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What is compliance? Importance of compliance

Reasons for non compliance

Burden of non compliance

Effective intervention to improve compliance

Medication errors

Types of medication error

Causes of medication error

Actions to be taken when medication error occurs

Methods of minimizing medication errors

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Compliance is passive adherence to health

providers instruction. It is different from adherence.

Adherence

Medication Adherence: The patients conformance with the providers recommendation with respect to timing, dosage, and frequency of medication-taken during the prescribed length of time 3

Drugs Dont Work In Patients Who Dont

Take Them ..C. Everett Koop, MD Former US Surgeon General

Of All Medication-related Hospital Admissions In The United States, 33 To 69 Percent Are Due To Poor Medication Adherence, With A Resultant Cost Of Approximately $100 Billion A Year.

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Decrease rehospitalization

Increase quality of life

Improve prognosis

High adherence to antihypertensive medication is

associated with higher odds of blood pressure

control

Each incremental 25% increase in proportion of

days covered (pdc ) for statins associated with ~3.8

mg/dl reduction in ldl cholesterol

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37% 38%

46%

32% 31%

37%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

CV Death Non-Fatal MI Revascularization

Perc

ent D

ecre

ase in

Occura

nces

Compliant Entire CohortWest of Scotland Coronary Prevention Study

(WOSCOPS). Compliance and adverse event

withdrawal:their impact. Eur Heart J 1997;18:1718-1724

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Limited English language proficiency

Low health literacy

Lack of family or social support network

Unstable living conditions

Burdensome schedule

Limited access to health care facilities

Medication cost

Inability or difficulty accessing pharmacy

Cultural and lay beliefs about illness

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Provider-patient relationship

Lack of positive reinforcement from the health care provider

Long wait times

Weak capacity of the system to educate patients and provide follow-up

Poor access or missed appointments

Patient information materials written at too high literacy level

Lack of continuity of care 10

Chronic conditions

Lack of symptoms

Severity of symptoms

Depression

Psychotic disorders

Mental retardation/developmental disability

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Complexity of medication regimen (number of daily

doses; number of concurrent medications) give examples

Treatment requires mastery of certain techniques (injections, inhalers)

Duration of therapy

Frequent changes in medical regimen

Lack of immediate benefit of therapy

Medications with social stigma attached to use

Actual or perceived unpleasant side effects

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PHYSICAL FACTORS

Visual impairment

Hearing impairment

Cognitive impairment

Impaired mobility or dexterity

Swallowing problems

PSYCHOLOGICAL FACTORS

Knowledge about disease

Fear of possible adverse effect

Fear of dependence

Psychosocial stress, anxiety, anger

Alcohol or substance abuse

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ECONOMIC CONSEQUENCES

CLINICAL CONSEQUENCES

INCREASED MORTALITY, HOSPITALIZATION, EMERGENCY DEPARTMENT

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Direct cost estimated at $100 billion to $289

billion annually Costs $2000 per patient in physician visits

annually Patient spends more

Sources: Ho 2009, Circulation; Levine et al. 2013, Annals of Neurology

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Poor adherence to medication is

associated with poor prognosis

Increased rehospitalization

Decreased quality of life

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S Simplify the regimen

I Impart knowledge

M Modify patients belief and human behaviour

P Provide communication and trust

L Leave the bias

E - Evaluate adherence

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The National Coordinating Council for

Medication Error Reporting and Prevention (NCC MERP) definition:

A medication error (ME) 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.

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Such events may be related to

professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

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Dosage miscalculation

Too many patients

Lack of concentration due to long hours of shift

Shortage of staff

Illegible prescription

Similar drug names

No time to counsel

Unclear or erroneous labeling of drugs

Too many telephone calls

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Prescribing Errors

Dispensing Errors

Drug administration Errors

Monitoring Errors

Compliance Errors

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Most common type of medication errors. Account for 80% of all medication

mistakes.

Occurs when prescribers orders drugs for specific patients e.g wrong drug, dose, illegible handwriting.

Inadequate/ incorrect instructions, length of therapy.

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Occur at any stage during the dispensing

process (from the receipt of a prescription to the supply of a dispensed product to the patient). Research estimates that 5% of all

prescriptions are dispensed improperly. Confusion occurs primarily with drugs that

have a similar name or appearance. Lasix (frusemide) and Losec (omeprazole) Confusion also occurs between amiloride

5mg and amlodipine 5mg tablets.

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Discrepancy between the drug therapy

received by the patient and the drug therapy intended by the prescriber.

Administration errors account for 26% to 32% of total medication errors.

Types: Wrong route error (Left eye instead of

Right) Wrong dosage form (Crushing tablets) Wrong time error Wrong administration technique (e.g :

Incorrect manipulation of Inhalers).

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Monitoring Errors: Monitoring errors are caused by

Failure to review a prescribed regimen for appropriateness

Failure to use appropriate clinical or laboratory data to assess the patients response to prescribed therapy.

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Compliance Errors: Compliance errors are caused by

Inappropriate patient behavior regarding adherence to a prescribed medication regimen

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PRESCRIPTION ERROR Inadequate knowledge Calculation errors Complicated dosage

regimens Poor patient history

taking Use of verbal orders. Illegible handwriting Drug name confusion

(Look alike Sound alike)

DESCRIPTION ERROR

Dispensing before seeing a written order. Confusing the

name of one drug with another. Lack of knowledge

on new medicines.

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ADMINISTRATION ERROR

Calculation to determine the correct dose.

Failure to check the patients identity prior to administration.

Storage of look-a-like preparations side by side in the drug trolley.

MONITORING ERROR

Failure to review a prescribed regimen for appropriateness

Failure to use appropriate clinical or laboratory data to assess the patients response to prescribed therapy.

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The case should be reported

The patient should be examined and the senior physician should be notified as soon as possible within 24 hours

The patient should be stabilized using appropriate antidote(s) where required

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The Physician should ask himself the following questions before prescribing medications Is the diagnosis correct? Can the condition be treated without

medication? Can the drug regimen be simplified? Are there are safer drugs available to

substitute with current medication?

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Ensuring up-to-date reference sources.

Use of computerised physician order entry.

Ensuring knowledge of a drug before prescribing.

Ensuring an accurate drug history is taken.

Printing the drug name and patient details clearly on the prescription

Including all details of drug therapy i.e. name of drug, dose, directions, duration of therapy

A zero should always precede expression of values