Transcript SMSHP Event Prevention Feb2016 v2

Medication Event
Prevention and
Error Reduction
James D. Newman
Human Performance Consultant
www.HumanPerformanceTools.com
Kristin C. Klein, PharmD, FPPAG
Clinical Associate Professor and Clinical Specialist
University of Michigan

The speakers have no actual or potential
conflicts of interest in relation to this
presentation.
Have you ever been involved in an
serious medication error that wasn’t
reported?
A.
B.
Yes
No
To err is human…

44,000-98,000 deaths/year due to
preventable medical errors in the United
States
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Less than cancer and heart disease
In the same range as influenza, pneumonia,
diabetes, and alzheimer’s
IOM estimates that a hospitalized patient is
at risk of 1 medication error per day
Kohn LT, ed, Corrigan J, ed, Donaldson MS, ed. To Err Is Human. http:/www.nap.edu/catalog/9728.html
Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Common Principles of Human
Performance
1.
2.
3.
4.
5.
People are fallible
Error-likely situations are predictable
Individual behaviors are influenced
Operational upsets can be avoided
People achieve high levels of performance
based encouragement and reinforcement
Human Limitations
Medication Errors

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Definition: "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“
“Do no harm”
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm
Human Error Types:
Can occur at any point in medication use process
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Active Errors
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Change equipment, system or processes
that trigger immediate undesired
consequences
Unsafe act committed directly by a person
in contact with the patient or system
Latent Errors

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Result in undetected organization-related
weaknesses or equipment flaws that lie
dormant
Failures within the system that may trigger
an event when combined with an active
failure
Reason J. BMJ 2000;320:768-70.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117770/?report=reader
Medication Use Process
Prescribing
•Physician
•Nurse
Practitioner
•PA
•Pharmacist
Transcribing
•Physician
•PA, NP
•Nurse
•Unit clerk
•Pharmacist
Dispensing
•Pharmacist
•Pharmacy
intern
•Pharmacy
technician
Administering
•Nurse
•Pharmacist
Adapted from: IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Monitoring
•Physician
•PA, NP
•Nurse
•Pharmacist
What is Human Performance?
An individual…
…working within organizational systems…
…to meet expectations set by leaders.
What is a Human Performance
Improvement Program?
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A program embedded into the workflow of a
system that is designed to prevent, detect,
and correct human error
When an error happens, this system’s
resilience is tested
How an error is treated after it is discovered
or revealed unveils the culture of the people
within the system
Why should I care?



What kinds of things do we do to reduce
consequence?
So what are we afraid of? What motivates us
to prevent errors? What motivates you?
Threats of sanctions in the real world –
medical industry: law suits built into the legal
system
Human Performance Definitions

Error: An unintentional deviation from an
expected behavior

Violation: Deliberate, intentional acts to
evade a known policy or procedure
requirement for personal advantage usually
adopted for fun, comfort, expedience, or
convenience
Origins of Human Error
Human Errors
Operational
Upsets
Human
Error
70%
30%
90%
10%
Equipment
Failure
System
Induced
Errors
Slip, trip,
or lapse
Human Limitations
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•
•
•
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Stress
Avoidance of mental
strain
Inaccurate mental
models
Limited working
memory
Limited attention
resources
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•
•
•
•
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Mind set
Difficulty seeing own
errors
Limited perspective
Susceptible to emotion
Focus on the goal
Fatigue
Hazardous Attitudes
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Pride: “Don’t insult my intelligence.”
Heroic: “Ill get it done, by hook or by crook.”
Invulnerable: “That can’t happen to me.”
Fatalistic: “What’s the use?”
Bald Tire: “Gone 60K miles without a flat
yet.”
Summit Fever: “We’re almost done.”
Pollyanna: “Nothing bad will happen.”
Error Precursors (TWIN)
Task Demands
• Time pressure (in a hurry)
• High Workload (memory requirements)
• Simultaneous, multiple tasks
• Repetitive actions, monotonous
• Irrecoverable acts
• Interpretation requirements
• Unclear goals, roles, & responsibilities
• Lack of or unclear standards
Work Environment
• Distractions / Interruptions
• Changes / Departures from routine
• Confusing displays or controls
• Workarounds / OOS instruments
• Hidden system response
• Unexpected equipment conditions
• Lack of alternative indication
• Personality conflicts
Individual Capabilities
• Unfamiliarity w/ task / First time
• Lack of knowledge (mental model)
• New technique not used before
• Imprecise communication habits
• Lack of proficiency / Inexperience
• Indistinct problem-solving skills
• “Hazardous” attitude for critical task
• Illness / Fatigue
Human Nature
• Stress (limits attention)
• Habit patterns
• Assumptions (inaccurate mental picture)
• Complacency / Overconfidence
• Mindset (“tuned” to see)
• Inaccurate risk perception (Pollyanna)
• Mental shortcuts (biases)
• Limited short-term memory
View on Human Error
Old

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Human error is a cause of
accidents
To explain failure,
investigations must seek
failure
They must find people’s
inaccurate assessments,
wrong decisions and bad
judgments
New

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Human error is a symptom
of trouble deeper inside a
system
To explain failure, do not try
to find where people went
wrong
Instead, find how people’s
assessments and actions
made sense at the time,
given the circumstances
that surrounded them
Ever see this before?
1
Major Accidents
Significant Events
Near Misses
Nonconsequential
Errors
10
30
600
The Traditional Heisenberg
Model
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Number of errors is
relative to the
Major Accidents
severity of
consequences
Significant Events
For every major
accident there are
many errors
Near Misses
Leads us to assume
that driving down
errors will eliminate Nonconsequential
Errors
major accidents
1
10
30
600
The New View of the model
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The consequence of
error has no relationship
to the number of errors
It is related to the
number and integrity of
defenses
Any error can lead to a
major accident if
defenses fail
Reactive
Major Accidents
Significant Events
Near Misses
Nonconsequential
Errors
Proactive
Commonly Accepted HP
Formula
Reducing Error AND Managing Defenses
leads to Zero Operational Upsets
Re + Md → OU
What kind of cultural traits should you be
pursuing in your organization?
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Encourage Reporting: Value errors as leading safety
data
Create a Just Work Environment: Don’t try and
punish errors out of the system
Flexibility: Prepare workers to adapt effectively to
changing demands
Learning: Create opportunities for observation,
reflection and feedback
Training: Knowledge and attitudes are being
adequately transferred to the less experienced
workers
System Vulnerabilities
 People
will never perform better than
what the organization will allow
 If
a system relies on people doing the
right thing every time, it will fail
 No
working system remains in stasis
How leaders influence the system
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What they pay attention to, measure, and control
Their reactions to critical incidents or crises
The allocation of resources
Their criteria for allocation of rewards and
punishment
Their criteria for selection, advancement, and
termination
Their deliberate attempts to coach or model
behaviors
Your Human Performance
Improvement initiative

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HPI is not just training
It is a way of doing business that includes:

Preventing
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Detecting
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Conduct of operations and work management
Simulations and training
Use of Human Performance Tools
Performance management and assurance
Systems development and re-engineering
Meaningful performance indicators
Behavioral observation and walk-arounds
Correcting
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Issues reporting, management and corrective actions
Event investigation and lessons learned
Which of the following
describes your hospital?
A.
B.
C.
D.
Community hospital
Regional hospital
Academic medical center
Other
PREVENTING MEDICATION
ERRORS
Preventing Errors
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CPOE with clinical decision support
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Associated with lower error rates
New error types
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Clinical pharmacists on inpatient units
Regular medical reconciliation
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Entering order for wrong patient
Especially at transitions of care
Automated dispensing cabinets
Neuspeil DR, Taylor MM. Health Services Insights 2013;6:47-59
When does medication reconciliation
take place at your institution?
A.
B.
C.
D.
Only at admission
Only at discharge
Both at admission and discharge
Whenever a patient is transferred to a
different phase of care
Preventing Errors
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Staff/trainee education
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Barcoding
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Associated with 48% reduction in preventable
adverse drug events
Standardization
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E-training, annual competencies
Implementing guidelines, preprinted ordersets
80:20 rule
Culture change
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Quality improvement projects
Neuspeil DR, Taylor MM. Health Services Insights 2013;6:47-59
Standardized Concentrations
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ISMP has recommendations for standardized
concentrations for neonatal infusions
Michigan initiative for standardizing pediatric oral
concentrations for compounding
ASHP developing national standardized
concentrations for IV and oral compounded
medications
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Funding from FDA’s Safe Use Initiative
http://www.ismp.org/tools/PediatricConcentrations.pdf
http://www.mipedscompounds.org/
Human Performance Tools
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Self-checking (STAR)
Verification Practices
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Peer-checking
Concurrent verification
Independent verification
Three-part communication
Job Site Review
Pre-job briefing
Post-job critique
Procedure use & adherence
Questioning attitude & Stop when unsure
HPT – Self-Checking (STAR)
Self-Checking (STAR) is a Human Performance Tool that helps the
individual methodically focus his/her attention on the details of the task
at hand.
The individual consciously and deliberately reviews the intended action
and expected response before performing the task.
This includes distinct thoughts and actions designed to enhance an
individual’s attention to detail in the moment just before performing the
task.
STOP
THINK
ACT
REVIEW
HPT – Verification Practices
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Both peer checking and concurrent verification can
prevent errors because they are being performed at the
same time as the action
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Peer checking simply requires checking prior to the manipulation
of the component
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Concurrent verification requires the verification of the
component and expected response before, during and after
manipulation of the component
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Tech check tech for cart fill; pharmacist checking tech preparing IV
compound
2 separate pharmacists verifying chemo order
Independent Verification focuses on confirming the
“status” of the system or component
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Pharmacist verifying physician order, nurse verifying physician
order and pharmacy preparation
HPT – Three-part Communication
Effective communication ensures all parties involved
are on the same page.
1. Sender states the message
•
When practical, the sender and receiver should be face to face
•
The sender ensures that he/she has the receiver’s attention—normally calling the
receiver by name or position
•
Sender states the message clearly and concisely
2. Receiver acknowledges the sender
•
The receiver paraphrases back the message in his or her own words
•
Equipment designators and nomenclature are repeated word for word
•
The receiver may ask questions to verify his or her understanding of the message
HPT – Three-part Communication
3. Sender acknowledges the receiver’s reply
•
If the receiver understands the message, then the sender responds with “That is
correct”
•
If the receiver does not understand the message, the sender responds with “That is
wrong” (or words to that effect) and restates the original message
4. If corrected
•
Receiver acknowledges the corrected message, again paraphrasing the message
in his or her own words
HPT – Job Site Review
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A Job Site Review is simply taking the time to examine your
work area to ensure conditions are as you expected them to be
It is also a tool to identify potential problem areas at the work
location
Explore the job site and adjacent surroundings prior to the
start of work to ensure you are knowledgeable of conditions
such as:
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Critical parameters or indicators important for task success
Error likely situations or conditions, particularly at the critical steps
Safety Concerns
Correct patient
Correct chart
Correct drug
HPT – Pre-job Brief
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Shift turnover and patient updates communicated
via discussion with outgoing shift or through
chart transcriptions
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Sign out, iVents, pharmacists’ sticky notes
HPT – Post-job Critique

Lessons learned, Near Misses, Good Catches,
and any other knowledge that can be transferred
to the system to improve it
HPT – Procedure Use and
Adherence
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Why following Procedures is Important
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Procedures are the primary tool we use to safely and
efficiently operate and maintain the medical use
process
Not properly following procedures is a large contributor
to human error and many consequential events
Clear guidance covering uncertainty will produce more
consistent and error-free performance
The way employees use and maintain procedures is a
primary indicator of your staff’s safety culture
HPT – Questioning Attitude & Stop
When Unsure
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A Questioning Attitude should exist at all times, causing you to
Stop When Unsure over any concern you may have. Many
Programs call these out as separate tools, but that is not
necessary. A questioning attitude must be constantly present to
use the tools deliberately and not just out of habit or by
accident. The bang for the buck is in choosing to use a tool
purposefully and employing it properly. Thinking about potential
consequences and reviewing your physical actions prior to
performing the action is how human performance tools are
successful in assisting us in our daily life and work
Tools should be used after identification of Critical Steps within
the work activity. These tools ensure Critical Steps are
completed correctly.
Managing Defenses

Defenses
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Means or measures (controls, barriers, and
safeguards) taken to prevent human error
and to mitigate the consequences of an error
Barrier

Anything that protects a system or person
from a hazard whether physical,
administrative, or human in nature
Managing Defenses

Defenses are designed to serve one or more of the
following functions:
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Create understanding and awareness of the local risks and hazards
Recover from off-normal conditions and restore the system to a safe
state
Provide clear guidance on how to operate safely
Detect and warn about the presence of off-normal conditions or
imminent dangers
Protect people, equipment, and the environment from injury,
damage, and undesired consequences
Contain and eliminate the sources of potential injury, damage, or
undesired consequence should they escape the barriers intended to
contain them
Enable the potential victims to escape or be rescued from hazards
What Are Managed Defenses?
 Soft Defenses / Administrative Controls
 Procedure/process focused defenses that guide
programmatic oversight
 Require human interaction
 EXAMPLES
 Identification of error-prone
work processes
 Procedure quality and backlog
management
 Assessments/Benchmarking
 Training
 Post-job reviews
 Reduction of fatigue
 Trending
 Checklists
 Causal analysis
 Error reporting
What Are Managed Defenses?
 Hard Defenses / Engineered Controls
 Equipment focused defenses
 Do not require human interaction
 EXAMPLES
 Elimination of workarounds
 Hand rails
 Labeling
 Locks placed on components
tagged out of service
 Med Dispensing Units
 Computer programs
 Physically locked barriers
 System interlocks
 Machine guards
DETECTING MEDICATION
ERRORS
Error Traps
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Change in job
conditions
Distractions
First/late shift
Mental/emotional stress
Multiple tasks
Overconfidence
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Peer pressure
Physical environment
Time pressure
Vague guidance
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Knowledge gap
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Room for
interpretation
Look-alike, sound-alike
medications
Administration devices
http://www.ishn.com/articles/88231-frontline-safety-avoid-these-11-error-traps
Inpatient Medication Errors

Prescribing and administering errors account for
~75% of medication errors
Prescribing:
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0.6-53 errors/1000 orders
 4-400 errors/1000 pediatric patients
Dispensing:
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2.6 errors/1000 admissions in a tertiary care center
6-12% of all errors
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Miller et al. Qual Saf Health Care 2007;16:116-26.
Inpatient Medication Errors
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Administering:
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Overall rate 0-26% (median=8.3%)
 3.3-6.6% in ICUs
 Occurs more frequently with IV medications
27% of all pediatric administrations at a
teaching hospital
Nurses responsible for catching 86% of errors
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Miller et al. Qual Saf Health Care 2007;16:116-26. Neuspeil, Taylor. Health Services Insights 2013;6:47-59.
Prescribing/Transcribing Errors
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Wrong drug
Wrong dose/wrong route
Wrong patient
Prescribing medication patient is allergic to/intolerant
of
Use of unapproved abbreviations

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E.g., MS for morphine sulfate or magnesium sulfate; U instead of
units
Inappropriate use/lack of use of zeros

“Always lead, never follow”
Dispensing Errors
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Wrong drug/wrong preparation
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Look-alike, sound-alike medications
Repackaging
Wrong dose/wrong concentration

Compounding
Wrong route
 Wrong patient
 Delay in delivery
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Why Dispensing Errors Occur
Workload/staffing issues
 Distractions/interruptions
 Inadequate dosing references
 Inadequate training
 Poorly designed work areas
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Inadequate lighting, inadequate counter space,
clutter
Inadequate package labeling
Administration Errors
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Wrong drug/wrong preparation
Wrong dose/wrong concentration
Wrong rate
Wrong time
Wrong route
Wrong patient
5 Rights of Administration
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Right drug
Right dose
Right route
Right patient
Right time
Monitoring Errors
Failure to monitor serum drug levels
 Failure to monitor signs of toxicity
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Failure to follow-up on labs

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E.g., creatinine, QT interval, LFTs
E.g., vancomycin level, anti-Xa level, PTT, INR
Failure to adjust therapy based on lab
values
High-Alert Medications
Drug Classes
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Adrenergic agonists/
antagonists
Anesthetics
Antiarrhythmics
Antithrombotics
Cardioplegic solutions
Chemo
Hypertonic dextrose/saline
Dialysis solutions
Epidural/intrathecal meds
Oral hypoglycemics
https://www.ismp.org/tools/institutionalhighAlert.asp
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Insulin
Inotropic meds
Liposomal meds (and
alternatives)
Narcotics
Moderate sedation agents
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Especially for children
Neuromuscular blockers
Parenteral nutrition
IV contrast
Sterile water for irrigation,
injection, inhalation (≥100 mL)
High-Alert Medications
Specific Medications
 Subcutaneous
epinephrine
 IV epoprostenol
 Insulin U-500
 Magnesium sulfate
injection
 Methotrexate oral (nononcologic use)
 Opium tincture
https://www.ismp.org/tools/institutionalhighAlert.asp
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IV oxytocin
Nitroprusside
Concentrated potassium
chloride injections
Potassium phosphate
injections
IV promethazine
Vasopressin
CORRECTING MEDICATION
ERRORS
How are medication errors
communicated in your department?
A.
B.
C.
D.
E.
Word of mouth
Via periodic departmental emails
Via departmental grand rounds or meetings
On an individual basis
Not at all
Voluntary Reporting
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Focus on improving safety
Focus on near misses or minimal patient
harm
Internal or external
Internal Reporting Systems
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Advantages:
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Timely advice for management of specific patient
Provides a record of the event
May prompt immediate review/advice from legal
counsel
Disadvantages:
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May miss patterns of behavior
Unjust disciplinary action
Inaction
External Reporting Systems
 Development
of best practices and
standards of case
 Development of smart technology to
reduce errors
 Identification of error that occurs in
rare situations/patient populations
Smetzer JL, Cohen MR. In: Medication Errors, 2nd ed.
External Reporting Systems
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ISMP Medication Error Reporting System
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FDA Medwatch
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https://www.ismp.org/errorReporting/reportErrortoI
SMP.aspx
http://www.fda.gov/Safety/MedWatch/default.htm
Confidential
Can be reported by anyone
Mandatory Reporting
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
Purpose is to hold providers/organizations
accountable
May be regulated by state agencies

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Subject to penalties or fines
Sentinel events are reportable to Joint
Commission
Barriers to Reporting
 Fear
of censure
 Fear of public disclosure
 Damage to reputation
 Leadership not supporting or valuing
 Nothing to gain
 Shame
Barriers to Reporting


Study of physicians, pharmacists, and nurses
to identify barriers to error reporting
Incentives to reporting:

Patient protection:
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Provider protection:
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Overall improvement patient care
Specific error that occurred in a patient
Fear of censure
To avoid legal action
Professional compliance:
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Expectation of reporting set by institution
Hartnell N, et al. BMJ Qual Saf 2012;21:361-8.
Barriers to Reporting
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Burden of reporting
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Professional identity
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Lack of awareness of what to report
Organizational factors
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Reluctance to report another’s error, fear of appearing incompetent
Information gap
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Accessibility, time to complete
Lack of trust in organization, inaction, no timely follow-up
Fear
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Censure, malpractice suit
Hartnell N, et al. BMJ Qual Saf 2012;21:361-8.
Error Reporting
 Error
report should be easily
accessible
 Best reported by an individual
involved
 Report should be factual
 Should be reported as soon as
possible
After an Event

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Timely reporting of event
Timely investigation of cause of event

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Root cause analysis, failure modes and effects
analysis (FMEA)
Identification of latent and active failures
Creation or revision of processes to prevent
error from occurring again
Ongoing analysis of processes
What to Report

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How error occurred
Normal workflow/procedure
Why error occurred
At risk behaviors
How to prevent it
Smetzer JL, Cohen MR. In: Medication Errors, 2nd ed.
http://www.nccmerp.org/sites/default/files/indexColor2001-06-12.pdf
CASES
Betsy Lehman Case
39-year old mother of 2, diagnosed with breast
cancer. Admitted November 14 for high-dose
cyclophosphomade (phase 1 trial). Protocol:
1000 mg/m2/day x4 days. Fellow misread
protocol as 4000 mg/m2/day x4 days. Betsy
died on December 3 as a result of the
overdose. Error not discovered until her data
was entered into the clinical trial computer 10
weeks later.
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Which of the following error traps may
have contributed to Betsy’s overdose?
A.
B.
C.
D.
E.
Knowledge gap
Time pressure
Distractions
Vague interpretation
Physical environment
Which of the following human
performance tools may help to prevent
this type of medication error?
A.
B.
C.
D.
E.
Peer checking
Independent verification
Post-job critique
Procedure use
S-T-A-R
Case
Full-term infant born to a Spanish-speaking mother with a
history of syphilis. Because it was difficult to elicit whether
the mother had received adequate therapy for syphilis, the
decision was made to treat the infant for congenital syphilis.
Through consultation with an ID physician and the health
department, a dose of benzathine penicillin G 150,000 units
IM was recommended.
The hospital physicians, nurses, and pharmacists were
unfamiliar with the treatment of congenital syphilis, or the
benzathine form of penicillin G.
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Case
The pharmacist:


Consulted patient’s chart for the dose
Consulted a drug information reference for the
dose


Misread dose as 500,000 units/kg (instead of 50,000
units/kg)
Prepared and dispensed 1,500,000 units (2.5
mL) of the drug
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Case
The nurse:


Questioned the volume (would require 5 injections)
Consulted drug information reference to see if medication
could be given IV



No information specific for benzathine penicillin
Aqueous penicillin safe to use IV
Missed the manufacturer’s label warning “IM use only”
The nurse practitioner:


Assumed benzathine penicillin was a brand name for
aqueous penicillin
Changed order to IV
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Case
Nurse administered benzathine penicillin via
slow IV push. After 1.8 mL of drug was
infused, the baby became unresponsive and
could not be resuscitated. Upon autopsy, it
was confirmed that the infant did not have
congenital syphilis.
IOM. Preventing medication errors. http://www.nap.edu/catalog/11623.html
Which of the following represents
latent failures that occurred in this
case?
A.
B.
C.
D.
E.
Inadequate drug information resources
Lack of specialized training for health-care
practitioners
Failure to identify large volume for IM
injection
Lack of means for communicating with
patients with language barriers
Failure to identify 10-fold overdose
Which of the following represents
latent failures that occurred in this
case?
A.
B.
C.
D.
E.
Inadequate drug information resources
Lack of specialized training for health-care
practitioners
Failure to identify large volume for IM
injection
Lack of means for communicating with
patients with language barriers
Failure to identify 10-fold overdose
Which of the following human performance
tools may be helpful to reduce the errors
identified in this case?
A.
B.
C.
D.
E.
Independent verification
S-T-A-R
Pre-job briefing
Three way communication
Concurrent verification
Case
A nurse prepares a bag of IV fluids containing
potassium phosphate at the nurse’s station for an
adult patient, and leaves the bag on the counter
while she checks on another patient. Another nurse
picks up the bag of IV fluids (with potassium
phosphate) thinking it is for her patient, a 7-month
old boy. Ten minutes after she hangs the fluids on
the baby’s IV pump, he goes into cardiac arrest and
cannot be resuscitated.

What are some latent failures which may
have contributed to this medication error?

What are some active failures which may
have contributed to this medication error?

What systems does your institution have in
place to prevent errors such as this?
Thank you.
Assessment Questions

Which of the following is an error trap that
may contribute to prescribing errors?
A.
B.
C.
D.
Inadequate lighting in the clean room
Working during the day shift
Use of treatment guidelines
ER resident completing a rotation in a pediatric
ICU
Assessment Questions

Which of the following is an error trap that
may contribute to prescribing errors?
A.
B.
C.
D.
Inadequate lighting in the clean room
Working during the day shift
Use of treatment guidelines
ER resident completing a rotation in a pediatric
ICU

With which of the following medications
would peer checking be most useful during
the order entry/verification process?
A.
B.
C.
D.
Lisinopril based upon a patient's home
medication list
Amoxicillin for a patient with community-acquired
pneumonia
TPN for an oncology patient
Levetiracetam for seizure prophylaxis

With which of the following medications
would peer checking be most useful during
the order entry/verification process?
A.
B.
C.
D.
Lisinopril based upon a patient's home
medication list
Amoxicillin for a patient with community-acquired
pneumonia
TPN for an oncology patient
Levetiracetam for seizure prophylaxis

Which of the following is a barrier to
voluntary reporting of medication errors?
A.
B.
C.
D.
Fear of retribution
Incorporation of a just reporting culture
Administrator expectation of reporting errors
Electronic submission process

Which of the following is a barrier to
voluntary reporting of medication errors?
A.
B.
C.
D.
Fear of retribution
Incorporation of a just reporting culture
Administrator expectation of reporting errors
Electronic submission process

Which of the following may contribute to
dispensing errors?
A.
B.
C.
D.
Minimizing distractions
Storing look-alike medications next to each other
Electronic medication references
Insuring adequate counter space

Which of the following may contribute to
dispensing errors?
A.
B.
C.
D.
Minimizing distractions
Storing look-alike medications next to each other
Electronic medication references
Insuring adequate counter space

Which of the following is an example of a
human performance tool that can help a
pharmacy technician prevent medication
errors?
A.
B.
C.
D.
Using automated dispensing cabinets
Tech checking tech during cart fills
Insuring appropriate lighting in critical work areas
Relying on peer opinion of compounding
procedure

Which of the following is an example of a
human performance tool that can help a
pharmacy technician prevent medication
errors?
A.
B.
C.
D.
Using automated dispensing cabinets
Tech checking tech during cart fills
Insuring appropriate lighting in critical work areas
Relying on peer opinion of compounding
procedure

How often is a hospitalized patient at risk of a
medication error?
A.
B.
C.
D.
E.
Once per day
Twice per day
Once per week
Twice per week
Once per month

How often is a hospitalized patient at risk of a
medication error?
A.
B.
C.
D.
E.
Once per day
Twice per day
Once per week
Twice per week
Once per month