IM1-MED ADMIN FOR EXAM 5,6,7 Flashcards
1
Q
Medical errors are the __1__ leading cause of death in the United States, after heart disease and cancer, according to findings published in BMJ, 2016…. and based on 34,416,020 hospitalizations, over ___2_____ deaths stemmed from a medical error
A
- 3rd
- 251,000
2
Q
Typically, nurses have more than ___ orders per shift
A
50
3
Q
Medication orders require how much of the nurse’s time?
A
- 1/3
4
Q
Medication errors cause at least ___ death every day in the U.S.
A
1
5
Q
Medication errors INJURE more than ___ million people every year in the US
A
1.3 Million
6
Q
The US spends more than ____ billion each year on patients who have been affected by med errors
A
40
7
Q
Medication errors have been made by __1___% of the nurses. . In addition, __2__% of the participants reported medication errors on the verge of occurence
A
- 64.55%
- 31.37 %
8
Q
The most common types of reported errors were wrong ____ and ____
A
- Dosage
- Infusion Rate
9
Q
The most important cause of medication errors was lack of ______?
A
- Pharmacological knowledge
10
Q
Medication errors can result in
List 5
A
- Death
- Life threatening situation
- Hospitalization
- Disability
- Birth defect
11
Q
True or false: Medication errors can be prevented?
A
Trie
12
Q
Can inappropriate medication use cause harm?
A
Yes
13
Q
A provider ____ and ____ meds
A
- Prescribes
- Monitors
14
Q
A pharmacist ____ and ____ meds
A
- Verifies
- Prepares
15
Q
A nurse _____ and ____ meds
A
- Administers
- Monitors
16
Q
What are points of medication errors?
A
- Ordering/prescribing
- Transcribing
- Dispensing
- Administering
- Monitoring
17
Q
As nurses we are “monitors” what does this mean for us?
A
- We are responsible for recognizing S/S of a reaction
18
Q
What are the 10 types of medication errors
A
- wrong patient
- wrong drug
- wrong route
- wrong time
- wrong dose/omitted dose
- wrong dosage form
- wrong technique
- deteriorated drug error- (expired, discolored drug)
- compliance (not given the way it was supposed to be given can be patient or RN fault)
- wrong documentation.
19
Q
What factors could a provider/pharmacist/nurse run into that could cause a medication error?
A
- Distractions
- Poor communication
- Lack of training
- Inadequate knowledge of a patient
- Inadequate knowledge of drug
- Overworked or fatigued/lack of sleep
- physical/emotional health issue/stress
- Administration technique
- Lack of knowledge of drug-drug inte
- Miscalculation of dosage
- Drug preparation
- Computer error
- Stocking error
- Transcription error
20
Q
What factors with the patient could cause a medication errors?
A
- Personality
- Literacy
- Language barriers
- Multiple health conditions
- Polypharmacy
- Inconsistent method
21
Q
What communication factors are associated with medication errors.
A
- Name confusion
- Illegible handwriting
- Verbal order
- Brand name confusion
- Generic name confusion
- Labeling
22
Q
What are ways to reduce medication errors?
A
- Patient and patient families take an active role and be informed
- Give healthcare workers tools and information needed to prescribe dispense and administer
-Computerized order entry system- Having a clinical pharmacist accompanying physicians in high risk area
- Bar-code systems
-Medication reconcilliation - Not using error prone abbreviations
- Medication education for new and existing staff
- Limitations and safeguards for verbal orders
23
Q
What are ways to reduce medication errors?
A
- Patient and patient families take an active role and be informed
- Give healthcare workers tools and information needed to prescribe dispense and administer
-Computerized order entry system- Having a clinical pharmacist accompanying physicians in high risk area
- Bar-code systems
-Medication reconciliation - Not using error prone abbreviations
- Medication education for new and existing staff
- Limitations and safeguards for verbal orders
24
Q
What is complacently in the workplace?
A
Is when you become so secure in your work that you take potentially dangerous shortcuts in your tasks, don’t perform to the same quality as you once did or become unaware of deficiencies
25
The TALL man system helps us do what?
Helps us differentiate meds and prevent med errors
26
What is a black box warning?
1. Strictest labeling requirements FDA can mandate for prescription drugs
2. Alert of increased risk- may result in death or serious injury
27
When a med error occurs what happens and who is the priority?
1. Assess/monitor patient continuously for adverse reactions, notify the charge nurse and contact physician
2. Complete and incident report
3. Evaluate the patient
4. The patient is the PRIORITY
28
"Every step of safe medication administration requires a discipled attitude and a comprehensive, systemic approach"
Nurses need to know
1. Medication knowledge -- pros & cons
2. Patient allergies
3. How to calculate medication dosages
4. Factors affecting the patients response
5. Nursing process
6. Nurse practice act (NPA)
29
The role of the nurse in med admin is.....
1. Having an up-to-date database of drugs.
-knowing the medication
- known/new
- Dose(s)
- route
- frequency
- reason
- instructions/considerations/precautions/drug-on-drug interactions
2. Know how to give meds correctly/know the skills
3. know your patient.
4. Implement nursing care plan
- assessments
- problems
- desired outcome/goal
- intervention(s)
- Evaluation(s)
5. Patient teaching from admission to D/C
6. Advocate by protecting the patient
30
How can we advocate for the patient when it comes to med admin
1. Question/clarify incorrect or incomplete medication orders
2. Know when to hold medications or request alternate route, if needed
3. Know if meds are compatible
4. Never leave meds unattended or at the bed side
31
Who is held accountable for a med admin error?
Nurse
32
What is the role of a patient during med admin?
1. Understand their responsibilities
2. Understand the treatment and question what they do not understand
3. adhere to the regimen (take medication correctly)
4. Avoid misuse or abuse of medications
5. Report adverse effects of medications or changes in medical condition
6. Store medications safely
7. Received a qualified nursing assessment
8. be informed of the name, dosage, reason, frequency, route, potential undesired effects
33
The patient has the right to (med admin)
1. Receive labeled mediation(s) & opened in their presence
2. Received mediation admin correctly
3. NOT to receive unnecessary medication
4. Refuse to take a medication - always double check if patient questions you.
34
What are the components of a medication order
1. Patient name
2. Date and time
3. Name of medication
4. Dosage
5. Route of administration
6. Time/frequency of admin
7. signature/verification of prescriber
35
What is a standing or route order
Administered until the dosage is changed or another medication is prescribed
36
What is a single (one-time) order?
Given one time only for specific reason
37
What is a NOW order?
1. When a medication is needed right away but not STAT.
38
What is a range order?
Medication order is written with dosage having a range
39
What is PRN/Contingency order?
Given when the patient requires it
40
What is a STAT order?
1. Given immediately in an emergency
41
What is a prescription?
Medication to be taken outside of the hospital
42
What information should you obtain during a verbal/telephone order? (med admin)
1. Patients name
2. Date and time
3. Medication
4. Dosage
5. Route
6. time and frequency
7. signature of prescriber
43
What should we avoid using during verbal/telephone orders?
DNU abbreviations
44
What must a charge nurse/RN do when taking a verbal/telephone order
must document "read back" "spell back"
45
How long does the provider have to approve and verify a telephone/verbal order?
24 hours
46
What are the 7 rights of medication administration?
1. Right patient
2. Right medication
3. Right dose
4. Right Time
5. Right route
6. Right reason
7. Right documentation
47
RIght ___ - use two identifiers --
Right patient
48
Right ___- check label!!
Medication
49
Right ______- know what the appropriate dose ranges are based on the route and patient
dose
50
Right ____- know how the drug can and cannot be given; order determines route
Route
51
Right ___ & ___ -know medication schedules
Date & Time
52
Right_____- is the order/medication appropriate
-patient history, diagnostics
-thorough assessments
Reason
53
Right____ in the eMAR
-May require co-signature/updated info
- Always document delays, omissions/refusals, reassessments/responses
Document
54
What is diversion?
DEA defines diversion as the use of prescription drugs for alternative purposes from the original intent. +15% of healthcare workers divert narcotics
55
What are the contributing factors leading to abuse of drugs?
1. stress and chronic illness
56
True or false: hospital narcotics are drug of choice (DOC) for abusers
True
57
What is the DEA's position on diversion?
Any employee who has knowledge that a co-worker is stealing drugs has an obligation to report such information to the immediate supervisors or employer
58
True or false: Diversion investigators do not address concerning activity reported from the hospital
False- they do address.
59
True or false: Narcotic accountability is maintained & monitored 100% of the time, 24 hours a day, every day via the pyxis system
True--- daily and weekly reports from pharmacy- every action on the pyxis system is recorded
60
True or false: Every other time a narcotic is pulled a before/after count of the narcotic is recorded
False-- Every time
61
True or false: Wastage of narcotics is always witnessed and immediately documented by another licensed nurse
True
62
What are the consequences of diversion?
1. Drug screening with 3-day suspension for positive finding for narcotics
2. Immediate termination if deemed necessary
3. Report peer review to establish tx
4. Report TNE of violation and TX
5. Police are notified, report filed, CEO involved, ETC
6. Can lose nursing license
63
What program is available for nurses who have diverted drugs?
Texas peer assistance program for nurses (TPAPN)
Voluntary participation or Mandated could be put in place
64
What is the goal of TPAPN Texas peer assistance program for nurses.
Goal is to identify nurses experiencing mental health, alcohol, or drug problems and assist these nurses in obtaining appropriate treatment and return to work
65
If a nurse is convicted of diverting a drug for personal use what could happen?
1. state jail felony-- 180 days to 2 years
2. fine up to 10,000
3. Suspension or revocation of license
66
If a nurse is convicted of diverting a drug for the benefit of others what could happen?
1. 2-10 years
2. Fine up to 10,000
3. Suspension or revocation of license.
67
What are the different types of medication names?
1. Chemical names (rarely used)
2. Generic
3. Trade
68
What is the classification of meds
1. It groups meds that work similarly....
2. have similar chemical makeup
3. Treat similar conditions
69
What are the types of medication forms
1. pills
2. injection
3. Liquid
4. Suppository
5. Topical
6. Orifice drops/sprays
7. troches
70
What are types of non-parenteral medications?
1. Oral
2. Topical
3. Suppositories
4. Eye medication
5. Ear medication
6. inhalant medication
71
What is an adverse drug reaction (ADR)
Unintended and undesired effects at normal drug doses
72
What do the side effects of an adverse side effect look like?
1. predictable
2. intensity is dose dependent
3. development depends varies
73
Severe ADR can cause what?
1. Toxicity- Can be either excessive drug dosing or therapeutic drug dosage
74
What are some things we should know about allergic reactions?
1. It is an immune response
2. Intensity of reaction varies
3. Not based on dosage
4. Sensitivity of drug can change over time
75
What is Idiosyncratic drug effect?
1. Uncommon drug response because of genetic disposition
76
What is a paradoxical drug effect?
1. Opposite effect drug was inteded for
77
What is a iatrogenic drug effect
Disease caused by drug
78
What is a teratogenic drug effect
Causing birth defects
79
What is a physical dependence drug effect?
1. Body has adapted to drug exposure.
2. Happens commonly with opioids, barbiturates, amphetamines, psyche meds...etc
3. Abstinence syndrome occurs-- which is why it is important to warn patients about abrupt discontinuation and the harmful effects it can have
80
True or false: Physical dependence drug effect is an adverse reaction?
true
81
What questions can we ask if we believe a patient is having an adverse drug reaction?
1. Did symptoms occur shortly after drug use
2. Did symptoms leave after drug discontinued
3. Did symptoms reappear when drug was reinstituted
82
What are some ways to minimize adverse drug reactions?
1. Education
2. Early Identification
3. Monitoring- lab values, S/S, individualized therapy (risks vs benefits)
4. Awareness of Black box warnings
83
What are the medication guidelines?
1.Have description of drug and indications
2. Know who should NOT take the drug
3. Know how the drug should be taken and what to do if there is an overdose or missed dose
4. Know what should be avoided while taking the drug
5. Know Possible and reasonable side effects
84
What forms of medication can an oral med come in?
1. Tablet
2. Caplets
3. Capsules
4. Syrups
5. Suspension
85
What are the different types of oral releases?
1. Delayed release-- enteric coated
2. Extended release-- controlled release, sustained release and long-acting
3. Oral disintegrating- disintegrates in mouth
86
What position should the patient be in when taking oral meds?
no lower than 30 degrees... the higher the degree the easier it is to swallow
87
How can we assess for potential aspiration?
Having a patient perform the swallow test.
1. Asking the patient to take a sip of water and assessing there ability there before giving meds.
88
True or false: You should or can ask the patient how many pills they wish to take together. However, you should limit the amount to 3 or less to prevent aspiration?
True
89
True or false: You should supervise a patient swallowing their pill?
Yes- 1. to make sure they do not aspirate and 2. To make sure they do not pocket the meds in their check
90
When measuring liquid medication you should always assess the volume at _______ level?
Eye
91
When should you avoid PO meds?
1. Changes in LOC
2. NPO status
3. Altered GI function-- NG tube w/suction or N/V
4. dysphagia
92
Which PO meds should you not crush, split or chew...
1. Enteric coated (EC)
2. Sustained release (SR)
3. Time released (TR)
4. Controlled delivery (CR)
5. Sublingual (SL)
6. Buccal
93
Review Non enteral medication slide 19 for a refresher on crushing pills
Review Non enteral medication slide 19 for a refresher on crushing pills
94
What should we clean a pill splitter with?
Alcohol before and after use
95
What are topical medications?
Medication applied to body surfaces or mucous membranes
96
What are Routes of topical medications?
1. Skin application
2. Eye instillation
3. Ear instillation
4. Vaginal instillation
5. Rectal instillation
97
What are types of topical meds?
1. Powders
2. Creams/pastes/gel/ointments
3. Drops
4. Aerosols or sprays
5. Medicated patches
6. Suppositories
98
When administering topical medications what should you do?
1. Assess area prior to application
2. Clean previous & present area well
3. Avoid shaving
4. Measure if needed
5. Apply as directed
6. Cover if called for
99
Why should you assess the area prior to topical medication administration?
You want to check the skin integrity. You do not want to use that site if the integrity of the skin has been compromised
100
Why do you not want to shave the area you plan to apply topical medication too?
It can cause irritation
101
How do we measure topical medications
Squeeze out about an inch---- but really depends on how much is needed to cover to tx area appropriately
102
True or false: You should remove previous transdermal patch & clean previous area before replacing
True
103
What should you write on the patch before applying it on the patient?
1. Date
2. Time
3. Inital
104
True or false: it is okay to cut all transdermal patches?
False- most are DO NOT CUT
105
What should you avoid when using a transdermal patch?
1. Heating pads
106
Besides replacing the patch, when else might you
have remove the transdermal patch?
1. For an MRI
2. If you have to use AED on patients
107
When giving a patient a rectal suppository what should you do?
1. Explain the procedure
2. Have pt lay on left lateral side (SIMS) position
3. Don gloves- remove packaging
4. Prep the med (lubercant)
5. Relaxation techniques
6. Proper insertion
7. Patient teaching ( try not to push for about 10-15 min)
108
When giving a vaginal medications what should you do?
1. Explain the procedure
2. Have patient lay in the lithotomy position
3. Don gloves-remove packaging
4. Proper insertion/application of (2-3in gently)
5. Patient teaching-- also a patient may administer own if desired, provide pad if needed
109
How far should you insert a rectal suppository in an adult patient?
1 1/2in
110
When administering eye medication what should you do?
1. Know the medication and why you are giving it
2. Explain the procedure and give instructions
3. Don gloves
4. Position pt & eyelid
5. Instill as prescribed-- conjunctiva sac
6. To prevent drug from becoming systemic put tissue on corner of eye and apply pressure.
7. Avoid touching the top or tube to the eye or eyelash
111
When administering ear medication what should you do?
1. Explain procedure and give instructions
2. Don gloves
3. Turn head or lie on unaffected side
4. Position auricle
5. Instill prescribed amount
6. Don't medicate opposite ear immediately. --- wait about 10 mins
112
When administering ear drops in an adult which direction should you move the ear?
Pull ear back and up
113
True or false: You should do a pre & post assessment when administering an inhaler?
True-- you want to be able to see if the drug helped
114
When administering an inhaler what should you do?
1. Explain procedure
2. Position patient & inhaler/spacer
3. shake the MDI 5-6 times
4. Deep breath than exhale > tilt head back slightly > depress canister x1 and then inhale slowly
5. Hold breath about 5-10 seconds
6. Wait 1 min and repeat if rxd
7. Rinse mouth
115
What is an MDI spacer?
It attaches to the mouthpiece of inhaler and spacer.
116
How do you use and MDI spacer with an inhaler?
1. Attach mouthpiece of inhaler to spacer
2. Shake inhaler
3. Patient seals mouth on spacer
4. Press inhaler than inhale. breath in
5. Remove inhaler from spacer and recap both
117
How do you administer a DPI inhaler?
1. Usually has dose counter
2. Pull the lever back to load inhaler
3. Hold it flat like a hamburger. Do not tilt.
4. Put mouth around mouthpiece after exhaling
5. Quickly inhale, hold breath
6. Take empty capsules and throw away if needed, clean mouthpiece
118
What could be an indication that you did not take your DPI inhaler correctly?
1. Strong medication taste in mouth.
119
What does DPI stand for?
Dry powered inhaler
120
What does MDI stand for?
Metered dose inhaler
121
When using multiple inhalers how long should you wait between each inhaler of different medications?
2-5 minutes
122
Which should you use first a bronchodilator inhaler or steroid inhaler
Bronchodilator
123
What are the verification steps in safe medication administration?
1. Acknowledge prescribers orders(s)
2. Check eMAR vs meds at pyxis, etc
3. check eMAR vs meds & patient at bedsire
124
What are the components of a drug label?
1. expiration date
2. lot number
3. drug form
4. manufacturer
5. generic name
6. brand name (trade)
7. dosage
125
What should we teach our patients when administering drugs?
1. Name of med (trade and generic)
2. Dosage
3. Route
4. Frequency
5. Reason
6. Possible side effects
