Fund Week 3 - medication administration Flashcards
Medication Legislation and Standards (the legislation controls my drugs, 2 nurses, and the pharmacy)***
➢ Regulates controlled substances
➢ Set standards for 2 RN checks for high alert medications
➢ Regulates pharmaceutical industry to protect public health by
ensuring medication safety and effectiveness
State Nurse Practice Act (NPA) (the practice defines the scope)
➢ Influences nursing practice and defines SCOPE of practice
(Functioning beyond scope of practice or skills = malpractice)
➢ Nurses may be partially responsible regardless of erroneous
order written by a provider
Adverse drug reactions (ADR) (the simplest explanation)
Harm experienced by a patient as a result of exposure to a medication
Adverse drug reactions - (my reaction is unintentional)
Preventable or unintentional
▪ Accounts for nearly 700,000 ED visits (25% are elderly) and
100,000 hospitalizations and deaths/year (~ 50% of hospitalizations due to ADE’s are the elderly)
▪ Transitions in care are well-documented source of preventable harm related to medications
Medication Errors-what to do (VS, notify, tell, report, root cause)***
- Assess the patient’s VS and any other symptoms
- Notify the primary care team, charge nurse and manager
- Inform the patient and family
- Complete an Incident Report
- Root cause analysis for sentinel
Risk factors for ADE’s (adverse drug event) (age, weight, renal, confusion, dehydration)
▪ Polypharmacy strongest risk factor
▪ Age/Life span
▪ Pediatrics – immature renal function
▪ Pregnancy and breast milk– some drugs cross the placenta and milk
▪ Geriatrics – more fat storage and functional, and cognitive and functional impairment
▪ Obesity and extreme underweight
▪ Impaired renal or hepatic function
▪ Poor health literacy
▪ Receiving treatment from multiple providers
▪ Comorbidities
▪ Confusion/cognitive dysfunction
▪ Dehydration/rapid hydration
geriatric considerations
•↑Comorbidities
•Physiological changes
-cognition change
- Vision/hearing impairment
- Dexterity
•↑adipose tissue, Low metabolism
•Dehydration more common
•Polypharmacy
•Poor compliance
•Drug interaction and Adverse reactions
•Inappropriate prescribing
▪Studies found older adults fail to adhere to their medication regimens as much as 60% of the time
▪START/STOPP Medications criteria in the Elderly:
▪STOPP (Screening Tool of Older Persons’ Prescriptions)
▪START (Screening Tool to Alert to Right Treatment)
Medications and Patient Safety
10,000 prescription medications available to clinicians (AHRQ 2017)
❖1/3 of adults take ≥ 5 medications
❖Institute of Safe Patient Practices implemented safe practices:
■Spell out SALADs (Sound Alike, Look Alike, Drugs) which have significant patient harm if used incorrectly
Distribution dependent on: (distribute if blood is good, protein is good, and can you get across the BBB)
- Blood circulation
- Protein binding (can drug leave circulation or is it stored in tissue)
- Permeability of the Blood Brain Barrier (BBB)/Placenta
2021 Hospital National Patient Safety goals (goal to communicate ID w/ safe med administration)
1 Improve accuracy of patient identification
▪ #2 Improve staff communication
▪ #3 Improve the safety of medication administration
Follow 6 rights of medication administration
- Right patient
- Right medication
- Right dosage
- Right route
- Right time
- Right to refuse
- Right documentation
other Rights - Right assessment
- Right education
- Right response
drug nomenclature
Chemical Name: the exact description of the drug’s chemical composition and molecular structure
-e.g. 2-(p-isobutylphenyl) propionic acid = ibuprofen
Generic name (nonproprietary): Assigned by the manufacturer that first developed the drug; identifies the drug’s active ingredient e.g.
Acetaminophen or Ibuprofen
Brand name (also trade or proprietary): selected by the
pharmaceutical company that sells the drug and is trademarked
e.g Tylenol and Advil
*Nurses should become familiar with both
Components of Drug Order (ordering drugs is DDDRT SSH)- (just what should be your script - your name, etc)
Patient’s full name
❖ Date and time of order
❖ Drug name-usually contains generic and brand name
❖ Dose
❖ Route
❖ Time and frequency of administration (may contain a stop
date/time order)
❖ Scheduled, continuous, prn, one time
❖ Name/Signature of ordering provider
❖ Hold and titrating parameters if appropriate
the 3 checks for meds
1st check:
Compare eMAR to the medication dispensing machine screen (select meds needed: check drug name, dose, route, and time due)
2nd Check:
Pull the selected medication out of dispensing drawer and compare drug against the dispensing display (check the drug name, dose, route, and expiration date of med)
Performed in patient Room
3rd Check:
At the bedside: scan pt armband, check name, DOB, allergies, drug name, dose, route, time against eMAR
- Right Patient
➔ 2 Identifiers: Verify patient’s name/MRN and DOB on the ID band
➔ Then scan barcode and check the patient identifiers against the MAR
➔ Verify patient’s recorded allergies and allergy wristband present
- Right Drug
➔ Compare drug name against patient’s MAR
➔ Pay attention to SALADs (Sound- A-Like Look-a-Like
Drugs)
◆ E.g. hydralazine vs hydroxyzine and dopamine and dobutamine
➔ Does it make sense for patient to receive this
drug
Right Dose
➔ Check label for medication dose
➔ Double check all medication calculations
◆ (be alert to units- 1mg vs 1mL, 0.125mg = 125mcg)
➔ 2 independent RN checks for high alert meds-(insulin,
narcotics, heparin)
➔ Question inappropriate dose
Right Route
➔ Evidence shows errors involving wrong route is most
common
➔ Verify medication route with medication order; only
administer via route specified in the order
➔ If giving IV medication, follow medication bag to tubing to
site
➔ Assess for appropriateness of route ordered
Right Time (and confirm something in the charts…)
➔ Verify medication time with order
1. Date
2. Time
◆ Check last dose of medication given to patient
◆ Hospitals now have one hour window before and after the actual scheduled time to administer meds; check your facility
3. Verify specific infusion time if medication is IV infusion
Right Time on call
➔ “On call”-given peri-operatively or pre-procedure
➔ STAT-give immediately
Should no longer be used – but
good to know if it comes up
➔ ac- before meals (from the Latin word “ante cibum”)
➔ pc- after meals (from the Latin word “post cibum”)
➔ hs – at bedtime (from the Latin word “hora somni”)
right time ➔Scheduled/Standing order (these are just examples)
➔Scheduled/Standing order
➔Single/One time order
Example: Tylenol 1000mg (2 tabs
of 500mg) by mouth x 1 (once)
➔ Prn- meaning as needed (from Latin phrase “pro re nata”)
Example: Nitroglycerin 0.4mg tab, sublingual every 5min x 3 prn chest pain
right documentation - what are you documenting?
➔ Never document before medication is administered.
Document at the bedside after the medication is taken. – RN must see patient take meds
➔ Document parameters-pain scale before and after
medication, vital signs, lab results as indicated
➔ Document reason for med not given (patient refused, patient off unit, med not available at scheduled time, nausea, etc.)
➔ Hospital policy – inform MD of refusal
Right Documentation
Document in MAR
- Medication
- Dosage
- Route
- Date and time
- Signature and credentials
- When appropriate, signature of other nurse checking
medication - Parameters if appropriate
Other Medication Rights: Education (educate the right effect and right precautions)***
➔ During medication administration, inform patient of purpose/desired effects of each medication
➔ Teach the patient to report significant side effects related to medications Educate patient about any special precautions with medication (Insulin, anticoagulants, opioids, etc.)
Medication: Right to Refuse
● The patient as well as the patient’s legal guardian (parent, family member, guardian) for patient’s care has the right to refuse any medication
● Inform responsible party consequences of refusing medication and verify that responsible party understands Document that MD was notified of patient refusal
● Document that patient or responsible party refused
med and that he/she was informed of the potential consequences
Medication: Assessment - what to assess? (hx, vs, etc)***
● Gather hx
● Many medications require specific assessments prior to administration-VS, apical pulse, bowel activity, pain level, lab values
● Many medications have parameters for administration or holds-cardiovascular medications, opioids, insulin sliding scale, anti-hypertensives and stools softeners
Antihypertensives: - when to hold
○ Know current BP and HR administration (within 30min): generally hold for SBP <100, HR <60
○ Some antihypertensives have no specified hold parameters; use judgment
Diuretics: - what to check for? (you’ve had personal experience)
○ Check BP and Creatinine level
○ Check K and Mg level (hold and report if <3.5 mEQ/L)
○ Monitor I and O
○ Assess weight esp for patients with heart failure
Digoxin (digging for a new heart) what to do before giving to patient? (And what else? Same as spiro)
Digoxin-for heart failure; Take APICAL pulse for 1 min;
Check Potassium Levels – low K+ ↑ risk of digitalis (this is just digoxin) toxicity
Laxatives/stool softeners - what to ask about
○ Assess number of BMs and
consistency. Any GI
discomfort?
