three mnemonics - AD CAVA DIMPLS, ADC VANDALISM, and ADCA VAN DIMLS + D - to help remember the components of typical admission orders. These components include admit, diagnosis, condition, activity, vital signs, allergies, diet, interventions, medications, procedures, labs, and special instructions. The document also outlines rules for effective order writing and explains each component of the admission orders in more detail.
Clinical Score leads the industry as a voice of the sites” by gathering front-line opinions and observations from Study Coordinators and other Clinical Professionals.This article of Clinical Trial…and Error was written in conjunction with Joshua Schoppe, Senior Outreach Coordinator for Research at Thomas Jefferson University Hospital.
Joshua.Schoppe@jefferson.edu
TMLT risk management staff conduct on-site practice reviews to help physicians determine and address their medical liability risks. In 2016, risk managers reviewed more than 2,000 physician practices, and gave the following 10 recommendations most frequently.
Presented by: Angela Greetham, Bay of Plenty DHB
at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am
Video URLs:
HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4
The document discusses recommendations to prevent accidental heparin overdoses in neonates after an incident where 3 neonates died from overdoses. It recommends eliminating high concentration heparin vials, requiring independent double checks of drugs, and reducing similar drug packaging. Unintended medication discrepancies are common at hospital admission and accurate medication histories are important. National patient safety goals include reconciling medications, reducing infections, and falls.
This document describes a quality improvement project to increase compliance with fall risk precautions for patients at medium to high risk of falling in inpatient units. An audit found that only 33% of patients had all precautions in place. The team identified the most common reasons for non-compliance and addressed them, such as providing more durable signage and repairing broken beds. Re-auditing showed compliance increased to 84%.
The document discusses medication reconciliation and errors. It notes that adverse drug events are common in hospitals and can result in harm or death. A study found over 50% of patients had at least one unintentional medication discrepancy upon admission. The challenges include a lack of standardized processes and clear ownership when patients transition between care settings. The document proposes interventions like education, standardized workflows, technology solutions, and policies to fully implement a medication reconciliation program across nursing, pharmacy, physicians, and patients to reduce errors and discrepancies.
This document describes a pilot study that evaluated the impact of including a pharmacist in the transitions of care process for patients discharged from an inpatient family medicine service. Key findings include:
- A pharmacist called patients within 2-7 days of discharge and documented any interventions in the electronic medical record. This reduced medication errors and delays in initiating new medications.
- A physician questionnaire found that including the pharmacist improved quality of care, reduced medication errors and prior authorization delays, and saved physician time with medication reconciliation.
- The readmission and emergency department visit rates during the 6 month pilot period were lower than the previous 6 months, suggesting the pharmacist interventions may have prevented readmissions.
This document discusses admitting a patient to the hospital. It provides three mnemonics - AD CAVA DIMPLS, ADC VANDALISM, and ADCA VAN DIMLS + D - to help remember the components of typical admission orders. These components include admit, diagnosis, condition, activity, vital signs, allergies, diet, interventions, medications, procedures, labs, and special instructions. The document also outlines rules for effective order writing and explains each component of the admission orders in more detail.
Clinical Score leads the industry as a voice of the sites” by gathering front-line opinions and observations from Study Coordinators and other Clinical Professionals.This article of Clinical Trial…and Error was written in conjunction with Joshua Schoppe, Senior Outreach Coordinator for Research at Thomas Jefferson University Hospital.
Joshua.Schoppe@jefferson.edu
TMLT risk management staff conduct on-site practice reviews to help physicians determine and address their medical liability risks. In 2016, risk managers reviewed more than 2,000 physician practices, and gave the following 10 recommendations most frequently.
Presented by: Angela Greetham, Bay of Plenty DHB
at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am
Video URLs:
HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4
The document discusses recommendations to prevent accidental heparin overdoses in neonates after an incident where 3 neonates died from overdoses. It recommends eliminating high concentration heparin vials, requiring independent double checks of drugs, and reducing similar drug packaging. Unintended medication discrepancies are common at hospital admission and accurate medication histories are important. National patient safety goals include reconciling medications, reducing infections, and falls.
This document describes a quality improvement project to increase compliance with fall risk precautions for patients at medium to high risk of falling in inpatient units. An audit found that only 33% of patients had all precautions in place. The team identified the most common reasons for non-compliance and addressed them, such as providing more durable signage and repairing broken beds. Re-auditing showed compliance increased to 84%.
A professor and vice chair for clinical research at Stony Brook School of Medicine, Dr. Elliott Bennett-Guerrero also serves as medical director of perioperative quality and patient safety in the Department of Anesthesiology. In his leadership role with the university, Dr. Elliott Bennett-Guerrero focuses a portion of his research on the safety and effectiveness of blood transfusions.
Blood consists of red blood cells, white blood cells, platelets, and plasma. A blood transfusion involves infusing whole blood or blood components into a patient's veins. Nurses must carefully verify orders, obtain consent, check blood types, and monitor the patient during and after a transfusion for any adverse reactions like fever, allergic reactions, or a hemolytic transfusion reaction. Immediate actions are required if a reaction occurs to stop the transfusion and notify the physician and blood bank.
This document discusses blood component transfusion. It defines blood components as any therapeutic substance prepared from human blood, including whole blood, red blood cells, platelets, plasma, cryoprecipitate, and growth factors. It describes how whole blood is separated into components through centrifugation. It provides indications, storage requirements, and dosages for transfusing various blood components in pediatric patients. Potential complications of transfusion like acute reactions, late infections, and iron overload are also summarized. The document concludes with SKMCH&RC transfusion protocols.
The document discusses medication errors, including common types, causes, and strategies for prevention. It notes that medication errors are a serious issue, causing up to 98,000 deaths per year. Errors can occur at any step in the medication process and are often due to human factors like poor communication or illegible handwriting, as well as system factors like confusing drug names. Strategies to reduce errors include using clear verbal order protocols, limiting dangerous abbreviations, implementing computerized physician order entry and barcoding, and having a just culture approach that supports healthcare workers involved in errors.
Preventing Patient Falls in Acute Care HospitalsJoe Tomsic
This document provides guidance for healthcare professionals developing falls and fall injury prevention programs. It outlines key factors that contribute to patient falls such as medications, mobility issues, and environmental hazards. The author recommends a multifactorial approach including fall risk screening, customized interventions, staff education, and monitoring programs. As a psychiatric nurse practitioner, the author is well-positioned to lead initiatives that address behavioral and cognitive risks for falls. Standardized communication tools like SBAR can help ensure fall risks are well-communicated between care teams.
This document provides an overview of blood transfusion, including:
- The components of blood and blood transfusion products like whole blood, red blood cells, and platelets.
- The importance of compatibility testing between donor and recipient blood, including ABO and Rh blood grouping.
- Common indications for blood transfusion like blood loss, anemia, and surgery.
- Potential adverse effects and nursing responsibilities in administering blood transfusions safely.
- Detailed steps nurses must take to correctly identify blood products, obtain consent, monitor patients during transfusion, and respond to any adverse reactions.
This document provides an overview of blood and blood transfusions. It discusses the properties and functions of blood, the components of blood including plasma, red blood cells, white blood cells and platelets. It describes how blood cells are produced in the bone marrow. The document also discusses blood typing and compatibility, the history of blood transfusions, the purposes and types of transfusions, and considerations around transfusion responsibilities and reactions.
1. Blood transfusion has evolved significantly since the first successful human transfusion in the early 1600s with discoveries like ABO blood grouping and advances in storage techniques.
2. Successful blood transfusion requires crossmatching between donor and recipient blood to minimize transfusion reactions as well as use of anticoagulants and plastic storage containers.
3. While blood transfusion can be life-saving, it also carries risks like acute transfusion reactions, chronic transfusion complications, and potential transmission of infections. Careful donor screening and testing helps reduce these risks.
This document defines blood transfusion and outlines its purposes, situations where it is needed, potential reactions, and nursing interventions. It describes blood transfusion as introducing blood products intravenously to replace lost blood or restore oxygen capacity. Common situations requiring transfusion include surgery, injuries, anemia, or bleeding disorders. The document also classifies different blood products like packed red blood cells, plasma, and platelets, and how they are used.
This document provides information on various aspects of medication administration in a nursing context. It discusses definitions of key terms, indications for drug use, routes of administration including oral, topical, intravenous, intramuscular and more. It also covers assessing patients, drug orders, rights of medication administration, policies, guidelines and procedures for safely preparing and giving different types of medications to patients.
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
This document discusses blood transfusion, including definitions, types of transfusions, blood products, indications for transfusion, risks, and guidelines. It covers topics like whole blood, packed red blood cells, platelets, plasma, and cryoprecipitate. Key points include that transfusion involves receiving blood products intravenously to replace lost blood, it can use one's own blood or from a donor, and decisions should be based on careful assessment of clinical and lab indications to save life or prevent morbidity.
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
Here are the key steps I would take:
1. Return to Mrs. Veena immediately to inform her of the error and assess for any allergic reaction symptoms. Her safety is the top priority.
2. Notify the physician right away about the error so they can determine the appropriate treatment and monitoring plan for Mrs. Veena.
3. Fill out an incident report per hospital policy documenting exactly what occurred, the medications involved, actions taken, patient assessment and outcome.
4. Review the situation to understand what factors may have contributed to the error so I can learn and help prevent similar mistakes going forward. Proper documentation and reporting of all errors is important for quality improvement.
5. Apologize to
This document discusses quality issues related to patient safety, specifically medication errors. It defines key terms like medical error, adverse event, and near miss. It then identifies systems and personnel issues that can contribute to medication errors, such as staffing levels, the physical environment, and a lack of adherence to policies and procedures. The document also outlines the nurse's role in preventing errors and systems that have been implemented, such as computerized order entry and barcoding. It provides an overview of a trigger tool for measuring adverse drug events and discusses the results of a previous study on using clinical decision support systems to change physician ordering behavior and reduce errors.
The document provides information about Drug Information Centres (DIC). It defines a DIC as a service that provides advice and refers queries about drugs to appropriate resources. DICs aim to promote evidence-based practice and improve patient care. They classify DICs as hospital-based, industry-based, or community-based. Clinical pharmacists working in DICs provide written or verbal drug information to healthcare professionals and patients. They respond to queries about various drug attributes like indications, dosages, interactions and side effects. When answering drug information questions, pharmacists gather background details, clarify the question, search multiple sources for relevant data, interpret the findings and formulate an appropriate response to address the query.
Learn best practices based on literature and how to perform a complex and accurate medication history. Recognize gaps/inconsistencies in systems that impede medication reconciliation and identify next steps in improving current medication reconciliation within your own practice.
Speaker:
Mary Pat Friedlander, MD
Lawrenceville Family Health Center
Pittsburgh, PA
This document summarizes a presentation on pharmacy risk management best practices and trends in 2015. The presentation covered topics such as patient-centered medication education, strategies to identify threats to outcomes-focused pharmacy practice, and effective risk reduction strategies for managing controlled substances. The objectives of the presentation were to describe characteristics of patient-centered medication education, review strategies to identify threats to pharmacy practice, describe effective risk reduction for controlled substances, and discuss techniques to avoid negligent pharmacy practice.
Human: Thank you for the summary. You captured the key topics and objectives discussed in the document concisely in 3 sentences as requested. Your summary provides a high level overview of the essential information from the original document.
Prescription event monitoring and record linkage systemVineetha Menon
This document discusses record linkage and its use in pharmacovigilance. Record linkage involves combining records from different data sources that relate to the same individual to create a single longitudinal record. It allows rapid access to a patient's complete medical history across different data sources. This reduces the time needed to study relationships between drug exposure and health outcomes. Challenges include ensuring data quality and completeness when integrating records from various sources.
A professor and vice chair for clinical research at Stony Brook School of Medicine, Dr. Elliott Bennett-Guerrero also serves as medical director of perioperative quality and patient safety in the Department of Anesthesiology. In his leadership role with the university, Dr. Elliott Bennett-Guerrero focuses a portion of his research on the safety and effectiveness of blood transfusions.
Blood consists of red blood cells, white blood cells, platelets, and plasma. A blood transfusion involves infusing whole blood or blood components into a patient's veins. Nurses must carefully verify orders, obtain consent, check blood types, and monitor the patient during and after a transfusion for any adverse reactions like fever, allergic reactions, or a hemolytic transfusion reaction. Immediate actions are required if a reaction occurs to stop the transfusion and notify the physician and blood bank.
This document discusses blood component transfusion. It defines blood components as any therapeutic substance prepared from human blood, including whole blood, red blood cells, platelets, plasma, cryoprecipitate, and growth factors. It describes how whole blood is separated into components through centrifugation. It provides indications, storage requirements, and dosages for transfusing various blood components in pediatric patients. Potential complications of transfusion like acute reactions, late infections, and iron overload are also summarized. The document concludes with SKMCH&RC transfusion protocols.
The document discusses medication errors, including common types, causes, and strategies for prevention. It notes that medication errors are a serious issue, causing up to 98,000 deaths per year. Errors can occur at any step in the medication process and are often due to human factors like poor communication or illegible handwriting, as well as system factors like confusing drug names. Strategies to reduce errors include using clear verbal order protocols, limiting dangerous abbreviations, implementing computerized physician order entry and barcoding, and having a just culture approach that supports healthcare workers involved in errors.
Preventing Patient Falls in Acute Care HospitalsJoe Tomsic
This document provides guidance for healthcare professionals developing falls and fall injury prevention programs. It outlines key factors that contribute to patient falls such as medications, mobility issues, and environmental hazards. The author recommends a multifactorial approach including fall risk screening, customized interventions, staff education, and monitoring programs. As a psychiatric nurse practitioner, the author is well-positioned to lead initiatives that address behavioral and cognitive risks for falls. Standardized communication tools like SBAR can help ensure fall risks are well-communicated between care teams.
This document provides an overview of blood transfusion, including:
- The components of blood and blood transfusion products like whole blood, red blood cells, and platelets.
- The importance of compatibility testing between donor and recipient blood, including ABO and Rh blood grouping.
- Common indications for blood transfusion like blood loss, anemia, and surgery.
- Potential adverse effects and nursing responsibilities in administering blood transfusions safely.
- Detailed steps nurses must take to correctly identify blood products, obtain consent, monitor patients during transfusion, and respond to any adverse reactions.
This document provides an overview of blood and blood transfusions. It discusses the properties and functions of blood, the components of blood including plasma, red blood cells, white blood cells and platelets. It describes how blood cells are produced in the bone marrow. The document also discusses blood typing and compatibility, the history of blood transfusions, the purposes and types of transfusions, and considerations around transfusion responsibilities and reactions.
1. Blood transfusion has evolved significantly since the first successful human transfusion in the early 1600s with discoveries like ABO blood grouping and advances in storage techniques.
2. Successful blood transfusion requires crossmatching between donor and recipient blood to minimize transfusion reactions as well as use of anticoagulants and plastic storage containers.
3. While blood transfusion can be life-saving, it also carries risks like acute transfusion reactions, chronic transfusion complications, and potential transmission of infections. Careful donor screening and testing helps reduce these risks.
This document defines blood transfusion and outlines its purposes, situations where it is needed, potential reactions, and nursing interventions. It describes blood transfusion as introducing blood products intravenously to replace lost blood or restore oxygen capacity. Common situations requiring transfusion include surgery, injuries, anemia, or bleeding disorders. The document also classifies different blood products like packed red blood cells, plasma, and platelets, and how they are used.
This document provides information on various aspects of medication administration in a nursing context. It discusses definitions of key terms, indications for drug use, routes of administration including oral, topical, intravenous, intramuscular and more. It also covers assessing patients, drug orders, rights of medication administration, policies, guidelines and procedures for safely preparing and giving different types of medications to patients.
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
This document discusses blood transfusion, including definitions, types of transfusions, blood products, indications for transfusion, risks, and guidelines. It covers topics like whole blood, packed red blood cells, platelets, plasma, and cryoprecipitate. Key points include that transfusion involves receiving blood products intravenously to replace lost blood, it can use one's own blood or from a donor, and decisions should be based on careful assessment of clinical and lab indications to save life or prevent morbidity.
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
Here are the key steps I would take:
1. Return to Mrs. Veena immediately to inform her of the error and assess for any allergic reaction symptoms. Her safety is the top priority.
2. Notify the physician right away about the error so they can determine the appropriate treatment and monitoring plan for Mrs. Veena.
3. Fill out an incident report per hospital policy documenting exactly what occurred, the medications involved, actions taken, patient assessment and outcome.
4. Review the situation to understand what factors may have contributed to the error so I can learn and help prevent similar mistakes going forward. Proper documentation and reporting of all errors is important for quality improvement.
5. Apologize to
This document discusses quality issues related to patient safety, specifically medication errors. It defines key terms like medical error, adverse event, and near miss. It then identifies systems and personnel issues that can contribute to medication errors, such as staffing levels, the physical environment, and a lack of adherence to policies and procedures. The document also outlines the nurse's role in preventing errors and systems that have been implemented, such as computerized order entry and barcoding. It provides an overview of a trigger tool for measuring adverse drug events and discusses the results of a previous study on using clinical decision support systems to change physician ordering behavior and reduce errors.
The document provides information about Drug Information Centres (DIC). It defines a DIC as a service that provides advice and refers queries about drugs to appropriate resources. DICs aim to promote evidence-based practice and improve patient care. They classify DICs as hospital-based, industry-based, or community-based. Clinical pharmacists working in DICs provide written or verbal drug information to healthcare professionals and patients. They respond to queries about various drug attributes like indications, dosages, interactions and side effects. When answering drug information questions, pharmacists gather background details, clarify the question, search multiple sources for relevant data, interpret the findings and formulate an appropriate response to address the query.
Learn best practices based on literature and how to perform a complex and accurate medication history. Recognize gaps/inconsistencies in systems that impede medication reconciliation and identify next steps in improving current medication reconciliation within your own practice.
Speaker:
Mary Pat Friedlander, MD
Lawrenceville Family Health Center
Pittsburgh, PA
This document summarizes a presentation on pharmacy risk management best practices and trends in 2015. The presentation covered topics such as patient-centered medication education, strategies to identify threats to outcomes-focused pharmacy practice, and effective risk reduction strategies for managing controlled substances. The objectives of the presentation were to describe characteristics of patient-centered medication education, review strategies to identify threats to pharmacy practice, describe effective risk reduction for controlled substances, and discuss techniques to avoid negligent pharmacy practice.
Human: Thank you for the summary. You captured the key topics and objectives discussed in the document concisely in 3 sentences as requested. Your summary provides a high level overview of the essential information from the original document.
Prescription event monitoring and record linkage systemVineetha Menon
This document discusses record linkage and its use in pharmacovigilance. Record linkage involves combining records from different data sources that relate to the same individual to create a single longitudinal record. It allows rapid access to a patient's complete medical history across different data sources. This reduces the time needed to study relationships between drug exposure and health outcomes. Challenges include ensuring data quality and completeness when integrating records from various sources.
This is a draft e-learning module for the Prescribe Project (http://ow.ly/uO53A). It is about how to improve communication with patients and colleagues around prescribing decisions.
Unsafe medication is a leading cause of harm, most of it preventable, in health care systems across the world. Medication incidents occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.
Full Details: https://goo.gl/gCQ64V
The document discusses safe medication administration practices for nurses. It covers the nurse's legal responsibility to safely administer medications, the six rights of administration, types of medication prescriptions, tools to minimize medication errors, using the nursing process, and providing atraumatic care when giving medications to pediatric patients.
This document provides guidance on proper prescription writing. It begins by noting that prescription writing is often not well covered in medical school, which can contribute to medication errors. The document then outlines the 11 required elements of a prescription, including patient information, drug name and strength, dosage instructions, refill information, and prescriber signature. Dangerous abbreviations are also identified. The document provides examples of correctly written prescriptions for both oral and liquid medications. Overall, the goal is to promote best practices in prescription writing to reduce medication errors.
This document provides information about a practical lab manual for hospital and clinical pharmacy. It includes 9 experiments covering topics like drug information queries, interpreting laboratory reports, adverse drug reaction reporting, demonstrating use of orthopedic aids and bandages, and case studies. The experiments aim to teach students a systematic approach to drug information, how to optimize drug therapy based on lab results, and skills like wound dressing and injection techniques. Key aspects covered are using primary, secondary and tertiary resources to answer drug queries; components of laboratory reports; and handling prescriptions and addressing patient queries. The document outlines the objectives, theory, and procedures for each experiment.
BioTech Medical Solutions - Pain RD short 8.5x11William Tillman
- Complete an application to become a member physician and set up your practice profile
- Attend online training for your staff on insurance billing, inventory management, and using the dispensing software
- Begin offering FDA-approved pharmacogenetic test kits and pre-filled injection kits to patients using point-of-care billing
- The company handles insurance credentialing and adjudication of claims, minimizing practice expenses and workload
- With 10% patient penetration, the average practice could earn over $369,000 annually from kit dispensing and testing
The document discusses post-marketing surveillance (PMS) of pharmaceutical drugs. PMS involves monitoring drug safety after market release using approaches like spontaneous reporting databases, patient registries, and record linkage between health databases. Data from PMS is important for discovering undesirable effects that were not found in pre-market clinical trials due to limited sample sizes and durations. PMS plays a key role in improving understanding of a drug's risks and benefits in real-world use.
The document discusses the International Patient Safety Goals (IPSG) which were developed by the Joint Commission International to help improve patient safety. It provides background on how the IPSG were adapted from the National Patient Safety Goals established by the Joint Commission. The document then outlines several of the IPSG, including proper patient identification, improving staff communication, reducing risks associated with medications, and preventing wrong site/procedure surgery. The goals are aimed at reducing common safety issues and medical errors in healthcare facilities.
This document discusses prescriptions, including what they are, types of prescriptions, required contents, and parts of a prescription. It notes that a prescription is a written order from a physician to a pharmacist with instructions for preparing and dispensing a prescribed drug for a patient. There are two main types: pre-compounded prescriptions for already prepared drugs, and compounded prescriptions which require the pharmacist to prepare the medicine. All prescriptions should contain key identifying and instructional information. The main parts of a prescription include the superscription, inscription, subscription, transcription, and prescriber's signature.
AETCOM all competencies.pptx pathology practical59w4pymhcm
This document discusses guidelines for treating multi-drug resistant tuberculosis (MDR TB). It notes that MDR TB is resistant to both isoniazid and rifampin, with or without resistance to other first-line drugs. Treatment involves 6-9 months of a combination of second-line drugs from various groups. It has removed kanamycin and capreomycin from recommendations and advises only using clavulanic acid with carbapenems. One of the new recommended MDR regimens is also mentioned.
This document discusses various aspects of informed consent in anesthesia practice and medical malpractice litigation. It notes that informed consent is required to respect patient autonomy and involves explaining the risks, benefits and alternatives of a procedure to allow for substantially autonomous decision making. The key elements of competence that a patient must demonstrate to provide valid consent are described. Maintaining thorough anesthesia records and communicating well with patients can help minimize the risk of malpractice lawsuits.
The development of a Patient Safety Programme for Primary Care is being informed by the learning from two ongoing primary care safety projects. This session highlights the approaches used, the early findings and describes how to sustain and spread the success of this work.
Mitigating Risk When Managing High Dose, Chronic Pain Patients Polsinelli PC
This document summarizes strategies for clinicians to mitigate risk when managing patients with chronic pain, including prescribing opioids. It recommends independently evaluating all patients and assessing risk of abuse before and during treatment. It also suggests establishing measurable treatment goals, checking prescription drug monitoring programs, and avoiding combining opioids with benzodiazepines or other sedating medications. The document provides guidance on tapering opioids and benzodiazepines safely for appropriate patients. It also stresses the importance of careful documentation when prescribing high doses of opioids to reduce legal risk.
This document provides guidance for clinical pharmacists on important tasks like reviewing patient medical notes and prescriptions, communicating with medical staff, and consulting with patients. It emphasizes the need to prioritize critical issues due to time constraints, understand different perspectives, and maintain patient privacy and comfort. Key responsibilities include identifying drug-related problems, making therapeutic recommendations, ensuring proper administration and monitoring, and answering patient questions to optimize medication management.
This document discusses supervision of undergraduate students in pharmacy and medicine schools regarding prescribing training. It notes variance in pharmacist time/funding and a need for standardized undergraduate training. A national prescribing assessment is being piloted from 2013-14 assessing prescribing, prescription review, planning management, data interpretation, drug monitoring, communication about medicines, drug calculations, and adverse drug reactions. Challenges include dispersed student placements and differences in curricula. The document discusses developing curriculum mapping, expanding ePortfolio resources, writing national exam questions, and competencies students should gain in phases one and two of their education.
Advanced Postgraduate Skills 2011 PresentationKurt Wilson
This document announces an advanced postgraduate skills workshop covering skills for manuscript and presentation preparation, literature search tools, and using advanced media and software. The workshop will focus on scientific illustration, communication skills, collaboration, and sharing information using tools like Google Docs, Dropbox, and Prezi. Learning activities include facilitator presentations, workshops, and peer review. Attendees are instructed to log into WiFi and bring laptops and smartphones to participate in engagement activities using polling software and to collaborate in real-time using cloud-based sharing platforms.
AMEE 2010 Authentic capture of longitudinal careKurt Wilson
The document discusses using virtual learning environments to help medical students experience longitudinal patient care. Medical students currently only see clinical snapshots due to time constraints. The virtual environment allows students to follow virtual patients over time from a distance to gain experience with longitudinal care and better understand its complexities. Students felt it could be useful to contrast different patient presentations and see how one family member's illness may affect others. They suggested including patient signs, questions and answers, and clickable elements to access information.
Clinical debriefing involves using case presentations and discussions to help students learn from clinical experiences. Students work in small groups to discuss cases, generate hypotheses, decide on exam findings and the best initial test. This allows students to apply their knowledge, get feedback, and learn from each other's perspectives. Clinical debriefing may help address gaps in understanding from clinical placements and stimulate deeper learning through interactive discussion of cases.
The document provides information about learning medicine in community clinical placements during the third year of medical school. It discusses why learning in the community is important, as most healthcare takes place outside of hospitals. It also outlines opportunities for students, such as interacting with patients, working with entire healthcare teams, asking questions, and gaining experience. Students are encouraged to be proactive, seek feedback, and learn from any mistakes. The document provides tips and explains how students can sign up for and participate in various community experiences.
This document outlines the intended use and structure of clinical debriefing sessions for medical students. The goals are to use debriefing to provide teaching, learning, and assessment; enhance reflective practice; and facilitate two-way feedback. Sessions typically involve groups of 8 students presenting and discussing patient cases over 2.5 hours. They aim to develop students' presentation, examination, and record keeping skills while discussing ethical issues and preparing for assessments. The document provides examples of structuring debriefing sessions around margin hypothesis generation, physical examination findings, and determining the best diagnostic test.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
17. What would be the safest and quickest way to confirm the correct dose?
18. What would be the safest and quickest way to confirm the correct dose?
19. What would be the safest and quickest way to confirm the correct dose?
20. What would be the safest and quickest way to confirm the correct dose?
21. What would be the safest and quickest way to confirm the correct dose? Confidence 1 2 3 4
22. What would be the safest and quickest way to confirm the correct dose? Phone the GP surgery to confirm dose? Ask patient to confirm dose? Check patient own medication to confirm dose? Look in case notes for recent letter from RA clinic to confirm dose?
23. Pharmacy Stamp Age D o B 21/1/54 Name (including forename and address) Alice Major 1 High Street Anytown Dispenser’s Endorsement Number of days’ treatment N.B. Ensure dose is stated NP Pricing Office Pack & Quantity Methotrexate 10mg Daily (4) Signature of Prescriber A Doctor Date 6/4/00 For Dispenser No. of Prescns. On form A Doctor A Surgery Anytown NHS PATIENTS – please read the notes overleaf FP10C 0899
24. Pharmacy Stamp Age D o B 21/1/54 Name (including forename and address) Alice Major 1 High Street Anytown Dispenser’s Endorsement Number of days’ treatment N.B. Ensure dose is stated NP Pricing Office Pack & Quantity Nystatin oral suspension 1mL QDS (OP) Chlorhexadine 0.2% mouthwash 10mL BD (300mL) Clotrimazole 1% cream BD (OP) Signature of Prescriber A Doctor Date 6/4/00 For Dispenser No. of Prescns. On form A Doctor A Surgery Anytown NHS PATIENTS – please read the notes overleaf FP10C 0899
34. 'Tweeting' medics expose patients “ Patient confidentiality is paramount and medical students and doctors obviously need to be very careful about any information they post online” A British Medical Association spokesman BBC NEWS / NEWS FRONT PAGE "You must make sure that your conduct at all times justifies your patients' trust in you and the public's trust in the profession." General Medical Council “ content may risk violation of patient privacy, even without using names or other identifiers” http://news.bbc.co.uk/1/hi/health/8266546.stm (24.09.09)
In this module we have given you an overview of the scale of medication errors and the range of errors that can occur. National systems are in place to help minimise errors (e.g. restriction of staff permitted to administer intrathecal medication) NPSA. The remainder of the module is allowing you to develop an approach to identify and minimise errors when you are a practicing health care professional.
Back in the first lecture we showed you the common drugs implied with drug related errors at a local Trust and the types of errors which commonly occur. Drug related errors can occur at any stage of the medication process. Each healthcare professional has a responsibility to maximise their role in helping prevent medication errors. Many roles in today’s NHS overlap, but each professional should practice to minimise medication errors from: Selection - most effective and safe Prescribing – clear instructions and monitoring plans
Dispensing – safe practice, clear lines of communication to clarify issues identified
Administration – clear instructions from the prescriber and dispensing process (e.g. infuse over X no of minutes on label and on prescription) Monitoring – clear roles for all health care professionals – MTX (FBC), Opiates (RR), Gentamicin (TDM) Special kardexs for warfarin so INR is monitored. Nurse knows not to administer unless dosed. Community pharmacists check yellow anticoagulant book before dispensing to unsure monitored).
As a team it is all our responsibilities to minimise drug related incidents. An error at any of these stages could present as patient harm. We should all be alert for drug related errors and act when we see one, put into practice procedures to minimise the risk.
Last week we gave you a case with some options to vote on and your confidence on your vote. Here are the results from the medicine and pharmacy cohorts. The confidence is…..
Do you remember the tap analogy from week 1? 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 said they would go for option A, and be pretty sure they had made the right decision. And they were pretty confident with their choice of turning off the tap. What if when you tried to turn off the tap, the water flow continued. Your strategy to approach the problem changes as you gather additional information. As you approach a situation you need to continually reassess the information presented which may change your management strategy. Your options here might change and so might your monitoring. If a patient with RA presented your initial treatment may be an NSAID. By talking to the patient you may find that the patient has a contra-indication to the NSAID and your choice of options may change. The patient may have a caution to the NSAID and your monitoring frequency would probably change. You may even change your choice of NSAID to choose one to minimise the risk to that caution. As you gather information your options will change as will your confidence – you need to adopt a style of prescribing / monitoring to ensure you build in safety as you gather information.
Today we have a case of a patient on methotrexate. This patient was started methotrexate for RA by the hospital (the hospital was responsible for the dosing and monitoring, the GP for the prescribing). Shared care arrangements are put in place for the prescribing and monitoring of MTX. Patient is increased according to tolerance and response to 17.5mg weekly over a 6 month period. The patient took 7x2.5mg tablets each week. Patient is admitted to hospital for an elective right knee replacement (Jan 2000). The following kardex is written. Patient is admitted for 8 days.
Any issues with this prescription? You might want to have a look at this week’s BNF extract regarding methotrexate…
(hopefully ID dose is incorrect – why? Methotrexate for RA is issued in 2.5mg tablets to prevent confusion with 10mg tablets used for chemo) What would you do about it? – clarify dose
You have identified the dose – how would you find out the correct dose? Phone the GP surgery to confirm dose?
You have identified the dose – how would you find out the correct dose? Ask patient to confirm dose?
You have identified the dose – how would you find out the correct dose? Check patient own medication to confirm dose?
You have identified the dose – how would you find out the correct dose? Look in case notes for recent letter from RA clinic to confirm dose?
A Phone the GP surgery to confirm dose B Ask patient to confirm dose C Check patient own medication to confirm dose D Look in case notes for recent letter from RA clinic to confirm dose Are you confident that your chosen action will find the correct dose?
Have a brief discussion with your neighbours… can you think of pros and cons to each option?
The error goes un-noticed. 4 months later (April 2000) at the end of a routine appointment the Patient asks GP to prescribe MTX in a way which involves less tablets like when she was in the hospital. The following prescription is issued which is dispensed by a community pharmacy. Any issues? Changed to daily. How did the error occur? Communication error with patient and data entry error. What could be done to prevent it? Under shared care protocol GP would not change dose without consultation with hospital. Pharmacy computers would flag this dose up which must have been overridden.
GP identifies error on prescription at next issue and corrects prescription (not on computer record). 8 days later patient contacts GP of feeling unwell. The following prescription is issued. Any issues / points for discussion? Should the pharmacist & doctor have identified these symptoms as a side effect of MTX. Were the notes accessed?
18 th April 2000: admitted to ENT ward. Fax of history not received by admitting doctor Clerked in using PODs Any issues? Incorrectly clerked in compounding error. Nurse gives 10mg dose daily but prescription not corrected. Hospital pharmacy do not service ENT wards, prescription arrives in dispensary – asks nurse to ask doctor to confirm with surgery. 10mg daily confirmed by non medical member of staff at GP surgery. 21 April patient deteriorating. Bloods taken on admission insufficient for blood counts and not performed. 22 nd April Bloods chased. Reveal extent of methotrexate overdose – low platelets and WBC. Transfer to haematology – patient dies 8 days later (GI haemorrhage, pancytopenia, methotrexate toxicity.
This is not a ficticous case – this is a true account of an incident in Cambridgeshire in 2000. Since 2004 the NPSA have received Of the 165 reports of incidents directly associated with oral methotrexate • 139 (84 per cent) occurred in general or acute hospital settings and 26 (16 per cent) occurred in primary care settings*; • 140 caused no harm to the patients involved, 13 caused low harm, eight caused moderate harm, two caused severe harm and two led to the patients’ deaths;
Also specific guidance on prescribing and administration.
How did you vote? Option A – the ENT doctor phoned the surgery and confirmed a dose of 10mg Daily Option B – The patient was confused or poorly informed about their methotrexate Option C – The 10mg daily dose was dispensed Option D – May not have been in the same hospital for their appointments but knowing a shared care arrangement was dosed at the hospital the true dose may have been obtained. Know the limitations of the resources you use. Know the high risk drugs. Know the ADRs, cautions and contraindications of drugs you prescribe. Have an understanding of the errors which can occur and why they occur. Keep informed of NPSA alerts.
This case is an example of the Swiss cheese effect. Numerous healthcare professionals had an opportunity to intervene before it was too late – GP, community pharmacy, ENT doctor, nurse, hospital pharmacist. In this module we are going to get you to identify the barriers to put in place prevent ‘the Swiss cheese phenomenon’ to improve patient safety
So how does the rest of the module work? On the VLE (virtual learning environment) Blackboard you will find your group and case allocation. We have divided you into small groups of 5 students.
From now until 9 th november The case study is a patient who has the potential (or has experienced) many patient safety incidents related to medication. You are looking at the patients complete life using resources from primary and secondary care including clips of interviews with either the patient or carers. This is similar to the methotrexate incident review board who after the incident looked at all the times the incident could be prevented to perform a route cause analysis of the incident to help prevent similar cases in the future. The resources are on BB. You need to identify the drug problems in the case and attempt to find the root cause of each problem. As a group you must agree an action plan to deal with the problems. You should explain your rationale behind your actions. You may discuss several actions but the group must agree one approach and back up that choice. The debate in deciding the agreed decision will be enlighting as in practice you have to take one course of action until further information is presented. You also need to indentify potential drug safety problems and decide on how to monitor these in the patient. Once you have completed this as a group you need to reflect and consider generic lessons learned and what actions can be implemented to improved patient drug safety for other patients. For example in the MTX case (potential problems before the critical incident) 1. Patient has RA and prescribed potentially toxic medication of methotrexate with complex administration regimen. Mechanisms to prevent: NPSA alert on weekly administration of MTX to all HCP and use of 2,5mg tablets only for RA Shared care protocol with monitoring and prescribing arrangements Use of methotrexate cards to keep patient informed with blood monitoring (plus patient counselling)
Identify and collect materials from blackboard Discuss the case Pharmacy students have a scheduled slot on Thursday afternoons to discuss with each other & academic staff Message board use – open to all professions – can post questions (check medics access to BB) You will need to work as a group to produce a brief report Timeline- provisional report Feedback Final report and question and answer session
PC with internet access in the lecture theatre and SHOW them blackboard/message boards/google/twitter? Consent to share emails
Medics posting messages on networking websites like Facebook and Twitter are breaching patient confidentiality, a leading journal reveals. Research in the Journal of the American Medical Association found examples of web gossip by trainee doctors sharing private patient stories and details. Over half of 78 US medical schools studied had reported cases of students posting unprofessional content online. "Sharing patient stories that are de-identified and respectful, as health professionals might do on personal blogs, can encourage reflection, empathy and understanding. "However, content may risk violation of patient privacy, even without using names or other identifiers," they warned. elect privacy settings on social networking sites and should be told to perform periodic Web searches of their own name to vet listed online content. If you opt to use Twitter, bear confidentiality in mind.
For pharmacy student we need to decide on a weighting of this report The marks allocation will be assigned to constructive, realistic etc. Example of feedback statements (well written/useful and poory written/not useful)? use description not judgement keep it friendly identify and reinforce strengths collect objective evidence collaborate on constructive solutions not capitulate on the standards. Do not let your own prejudice affect feedback Describe the impact
Tell students about the afternoons when we are available for drop in support? Also, Brian Pollard has agreed to come along to the final question and answer session. This will make it very popular with the medics, as he is happy for us to let them know that he is heavily involved in 5 th year assessment in pharmacology, practical prescribing, medication safety and therapeutics, and their exempting exams (i.e. qualification) are in January!
In the module in BB Click on the left course tools ‘discussion’ Click on drop box for correct weeks assignment Create message Label with correct group name and profession Click on add attachment
Develop a problem solving approach to dealing with medication-related patient safety issues Access appropriate medicines information reference sources Review patient specific information (e.g. medical history, laboratory test results, interview transcripts) as an aid to decision-making Devise a patient-centred plan to optimise care