safe medication adminisitration

Question 1

from who can RN accepts prescriptions

Answer 1

MDs
NPs
midwives
chiropodists
dentists

Question 2

what should all prescriptions include

Answer 2

patients full name + identifiers
date
drug name
dosage
frequency
duration
route
PRN explanation
Refills outpatient only
Dispensing instructions outpatient only
Signature/designation

Question 3

what are applications of medication

Answer 3

administration
dispensing
storage
inventory managment

Question 4

What are the 3 CNO principles of medication administration?

Answer 4

authority
competence
safety

Question 5

What will you need to use when deciding on authority, safety and competence principles of medication practice

Answer 5

knowledge
skill
judgment

Question 6

authority

Answer 6

orders from a prescriber required when:
a) a controlled act is involved
b) administering a prescription medication
c) it is required by legislation that applies to a practice setting

Question 7

controlled act is involved,

Answer 7

it means that a specific action is designated as a controlled act by law, and can only be performed by a regulated health professional who is authorized to do so

Question 8

orders should be:

Answer 8

clear
complete
appropriate

Question 9

orders can be for

Answer 9

Direct specific client or directives apply to several but cannot involve controlled substances

Question 10

What nurser should do regarding safety competence

Answer 10

Ensure patient understanding and knowledge about medication

Report and take appropriate action to resolve or minimize harm from medication errors or adverse reactions

Promote/implement secure storage, transportation and disposal of medication and minimize drug misuse

Collaborate to establish systematic medication safety

Question 11

for competence what nurse must

Answer 11

Ensure medication practices are evidence-informed

Consider the client, the med and the environment when medication appropriateness such as it is appropriate for the unit ex. on the surgical floor didn’t have the heart equipment to refuse the patient, so you are not responsible.

Seek help when medication practice are beyond their knowledge, skill and judgment

Question 12

when should you do best possible medication history

Answer 12

1. at admission; when they arrive, if they can’t give a call and find out
2. transfer to a unit
3. discharge
4. status change

Question 13

what does dispensing involves

Answer 13

preparing and transferring medication for a patient or patient representitive

Question 14

best possible medication history

Answer 14

1. any and all medication including natural and OTC
2. alcohol, caffeine and tobacco
3. past and present health history
4. family history
5. racial, ethnic, and cultural assessment
6. unusual responses to medication such as allergies, sensitivities and adverse reaction
7. growth and development
8. functional assessment including cognitive and psychomotor
9. lifestyle ( socioeconomic, education, schedule )

Question 15

Time-crititcal medication

Answer 15

Administer at the exact time when necessary, eg. rapid-acting insulin; otherwise within 30 min before or after the scheduled time

Question 16

non-critical medication

Answer 16

Administer within 2 hours before or after the scheduled tie for daily, weekly or monthly meds.

Medication prescribed more frequently than daily but not greater than q4h; administered within 1 hour before or after the scheduled time.

Question 17

DO’s with medication

Answer 17

encourage written order as much as possible

document medication health teaching

Question any incomplete or confusing order

trust the client’s knowledge about their meds when they question you

Question 18

do not

Answer 18

Record in advance

Use the term refuse. Using decline is a better choice.

Leave medication at the bedside and chart that they were administrated

Question 19

medication reconciliation

Answer 19

A formal process in which medications are “reconciled” at all points of entry and exit to and from the health care entity. Continuous assessment and updating of patient medication information to prevent medication error

Question 20

When do you do medication reconciliation and what does require and why its been used

Answer 20

admission =
transfer from the surgery
status change such as into or out of the intensive care
discharge

It requires the best possible medication history BPMH

It is used to ensure that there are no discrepancies between what patients have been taking at home and what they take in the hospital

Question 21

what does involve in medication reconciliation

Answer 21

verification=collection of patients’ medication information with a focus on medications currently used

clarification=PROFESIONAL VIEW OF THIS INFORMATION TI ENSURE THAT ALL MEDICATIONS AND DOSAGE ARE APPROPRIATE FOR THE PATIENT

reconciliation=Further investigation of any discrepancies and documentation of relevant communications and changes in medication orders.

Question 22

Patient education :
assessment

Answer 22

illness and physical sensory limitation

readiness for change/ learning

current med knowledge/compliance

cognitive abilities

support (financial, human, services, environment

culture/health beliefs

developmental status

literacy and language

Question 23

patient education
nursing diagnosis

Answer 23

deficient knowledge

readiness for enhanced knowledge

ineffective self-health management

readiness for enhanced health management

impaired memory

injury risk for

non-adherence

falls, the risk for

readiness for enhanced decision making

Question 24

At what grade literacy should the materials should be written for adults

Answer 24

at grade 8

Question 25

what should you document

Answer 25

teaching, including learner assessment, goals content, delivery, patient response and outcomes

Question 26

what should you do for non-adherence and inadequate learning

Answer 26

develop and implement new plan

Question 27

What should you do with patients to get involved in their medication managam=gment

Answer 27

encourage and empower patient to get involved in their medication management

Question 28

patient education: implementation/evaluation

Answer 28

5 questions to ask about your medication

1. CHANGES: Has any medication been added, changed or stopped
2. CONTINUE: What medication do I need to continue and why
3. Proper Use: How do I take my maedication

Question 29

patient education: implementation/evaluation

Answer 29

5 questions to ask about your medication

1. CHANGES: Has any medication been added, changed or stopped
2. CONTINUE: What medication do I need to continue and why
3. Proper Use: How do I take my medication and for how long
4. Monitor: How will I know if my medication is working and what side effects do I watch for
5. Follow-Up Do I need any test an when I book next visit

Question 30

Medication errors

Answer 30

any preventable adverse drug event involving inappropriate medication use by a patient or health care provider that may or may not cause patient harm

may be patient or system-related

Question 31

The major categories of medical errors are

Answer 31

1) NEAR MISS or CLOSE CALL where an event could result in unwanted consequences but it doesn’t it

2)NO-HARM event where the incident occurred but it results in no injury to the patient

3) medication error causes harm

4) critical incident resulting in harm

Question 32

High alert medications HAM ARE

Answer 32

medications with the greatest potential for error often due to looking or sounding like another medication

Question 33

adverse drug event includes:

Answer 33

medication
adverse drug reaction ADRs

Question 34

ADRs adverse drug reations

Answer 34

unexpected
unintended or excessive response to medication given at therapeutic dosage as opposed to overdose

Question 35

3 types of adverse drug reactions ADRs

Answer 35

Adverse effect
Allergic reactions
Idiosyncratic reaction

Question 36

when the error occur

Answer 36

the error can occur during any step of a medication process
procuring
prescribing
transcribing
dispensing
administering
monitoring

Question 37

Just culture

Answer 37

Recognize that “systems: are generally at fault when an error occurs

When professionals do not follow policies or have repeated errors they need remedial education and be held accountable

Question 38

Responding
reporting and
Documenting Medication Errors

Answer 38

is a professional responsibility

notify the appropriate caregiver ad to seek guidance
provide appropriate follow-up care to patients s priority
Follow facility policy/forms using factual information
Advocate for change when policies do not reflect the Institute for Safe Medication Practice Canada ISMP

Question 39

How to prevent medication errors

Answer 39

System-based preventative approaches and advocacy for improvement
Use of current drug references or literature 3-5 years
follow 10 rights and 3 checks guidelines
ALWAYS USE A LEADING ZERO AND NEVER USE A TRAILING ZERO
Do not crush enteric-coated tablets
Always investigate any client concerns/objections
Always clarify unclear orders that you question
Ensure adequate assessment and evaluation
Asses 2 patient identifiers
Do not administer meds you did not draw up or prepare yourself
Minimize verbal or telephone orders
repeat the order to the prescriber
spell drug names aloud
speak slowly and clearly
only used approved ISMP abbrevations