Roles Flashcards
Pharmacist’s Role
The pharmacist prepares and distributes prescribed medications.They are responsible
for filling prescriptions accurately and being sure that prescriptions are
valid. Dispensing the correct
medication, in the proper dosage and amount, with an accurate label is the
pharmacist’s main task. Pharmacists also provide information about
medication side effects, toxicity, interactions, and incompatibilities.
Nurse’s Role
Determines medications ordered are correct
Assesses patient’s ability to self-administer
Determines medication timing
Administers medications correctly
Closely monitors effects
Provides patient teaching
Does not delegate medication administration to AP
Steps to Take to Prevent Medication Errors
(AMDS, Automated medication dispensing system;
MAR, medication administration record.)
• Follow the seven rights of medication administration.
• Prepare medications for only one patient at a time.
Be sure to read labels at least 3 times (comparing MAR with label): (1)
when removing medication from storage, (2) before taking to patient’s
room, and (3) before giving medication.
• Use at least two patient identifiers every time you administer
medications (e.g., patient name, birthday, hospital number) whenever
administering a medication (TJC, 2020).
• Do not allow any other activity to interrupt administration of
medication to a patient (e.g., phone call, pager, discussion with other
staff).
• Double check all calculations and other high-risk medication
administration processes (e.g., patient-controlled analgesia) and
verify with another nurse.
• Do not interpret illegible handwriting; clarify with the health care
provider.
• Question unusually large or small doses.
• Document all medications as soon as they are given.
• When you have made or discovered an error, reflect on what went
wrong and ask how you could have prevented it. Complete an
occurrence report per agency policy.
• Evaluate the context or situation in which a medication error
occurred. This helps to determine whether nurses have the necessary
resources for safe medication administration.
• When repeated medication errors occur within a work area, identify
and analyze the factors that may have caused the errors and take
corrective action.
• Aend in-service programs on the medications you commonly
administer.
• Ensure that you are well rested when caring for patients. Nurses
make more errors when they are tired.
• Involve and educate patients when administering medications.
Address patients’ concerns about medications before administering
them (e.g., concerns about their appearance or side effects).
• Follow established agency policies and procedures when using
technology to administer medications (e.g., automated medication
dispensing system [AMDS] and bar-code scanning). Medication
errors occur when nurses “work around” the technology (e.g.,
override alerts without thinking about them) (Zhu and Weingart,
2018).
Medication Errors
Medication error
Any preventable event that may cause inappropriate medication use or jeopardize patient safety
When an error occurs
First assess the patient’s condition, then notify the health care provider
When patient is stable, report the incident
Prepare and file an occurrence or incident report
Report near misses and incidents that cause no harm For example, you
are caring for a patient who has a urinary tract infection and is allergic to
sulfa medications.
During transitions in care, reconcile medications
Seven rights of medication administration
1. The right medication
- The right medication - A medication order is required for every medication that you administer. nurse compares the health care provider’s written
orders with the medication administration record (MAR) or electronic
MAR (eMAR) when it is ordered initially.
to a patient. Nurses verify medication
information whenever new MARs are created or distributed or when
patients transfer from one nursing unit or health care setting to another. Once you determine that information on a patient’s MAR is accurate,
use it to prepare and administer medications.When preparing
medications from bottles or containers, compare the label of the
medication container with the MAR 3 times: (1) before removing the
container from the drawer or shelf, (2) as the amount of medication
ordered is removed from the container, and (3) at the patient’s bedsidebefore administering the medication to the patient. Never prepare
medications from unmarked containers or containers with illegible labelsFinally verify all medications at the patient’s bedside with the
patient’s MAR and use at least two identifiers before giving the patient
any medications.If a patient questions the medication, do not ignore these concerns.
A patient or a family caregiver familiar with a patient’s medications often
knows whether a medication is different from those received before. In
most cases a patient’s medication order has changed; however, sometimes
patient questions reveal an error. When this occurs, withhold the
medication and recheck it against the health care provider’s orders. If a
patient refuses a medication, discard it rather than returning it to the
original container. Unit-dose medications can be saved if they are not
opened. If a patient refuses opioids or any controlled substance, follow
proper agency procedure by having someone else witness the “wasted”
medication.
- The right dose
You need to have another qualified nurse check the calculated doses when performing
medication calculations or conversions.Mix crushed medications with very small amounts of food or
liquid (e.g., a single tablespoon). Do not use a patient’s favorite foods or
liquids because medications alter their taste and decrease the patient’s
desire for them. This is especially a concern for pediatric patients. Not all medications are suitable for crushing.
- The right patient
Use at least two patient identifiers.Acceptable patient identifiers include the patient’s name, his or her
medical record number assigned by a health care agency, or a telephone
number. Do not use the patient’s room number or physical complaint as
an identifier. To identify a patient correctly, you usually compare the
patient identifiers on the MAR with the patient’s identification bracelet
while at the patient’s bedside.
- The right route
Always consult the health care provider if an order does not include a
route of administration. Likewise alert the health care provider
immediately if the specified route is not the recommended route. Recent
evidence shows that medication errors involving the wrong route are
common.The accidental IV injection of a liquid designed for oral use produces
local complications, such as sterile skin abscess, or systemic effects, such as
a fatality.use only enteral syringes (e.g., ENFit) when you prepare oral
medications (ISMP, 2015c). Enteral syringes often use a color different
from the parenteral syringes and are clearly labeled for oral or enteral use.The syringe tips of enteral syringes will not connect with parenteral
medication administration systems.Needles do not attach to enteral
syringes, and the syringes cannot be inserted into any type of IV line.
Label the syringe after preparing the medication and be sure to remove
any caps from the tip of an oral syringe before administering the
medication.
- The right time
For example, two medications are ordered, one q8h (every 8
hours) and the other 3 times a day. Both medications are scheduled for 3
times within a 24-hour period. You need to give the q8h medication every
8 hours ATC to maintain therapeutic blood levels of the medication. In
contrast, you need to give the 3-times-a-day medication at 3 different times
while the patient is awake. Each agency has a recommended time schedule
for medications ordered at frequent intervals.You
administer time-critical medications within 30 minutes before or after their
scheduled time. For example, give insulin (a time-critical medication) at a
precise interval before a meal. Give antibiotics 30 minutes before or after
they are scheduled ATC to maintain therapeutic blood levels. Give all
routinely ordered non–time-critical medications within 1 to 2 hours before
or after the scheduled time or per agency policy.Give
a medication ordered PC (after meals) within half an hour after a meal,
when a patient has a full stomach. Give a STAT medication immediately.
Give priority to time-critical medications that must act and therefore be
given at certain times.
- The right documentation
Nurses and other health care providers use documentation to
communicate with one another. Many medication errors result from
inaccurate documentation. Therefore, always document medications
accurately at the time of administration and identify any inaccurate
documentation before you give medications.Before you administer a medication, ensure that the MAR clearly shows:
• The patient’s full name
• The full name of the ordered medication (without abbreviations of
medication names)
• The time the medication is to be administered
• The dosage, route, and frequency of administration
The health
care provider is responsible to provide accurate, complete, and
understandable medication orders. If he or she is unable to do this, nurses
implement agency policy (usually a “chain of command” policy) to
determine whom to contact until they resolve issues related to patients’
medications. You are responsible to begin this chain of command to ensure
that patients receive the correct medication
After administering a medication, immediately document which
medication was given on a patient’s MAR per agency policy to verify that
it was given as ordered.Never document that you have given a medication until you have actually given it
- The right indication
Indication-based prescribing would narrow medication choices,
dosage forms, and dosing regimens, which reduces the risk of a wrong
medication being chosen
Maintaining Patients’ Rights
a patient has the following rights:
• To be informed of the name, purpose, and action of a medication
and its potential for undesired effects
• To refuse a medication regardless of the consequences
• To have qualified nurses or physicians assess a medication history,
including allergies and use of herbals
• To be properly advised of the experimental nature of medication
therapy and give wrien consent for its use
• To receive labeled medications safely and without discomfort in
accordance with the seven rights of medication administration
• To receive appropriate supportive therapy in relation to
medication therapy
• To receive no unnecessary medications
• To be informed if medications are a part of a research study
