Final Med Admin Flashcards

1
Q

Causes of medication errors

A

Transcription
Prescribing
Documentation
Not adhering to med rights
Trailing and leading zeros
Confusing names
Inappropriate use of abbreviations
Distractions

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2
Q

Sade admin includes knowledge of

A

Generic/trade
DEA schedule
Pregnancy/lactation category
Safety of dosage
Action of med
Side effects
Rate/route of excretion
Interactions
Nursing considerations

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3
Q

Nurses responsibility

A

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

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4
Q

Principles of Med Admin

A

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

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5
Q

Medication reconciliation

A

A process specifying and maintaining an accurate list of meds

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6
Q

Three checks med admin

A

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

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7
Q

Eleven Rights of Meds

A

Right patient
Right medication
Right dose
Right route
Right time
Right reason
Right assessment
Right documentation
Right response
Right to educate
Right to refuse

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8
Q

1 Right patient

A

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

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9
Q

2 Right medication

A

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

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10
Q

3 Right dose

A

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

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11
Q

4 Right Route

A

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

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12
Q

5 right time

A

Verify schedule of med with the order
- date
- time
- specified frequency
evaluation of patient within 30 min or sooner per medication/policy

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13
Q

6 right reason

A

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

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14
Q

7 right assessment

A

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

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15
Q

8 Right documentation

A

Complete documentation per facility policy immediately after admin
Document and report to the appropriate provider any related signs and symptoms

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16
Q

9 Right Response

A

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

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17
Q

10 Right to education

A

Assess patients knowledge level
Provide education regarding:
- dosing
- admin times
- medication site effects
- contraindications

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18
Q

11 Right to refuse

A

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

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19
Q

Important to remember

A

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

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20
Q

Medication errors

A

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

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21
Q

When to not give meds

A

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!

22
Q

Infection control

A

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

23
Q

Remembers with meds

A

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

24
Q

Ensuring Safe Administration

A

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

25
Absorption
Drug is transferred from site of entry into bloodstream
26
Distribution
Drug is distributed throughout the body
27
Metabolism
Drug is broken down into an inactive form Liver
28
Excretion
Drug is excreted from the body Kidneys
29
Oral drugs
Capsule Pill Tablet Extended release Elixir Suspension Syrup
30
Suspension drugs
Powders added to water
31
Topical drugs
Liniment Lotion Ointment Suppository Transdermal patch
32
Parenteral drugs
Anything that isn’t PO
33
Subcutaneous injection
Subcutaneous tissue SQ
34
Intramuscular injection
Muscle tissue IM
35
Intradermal injection
Corium (under epidermis) ID
36
Intravenous injection
Vein IV
37
Intraarterial injection
Artery
38
Intracardial injection
Heart tissue
39
Intraperitoneal injection
Peritoneal cavity (abdomen)
40
Intraspinal injection
Spinal canal (Like an epidural)
41
Intraosseous injection
Bone
42
Criteria for choosing equipment for injection
Route of admintion Viscosity of the solution Quantity to be administered Body size Type of medication
43
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)
44
Parts of a needle and syringe
Plunger Barrel Threads for Luger lock Needle hub Needle Safety guard Bevel Shaft Lumen
45
How to inject bevel
Bevel up in SQ and intradermal Doesn’t matter in IM
46
Syringe sizes
Standard (3 mL) Tuberculin (1 mL) Insulin (in units) Tubex (metal case or blue plastic case)
47
Intradermal sizes to use
Needle length: 1/4 - 1/2 Gauge: 18-25
48
Intramuscular sizes
Needle length: 1-1 1/2 Gauge: 18-25
49
Sizes for SQ
Needle length: 5/8-1 Gauge: 25-29
50
Withdrawing