Week 6a: Medication Administration 2

Question 1

Prescriber role

Answer 1

Gives:

Medical directives – not for a specific client

Direct orders – for a specific client

States frequency: Routine, prn, single (one time), STAT, now, etc.

Question 2

Pharmacist role (5)

Answer 2

• Prepares and distributes prescribed medications
• Administers medications
• Responsible for filling prescriptions accurately and ensuring the prescriptions are valid
• Provide information about side effects, toxicity, interactions and incompatibilities

In Ontario, able to prescribe some medications or extend prescriptions for ongoing conditions (community-based practice)

Question 3

Nurse role

Answer 3

• administration
• dispensing
• medication storage
• inventory management
• disposal
• evaluating effects of meds
• teaching patients about meds and adverse drug events,
• promoting adherence
• evaluating patient technique for taking meds

Nurses are legally responsible for ALL medications that they administer.

Question 4

3 principles of medication administration

Answer 4

Authority
Competence
Safety

Question 5

Authority

Answer 5

Registered Nurses and Registered Practical Nurses require an order for a medication practice when:

1. A controlled act is involved
2. Administering a prescription medication
3. It is required by legislation that applies to a practice setting

Question 6

Competence

Answer 6

Knowledge, skill and judgment:

• Evidence-informed practice
• Appropriateness of medication practice
• Know limits of own knowledge and ask for help

*Do not perform medication practice if not competent to perform

Question 7

Safety (8)

Answer 7

Promote safe care and contribute to a culture of safety

• Seek information from client
• Provide education to client
• Collaborate with client
• Promote and/or implement secure storage, transportation and disposal
• Promote or implement strategies to minimize drug diversion (e.g., when prescription drugs are obtained and used illegally) and misuse
• Take appropriate action to help client if medication error or adverse reactions occur
• Report errors, near misses or adverse reactions in a timely manner
• Collaborate in approaches that support safe medication practices

Question 8

Nursing Student accountabilities

Answer 8

• Must follow the three principles
• When 2 RN signatures are required by agency policy, the student’s signature is in addition to the 2 RN signatures

Students are NOT permitted to:

1. Accept verbal or telephone orders from a prescriber
2. Accept responsibility for carrying the narcotics keys

Question 9

Guidelines for Preparing and Giving Medications

Answer 9

• Prepare medications alone – no distractions
• Don’t leave medications unattended
• Check client ID band – have client state their name (2 unique identifiers)
• Know generic and trade names
• Administer only what YOU prepare
• If a client refuses a medication, discard it rather than returning it to the original container
• Unwrap medication at Point of Care (POC)
• Return to original prescriber’s order if questions arise
• Call pharmacist if you have questions

Question 10

10 “Rights” of Medication Administration

Answer 10

1. RIGHT patient
2. RIGHT medication (3 checks)
3. RIGHT reason
4. RIGHT dose
5. RIGHT time and frequency
6. RIGHT route
7. RIGHT documentation
8. RIGHT to refuse
9. RIGHT patient education
10. RIGHT evaluation

Question 11

Patient Education for med admin. (4)

Answer 11

• Clients should be fully informed
• Education may also involve family members in some situations
• Education includes reason for taking drug, action and possible side effects
• Should also include how to take medication

Question 12

Components of a Complete Order (7)

Answer 12

1. Patient’s full name – may include unique identification number in a hospital
2. Date and time the order is written
3. Medication name (may use generic or trade name)
4. Dose
5. Route of administration
6. Time and frequency of administration
7. Signature of prescriber

Question 13

Medication Error

Answer 13

Any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer

Can be errors of commission or errors of omission

Question 14

If you make a medication error… (7)

Answer 14

1. Notify prescriber
2. Determine how long client must be monitored and if treatment is needed
3. Treat and/or monitor adverse reaction and document in chart
4. Report error (incident report)
5. Corrective actions
6. Advocate for systems that reduce risk of error
7. Check hospital policy about disclosure to client

Question 15

High-Alert medication

Answer 15

• Drugs that bear a heightened risk of causing significant harm when they are used in error
• Drug classes – opiates, antiarrhythmics, antithrombotic agents, dextrose, dialysis solutions, oral hypoglycemics, total parenteral nutrition solutions

Question 16

Technology and Safety Measures (9)

Answer 16

• Medication carts/IV pumps
• Bar codes
• Blister packs

Informatics and medication safety:

• Networked computers
• Prescriber entered orders
• IntRAnet resources
• Automated dispensing systems
• Medication safety zones

Question 17

Medication Reconciliation

Answer 17

Formal process of :

1. Obtaining a complete & accurate list of each current medications – including name, dosage, frequency and route
2. Using list when writing admission, transfer and/or discharge medication orders, and
3. Comparing the list against the admission, transfer and/or discharge orders, identifying and bringing any discrepancies to the attention of the prescriber and, if appropriate, making changes to the orders. This list should accompany the patient to the next care site.

Question 18

Components of an Incident Report (5)

Answer 18

• Patient identification information
• Location and time of the incident
• An accurate, factual description of the incident and
• Measures taken to address the error