Med Admin Flashcards
medical error
third leading cause of death in the US, after heart disease and cancer, according to BMJ, 2016 … and based on 35 million hospitalizations, over 251,000 deaths stemmed from a medical error.
(just medical error, but medication error falls under this)
medication stats
- nurses require more than 50 orders per shift
- requires 1/3 of the nurse’s time
- 7000-9000 Americans die as a result of a med error
- med errors cause at least 1 death every day in the US
- med errors injure more than 1.3 million people every yr in the US
- US spends more than 40 billion each yr on patients who have been affected by med errors
- med errors has been made by 64.55% of the nurses. 31.37% of the participants reported med errors on the verge of occurence.
- the most common types of reported errors were wrong dosage and infusion rate
- the most important cause of med errors was lack of pharmacological knowledge
medication errors
- death
- life threatening situation
- hospitalization
- disability
- birth defect
med errors - who
preventable event
- inappropriate medication use
- may cause harm
provider order: prescribes, monitors (physician, APRN, nurse prac)
–> pharmacist (resource, dispenses): verification, preparation
–> nurse administers: administers, monitors
(provider - could confuse patients, meds, or correct dosages for meds, and prescribe wrong,
nurse monitors vital signs, s/s, and labs (if don’t monitor correct labs by checking them before for specific meds = error))
points of med error - when
- ordering/prescribing
- transcribing
- dispensing
- administering
- monitoring
types of med errors - what
- wrong patient (identify with armband)
- wrong drug (pyxis should be correct but look at name, dose and expiration date)
- wrong route (ex: supposed to be IV, gave IM)
- wrong time (always stick to given with food or w/o food but can be given within the hour that it is listed)
- wrong dose/omitted dose (ex: forgot or overlooked dose, only gave 1 pill when it is 2)
- wrong dosage form (ex: supposed to be tablet, but it is liquid)
- wrong technique (ex: levanox given in specific areas, but not near belly button, gave near belly button)
- deteriorated drug error (IV liquid cloudy)
- compliance (_)
- wrong documentation (wrong chart, date, time, dose, med, patient)
factors associated with med errors - why
provider/pharmacist/nurse
- distractions
- poor communication (between nurses)
- lack of training (don’t know how to use IV)
- inadequate knowledge of patient (don’t know patient already took med from home)
- inadequate knowledge of drug
- overworked or fatigued/lack of sleep
- physical/emotional health issues/stress (interfere with being present)
patients:
- personality
- literacy (they can’t understand what you’re telling or asking them, ex: allergic to something)
- language barriers
- multiple health conditions
- polypharmacy
- inconsistent method (need to be systematic and do the same things every time so you don’t mess up)
factors associated with med errors - why
pharmacy/pharmacist/nurse:
- admin technique
- lack of knowledge drug-drug interactions
- miscalculation of dosage
- drug preparation
- computer error
- stocking error
- transcription error
communication:
- name confusion (med names sound same, look same)
- illegible handwriting
- verbal order
- brand name confusion
- generic name confusion
- labeling (wrong pill is labeled as med, when it is a different med)
ways to reduce med errors
- patients and patient families take an active role and be informed: educating the patient
- give healthcare workers tools and info needed to dispense and administer
– computerized order entry system
– having a clinical pharmacist accompanying physician in high risk areas
– bar-code systems
– med reconciliation
– not using error prone abbreviations (Joint Commission banned)
– med education for new and existing staff
– limitations and safeguards for verbal orders
(teach pt about med every time they take it, unless they tell you to stop)
no place for complacency in nursing
complacency = 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
pay attention to
look-alike or sound-alike meds
the TALL man system
(capitalizes some letters to help us tell meds apart that sound and look similar)
black box warning
- alert of increased risk: may result in death or serious injury
- strictest labeling requirements FDA can mandate for prescription drugs
when an error occurs - priority is pt
- assess/monitor patient continuously for adverse reactions, notify the charge nurse and contact the physician
- complete an incident report
- evaluate patient’s status, make sure stable
- report all errors even if no s/s so they can investigate why error occurrred and make system better
- want a safe culture
nurses need to have and know
- disciplined attitude + comprehensive systematic approach
- med knowledge - pros and cons (patient safety)
- patient allergies
- how to calculate med dosages
- factors affecting the patient’s response (in drug resource)
- nursing process
- nurse practice act (NPA)
roles of the nurse
- up to date data base
medications: - known/new
- dose
- route
- frequency
- reason
- instructions/considerations/precautions/drug-on-drug interactions
(some of these in drug resource)
