Session 8 Safe prescribing and BNF

• A known effect, other than that primarily intended, relating to the pharmacological properties of a medication. - Side effect
• An incident that results in harm to a patient. - Adverse event
• Unexpected harm arising from a justified action where the correct process was followed for the context in which the event occurred. - Adverse reaction
• Failure to carry out a planned action as intended or application of an incorrect plan - Error
• 5Rs of prescribing?

  • Right drug
  • Right route
  • Right time
  • Right patient
  • Right dose
• Prescribing involves?

  • Choosing an appropriate medication for a given clinical situation taking individual patient factors into account such as allergies
  • Selecting the administration route, dose, time and regimen
  • Communicating details of the plan with: whoever will administer the medication (written or verbal) and the patient
  • documentation
• How can Prescribing go wrong?

  • Inadequate knowledge about drug indications and contraindications
  • Not considering individual patient factors such as allergies, pregnancy, co morbidities, other medications
  • Wrong patient, wrong dose, wrong time, wrong drug, wrong route
  • Inadequate communication (written, verbal)
  • Documentation - illegible, incomplete, ambiguous
  • Mathematical error when calculating dosage
  • Incorrect data entry when using computerised prescribing e.g. duplication, omission, wrong number.
• The 5 Rs in prescribing?

  • Right time
  • Right route
  • Right patient
  • Right dose
  • Right drug
• Which patients are most at risk of medication errors?

  • Patients on multiple medications
  • Patients with another condition
  • Patients who cannot communicate well
  • Patients who have more than one doctor
  • Patients who do not take an active role in their own medication use
  • Children and babies (dose calculations required)
• In what situations are staff most likely to contribute to a medication error?

  • Inexperience
  • Rushing
  • Doing two things at once
  • Interruptions - Fatigue, boredom, being on “auto-pilot” leading to failure to check and double-check
  • Lack of checking and double checking habits
  • Poor teamwork and/or communication between colleagues
  • Reluctance to use memory aids