Home Care Organizations Medication Safety Self-Assessment Key Definitions

Key definitions are designated throughout the self assessment with small capital letters.

1. Adverse Drug Events: An injury from a medicine or lack of an intended medicine. Includes adverse drug reactions and harm from medication incidents.
   
   Adapted from Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ and Leape LL, "The Costs of Adverse Drug Events in Hospitalized Patients. Adverse Drug Events Prevention Study Group," Journal of the American Medical Association 277, 4 (January 22, 1997): pp. 307-11.
2. Allergy Information: Includes medication name, type and severity of reaction.
3. Best Possible Medication History (BPMH): BPMH is a history created using 1) a systematic process of interviewing the patient/caregiver, and 2) a review of at least one other reliable source of information to obtain and verify all of a patient's medication use (prescribed and non-prescribed). Complete documentation includes drug name, dosage, route and frequency. The BPMH is more comprehensive than a routine primary medication history, which may not include multiple sources of information.
   
   The BPMH is a 'snapshot' of the patient's actual medication use, which may be different from what is contained in their records. This is why patient involvement is vital.
4. Comprehensive Medication Review: A comprehensive medication review (CMR) is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber. A CMR is performed by a knowledgeable practitioner (pharmacist, nurse practitioner or physician) directly engaging the patient / caregiver.
5. Hierarchy of Intervention Effectiveness: A risk management theory that rates interventions related to human behaviour (e.g. education and training) at the lower end of its scale, and technological interventions (e.g. forcing functions and automation) as higher leverage actions and more reliable.
   
   Institute for Safe Medication Practices. 1999. Medication Error Prevention "Toolbox" Horsham, PA: Author.
6. High Alert Medications: Medications that bear a heightened risk of causing significant patient harm when they are used in error. Examples of high alert medications include warfarin, insulin, chemotherapy, opioids, antithrombotic agents and oral hypoglycemics. Refer to ISMP's List of High-Alert Medications in Community/Ambulatory Healthcare
7. Interdisciplinary Committee: A selected group of healthcare practitioners (including front-line staff) that convenes to assess and address situations/issues. When medication related issues are being discussed, the committee should include a pharmacist or healthcare practitioner with medication expertise.
8. Legal Prescription: The information required on every prescription. Refer to the CPSO policy on prescribing drugs. Read more...
9. Limitations: Factors that prevent optimal medication use are related to: knowledge of medications, physical (hearing, seeing, manipulation), cognitive (understanding, memory, confusion), storage (wrong temperature, unlabeled containers), accessibility (no deliveries, drugs not affordable), adherence (unable to manage a complex regimen), safety (expired)
10. Medication Incident: Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Medication incidents may be related to professional practice, medication products, procedures, and systems, and include prescribing, order communication, product labelling/packaging, compounding, dispensing, distribution, administration, education, monitoring, and use. Similar Term: Medication Error
11. Medication Management: The goal of medication management is to ensure the safe, accurate and consistent use of medications across the organization. Includes selecting and procuring medications; storing medications; prescribing, ordering, and transcribing medications; preparing, dispensing, and delivering medications; and administering medications and monitoring the effects of medications on patients.
    
    From Qmentum Program, Standards, Medication Management Standards for Community-Based Organizations, Accreditation Canada, Ottawa, January 2014.
12. Medication Care Plan: A comprehensive written plan that identifies the medication treatment goals, actual and potential medication-related problems, resolution of such problems, a monitoring plan (including signs or symptoms that a patient / caregiver needs watch for that may be related to an adverse effect of a medication and provides an action plan on how to get it resolved; specific monitoring parameters such as blood pressure measuring or laboratory testing).
13. Medication Non-Adherence: Both intentional and/or non-intentional behaviours that can lead to under or over use of medications. Read more...
14. Medication Reconciliation: Is a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. Medication reconciliation requires a systematic and comprehensive review of all the medications a patient is taking (known as a BPMH) to ensure that medications being added, changed or discontinued are carefully evaluated. It is a component of medication management and will inform and enable prescribers to make the most appropriate prescribing decisions for the patient.
15. Medication Risk: A situation involving medications where a patient is likely to experience a medication error, incident or adverse event.
16. Near Miss: An event that could have resulted in unwanted consequences, but did not because either by chance or through timely intervention the event did not reach the patient.
17. Parenteral Medication: A medication that is administered through an intravenous, subcutaneous or intramuscular route.
18. Prohibited, Dangerous Abbreviations: Abbreviations, symbols and dose designations that have been identified as easily misinterpreted or involved in medication incidents leading to harm and should be avoided in medication-related communications. See ISMP Canada's Do Not Use: List of Dangerous Abbreviations, Symbols, and Dose Designations
19. Root Cause Analysis: A team-based retrospective process for identifying the underlying causal factors that may have led to a preventable adverse event.
    
    This process can be used to perform a comprehensive, system-based review of critical incidents. It includes the identification of the root and contributory factors, determination of risk reduction strategies, and development of action plans along with measurement strategies to evaluate the effectiveness of the plans. Available from...
20. Smart Pumps: An infusion pump with computer software that is capable of alerting the user to unsafe dose limits and programming errors if standard concentrations and dose limits have been programmed into the pump's library. Smart pumps may also have the capability to block user over-rides and be bar code technology compatible.
21. Standardized Process: A defined systematic and standardized process with clearly defined steps and expected endpoints that have been agreed upon by the organization and all staff have been educated to follow.