Module 13 Flashcards
Alarming trends for medication in nursing
each year there are 1 mil emergency dept visits and hospitalizations due to adverse drug effects
approx 82% of American adults take at least one med and nearly 29% take five or more
We have aging pop with more chronic illnesses - so theres age related changes in drug response
Are side effects and adverse drug effects different?
yes, adverse are harmful and unintended unlike side effects which are manageable
Causes of medication errors
Transcription
prescribing
documentation
not adhering to the medication rights
trailing zeros and not placing a zero in front of the decimal
confusing names (similar names)
inappropriate use of abbreviations
distractions (poor lighting, heat, noise, interruptions, wrong medications, expired/discontinued or contaminated medications)
Prescribing Errors can be in the form of …
wrong times or dosages - nurse should double check
Safe Medication Administration includes understanding of …
generic/trade names
DEA schedules
pregnancy/lactation category
safety of dosage
medication of action
side effects
rate/route of excretion
interaction of medications
nursing considerations (lab values, effectiveness)
What is generic v trade name
Generic name is the chemical name
Trade name is the name on the label
DEA schedule describes …
level of addictiveness
What are nurses responsibilities for medication administration?
Legally responsible for medication they administer, so if they suspect an error they must question it
The nurse assumes individual accountability for safe drug administration by following the standards
Understand policy and procedures for safe medication handling and administration at each facility
No medication can be administered without being …
prescribed by a licensed practitioner !!!
Safe practice dictates that a nurse only follow what types of orders?
written, typed, or order entry orders
What situation allows for verbal orders
emergency
Student nurses are NOT allowed in any circumstance to accept ___ orders
verbal
There are ___ ___ for verbal Orders
legal implications for verbal orders
Medication reconcilitation
a process specifying and maintaining an accurate list of medications
When should the 3 checks of the 11 rights of medication administration be done?
First, when nurse reaches for the unit dose package or container
Second, after retrieval from drawer and compared with CMAR/MAR or compared immediately before pouring from multi dose container
Third, before giving unit dose to patient or when replacing the multi dose container in drawer or shelf
It is ___ for students to dispense medications
illegal
11 Rights of Medication Adminstration
Right Patient
Right Medication
Right Dose
Right Route
Right Time
Right Reason
Right Assessment
Right Documentation
Right Response
Right to education
Right to refuse
Right #1
Right Patient:
check patient name and DOB, compare to ID bracelet and what is stated
verify allergies
Right #2
Right Medication:
Perform triple check of all rights and medication label
(brand v generic names, be aware of similar sounding names, be familiar with medicine)
Never administer medication when…
it was prepared by another person
it was not labeled or had its labeled tampered with
Right #3
Right Dose:
check label for med concentration and compare dose with order
triple check med calculations
verify dose is in appropriate dose safe range for patient and in therapeutic range
Right #4
Right Route:
verify med route with order before administering
medication can only go via route specified
ID and use appropriate tools needed
Right #5
Right Time:
Verify schedule of med with the order
check for stop date and what time of day (in regard to order and institution policy
check for frequency and prior dosages
eval patient within 30 minutes or sooner per medication/policy
When performing Right Time, really focus on…
specified frequency and evaluation
Right #6
Right Reason:
Confirm the rationale for the ordered med
What is the pt hx, why are they taking it, revisit reasons for long term med use
Right #7
Right Assessment:
properly assess the patient and tests to see if med is safe and appropriate
if contraindicated, NOTIFY provider ASAP
If med was NOT administered, document and report
Right #8
Right Documentation:
completely document per facility policy immediately following administration
doc and report to approp provider any related S/S
Right #9
Right Response:
Monitor patient
Detect and prevent complications
evaluate any health changes
assess lab values and detect changes
document patients response to medication
provide patient education
Right #10
Right to Education:
Assess patients knowledge level
Provide education regarding: dosage, administration times, med side effects, confusion, contraindications
Right 11
Right to Refuse:
can refuse, but inform them on consequences of refusing
ensure that they understand consequences of refusal
notify the provider that the ordered medication was not given and document
document refusal and that they fully understand the consequences
Important considerations for medication administration?
Do not administer expired meds
Do not administer beyond stop date
Do not administer a medication that has had some chemical change`
Administer only medications labeled correctly and not tapered
What to do in the case of medication errors?
All med errors need to be reported; and all “near” misses need to be reported per facility policy
NEVER HIDE an error - it is important to get immediate attention
Errors can do what for patient safety
can highlight system flow issues and help facilitate changes to improve patient safety
Times you should not give medications
When the entire order is incomplete
Order should be signed by the provider
If the patient is showing any abnormal/physical concerns
When any of the 11 rights are missing
if the patient refuses
Any questions that are unanswered need to be double checked
Important Tips for Infection Control with med Administration
Infection control techniques
Hand washing
scrub hub for 15-30 seconds
1 needle/1 syringe/ 1 patient - EVERYTIME
per guidelines always insert a new sterile needle and syringe into a vial
Avoid distractions in red zone
follow policy for cosigning of meds
never pre pour meds
perform all rights 3 times
document now, not later
__ needle, syringe, patient
1 (EVERYTIME)
Best practice is to _____ multi dose vials
not use
When you administer meds, always do what
double check allergies
When you administer meds, never…
leave medications at the bedside
How many times should the 11 right be checked?
3 times
Ways to ensure safe medication administration
keep head elevated
make sure patient swallows and does not pocket the medication
consider oral motor concerns
difficulty or delayed swallowing (aspiration/choking) - check for it
“tonic” biting
age related changes
special needs for some patients
appropriate land marking for injectable medications
What are some other considerations regarding medications?
Reconcile medications as frequent as necessary but also per facility policy
cont monitoring of meds is essential for safety
watch for signs of DELIRIUM (confusion and disorientation)
med metabolism and absorption may be impacted by chronic illness and infection
What is the most common form of medication error
Omitted doses
Most common cause of medication errors is …
transcription errors
What contributes to the perpetuation of errors?
failure to do required double checks
Reliance on newer medication systems is changing the nature of medication errors how?
because nurses are becoming reliant on them rather than doing the 6 steps to minimize errors
What are the single most preventable cause of patient injury?
medication errors
What types of medication errors are there?
Prescribing Errors
Dispensing Errors
Administration errors
Prescribing Errors
Wrong patient, wrong dose, etc
failure to comply with legal requirements for prescription writing. The prescriber must specify the information which the pharmacist needs to dispense the drug in the correct dosage and form
Dispensing Error
Wrong thing given
errors that occur at any stage during the dispensing process from the receipt of a prescription in the pharmacy through to the supply of a dispensed product to the patient.
Administration Error
incorrect administration of the drug
discrepancy between the drug therapy received by the patient and the drug therapy intended by the prescriber.
What are some examples of prescribing errors?
incorrect drug dose, strength, route, quantity
adverse patient effects, drug allergies, wrong drug name, dosage form or abbreviation
incorrect dosage calculations
incorrect frequency
What are some examples of dispensing errors?
the selection of the wrong strength/product (two or more drugs have a similar appearance or similar name)
The use of computerized labeling which has led to the emergence of transposition and typing errors which are now among the most common causes of dispensing error
wrong dose
wrong drug
wrong patient
What is considered the highest risk area in nursing practice
drug administration (administration errors)
Administration errors largely involve what?
Errors of omission where administration is omitted due to a variety of factors
e.g. wrong patient, lack of stock
What are some examples of administration errors
wrong administration technique
administration of expired drugs
wrong preparation administered
What are some contributing factors to medication errors/prescribing error occurrence?
Illegible handwriting
Inaccurate drug history taking
Drug name confusion
Inappropriate use of decimal points
Use of abbreviations
Use of verbal orders
Lack of knowledge of the prescribed drug, recommended dose, and the patient may also contribute to prescribing errors
MAR
Medication administration record
What are the 3 general rules for med administration?
- Before giving a drug, nurse must be familiar with all information on that drug
- Check to see if patient has any allergies
- Student must check ORIGINAL physicians order against med sheet before giving med as it could be different between the order and MAR
A complete order from a physician includes what things?
Medication Type
Dosage
Frequency
route
Patient Name
Date and Time
Physician Signature
immediately after giving a medication …
document that it was given
Right time includes what things
What time IS it,
has it been signed for as given,
is the drug time limited
What should be observed and done while pouring medications?
Silence!
Do not allow distractions when pouring or preparing medications
Always check the dose on each individual ___
Tablet
What are the 4 types of time limited drugs
Anti Infectives (biotics, virals, etc)
Narcotics/Controlled Substances
Anti Coagulants
Steroids
Excess meds refused from stock supply refused by patient should be … EXCEPT…
discarded per agency policy
EXCEPT controlled drugs which may need to be saved for verification of count
Another nurse should go with you to see that the drug is properly been ridden of
Medications are not to be poured..
from one bottle to another
