a beautiful ppt, illustrating the principles for prescribing, current concepts for clinical decision making, for practicing medicine and health care planning worldwide...
Self-medication is a global phenomenon and potential contributor to human pathogen resistance to antibiotics. The adverse consequences of such practices should always be emphasized to the community and steps to curb it.
a beautiful ppt, illustrating the principles for prescribing, current concepts for clinical decision making, for practicing medicine and health care planning worldwide...
Self-medication is a global phenomenon and potential contributor to human pathogen resistance to antibiotics. The adverse consequences of such practices should always be emphasized to the community and steps to curb it.
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
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Slide 1 : Title: ROLE OF PHARMACIST IN INTENSIVE CARE UNIT
By: Falakaara Saiyed
Slide 2: Introduction
Medication management plays a crucial part in managing a critically ill patient.
When it comes to drug therapy, intensivist have plenty of decision making every day including drug selection, dosing, administration, and monitoring strategies to optimize effective pharmacotherapy.
Even though the patient receives appropriate drug, a suboptimal dose or overdosing may result in either therapeutic failure or drug toxicity.
The concept of having a clinical pharmacist in an intensivist-led multidisciplinary team evolved in the early 1980s in USA.
In Today’s World Intensive Care Unit (ICU), the skills of a Critical care pharmacist addresses adverse drug events caused due to drug-related problems and medication errors. It improves the appropriateness, quality of prescribing and increases patient safety.
Slide 5: Aims & Objective
This aims to evaluate the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.
Even though the contribution of critical care pharmacist to improve the quality of patient care is accepted worldwide, many ICUs have not recognized this important reserve.
This presentation is used to educate other healthcare professionals and administrators on impact of clinical pharmacist in the care of critically ill patients.
Slide 14: Pharmaceutical Care Process
Assess the patient
Identify the problems and opportunities
Develop care plan
Implement Plan
Evaluate for Efficacy and Safety
Slide 24: Desirable activities of ICU pharmacist
Includes formulating guidelines for the critically ill patients, active participation in research, and educating the ICU team.
Guidelines which have been developed and implemented by the clinical pharmacist in our ICU includes protocols for pain, sedation, delirium, stress, drug compatibility chart , drug administration, dilution guidelines, and toxicological management protocols.
Once the protocols are formulated, all the members of the ICU team are educated on how to use the protocol.
Most of these clinical pharmacist enforced protocols are nurse oriented, and hence, it becomes easy for optimizing patient care.
The effectiveness of these guidelines is under the supervision of a critical care pharmacist, and it is well studied in Western countries.
Slide 25: conclusion
Clinical pharmacist as a part of multidisciplinary team in an ICU is associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.
Clinical pharmacists are essential to improve patient safety and outcome, reduce costs, and provide quality of care in critically ill patients.
Slide 26: References
Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med. 2010
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
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Slide 1 : Title: ROLE OF PHARMACIST IN INTENSIVE CARE UNIT
By: Falakaara Saiyed
Slide 2: Introduction
Medication management plays a crucial part in managing a critically ill patient.
When it comes to drug therapy, intensivist have plenty of decision making every day including drug selection, dosing, administration, and monitoring strategies to optimize effective pharmacotherapy.
Even though the patient receives appropriate drug, a suboptimal dose or overdosing may result in either therapeutic failure or drug toxicity.
The concept of having a clinical pharmacist in an intensivist-led multidisciplinary team evolved in the early 1980s in USA.
In Today’s World Intensive Care Unit (ICU), the skills of a Critical care pharmacist addresses adverse drug events caused due to drug-related problems and medication errors. It improves the appropriateness, quality of prescribing and increases patient safety.
Slide 5: Aims & Objective
This aims to evaluate the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.
Even though the contribution of critical care pharmacist to improve the quality of patient care is accepted worldwide, many ICUs have not recognized this important reserve.
This presentation is used to educate other healthcare professionals and administrators on impact of clinical pharmacist in the care of critically ill patients.
Slide 14: Pharmaceutical Care Process
Assess the patient
Identify the problems and opportunities
Develop care plan
Implement Plan
Evaluate for Efficacy and Safety
Slide 24: Desirable activities of ICU pharmacist
Includes formulating guidelines for the critically ill patients, active participation in research, and educating the ICU team.
Guidelines which have been developed and implemented by the clinical pharmacist in our ICU includes protocols for pain, sedation, delirium, stress, drug compatibility chart , drug administration, dilution guidelines, and toxicological management protocols.
Once the protocols are formulated, all the members of the ICU team are educated on how to use the protocol.
Most of these clinical pharmacist enforced protocols are nurse oriented, and hence, it becomes easy for optimizing patient care.
The effectiveness of these guidelines is under the supervision of a critical care pharmacist, and it is well studied in Western countries.
Slide 25: conclusion
Clinical pharmacist as a part of multidisciplinary team in an ICU is associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.
Clinical pharmacists are essential to improve patient safety and outcome, reduce costs, and provide quality of care in critically ill patients.
Slide 26: References
Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med. 2010
Objective
Introduce principles and review strategies for supporting healthcare professionals impacted by adverse patient safety events. By the end of the session the participant will be able to:
1.Relate to the impact of a patient safety adverse event on the provider, based on a personal story provided by a healthcare professional.
2.Describe the potential impact of traumatic experiences on the health and well-being of healthcare professionals.
3.Identify key elements of an effective program for supporting caregiver coping with adverse patient safety events.
4.Explain how a just culture promotes peer to peer support of the second victim.
WATCH: http://bit.ly/1HxceIf
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
Becoming Better Advocates for Your HealthBest Doctors
A leader and innovator in research on patient-centered care, Dr. Leana Wen will share her perspectives on what patients and providers can do to work more effectively together to achieve their shared goal – better health and outcomes. She will be joined by Sonia Millsom, VP of Best Doctors, who will discuss how optimizing care and controlling costs are within reach for today’s patient. The presenters will finish with live questions from the audience.
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
The failure of a planned action to be completed as intended, or as the use of a wrong plan to achieve an aim.
A preventable adverse effect of care, whether or not it is evident or harmful to the patient.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Healthcare’s Challenging Trio: Quality, Safety, and Complexity Health Catalyst
Dr. John Haughom expands upon the challenges with patient safety and quality in today’s modern healthcare system. First brought to light in the Institute of Medicine’s (IOM) publication of “To Err is Human: Building a Safer Health System”, the situation has only grown more complex since that seminal report. With the total cost of preventable adverse events at as much as $29 billion, preventable readmissions at $17 billion, and preventable medication errors at $16.4 billion, these are all examples of terrible medical waste that must be eliminated.
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!
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.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
1. John F. Mitchell, Pharm.D.,
FASHP
Medication Safety Consultant
Recipient, ISMP CHEERS Award
formerly
Medication Safety Coordinator
University of Michigan
Hospitals
Uh oh, did “I” do
that ?
Medication Errors
in Long-Term Care
2. • Define medication errors and classify their
significance
• Understand the extent of medication errors
and their impact on patient care
• Discuss the many factors that contribute to
errors and the impulse to “place blame” on
healthcare workers
• Examine approaches to minimize the risk of
medication errors with applications to LTC
Our goals for today
3. To Err Is Human
Kohn LT,
Corrigan JM,
Donaldson MS,
Eds. To Err Is
Human.
Washington
National Press,
Wash, DC. 2000.
4. "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. Such events may be related to:
Defining medication errors
National Coordinating Committee-Medication Error Reporting and Prevention (NCC MERP); accessed at
http://www.nccmerp.org/aboutMedErrors.html; Jan. 2012.
• professional practice
• health care products
• procedures and systems
• product labeling, packaging,
and nomenclature
• dispensing
• distribution
• administration
• education
• monitoring
5. If you saw this, would you fly ?
Extra Extra
Airlines expect 1-2
jets to crash daily
Over 1000 deaths expected weekly
6. Buy what about being a patient in
the health care system
Kohn et al. Committee on quality health care in America. IOM. Academy Press. 1999.
Extra Extra
Airlines expect 1-2 jets to
crash daily
Over 1000 deaths expected
weekly
=
44,000 – 98,000
deaths annually
due to
medical errors
8. Some reasons errors occur
• poor communications within healthcare team
• verbal orders
• poor handwriting
• improper drug selection
• missing medication
• incorrect scheduling
• look alike / sound alike drugs
• polypharmacy
• availability of floor stock (no second check)
• drug interactions
• hectic work environment
• lack of computer decision support
9. NCC MERP. accessed Jan 2012. www.nccmerp.org
Classifying medication errors
A circumstances exist for potential errors to occur
B an error occurred but did not reach the patient
C error reached the patient but did not cause harm
D patient monitoring required to determine lack of harm
E error caused temporary harm and some intervention
F temporary harm with initial or prolonged hospitalization
G error resulted in permanent patient harm
H error required intervention to sustain the patient’s life
I error contributed to the patient’s death
12. • Attending MD tells the resident to give the patient
“free water” (meaning let her drink water”)
• Resident assumes he meant an IV and writes for
water to be given IV
• New RN can’t find IV water and calls pharmacy
asking where they get IVs; pharmacy asks no
questions and tells the RN they get them from C.S.
• RN obtains IV from C.S. never questioning RN
why she by-passed pharmacy; water bag says
“water for irrigation”
A true comedy of errors
(continued)
13. • RN attaches the bag to regular IV tubing;
RN infuses 600 mL of “free water”
• At change of shift, more experienced RN notes
patient is lethargic, sees bag of water, removes
it, and calls MD
A true comedy of errors
Free water has no electrolytes and would
likely have caused burst red blood cells and
death if the second RN hadn’t interceded
14. • MD #1: used an unfamiliar term “free water”
when he meant let the patient drink water
• MD #2: intimidated to clarify so he wrote what
he assumed was supposed to be an IV
• RN: well-meaning, wanted to help her patient;
she called pharmacy and talked to whoever
answered the phone; went to obtain the IV
directly from Central Stores Dept
What did staff do wrong ?
Should someone be fired ?
(continued)
15. • Pharmacy tech: didn’t identify herself as a
tech; didn’t ask why the RN had this unusual
request; didn’t consider having pharmacist
consult with RN
• C.S. staff: never questioned RN why
pharmacy was not involved; provided drug
directly to RN without normal pharmacy
process
What did staff do wrong ?
Should someone be fired ?
17. JUST CULTURE
Managing Errors
• Concept
You are a fallible human being,
susceptible to human error and
behavior drift
• Human error
• At-risk behavior
• Reckless behavior
18. Inadvertently doing other
than what should have
been done; a slip, lapse,
or mistake.
Manage through
• Choices
• Procedures
• Training
• Design
• Environment
“Creating an Environment of Safety: Just Culture in the Workplace”. ASHP. Nov 4, 2007.
“Just Culture”
Human error
Console
19. A behavioral choice that increases
risk where risk is not recognized,
or is mistakenly believed to be
justified.
Manage through:
• Removing incentives for
at-risk behaviors
• Creating incentives for
healthy behaviors
• Increasing situational
awareness
“Just Culture”
At-risk behavior
Coach
“Creating an Environment of Safety: Just Culture in the Workplace”. ASHP. Nov 4, 2007.
20. A behavioral choice to
consciously disregard
a substantial and
unjustifiable risk.
Manage through:
• Remedial action
• Punitive action
“Just Culture”
Reckless behavior
Punish
“Creating an Environment of Safety: Just Culture in the Workplace”. ASHP. Nov 4, 2007.
22. http://seattletimes.nwsource.com/html/localnews/2014830569_nurse21m.html
Dealing with the SECOND VICTIM in a “Just
Culture” environment
• Kimberly H, age 50, an RN with 27 years of
pediatric experience
• She made a mathematical error that led to an
overdose of calcium chloride and the subsequent
death of a critically ill infant
• She was fired; her licensing board made her pay a
fine and placed her on 4 years probation
• Despite receiving a perfect score in an advanced
cardiac life support certification exam, she was
refused work and could not find a job
23. http://seattletimes.nwsource.com/html/localnews/2014830569_nurse21m.html
Dealing with the SECOND VICTIM in a “Just
Culture” environment
• With no job offers, she experienced increasing
isolation, despair, regret, hopelessness, low self-
esteem, and shame and guilt regarding her role in the
fatal error
Kimberly took her own life 7
months after the death of her
patient
24. Denham C. TRUST: the 5 rights of the second victim. J Patient Saf. 2007;3(2):107-119.
Dealing with the SECOND VICTIM in a “Just
Culture” environment
TRUST:
• Treatment that is just
• Respect
• Understanding and compassion
• Supportive care
• Transparency and opportunity to contribute
Five rights of the second
victim
26. • 12-month observational study
• 18 participating nursing homes
• 28,839 nursing home resident-months
Incidence and preventability of adverse drug events in nursing homes. Gurwitz
JH. Am J Med. 10:87-94. August 2000.
Med errors in nursing homes
• 546 drug events (1.89 per 100 resident-months)
– 1 fatality
– 31 (6%) were life-threatening
– 206 (38%) were serious
– antipsychotics, antidepressants, sedatives/hypnotics and
anticoagulants were most common
27. • In 2005, a Gurwitz study1
estimated
800,000 medication errors yearly in
LTC facilities.
• Barker2
reported average error rates in
nursing homes / SNFs = 12.2%
– non-prescribed drug = 44.8%
– wrong dose = 11%
– wrong route = 2%
– wrong dosage form=0.4%
1. Gurwitz JH et al. American Journal of Medicine. 118(3):251–258. 2005 2. Barker KN et al. American
Journal of Hospital Pharmacy. 39:987–991. 1982.
Nursing home non-physician errors
28. 1. Sloane PD et al. Archives of Internal Medicine.164(18):2031–2037. 2. Brown MN et al. Journal of the American Geriatrics
Society. 50:69–76. 3. American Geriatrics Society. Journal of the American Geriatrics Society. 50(Suppl. 6):S205–S224.
Prescription errors of omission
in nursing homes
Patient Type Drug Omission
65+ with CHF 62% no ACEI1
65+ with MI 60% no aspirin1
65+ with MI 74% no beta-blocker1
65+ with stroke 37% no anticoag or ASA1
65+ with osteoporosis 51% no treatment1
patients with depression 45% no treatment2
patients with pain 20-55% uncontrolled3
30. • In general:
– a safety culture is pivotal to improving medication
safety (encourage voluntary reporting)
– senior management must devote adequate attention to
safety
– provide sufficient resources to quality improvement
and safety teams
– authorize resources to invest in technologies, such as
computerized provider order entry (CPOE) and
electronic health records
Preventing Medication Errors: Quality Chasm Series. accessed 2010. www.nap.edu/catalog/11623.html.
Reducing medication errors in long-term care
facilities
31. • Prescribers:
– use sound med reconciliation techniques
– avoid verbal orders except in emergencies
– avoid abbreviations (U for units seen as a 0)
– inform patients of reasons for all medications
– work as a team with consultant pharmacists
and nurses
– use special caution with high-risk medications
– report errors and ADEs
Preventing Medication Errors: Quality Chasm Series. accessed 2010. www.nap.edu/catalog/11623.html.
Reducing medication errors in long-term care
facilities
32. • Pharmacists:
– monitor the medication safety literature
– in conjunction with doctors and nurses, develop,
implement, and follow a medication error avoidance
plan
– verify the accurate entry of data on new prescriptions
(avoid abbreviations; use TALLman lettering)
e.g. Morphine HYDROmorphone
– report errors and near misses to internal and external
medication error reporting programs
Preventing Medication Errors: Quality Chasm Series. accessed 2010. www.nap.edu/catalog/11623.html.
Reducing medication errors in long-term care
facilities
33. • Nurses:
– foster a commitment to patients’ rights (YOU are
the patient’s advocate)
– be prepared and confident in questioning
medication orders
– participate in, or lead, evaluations of the efficacy
of new safety systems and technology
– support a culture that values accurate reporting of
medication errors
Preventing Medication Errors: Quality Chasm Series. accessed 2010. www.nap.edu/catalog/11623.html.
Reducing medication errors in long-term care
facilities
35. This platform has been started by
Parveen Kumar Chadha with the
vision that nobody should suffer the
way he has suffered because of lack
and improper healthcare facilities in
India. We need lots of funds
manpower etc. to make this vision a
reality please contact us. Join us as a
member for a noble cause.