Unit6

RightDrug,WrongPatient1/19Reader'sDigestmonthlygeneral-interestfamilymagazineco-foundedin1922byLilaWallaceandDeWittWallace,andbasedinNewYork,UnitedStates.thebest-sellingconsumermagazineintheUnitedStates.anadditional40millionpeopleinmorethan70countries,with50editionsin21languages;aglobalcirculationof17millioncompact,withitspagesroughlyhalfthesizeofmostAmericanmagazines'."Americainyourpocket." "Lifewellshared.“2/19CulturalNotesCareersinmedicineintheUS

bachelor’sdegreemedicalschoolaninterninahospital(“makerounds”withotherdoctors)aresident(internandresidencyneed3-5yrs)chiefresident3/19Threetypesofdoctors1.Generalpractitioners2.Specialists3.Researchers4/19CulturalNotesIMSHealth

IMSHEALTHistheworld'sleadingproviderofinformationsolutionstothepharmaceuticalandhealthcareindustries.Withnearly50yearsofexperience,theyuseleading-edgetechnologiestotransformbillionsofpharmaceuticalrecordscollectedfromthousandsofsourcesworldwideintovaluablestrategicinsightsforourclients.5/19CulturalNotes

U.S.Pharmacopeia

Inpursuitofitsmissiontopromotepublichealth,USPestablishesstate-of-the-artstandardstoensurethequalityofmedicinesforhumanandveterinaryuse.USPalsodevelopsauthoritativeinformationabouttheappropriateuseofmedicines.NationalhealthcarepractitionerreportingprogramssupportUSP'sstandardsandinformationprograms.Inaddition,USPsupportsmanypublicserviceprograms.6/19FDA

7/19CulturalNotesTheAmericanPharmaceuticalAssociation(APhA)thefirstnationalprofessionalsocietyofpharmacists,foundedin1852andlargest

professionalassociationofpharmacistsintheUnitedStates.Themorethan50,000membersofAPhAincludepracticingpharmacists,pharmaceuticalscientists,pharmacystudents,pharmacytechnicians,andothersinterestedinadvancingtheprofession.8/19MedicationErrorsAmedicationerroroccurswhenanyofthefollowingactionsaretaken:AdrugisgiventothewrongpatientThewrongdrugisgivenThedrugisgivenatthewrongtimeThewrongdoseisgivenThewrongdatawasdocumented9/19“SixRights”ofDrugAdministration1.Rightdrug:knowdrugyouaregiving2.Rightdose:knowdosagecalculations3.Rightroute:knowtheproperroute4.Righttime:whenmedicineisgiven5.Rightpatient:knowyourpatient6.Rightdocumentation:apatient’schartisalegaldocument10/19MedicationGuidelinesPracticemedicalasepsis.Workinawell-lightedarea.Followthe“sixrights”ofadministration.AlwayscheckforallergiesPRIORtoadministeringanymedication.NEVERgiveamedicationifyouhaveanyquestionsabouttheorder.11/19MedicationGuidelinesNevergiveadrugifitsnormalappearancehasbeenalteredinanyway.Donotallowsomeoneelsetogiveamedicationthatyouhaveprepared.Onceyouhavepreparedamedicationforadministration,donotleaveitunattended.Keepalldrugsnotbeingadministeredinasafe,lockedstorageplace.12/19Howtodealwiththeproblem(fromJamesReason)PrinciplesPoliciesProceduresPractices13/19BuildingasafehealthcaresystemPrinciplesSafetyiseverybody’sbusinessTopmanagementacceptssetbacksandanticipateserrorssafetyissuesareconsideredregularlyatthehighestlevelPasteventsarereviewedandchangesimplemented14/19BuildingasafehealthcaresystemPoliciesSafetyrelatedinformationhasdirectaccesstothetopMeetingsonsafetyareattendedbystafffrommanylevelsanddepartmentsMessengersarerewarded,topmanagerscreateareportingculture15/19BuildingasafehealthcaresystemPoliciesReportingincludesqualifiedindemnity(賠償),confidentiality,separationofdatacollectionfromdisciplinaryprocedures（懲戒程序）16/19BuildingasafehealthcaresystemProcedures-TrainingintherecognitionandrecoveryoferrorsFeedbackonrecurrenterrorpatternsProtocols（draft）Proceduresmustbeintelligible,workable,available17/19BuildingasafehealthcaresystemPracticesRapid,useful,andintelligiblefeedbackonlessonslearntandactionsneededBottomupinformationlistenedtoandactedonAndwhensth.badoccurAcknowledgeresponsibilityApologizeConvincepatientsandvictimsthatlessonslearnedwillreducechanceofrecurrence18/19MedicationErrorProcedureIfanerrorocc