Final Med Admin Flashcards
Causes of medication errors
Transcription
Prescribing
Documentation
Not adhering to med rights
Trailing and leading zeros
Confusing names
Inappropriate use of abbreviations
Distractions
Sade admin includes knowledge of
Generic/trade
DEA schedule
Pregnancy/lactation category
Safety of dosage
Action of med
Side effects
Rate/route of excretion
Interactions
Nursing considerations
Nurses responsibility
They are legally responsible for the meds they administered so if there is an error suspected they MUST ??
They assume individual accountability
Understand policy and procedures
Principles of Med Admin
No medication can be administered without being prescribed by a licensed practitioner.
Safe practice dictates that a nurse follows only a written, typed, or order entry order.
Under certain circumstances, such as an Emergency, will a verbal order to a Registered Nurse or Pharmacist be permitted.
*Student Nurses are NOT permitted to accept verbal orders
*** There are Legal Implications for Verbal orders
Medication reconciliation
A process specifying and maintaining an accurate list of meds
Three checks med admin
First: when the nurses reaches for the unit dose package or container
Second: after retrieval from the drawer and compared with the CMAR/MAR or compared immediately before pouring from a multi-dose container
Third: before giving the unit dose to the patient or when replacing the multi-dose container in the drawer or shelf
Eleven Rights of Meds
Right patient
Right medication
Right dose
Right route
Right time
Right reason
Right assessment
Right documentation
Right response
Right to educate
Right to refuse
1 Right patient
Ensure that patients full name is used
Ask to state full name and DOB
Compare MAR to ID bracelet
Verify allergies each time, ask about specific reaction
Be aware prescriber could have entered an order in the wrong patient’s record
2 Right medication
Perform triple check of all the rights and the med label
Know brand vs generic names
Be aware of names that sound similar
Be familiar with meds
NEVER admin med prepared by another person
NEVER admin med that is not labeled or has been tampered with
3 Right dose
Check the label for [med]
Compare dose with med order
Triple check med calculations
Verify the dosage is within appropriate dose range - safe for the patient and therapeutic range for meds
4 Right Route
Verify med route with med order before admin
Medication may only be administered route specified
Identify and use the appropriate medication admin tools needed
- length of needle
- appropriate syringe
- oral syringe
- etc
5 right time
Verify schedule of med with the order
- date
- time
- specified frequency
evaluation of patient within 30 min or sooner per medication/policy
6 right reason
Confirm the rationale for the ordered medication
What is the patient’s history
Why are they taking this medication
Revisit the reason for long-term medication use
7 right assessment
Properly assess the patient to determine if the medication is safe appropriate
If unsafe or inappropriate, NOTIFY provider immediately
If med was NOT administered document and report
8 Right documentation
Complete documentation per facility policy immediately after admin
Document and report to the appropriate provider any related signs and symptoms
9 Right Response
Monitor the patient
Detect and prevent complications
Evaluate any health changes
Assess lab values and detect changes
Document patient’s response to med
Provide patient education
10 Right to education
Assess patients knowledge level
Provide education regarding:
- dosing
- admin times
- medication site effects
- contraindications
11 Right to refuse
The legal responsible party for the patient’s care has the right to refuse any meds
Inform patient or responsible party of consequences of refusing
Ensure that they understand the consequences of refusing
Ensure that they understand the consequences of refusal
Notify the provider that the ordered medication was not given and document
Document refusal and that they fully understand the consequences
Important to remember
Do not admin outdated/expired meds
Do not admin beyond the stop date
Do not admin a med that has had some chemical change (color, odor, consistency)
Admin only med that are labeled correctly and NOT tapered with
Medication errors
Should all be reported
Report all “near misses”
NEVER hide a medication error - it is more important that the patient gets immediate attention
Errors can highlight system flow issues and help facilitate changes to improve patient safety
When to not give meds
Make sure the entire order is complete
The order should be signed by the provider
If the patient is showing any abnormal/physical concerns
Any of the 11 rights are missing?
If the patient/patient’s party refuses to
ANY QUESTIONS THAT MAY NOT BE ANSWERED - DOUBLE CHECK!
Infection control
Remember infection control
Hand washing
Scrub hub for 15-30 sec
1 needle/1 syringe/ 1 patient EVERY TIME
Per guidelines always insert a new sterile needle and syringe into a vial
Best practice is to NOT use multi-dose vials
Remembers with meds
Avoid distractions - in RED ZONE
Follow policy for co-signing of med
Never pre pour meds
Document now not later
Perform all rights 3 times
ALWAYS double check allergies
NEVER leave med at the bedside
Ensuring Safe Administration
Head elevates
Make sure patient swallows
Consider oral motor concerns
Difficulty or delayed swallowing
“Tonic” biting
Age relate changes
Special needs for some
Appropriate land marking for injectable medications
Absorption
Drug is transferred from site of entry into bloodstream
Distribution
Drug is distributed throughout the body
Metabolism
Drug is broken down into an inactive form
Liver
Excretion
Drug is excreted from the body
Kidneys
Oral drugs
Capsule
Pill
Tablet
Extended release
Elixir
Suspension
Syrup
Suspension drugs
Powders added to water
Topical drugs
Liniment
Lotion
Ointment
Suppository
Transdermal patch
Parenteral drugs
Anything that isn’t PO
Subcutaneous injection
Subcutaneous tissue
SQ
Intramuscular injection
Muscle tissue
IM
Intradermal injection
Corium (under epidermis)
ID
Intravenous injection
Vein
IV
Intraarterial injection
Artery
Intracardial injection
Heart tissue
Intraperitoneal injection
Peritoneal cavity (abdomen)
Intraspinal injection
Spinal canal
(Like an epidural)
Intraosseous injection
Bone
Criteria for choosing equipment for injection
Route of admintion
Viscosity of the solution
Quantity to be administered
Body size
Type of medication
Preparing med for injection
Ampules - do NOT put air into
Virals - put in as much air as med that you are taking out
Prefilled cartridges - need special injectors (tubex injector)
Parts of a needle and syringe
Plunger
Barrel
Threads for Luger lock
Needle hub
Needle
Safety guard
Bevel
Shaft
Lumen
How to inject bevel
Bevel up in SQ and intradermal
Doesn’t matter in IM
Syringe sizes
Standard (3 mL)
Tuberculin (1 mL)
Insulin (in units)
Tubex (metal case or blue plastic case)
Intradermal sizes to use
Needle length: 1/4 - 1/2
Gauge: 18-25
Intramuscular sizes
Needle length: 1-1 1/2
Gauge: 18-25
Sizes for SQ
Needle length: 5/8-1
Gauge: 25-29
Withdrawing
