Medication Administration

Question 1

What percentage of patients experience a medication error

Answer 1

3% - 6.9%

Question 2

What contributes to medication errors

Answer 2

System processes
Workload
Lack of communication and collaboration
Inadequate education
Work arounds

Question 3

What must be reported

Answer 3

Errors and near misses
(In order to induce change)

Question 4

What is a near miss

Answer 4

Exposed but not harmed d/t detection or luck

Question 5

Errors can begin at what stage and are followed until what stage

Answer 5

Prescribing stage followed by the administration phase

Question 6

Potential errors are not eliminated by

Answer 6

Technology
(Do not assume and question any issue)

Question 7

Nurses need to do what involving medication errors

Answer 7

Nurses need to meet the standards of practice

Question 8

Who does the prescribing phase

Answer 8

HCP or pharmacist

Question 9

Who does the transcribing phase

Answer 9

Nurse

Question 10

Who does the dispensing phase

Answer 10

Pharmacist

Question 11

Who does the administering phase

Answer 11

Nurse

Question 12

Who does the monitoring phase

Answer 12

Nurse, physician, pharmacist

Question 13

Failure to assess/evaluate would include

Answer 13

Failure to…
-See significant changes in patient’s condition after taking a medication
-report the changes in condition after medication
-take a complete medication history and nursing assessment/history
-monitor patient after medication administration

Question 14

Failure to ensure safety would include

Answer 14

-lack of adequate monitoring
-Failure to identify patient allergies and other risk factors related to medication therapy
-inappropriate drug administration technique
-failure to implement appropriate nursing actions based on a lack of proper assessment of patient’s condition

Question 15

Medication errors would include

Answer 15

Failure to…
-clarify unclear medication order
-identify and react to adverse drug reactions
-be familiar with medication before its administration
-maintain level of profesional nursing skills for current practice
-identify patients identity before drug administration
-document drug administration in medication profile

Question 16

Fraud would include

Answer 16

-Falsification of documentation on the medication profile or patient’s record
-failure to provide the nursing care that was documented

Question 17

What are the rights of medication administration

Answer 17

-right drug
-right dose
-right time
-right route and form
-right patient
-right documentation
-right reason
-right reason
-right response
-right to refuse

Question 18

What are the components of a medication order

Answer 18

-patients name
-medication name
-dose with unit measurement
-frequency
-route
-prescribers signature w/date and time
(indication may not be indicated with PRN)

Question 19

What are the causes of medication errors

Answer 19

-not doing “three checks”
-giving medications to the wrong patient
-confusing sound a-like and look alike drugs
-not obtaining a through medical history
-lack of knowledge
-dosing miscalculations
-work arounds
-environmental factors

Question 20

How can a nurse prevent medication errors

Answer 20

-assess drug allergies, vital signs, and lab data
-never administer drugs you did not prepare yourself
-recalculate doses for high alert and pediatric patients and second RN
-avoid verbal orders if possible
-use authoritative sources
-question the need for overriding systems
-investigate patient concerns
-seek translators when needed
- ask questions (no question is stupid)
-report errors and near misses

Question 21

When reporting and documenting errors you should

Answer 21

-assess patient first
-report to the instructor and nurse
-monitor changes in condition
-document follow up assessments using factual information (dont use the word error bc it is judgmental)
-notify physician and follow up orders
-provide full disclosure to the patient
-file incident report (not in the chart)

Question 22

What do you do if a medication order has a missing component

Answer 22

Call the physician

Question 23

ISMP

Answer 23

Institute of safe medication practices
Primary purpose is identifying the causes of medication errors and of recommending evidence based strategies for the prevention of these errors

Question 24

What has the ISMP done

Answer 24

Made a list of error prone abbreviations, symbols, and dose designations
Identify high alert medications that have increased potential for patient harm
Made a list of the look alike/sound alike drugs

Question 25

FDA

Answer 25

The office of generic drugs of the U.S. food and drug administration (FDA)
Recommends that drug manufactures use tall man lettering

Question 26

Tall man lettering

Answer 26

Is the use of mixed case letters in a drug name with the specific purpose of highlighting a section of the drug name in bold capital letters, therefore making the name more noticeable on the packaging and on the drug label
(Helps distinguish the drug form another drug with a similar name)

Question 27

Black box warning

Answer 27

Included on the label or specific prescription medications to advise the healthcare professional and patient about serious and potential risks and side effects related to the use of the drug

Question 28

Regardless of the format the MAR must have

Answer 28

-drug name
-ordered dose
-route
-frequency
-correctly identify patient
(Ordered by physician)

Question 29

What does each right provide

Answer 29

The nurse the opportunity to question and clarify any misinterpretations in the administration of the drug that may lead to a medication error before administering the drug to the patient
(Promotes patient safety)

Question 30

What are the 6 rights of medication administration

Answer 30

Right drug
Right dose
Right route
Right patient
Right time
Right documentation

Question 31

The nurse needs to correlate the medication with ?
What is the nurse required to do?

Answer 31

Correlation of the medication with the patient’s needs and follow up care of the patient after the administration of the drug

-know the drugs action
-have an understanding of why the drug is ordered for the patient
-carefully monitor the patient for the drug’s therapeutic and side effects

Question 32

What are the rights associated with the preparation phase

Answer 32

Right drug
Right dose
Right route

Question 33

What is a “no interruption area”

Answer 33

Allow the nurse to prepare the patients medication in a distraction free enviorment employing a “medication pass time out” could also wear a “do not disturb” vest to minimize disruptions during this process

Question 34

To ensure medications are given at the right time the nurse

Answer 34

Follows the medication administration times and guidelines set by the healthcare facility

Question 35

ADE

Answer 35

Adverse drug event is a broad term for any undesirable occurance involving medication
(Can’t vary from no effects to mild discomfort to life threatning complications, permenat disability, disfigurement, or death)
*can be preventable or unpreventable

Question 36

ADE external vs. internal

Answer 36

External: errors by caregivers either professional or unprofessional or malfunctioning equiptment

Internal: patient induced, when a patient fails to take medications as prescribed or drinks an alcoholic beverage when advised not to

Question 37

What are the categories of ADEs

Answer 37

Medication errors

ADRs

Question 38

What is a medication error

Answer 38

A preventable situation in which there is a compromise in the 6 rights
(More common then ADRs)

Question 39

ADR

Answer 39

Adverse drug reaction is any reaction to a drug that in unexpected and undesiarbable and occurs at therapeutic drug dosages
(May or may not be causes by medication errors)

Question 40

What can an ADR result in

Answer 40

Hospital admission, prolongation of hospital stay, change in drug therapy, initiation of supportive treatment, or complication of patient’s disease

Question 41

What are the drug categories that are specific to a particular drugs group

Answer 41

Pharmacologic reaction
Hypersensitivity reaction (allergic reaction)
Idiosyncratic reaction
Drug interaction

Question 42

Pharmacologic reaction

Answer 42

An extension of the drug’s normal effects in the body
Ex. Drug used to lower blood pressure lowers it too much and the patient becomes unconscious

Question 43

What are some facts about pharmacologic reactions

Answer 43

Adverse effects are predictable, well known, result in minor changes in patient managment

Usually related to dose and resolve upon discontinuation of the drug

Question 44

Allergic reactions

Answer 44

“Hypersensitivity reactions”

Involves the patient’s immune system, the immunoglobulins recognize the drug molecule, its metabolites, or other ingredient as a foreign substance causing the immunoglobulins to bind to the drug, releasing cytokines and histamine.

Reaction can be mild such as a rash or severe or life threatning such as constriction of bronchial airways and tachycardia

Question 45

Idiosyncratic reaction

Answer 45

occurs unexpectedly in a particular patient, is a genitaclly determined abnormal response to normal dosages of a drug
(Usually caused by a deficiency or excess of drug metabolizing enzymes)

Question 46

Drug interactions

Answer 46

Occurs when the presence of two or more drugs in the body produces an unwanted effect, results when one drug either enhances or reduces the effects of another drug

(Can be intentional and beneficial or can be harmful)

Question 47

What does SALAD stand for

When are they most dangerous

Answer 47

Sound
Alike
Look
Alike
Drugs

(Mix ups are most dangerous when the drugs have different therapeutic classes but have similar names)

Question 48

What should the nurse do when taking a verbal prescription

Answer 48

Write the prescription, sign it with the providers name, followed by your name and credentials
Repeat the perscription to the provider and spell the medication name to ensure accurency
(Should only be done in urgent situations bc of risk for miscommunication)

Question 49

What should you do if you belive a perscription is incorrect

Answer 49

-look up the medication in a reliable resource, verify spelling, usage, dosage, and route
-ask another nurse or provider to check the perscription and compare it to your resource data
-contact the prescriber for clarifications, concerns, or questions

Question 50

What are the three checks

Answer 50

1. BEFORE you pour a medication check its label against the entry on the eMAR for name, route, dose, and time
2. AFTER you prepare the medication and before returning the container to the medication cart or discarding anything, check label again
3. AT THE BEDSIDE check the medication before actually administering it