Medication Administration

Question 1

what is a near miss?

Answer 1

when a Pt. is exposed but not harmed due to d/t detection or luck

Question 2

does a near miss have to be reported?

Answer 2

yes

Question 2

what contributes to medication errors?

Answer 2

-system processes
-workload
-lack of communication and collaboration
-inadequate education
-workarounds

Question 3

technology eliminates potential medication errors. true or false?

Answer 3

false. (do not assume correct and question any issues)

Question 4

what are the stages of the medication process?

Answer 4

1. prescribing
2. transcribing
3. dispensing
4. administering
5. monitoring

Question 4

what % of pts. experience a medication error?

Answer 4

3-6.9%

Question 5

what phases of the medication process is the nurse involved in?

Answer 5

transcribing
administering
monitoring

Question 6

who is involved in the prescribing phase?

Answer 6

HCP, pharmacist

Question 7

what is involved in the prescribing phase? (5 steps)

Answer 7

-clinical decision making→ -drug choice→
-drug regimen determination→
-medical record documentation→
-order (written, verbal, electronic)

Question 8

who is involved in the transcribing phase?

Answer 8

the nurse

Question 9

who is involved in the dispensing phase?

Answer 9

the pharmacist

Question 9

what is involved in the transcribing phase? (2 steps)

Answer 9

-receive order from eMAR→
-check if correct (acknowledge is all we do)

Question 10

what is involved in the dispensing phase? (4 steps)

Answer 10

-data entry and screening→
-preparing, mixing, -compounding→
-pharmacist double-check→
-dispensing to unit

Question 11

who is involved in the administering phase?

Answer 11

the nurse

Question 12

what is involved in the administration phase? (4 steps)

Answer 12

-drug preparation for administering→
-nurse verifies orders→
-drug administered→
-documented in eMAR

Question 13

who is involved in the monitoring phase?

Answer 13

nurse
physician
pharmacist

Question 14

what is involved in the monitoring phase? (4 steps)

Answer 14

• assess for therapeutic and adverse effects→
  -review laboratory results if necessary→
  -treat adverse drug event if occurring→
  -medical record documentation

Question 15

what happens after the monitoring stage?

Answer 15

quality improvement activities (as needed)
-voluntary safety reporting
-mandatory safety reporting for serious events w/in organization
-outcomes measurement for certain populations

Question 16

what are the 9 rights of medication administration?

Answer 16

1. right drug
2. right dose
3. right time
4. right route and form
5. right patient
6. right documentation
7. right reason
8. right response
9. right to refuse

Question 16

how is the right patient identified?

Answer 16

ask pt. name and DOB
verify with eMAR
verify with ID band

Question 17

what are the 7 components of a medication order?

Answer 17

1. patients name
2. medication name
3. dose with unit measurement
4. frequency
5. route
6. prescribers signature w/ date and time
7. indication

Question 18

when is “indication” not used?

Answer 18

in PRN meds in acute care (req. in LTC)

Question 19

what is missing?
acetaminophen 650mg q6h prn pain

Answer 19

route

Question 20

what is missing?
hydrocodone/acetaminophen tabs PO q4h prn

Answer 20

dose

Question 20

what is missing? morphine sulfate 2 q2h prn pain

Answer 20

measurement route

Question 21

what is missing? furosemide 40mg one tab PO

Answer 21

frequency

Question 22

what does SALAD stand for?

Answer 22

sound-alike, look-alike drugs

Question 23

what is the point of TALLman lettering?

Answer 23

FDA and ISMP have drawn attention to sound-alike, look-alike drugs by using distinctive tall lettering on drugs that are often confused Ex oxyCODONE and oxyCONTIN

Question 24

What are the four umbrellas under Adverse Drug Reactions (ADRs)?

Answer 24

-drug-drug interactions -allergic -adverse reactions (side effects) -idiosyncratic

Question 25

what is the difference between ADRs and medication errors?

Answer 25

one is preventable (med errors)

Question 26

what are adverse drug events (ADEs)

Answer 26

any injuries resulting from medication use. can result in prolonged hospitalization, disability, life-threatening problems or death

Question 27

what are the (2) characteristics of drug-drug interaction?

Answer 27

-2 or more drugs -enhances or diminish effects of another drug

Question 28

what are three points under adverse reactions (side effects)?

Answer 28

-predictable -may need symptom management (stool softener) -resolves with discontinuation

Question 29

what are the two points under allergic reactions?

Answer 29

-hypersensitivity -immune response

Question 30

what are the two points under idiosyncratic reactions?

Answer 30

-unpredictable, unexpected -rare and peculiar

Question 31

how are medication errors different from the other Adverse Drug reactions?

Answer 31

they are preventable

Question 32

what is the definition of adverse drug reactions?

Answer 32

unexpected, unintended or excessive reaction that occurs at therapeutic doses

Question 33

what are the bullet points under medication errors?

Answer 33

-error in the med process -may/may not cause harm -"rights" compromised -known allergies

Question 34

what are the 7 steps that need to be taken if a medication error occurs?

Answer 34

1. assess pt. first 2. report to the instructor/charge nurse 3. monitor changes in condition 4. document follow-up assessments using factual information (no using word "error") 5. notify physician and follow-up orders 6. provide full discloure to the pt. 7. file incident report to hospital

Question 35

what are (8) common kinds of medication errors?

Answer 35

-not doing 3 checks -giving meds to the wrong pt. -confusing sound-alike drugs -not obtaining a full medical history -lack of knowledge -dosing miscalculations -work-arounds -environmental factors

Question 36

what is a recommended way to avoid dosing miscalculations?

Answer 36

ask another nurse to calculate the dosage to verify (without knowing what answer you got)