Chp 5-6 Med Errors/Patient Ed

Question 1

Allergic reaction

Answer 1

an immuniologic reaction resulting from an unusual sensitivity of a patient to a certain medication

Question 2

Idiosyncratic reaction

Answer 2

any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.

Question 3

IOM

Answer 3

Institute of Medicine

Question 4

IOM 2006 Report statistics:

Answer 4

Medical errors harm at least 1.5 million people per year,

including 117,000 hospitalizations at a cost of over $4 billion.

Question 5

Drugs commonly involved in severe medication errors include:

Answer 5

• central nervous system drugs
• anticoagulants
• chemotherapeutic drugs

Question 6

“High-alert” medications:

Answer 6

those that, because of their potentially toxic nature, require special care when prescribing, dispensing, and/or administering.

Question 7

SALAD

Answer 7

sound-alike, look-alike drugs (common error causing)

Question 8

LASA

Answer 8

look-alike, sound-alike (common error causing)

Question 9

What are the issues that contribute to errors?

Answer 9

• Errors during any step of medication process (procuring, prescribing, transcribing, dispensing, administering, monitoring)
• Organizational issues
  Educational system issues
• Sociologic factors

Question 10

What are four types of medication errors?

Answer 10

1. no error, although circumstances or events occurred that could have led to an error
2. medication error that causes no harm
3. medication error that causes harm
4. medication error that results in death

Question 11

When is it ok and not ok to use a 0 when writing a decimal for a dosage?

Answer 11

NEVER use a trailing zero! (i.e. 1.0 can be misread as 10)

ALWAYS use a leading zero! (i.e. use 0.25 rather than .25 which can be misread as 25)

Question 12

How should you report medication errors internally?

Answer 12

• Report to prescriber and nursing management
• Document error per policy and procedure
• Factual documentation only (Med administered, actual dose, observed changes in patient condition, prescriber notified/follow-up orders)

Question 13

Who should you report medication errors to externally?

Answer 13

• USP MERP (United States Pharmacopeia Medication Errors Reporting Program)
• MedWatch, sponsored by the FDA
• Institute for Safe Medication Practices (ISMP)
• the Joint Commission

Question 14

What are the three steps of medication reconciliation?

Answer 14

1. Verification - collection of the patient’s medication information with a focus on medications currently used
2. Clarification - professional review of this information to ensure that medications and dosages are appropriate for the patient
3. Reconciliation - further investigation of any discrepancies and changes in medication orders.

Question 15

When should medication reconciliation be performed?

Answer 15

At each stage of health care delivery (Admission, status change, patient transfer within or between facilities/provider teams, discharge)

Question 16

Cognitive domain

Answer 16

the domain involved in the learning and storage of basic knowledge. It is the thinking portion of the learning process and incorporates an individual’s previous experiences and perceptions; the learning/thinking domain

Question 17

Affective domain

Answer 17

the most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain

Question 18

Psychomotor domain

Answer 18

the domain involved in the learning of a new procedure or skill; often called the doing domain

Question 19

What are some of the most commonly used and currently approved NANDA-I nursing diagnoses related to patient education and drug therapy?

Answer 19

• Deficient knowledge
• Impaired memory
• Ineffective self-health management
• Readiness for enhanced self-health management
• Noncompliance
• Risk for falls
• Risk for injury
• Sleep deprivation

Question 20

What are the goals and outcome criteria that need to be met in the planning stage of patient education?

Answer 20

• measurable
• realistic
• based on patient needs
• Stated in patient terms
• time frame
  (list, identify, demonstrate, self-administer, state, describe, and discuss)

Question 21

During implementation of patient education what must you consider?

Answer 21

• teaching-learning sessions
• age-related changes
• language barriers
• safe administration of medications at home (return demo with equipment)
• for adults, it is recommended that materials be written at an 8th grade level

Question 22

What happens during the evaluation phase of patient education?

Answer 22

Validate whether learning has occurred:
- ask questions
- have the patient provide a return demo
- behavior, such as compliance and adherence to a schedule
- occurrence of few or no complications
Develop an implement a new plan of teaching as needed for:
- noncompliance
- inadequate levels of learning