Safety First!
What is Just Culture?
Just Culture - a way of approaching patient safety which focuses on a culture of shared accountability. The employer is accountable for designing safe systems. The employee is accountable for behavioral choices (human error, at-risk, reckless)
Calculate the IBW for a 24 year old man who is 5'9" and weighs 182lbs. Answer should be in kg.
70.7kg
IBW(male) = 50kg + 2.3(each inch over 5')
IBW(male) = 50kg + 2.3(9) = 70.7
Remember for women the IBW formula is different:
IBW(women) = 45.5kg + 2.3(each inch over 5')
A medication is ordered to run at a rate of 470mg/hr. The medication is available in a concentration of 15mg/mL, what is the infusion rate in mL/hr?
31.3 mL/hr
What percent strength is made by mixing 100mL of 35% drug with 400ml of water?
7%
C1V1 = C2V2
(35%)(100mL) = (C2)(500mL)
C2 = [(35%)(100mL)] / 500mL
United States Pharmacopeia (USP)
USP <797>
A physician prescribes warfarin 2 mg tablets with directions to take one tablet by mouth daily. The pharmacy technician accidentally selects warfarin 5 mg tablets when filling the prescription. The pharmacist performs the final verification but fails to notice the incorrect tablet strength. The patient takes the medication for five days and develops a gastrointestinal bleed due to an elevated INR.
Classify the type of error that occurred.
Dispensing Error
A patients ABW:IBW ratio was determined to be greater than 1.3. Which weight do we use now?
Adjusted Body weight (AdjBW)
AdjBW = IBW + 0.4(ABW-IBW)
How many grams of dextrose are present in 831mL of 14% dextrose (w/v)?
116.34g
14g/100mL = (x)/831mL
x = 116.34g
How many mL of 15% ethanol is needed to make 750mL of 2% solution?
100mL
C1V1 = C2V2
(15%)(V1) = (2%)(750mL)
V1 = [(2%)(750mL)] / 15%
*To find the amount of water needed, take final volume and subtract the volume of drug needed (750mL total - 100 mL drug = 650mL of water needed)
The slides list 5 products that must be sterile, list 2 of them
Infusion, injection, eyedrops, intrathecal medications, parenteral nutrition
Differentiate a Medication Error from an Adverse Drug Reaction from an Adverse Drug Event
ADE: an umbrella term to describe any injury that occurred as a result of a drug, preventable or not preventable.
ADR: term to describe a non-preventable injury caused from a drug (taking a drug and having a side effect)
Medication Error: a preventable mistake in the prescribing, dispensing, administering, or monitoring of a medication. It may or may not cause harm.
70kg
AdjBW = IBW + 0.4(ABW - IBW)
AdjBW = 61.6kg + 0.4(83.2-61.6)
AdjBW = 70kg
A medication is ordered to run at a rate of 70mg/hr. The medication is available in a concentration of 31mg/mL, and a drop factor of 15gtts/mL, what is the infusion rate in gtts/hr?
34 gtts/hr (the math gives you 33.9, but you cannot have 0.9 of a drop so round to the nearest whole drop)
What percent strength is obtained from mixing 630mL of 17% ethanol, 40mL of 35% ethanol, 1L of 8% ethanol, and 500mL of water?
9.3%
1. Find how much drug is given from each solution
17g/100mL = (x)g/630mL = 107.1g
35g/100mL = (x)g/40mL = 14g
8g/100mL = (x)g/1000mL = 80g
2. Add masses together: 107.1g + 14g + 80g = 201.1g
3. Add all volumes to get total volume
630mL + 40mL + 1000mL + 500mL (from water) = 2170mL
3. Find % strength: (201.1g/2170mL) x 100% = 9.3%
What 3 sections make up the compounding space?
1. Anteroom: area where hand hygiene and garbing occur
2. Buffer Room: area which houses the PEC (flow hood)
3. Primary Engineering Control (PEC): the place where compounding occurs and products are exposed to first air (the flow hood)
According to the NCC MERP Medication Error Classification Scale, which category is the most severe in terms of harm the patient could occur?
Category I
Remember the NCC MERP Scale goes from A-I, the harm the patient incurs increases as you move along the scale
A: situation/event that has the capacity to cause harm (near miss situations)
I: Patient Death
Calculate the Creatinine Clearance (CrCl) for a 27 year old male patient using the Cockcroft-Gault equation. The patient weights 168lbs, is 5'11", and has a serum creatinine (SCr) of 1.1 mg/dL.
*Hint: make sure to double check which weight to use
107.4 mL/min
First, figure out which weight to use: IBW - 75.3kg, ABW - 76.36, ABW:IBW - 1.01 -> use IBW
Find CrCl: [(140-age) x (weight)] / (72 x SCr)
CrCl = [(140-27) x (75.3kg)] / (72 x 1.1 mg/dL)
Convert 30mcg/min to mg/day
43.2mg/day
A patient is ordered an infusion of 800mL of a 6.75% sodium chloride over an 8 hour duration. You only have 0.9% and 23.4% solutions in stock. How many mL of each concentration is needed to make 800mL of the 6.75% solution.
0.9% - 592mL, 23.4% - 208mL
x = mL of 23.4%, 800 - x = mL of 0.9%
(0.234)(x) + (0.009)(800 - x) = (800mL)(0.0675)
0.234x + 7.2 - 0.009x = 54
0.225x + 7.2 = 54
0.225x = 46.8
x = 208mL
mL of 0.9% = 800mL - 208mL = 592mL
Place the steps of donning PPE for sterile compounding in the order which they occur.
*Hint: there are 6 steps
1. Shoe Covers
2. Hair/beard covers
3. Mask
4. Hand Hygiene
5. Gown
6. Gloves
*Remember, the order of doffing is the exact opposite*
What are ways identified in the slides to prevent risks associated with Look Alike, Sound Alike drugs? Name one
*Hint: the slides list 4 ways
Use brand and generic names on labels/prescriptions
Include the indication on the prescriptions
Prevent look-alike names from appearing consecutively on screens
Use Tall-Man lettering, color, or font to differentiate (hydrALAzine vs hydrOXYzine)
A 48 year old female patient (136lbs, 5'4", SCr of 0.9 mg/dL) was ordered the following dosing regimen:
a) Loading dose of 64mg/kg (based on IBW)
b) Maintenance dose of 46mg/kg (based on ABW)
c) Interval depending on her CrCl: CrCl > 60 mL/min use q12h, CrCl≤60 mL/min use q24h
Calculate a, b, and c
a) IBW = 45.5kg + 2.3(4) = 54.7kg
(64mg) x (54.7kg) = 3,500.8mg
b) ABW = 136lbs/2.2 = 61.8kg
(46mg) x (61.8kg) = 2,842.8mg
c) CrCl =( [(140-48) x (54.7kg)] / (72 x 0.9) ) *0.85 = 66.01 mL/min -> use q12h interval
*Remember to multiple CrCl by 0.85 when calculating a female's CrCl*
A medication is ordered to run at a rate of 751mg/day. The medication is available in a concentration of 98mg/mL, and a drop factor of 20gtts/mL, what is the infusion rate in gtts/hr?
6gtts/hr (the math gives you 6.4gtts/hr, round to the nearest whole drop)
A patient is prescribed 1,000 mL of a 5% dextrose solution. You have sterile water and 50% dextrose solutions available. How many mL of each solution is required to make the product?
900mL sterile water (0%), 100mL 50% dextrose
x= mL of 0%
1,000 - x = mL of 50%
(0)(x) + (0.5)(1000-x) = (0.05)(1,000)
500 - 0.5x = 50
-0.5x = -450
x = 900mL of sterile water
Volume of sterile water = 1,000mL - 900mL = 100mL
What are the 3 ISO classes needed for sterile compounding and which section of the compounding suite require which class?
ISO Class 5: required in the PEC
ISO Class 7: required in the Buffer room (SEC)
ISO Class 8: required in the anteroom (more on this in PP2)
Remember: the lower the ISO number, the cleaner the air. The closer you get to the PEC, the cleaner the air should be