keyterms
Compulsive and uncontrollable use of a drug substance for reasons other than prescribed.
Addiction
Occurs when aseptic technique is not followed during compounding, causing the drug to lose sterility and potentially cause infection.
Contaminated product error
An error in which more doses are received by a patient than were prescribed.
Extra dose error
A specific risk assessment program for isotretinoin to prevent birth defects by closely monitoring its use.
iPLEDGE program
An internet-based USP program used by hospitals and healthcare systems to document, track, and identify trends in medication errors and adverse events.
MEDMARX
Occurs when the prescribed drug initiates an allergy or an adverse drug interaction flag that was missed.
Adverse drug error
Occurs when a technician or pharmacist is interrupted during the filling process and misses or forgets key information.
Distraction error
Occurs when a technician is afraid of the consequences of speaking up or asking for a double-check of a prescription.
Fear error
FDA-approved printed information that communicates side effects, adverse reactions, and black-box warnings for high-risk drugs.
MedGuide
A voluntary FDA program that allows healthcare professionals and consumers to report serious adverse events related to drugs, biologics, devices, or supplements.
MedWatch
A negative consequence to a patient from taking a particular drug due to the nature of the drug itself, especially in vulnerable populations.
ADR
When essential information (such as allergies, patient requests, or prescriptions) is not properly noted or processed.
Documentation error
An error generated by failure at the individual level.
Human failure
Occurs when proper medication counseling materials and instructions are not provided to the patient.
Medication education error
Occurs when incorrect information on a medication label leads to the wrong use or wrong patient receiving it.
Mislabeling error
When the technician and/or pharmacist becomes desensitized to alerts and bypasses utilization warnings.
Alert fatigue
A patient dependent on or addicted to drugs who attempts to obtain the same or similar controlled drugs from multiple physicians or pharmacies.
Drug seeker
Occurs when full information is not available because proper questions were not asked, answers were not recorded, or information was withheld.
Incomplete information
Any preventable event that may cause inappropriate medication use or patient harm while the medication is under healthcare professional, patient, or consumer control.
Medication error
An administration error in which a prescribed dose is not given.
Omission error
An error that occurs when focus on a task is diverted elsewhere and the error goes undetected.
Capture error
When the body adapts to a drug so higher doses are needed to produce the same effect.
Drug tolerance
Occurs when essential information cannot be verified and an assumption is made instead.
Incorrect assumption error
Failure to take medication therapy as instructed by the physician (also called nonadherence).
Medication noncompliance
Groups that collect and analyze error data from healthcare providers and offer quality improvement guidance.
Patient Safety Organization (PSO)