Chp 5-6 Med Errors/Patient Ed Flashcards
Allergic reaction
an immuniologic reaction resulting from an unusual sensitivity of a patient to a certain medication
Idiosyncratic reaction
any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.
IOM
Institute of Medicine
IOM 2006 Report statistics:
Medical errors harm at least 1.5 million people per year,
including 117,000 hospitalizations at a cost of over $4 billion.
Drugs commonly involved in severe medication errors include:
- central nervous system drugs
- anticoagulants
- chemotherapeutic drugs
“High-alert” medications:
those that, because of their potentially toxic nature, require special care when prescribing, dispensing, and/or administering.
SALAD
sound-alike, look-alike drugs (common error causing)
LASA
look-alike, sound-alike (common error causing)
What are the issues that contribute to errors?
- Errors during any step of medication process (procuring, prescribing, transcribing, dispensing, administering, monitoring)
- Organizational issues
Educational system issues - Sociologic factors
What are four types of medication errors?
- no error, although circumstances or events occurred that could have led to an error
- medication error that causes no harm
- medication error that causes harm
- medication error that results in death
When is it ok and not ok to use a 0 when writing a decimal for a dosage?
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)
How should you report medication errors internally?
- 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)
Who should you report medication errors to externally?
- USP MERP (United States Pharmacopeia Medication Errors Reporting Program)
- MedWatch, sponsored by the FDA
- Institute for Safe Medication Practices (ISMP)
- the Joint Commission
What are the three steps of medication reconciliation?
- Verification - collection of the patient’s medication information with a focus on medications currently used
- Clarification - professional review of this information to ensure that medications and dosages are appropriate for the patient
- Reconciliation - further investigation of any discrepancies and changes in medication orders.
When should medication reconciliation be performed?
At each stage of health care delivery (Admission, status change, patient transfer within or between facilities/provider teams, discharge)
Cognitive domain
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
Affective domain
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
Psychomotor domain
the domain involved in the learning of a new procedure or skill; often called the doing domain
What are some of the most commonly used and currently approved NANDA-I nursing diagnoses related to patient education and drug therapy?
- Deficient knowledge
- Impaired memory
- Ineffective self-health management
- Readiness for enhanced self-health management
- Noncompliance
- Risk for falls
- Risk for injury
- Sleep deprivation
What are the goals and outcome criteria that need to be met in the planning stage of patient education?
- measurable
- realistic
- based on patient needs
- Stated in patient terms
- time frame
(list, identify, demonstrate, self-administer, state, describe, and discuss)
During implementation of patient education what must you consider?
- 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
What happens during the evaluation phase of patient education?
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
