Medication Administration Flashcards
What percentage of patients experience a medication error
3% - 6.9%
What contributes to medication errors
System processes
Workload
Lack of communication and collaboration
Inadequate education
Work arounds
What must be reported
Errors and near misses
(In order to induce change)
What is a near miss
Exposed but not harmed d/t detection or luck
Errors can begin at what stage and are followed until what stage
Prescribing stage followed by the administration phase
Potential errors are not eliminated by
Technology
(Do not assume and question any issue)
Nurses need to do what involving medication errors
Nurses need to meet the standards of practice
Who does the prescribing phase
HCP or pharmacist
Who does the transcribing phase
Nurse
Who does the dispensing phase
Pharmacist
Who does the administering phase
Nurse
Who does the monitoring phase
Nurse, physician, pharmacist
Failure to assess/evaluate would include
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
Failure to ensure safety would include
-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
Medication errors would include
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
Fraud would include
-Falsification of documentation on the medication profile or patient’s record
-failure to provide the nursing care that was documented
What are the rights of medication administration
-right drug
-right dose
-right time
-right route and form
-right patient
-right documentation
-right reason
-right reason
-right response
-right to refuse
What are the components of a medication order
-patients name
-medication name
-dose with unit measurement
-frequency
-route
-prescribers signature w/date and time
(indication may not be indicated with PRN)
What are the causes of medication errors
-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
How can a nurse prevent medication errors
-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
When reporting and documenting errors you should
-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)
What do you do if a medication order has a missing component
Call the physician
ISMP
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
What has the ISMP done
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
FDA
The office of generic drugs of the U.S. food and drug administration (FDA)
Recommends that drug manufactures use tall man lettering
Tall man lettering
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)
Black box warning
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
Regardless of the format the MAR must have
-drug name
-ordered dose
-route
-frequency
-correctly identify patient
(Ordered by physician)
What does each right provide
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)
What are the 6 rights of medication administration
Right drug
Right dose
Right route
Right patient
Right time
Right documentation
The nurse needs to correlate the medication with ?
What is the nurse required to do?
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
What are the rights associated with the preparation phase
Right drug
Right dose
Right route
What is a “no interruption area”
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
To ensure medications are given at the right time the nurse
Follows the medication administration times and guidelines set by the healthcare facility
ADE
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
ADE external vs. internal
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
What are the categories of ADEs
Medication errors
ADRs
What is a medication error
A preventable situation in which there is a compromise in the 6 rights
(More common then ADRs)
ADR
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)
What can an ADR result in
Hospital admission, prolongation of hospital stay, change in drug therapy, initiation of supportive treatment, or complication of patient’s disease
What are the drug categories that are specific to a particular drugs group
Pharmacologic reaction
Hypersensitivity reaction (allergic reaction)
Idiosyncratic reaction
Drug interaction
Pharmacologic reaction
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
What are some facts about pharmacologic reactions
Adverse effects are predictable, well known, result in minor changes in patient managment
Usually related to dose and resolve upon discontinuation of the drug
Allergic reactions
“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
Idiosyncratic reaction
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)
Drug interactions
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)
What does SALAD stand for
When are they most dangerous
Sound
Alike
Look
Alike
Drugs
(Mix ups are most dangerous when the drugs have different therapeutic classes but have similar names)
What should the nurse do when taking a verbal prescription
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)
What should you do if you belive a perscription is incorrect
-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
What are the three checks
- BEFORE you pour a medication check its label against the entry on the eMAR for name, route, dose, and time
- AFTER you prepare the medication and before returning the container to the medication cart or discarding anything, check label again
- AT THE BEDSIDE check the medication before actually administering it
