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a presentation of compliance and medication error
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1
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