CH. 22 Principles and Practice of Medication Administration

Question 1

What does critical thinking associated with med admin involve?

Answer 1

integrating knowledge associated with the skills and concepts in relation to giving medication

Question 2

4 things that med admin involves

Answer 2

1. Knowledge
2. Thinking
3. Manual Dexterity
4. Caring

Question 3

“Knowing” aspect of med admin

Answer 3

Know your meds and why they are being prescribed. This includes: side effects, incompatibilities, concentrations, why these particular meds are relevant to the care of your patient, etc.

Question 4

“Thinking” aspect of med admin

Answer 4

You cannot just memorize things-you must understand them. You also need to bring previous knowledge to your current patient care situation

Question 5

“Caring” aspect of med admin

Answer 5

A powerful synthesis of the following based on nursing priorities - compassion - thorough assessment skills - application of patient safety principles - organized care

Question 6

“Manual Dexterity” aspect of med admin

Answer 6

This becomes easier with practice-drawing meds seems hard at first but you will get the hang of it

Question 7

What is one of the most closely supervised skills engaged in by nursing instructors?

Answer 7

Med admin

Question 8

Two things that fear can do to a student in regards to med admin

Answer 8

1. healthy fears may assist you to adequately prepare
2. unhealthy fear can immobilize you at the time of admin

Question 9

Students can feel more prepared if they look into the following 6 areas before admin any meds

Answer 9

1. Preparing - knowledge and understanding regarding specific medications
2. Practicing skills in lab to ensure that the student has a baseline sense of comfort with his or her skills
3. Understanding the rationale for the use of specific meds with specific patients
4. Comprehending the admin of meds within the specific context of the patient’s entire care plan
5. Incorporating med admin within the context of overall nursing priorities and planned nursing work for the morning, afternoon, and/or entire shift or setting
6. Understanding that med admin has several phases: preparation, patient encounter, and medication admin evaluation, and documentation

Question 10

Faculty and students can work together to reduce potential stress of med admin by engaging in one or more of the four following activities:

Answer 10

1. Communication (faculty, students and staff should be on the same page when it comes to med admin. Faculty and students can communicate with staff to make this happen more smoothly. Faculty need to tell students what they expect and students need to know about policies and procedures of agency and school
2. Working together to make it happen safely
3. Knowing when it isn’t working (faculty need to help students eval their med admin practices to ensure they are safe and effective. Students need to recognize when they can’t give meds safely and inform their faculty and staff in a timely fashion
4. Celebrating the successes (students and faculty need to celebrate when students successfully admin meds and review what principles and practices went well

Question 11

Who does each province/terr in Canada grant the responsibility for the regulation of nursing?

Answer 11

professional colleges and/or associations

Question 12

Nurses are held directly accountable for doing what in terms of medication?

Answer 12

admin safely and competently

Question 13

Who is responsible for deinfing the scope of practice for nurses?

Answer 13

provincial regulatory bodies

Question 14

What two things ill improve med admin?

Answer 14

critical thinking and paying attn to safety

Question 15

3 ways you can actively prevent MEs?

Answer 15

1. avoiding assumptions (that med ordered by another HCP is safe)
2. safety check (ie 3 checks in med prep)
3. critically thinking about effects of certain meds (ie, drug interactions)

Question 16

4 reasons for med errors (aka ADEs)

Answer 16

1. nurse gives wrong med
2. nurse gives two incompatible meds
3. nurse forgets to give meds
4. nurse gives med at the wrong time (* giving med 30 mins late may be considered an ADE)

Question 17

4 key danger points to be aware of when administering meds

Answer 17

1. meds known as “high-alert” are more prone to given incorrectly
2. confusing or unclear drug labels
3. taking shortcuts (i.e., not using proper monitoring equipment)
4. not clarifying orders

Question 18

Meds that are more prone to being given incorrectly are called what?

Answer 18

High-alert

Question 19

What is your primary concern when errors occur?

Answer 19

patient safety

Question 20

What is the approach to patient safety where individuals feel safe reporting? Rather than blaming, what does this approach focus on?

Answer 20

“no-blame culture approach”

focus is on looking at the nurse within the HC system and the role indv/systems play when errors occur

Question 21

How does communicating MEs help?

Answer 21

because there are so many resons they may occur, it helps individual nurses and systems prevent future errors

Question 22

Drug regulation at both federal and provincial levels are concerned with 3 things:

Answer 22

1. intro of new drugs into market
2. production and regulation of controlled foods and meds
3. distribution of drugs within canada

Question 23

What is the federal governments role in drug regulation/legislation?

Answer 23

Health Canada reviews, approves and regulates food and drugs for quality and safety

Question 24

What needs to happen before new drugs are approved for sale?

Answer 24

Scientific review;

Question 25

The government of Canada amended the FDA to include what?

Answer 25

Stricter requirements for labeling of food additives and nutritional claims on foods/items called natural health products;

Question 26

Provincial government shares responsibility for regulating drugs by doing 3 things:

Answer 26

1. managing health care services
2. regulating HCPs and their scopes of practice
3. consideration of financial details of drug distribution within provincial health care systems

Question 27

Why are some drugs more regulated than others?

Answer 27

Safety reasons

Question 28

What are the two key concepts students should know about the legal and legislative aspects of drug control?

Answer 28

1. federally and provincially, there is a distribution control and management of therapeutic drugs and pharmaceutical agents
2. there is also control of particular substances believed to result in addiction and/or potential abuse, and these are referred to as controlled substances

Question 29

Substances believed to result in addiction and/or potential abuse are reffered to as:

Answer 29

controlled substances

Question 30

Which act lists different levels of drug regulation within Canada?

Answer 30

Controlled Drugs and Substances Act (Gov. of Canada)

Question 31

What are the different levels of drug regulation within Canada?

Answer 31

• Schedule 1 - require a prescription/direct intervention from a licensed pharmacist; subject to all of the same consideractions as drugs listen in Schedule F of the national food and drug regulations (Canada)
• Schedule 2 - don’t need prescription but are kept behind the pharmacy counter
• Schedule 3 - no prescription; open area that allows for self-selection within a pharmacy
• Unscheduled - drugs not included in schedule 1, 2, or 3 that can be sold from any retail outlet
• Controlled Drugs - drugs included in Schedule F (part I and II) from the Food and Drug Regulations (Canada) and in the Controlled Drugs and Substances Act (formerly the Narcotic Control Act and Schedule G to the Food and Drug Regulations)

Question 32

Where must nurses record the administration of controlled substances?

Answer 32

On the agency’s (or unit’s) narcotic sheet or via electronic medication system AND on the patient’s MAR so an accurate inventory is maintained

Question 33

When do nurses typically engage in a count of controlled substances and why?

Answer 33

at the beginning and end of each shift to ensure that the remaining inventory balances out with the medication that was admin and/or wasted

Question 34

Why does the CNA state that substance abuse is a threat to safe nursing care?

Answer 34

because it impairs judgment and decision-making

Question 35

Nurses who abuse meds or struggle with addictions are held professionally accountable according the the CNA Code of Ethics for their ___________________

Answer 35

personal fitness to practice

Question 36

Medication administration requires a combination of these three things:

Answer 36

Skill

Critical Thinking

Clinical decision-making

Question 37

When administering medication, nurses must use their knowledge of these 7 things:

Answer 37

• pharmacology
• technology
• physical med admin techniques
• documentation
• dosage calculation
• med prep
• implementation of critical safety checks ( like rights of med admin and pt identification)