6 Quality Improvement in Medication Safety Free Online FlashCards

What is the goal of medication-safety improvement?

The goal is to find how the medication-use system made an error possible, test changes that address those conditions, and check for improvements or new problems.

What sources can reveal medication-safety risks?

Useful data include incident and near-miss reports, pharmacy interventions, observations, chart reviews, technology records, audits, and staff or patient feedback.

Why review near misses and unsafe conditions?

Near misses and unsafe conditions can expose system weaknesses before a patient is harmed.

Does a rise in medication-safety reports prove safety worsened?

Not necessarily. More reports may reflect more consistent reporting, while fewer reports do not prove that errors declined.

How should medication-error rates be compared across periods?

Use a meaningful denominator, such as errors per 1,000 doses or per 100 administrations, rather than comparing raw counts alone.

Why stratify medication-safety data?

Stratify results by factors such as medication, process stage, unit, shift, route, patient group, or event severity to identify where risks cluster.

What does a systems analysis of an event examine?

Reconstruct what was expected, what happened, how the error was detected, and which system conditions shaped the actions of people and technology.

What is failure mode and effects analysis (FMEA) used for?

FMEA is a prospective analysis: map process steps, identify possible failures and consequences, consider detectability, and prioritize vulnerabilities for action.

What should guide the choice of a medication-safety intervention?

Choose safeguards that address the identified cause and make safe actions easier and unsafe actions harder; layered safeguards are often more dependable than relying on memory alone.

When is a manual independent double check appropriate?

It may help in selected situations, but it is not automatically the best safeguard for every high-alert medication. Define what must be checked independently and ensure it fits the workflow.

What three questions begin the Model for Improvement?

What are we trying to accomplish? How will we know a change is an improvement? What change can we make?

What is the purpose of Plan–Do–Study–Act (PDSA) cycles?

Plan–Do–Study–Act cycles test changes on a small scale, help teams learn from results, and support adaptation before wider implementation.