Human Factors Analysis And Classification System

Pharmacokinetics and Pharmacodynamics

Discuss about the Human Factors Analysis and Classification System.

Product information component of Therapeutic drug administration (TGA) offer health professional summarized scientific information about the safe and effective use of prescription medicine. This information provided by the pharmaceutical company and approved by TGA. Hence, this assures safe administration of prescription medicines (AGDH, 2016).

TGA classifies medicines relative to the risk of the person. There are different medications and different doses of same medication are available for people with different risk consuming these medicines. This helps in consuming the optimum use of medicines with desired clinical effect and no adverse reactions of the medicine in that particular person (AGDH, 2016).

Pharmacokinetics: Pharmacokinetics is the specialized branch of pharmacology in which fate of the administered medicine or substance determined in the animals or humans. In pharmacokinetics effect of body on the drug or substance studied in terms of absorption, distribution to different body parts, metabolism and excretion or elimination from the body. Pharmacokinetics determines fate of the drug from the time of entry in to the body until time of elimination from the body including metabolism of drug (Bonate, 2011).

Pharmacodynamics determines the biochemical and physiological effects of the drug substance on humans, animals and microorganisms. Pharmacodynamics determines effect of drug on the body (Lilley & Savoca, 2011; Maxwell, 2016).

In first pass effect drug is swallowed, absorbed through the GI tract, enters hepatic portal system and liver through hepatic portal vein. In liver many drugs gets metabolized and very small fraction of drug is available to be supplied to the circulatory system and rest of the body. Enzymes playing significant role in first pass effect are gastrointestinal lumen enzymes, gut wall enzymes, bacterial enzymes and hepatic enzymes (Bullock & Manias, 2011). In hepatic first pass effect most of the absorbed drug is metabolized and very less drug is available for systemic circulation. Hepatic first pass metabolism of drug results in the requirement of high oral dose and this precludes some drugs from oral consumption. Many clinically and medicinally used drugs available in the market undergo hepatic first pass effect. Hepatic first pass effect can be bypassed by administering the drug via sublingual or buccal routes. Hepatic first effect can also be avoided by using prodrug formulations (Markowitz, 2013).

Glyceryl Trinitrate 600 microgram tablets have high hepatic first effect. If it is administered through oral route, its bioavailability will be very less. When sublingual tablets kept in contact with mucous membrane underneath tongue, this tablet diffuses through mucous membrane due to the perfusion of capillaries in the connective tissue below the epithelium. As a result Glyceryl Trinitrate tablet enters venous circulation very easily, avoids hepatic first pass effect and exhibits faster action (Bullock & Manias, 2011).

Patient Education

Glyceryl Trinitrate tablets should be allowed to dissolve beneath the tongue and should not be swallowed in alike other tablets.

Glyceryl Trinitrate produces dizziness hence patient consuming this medicine should not drive or handle machineries after its consumption.

Container of Glyceryl Trinitrate tablets should not kept open, as it loses its contents through evaporation. 

Glyceryl Trinitrate should not be taken along with alcohol as it can exaggerate side effects of medicine (Lilley et al., 2010).

Nurse: Nurse plays significant role in patient education for medication use. Nurse should administer specific medicine to the right patient and also should ask patient to identify medication. Nurse should check medication label and order of medicine. Nurse should calculate accurate dose for the medication and check from the recent drug references with other nurse. Nurse should administer drug at the correct time, with correct frequency and also nurse should ask patient timings of last dose. Nurse should document all the information regarding medication administration like time, dose and route of administration. Nurse should consider patient’s history and other medications for patients while administering medication to the patient. Nurse should assess whether, administered medication is exhibiting desired effect in the patient (Bullock & Manias, 2011).

Doctor: Doctor should accurately diagnose disease and prescribe the relevant medicine to the patient. Doctor should prescribe the optimum dose considering patients age and condition, also doctor should mention route of drug administration and frequency with which medicine should be taken. Doctor should educate patient and family members about the safe use of medication. Doctor should evaluate the effectiveness of medicine in the timely manner. Doctor should prescribe medication considering the diet, other medication and past history of patient about particular medicine to minimize adverse effects of the prescribed medication (Bullock & Manias, 2011).

Pharmacist: Pharmacist should educate and communicate to health care professionals about the recent advancements in the medications with more efficacies and less side effects. Pharmacist should educate health care professionals, patient and family members about the preparation and safe use of drugs. Pharmacist should dispense medicines regularly without any delay. Pharmacist should specifically monitor supply of medications in residential aged care facilities and in the home care facilities as at these places there are more chances of misuse of medications because of poor understanding of the aged people about the use of medications (Bullock & Manias, 2011).

Medication error occurred due to the five rights like right drug, right client, right dose, right route and right time (Bullock & Manias, 2011).

Nurse, Doctor, and Pharmacist Roles

Right drug: If there are the two similar in appearance drugs prescribed for a particular patient, there is the possibility of administering wrong drug to the patient. This can happen due to negligence or not reading the label on the medicine. 

Right client: If nurse has to administer medications to two patients at the same time, there is the possibility that nurse may administer drug of one patient to another patient. This may occur due to not maintaining the proper documentation for the drug administration for individual patients.

Right dose: Sometimes there is the possibility that nurse can administer very high or very less dose of medication to the particular patient. This error can occur due to error in manual calculation or error in the calculator.

Right route: There is the possibility that nurse can administer sublingual tablet through oral route. This error can happen due to not maintaining the proper record of drug administration or overlook of the maintained documents.

Right time: This error occurred due to the missing administration of drug at a particular time or not administering medication with prescribed frequency. This error can occur due to the work overload on the nurse and she can’t focus completely on the medication administration. 

Nurse should immediately report to all the stakeholders of the drug administration like doctor, pharmacist and senior nursing staff and should monitor the patient keenly for the possible adverse effects, therapeutic effect and allergies due to the medication error. Also nurse should inform patient family about the incidence.

Nurse should maintain all the documents related to medication error. It includes dose, route and timings of medication administration. Also document related to the deviation from the normal administration of the medication should be maintained (Bullock & Manias, 2011).

Person – centered approach is mainly errors occurred due to individuals. It comprises of forgetfulness of individual, less attention towards medication administration, carelessness, moral weakness, negligence and carelessness. System – centered errors occurred mainly due to the deficiency in the overall system. In system – centered approach individuals work in adverse conditions and struggle to overcome these conditions, so that they can minimize the errors.

Workplace disadvantages and failure in the organizational processes are mainly responsible for these types of errors. In person- centered approach preventive measures are used to be taken in the form of changing and minimizing undesired human behavior. In system- centered approach preventive measures used to taken in the form of changing working conditions in the organizations to minimize the individual errors. Actions to be taken to prevent individual – centered approach are change in procedure, disciplinary action against individual, legal action against individual, blaming and shaming. Action to be taken in the system – centered approach are removal of all unsuitable technologies and barriers (Reason, 2000).

Each defensive layer should be considered as unbroken. However, reality is different. Same like the slices of Swiss cheese, there are many holes in the defensive player of the system or organization. These holes are prone to open, shut down and shift on their own. Presence of one hole never results in the adverse outcome or error. However, in case of presence of many holes and due to the movements these holes lined up to make path for the adverse events and are prone to accidental errors. As a result it produces adverse events in the victims. These holes are generally of two types’ active failures and latent conditions (Reason, 2000).

Medication error occurred due to the insufficient staff in the ward. As one nurse is taking care of all the patients and this leads to switching of medication from one patient to another.

Inexperienced nurse could not calculate exact dose of medication based on the patient condition, hence it leads to the medication error. 

Due to the improper documentation of the medication, schedules for the medication administration are not available and this leads to the medication error.

This medication error can occur due to mistake of nurse to administer particular medicine to specific condition.

Medication error occurred because nurse forgets to administer morning dose of the medicine. 

Nurse administered medicine through oral route instead of sublingual route which is desired route of administration of medication (Douglas et al., 2003).

References:

Australian Government Department of Health (AGDH). Therapeutic Goods Administration. Retrived from https://www.tga.gov.au/ on 16 September 2016.

Bonate, P. L. (2011). Pharmacokinetics. Wiley Interdisciplinary Reviews: Computational Statistics, 3(4), 332-342.

Bullock, S., & Manias, E. (2011). Fundamentals of pharmacology (6^th ed.). Frenchs Forest, N.S.W: Pearson.

Douglas, A., Wiegmann, & Shappell, S. A. (2003). A Human Error Approach to Aviation Accident Analysis: The Human Factors Analysis and Classification System. Ashgate Publishing, Ltd.

Lilley, L.L., Collins, S.R., Harrington, S., & Snyder, J.S. (2010). Evolve Resources for Pharmacology and the Nursing Process. (6^th ed.). St. Louis, MO: Mosby/Elsevier.

Lilley, L. L., & Savoca, D. (2011). Pharmacology and the nursing process (6^th ed.). St. Louis, MO: Mosby/Elsevier.

Markowitz, J. S. (2013). Transforming events: Hepatic metabolism and individual variability. Clinical Therapeutics, 35(3), 202-204.

Maxwell, S. R. J. (2016). Pharmacodynamics for the prescriber. Medicine (United Kingdom), 44(7), 401-406.

Reason, J. (2000). Human error: models and management. British Medical Journal, 320, 768–70.