patient safety week jeopardy
DESCRIPTION
Patient Safety Week Jeopardy. Click to begin. Choose a point value. Choose a point value. Click here for Final Jeopardy. The Usual Suspects. Its Gotta Be “Right”. Med Rec or Med Wreck. By The Numbers. Potporrui. 10 Point. 10 Point. 10 Point. 10 Point. 10 Point. 20 Points. - PowerPoint PPT PresentationTRANSCRIPT
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Click to begin.
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Click here for Final Jeopardy
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Its Gotta Be “Right”
By The Numbers
Potporrui
10 Point
20 Points
30 Points
40 Points
50 Points
10 Point 10 Point 10 Point 10 Point
20 Points 20 Points 20 Points 20 Points
30 Points
40 Points
50 Points
30 Points 30 Points 30 Points
40 Points 40 Points 40 Points
50 Points 50 Points 50 Points
Med Rec or
Med Wreck
The Usual Suspects
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Most medication errors resulting in
harm are caused by confusing these two
drugs
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What are Morphine and
Hydromorphone?
As compiled by the Institute for Safe Medication Practices Canada
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This drug tops the list of medications most likely to cause harm as a consequence of a
medication error
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What is Insulin?
As compiled by the Institute for Safe Medication Practices Canada
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Three of the top ten drugs most likely to
cause harm as a result of a medication error
are from this class
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What are
anti-coagulants
(Heparin,Warfarin, Dalteparin)
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This popular antihypertensive
isn’t inhibited about being number ten on
the list
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What is Ramipril?
As compiled by the Institute for Safe Medication Practices Canada
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Because of its high risk potential, Health Canada
recommends disposing this top ten narcotic down
the toilet
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Fentanyl Transdermal
2005 Public Advisory still on the Health Canada website
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Failure to identify this “right” is rarely
involved in medication errors reported as
causing harm
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What is the
“right patient”
Wrong drug and wrong dose are # 1 and # 2
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To obtain the maximum benefit,
anti-Parkinson’s drugs should be given with this “right” in mind
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The right time
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You would have been “right” if you answered 5 to this
question before 2008
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How many “rights” of safe medication
administration are there according to the College
of Nurses
Now there are 8
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After making sure it’s the “right route”, this intramuscular site is
the preferred location for most adults
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What is ventrogluteal?
Dorsogluteal is the least recommended
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One of three new “rights” in the updated
standards, this is the one least likely to be
written in the Doctors’ Orders
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What is the
right reason?
Right frequency and right site are the other two
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Dr. House would have no problem breaking
into a patient’s medicine cupboard to improve a “BPMH”
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What is a Best Possible
Medication History He would also have to check with their pharmacy, talk with
them and their family, contact any other healthcare providers and or institutions, and check their medication
administration record from any other unit
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“ADE”
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What is an adverse drug event
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According to a recent Quebec study, this
percentage of ADE’s are caused by medication
“irreconciliation” between hospitals and
LTC facilities
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What is 20%
95% of
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What you have when the physician has made an
intentional choice to add, change the dose or route or
discontinue a medication and their choice is clearly
documented
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What is an intentional discrepancy
Documented intentional discrepancies are considered best practice in medication reconciliation.
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This category of discrepancies accounts for most discrepancies
and is generally not considered a “med
error”
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What are “undocumented
intentional discrepancies”
An unintentional discrepancy is one in which the physician unintentionally changed the dose or route, added or omitted a
medication the patient was taking prior to admission. These are
medication errors and can lead to adverse drug events (ADEs)
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At 7.5% our rate is better than many, but not better than
the rate of every country in the world
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What is the percentage of persons admitted to
hospital in Canada who will experience an
adverse event
Worldwide rates are between 2.9 and 16.6
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The percentage of patients in a
Canadian Hospital who will receive the wrong medication or
the wrong dose
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What is 1 in 9
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Medication errors rank here on the top ten list of causes of
death in North America
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What is 8
In Canada, medication errors and other hospital related adverse events cause more deaths than
MVAs, breast cancer and HIV combined
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3300 members of this age group die in Canada each year as a result of
a medication error
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Who are the Elderly
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Of between 4-8, 5-10, 9-13, 10-14, what is number of regularly
scheduled medications that residents of LTC
facilities take daily
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What is 9-13
Remember, many may one day be your patient as well. With PRNs, some take as many as
21different medications as often as 4 times daily
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What is Avandia
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When it comes to abbreviations, this list is the most important one
to know
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What is the ISMP “Do NOT Use List”
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Of the major categories of infusion
pump errors, this one leads the list at
58%
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What is incorrect flow rate
Over 62% of these are overdose errors
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Besides beginning with the letter “G”, garlic,
ginseng, gingko biloba, ginger and green tea have this in common
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What is interact with Coumadin
Decrease INR: Ginseng, green tea,
Increases INR: garlic
Inhibit platelet aggregation: ginkgo, ginger
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This list of medications considered inappropriate for the elderly is named after a doctor and not a
popular drink
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What is the
Beers List?
AKA the Beers Criteria, it was first compiled in 1991 and updated in 2003
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Make your wager
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ISMP CMIRPS Program
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What is the national error reporting
mechanism that nurses may use to
anonymously report medication errors