Module 8: Principals of Safe Medication Administration Flashcards
Stock Supply System
- Medications are available in quantity, in large, multi-dose containers
- Is time consuming and costly
- High rate of medication errors
- Not commonly used today
Unit-Dose System
- Uses portable carts containing a drawer with a 24-hour supply of medications for each patient
- Each drawer is labelled with the patients name
- Each tablet or capsule is wrapped in a foil or paper container
- At a designated time each day the pharmacy refills the drawers
- Also contains limited amounts of PRN medications
- Controlled substances are not kept in the individual drawers
- Designed to reduce medication errors and save steps when dispensing medication
Automated Dispensing System (AMDS)
- Use computerized controls to dispense narcotics and unit-dose medication
- Each nurse accesses with a security code
- Are controlled electronically via pt’s profile
- PTs name and drug profile must be accessed before AMDS will dispense the medication
- COW (Computer on wheels)
Information contained on a MAR
-Patient name, DOB, hospital #
-Date/time
-Medication ordered
-Dose ordered
-Frequency
-Route
-Scheduled medications
-PRN medications
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Forms of Medication
- Oral
- Topical
- Parenteral
- Instillation
Routes of Medication Administration
-Oral routes (SL, Buccal)
-Parenteral routes (ID, IV, IM, SC)
Epidural, Intrathecal, Intraosseous.
-Topical administration
Transdermal disc aka patch
-Inhalation
-Intraocular
High-Alert Medications
Medications that present a risk of causing serious injury or death if used incorrectly
Additional precautions to prevent errors with High-Alert Medications
- Independent double checks are required
- Two health care professionals shall independently verify:
a) the most current prescriber order or medication administration record
b) the patient’s relevant laboratory values and/or diagnostic results
c) medication dosage calculations
d) 7 medication rights
e) pump programming
Seven Rights of Safe Medication Delivery
- RIGHT Client (Name, DOB, ID #)
- RIGHT Medication
- RIGHT Dose
- RIGHT Route
- RIGHT Time
- RIGHT Reason
- RIGHT Documentation
Three Additional Rights of Medication Delivery
- RIGHT to refuse
- RIGHT Patient education
- RIGHT Evaluation
Forms of Oral Medication
Solid -Tablet -Capsule -Enteric-coated Liquid -Extract -Syrup -Elixir Other -Aerosol -Lozenges -Sustained release
Forms of Topical Medication
- Ointment
- Liniment
- Lotion
- Paste
- Transdermal disc or patch
Forms of Parenteral Medication
- Solution
- Powder
Forms of Instillation Medication
- Solution
- Intraocular disc
- Suppository
Process of Medication Reconciliation (4)
- Verify
- Clarify
- Reconcile
- Transmit
- When a patient is admitted into any health care setting, the nurse should compare the medications the patient took in the previous setting with the current ordered medications.
- Upon discharge, the nurse reviews the patient’s current medications with the health care providers in the new setting
Benefits of Medication Reconcilliation
-Essential step in ensuring medication safety
Common Causes of Medication Errors
- Preparing drugs on multiple patients
- Nonstandard times
- Documentation
- MAR’s unavailable
- Held/discontinued meds
- Nonspecific doses
- Monitoring issues
Typed of Orders
- Routine or scheduled – carried out until the prescriber cancels it by writing a new order or until a prescribed number of days have elapsed
- As needed (“PRN”) – given when the patient requires it
- Single or one-time dose – given one time only for a specific reason (e.g. before surgery)
- STAT – given immediately such as in an emergency
How to Reduce Med Errors Associated with Verbal Orders/Rx
- Read labels at least 3 times; compare label with MAR before, during, and after
- Use at lease two patient identifiers
- Double check all calculations and verify with another nurse
- Don’t interpret illegible handwriting; clarify with prescriber
- Questions unusually large or small doses
- Document as soon as meds are given
- Avoid abbreviations
Common Dosage Administration Schedules
am: 0800
pm: 1700
hs: 2200
bid: 0800, 1700
tid: 0800, 1200, 1700
qid: 0800, 1200, 1700, 2200
am ac: 0700
bid ac: 0700 1600
qid ac: 0700, 1100, 1600. 2200
q6h: 0600, 1200, 1800, 2400
q8h: 0600, 1400, 2200
q12h: 1000, 2200
Guidelines for Safe Narcotic Administration and Control
- Store all narcotics in a locked, secure cabinet or container
- Count narcotics frequently and record inventories
- Report discrepancies immediately
- Use a special narcotic record every time a narcotic is dispensed
- If you only administer part of a premeasured dose another nurse must witness the disposal of the remaining amount
- Meds are not to be disposed of in the sink,toilet or garbage. But returned to pharmacy in designated container
