Week 9 Nursing Flashcards
Schedule 2 (Pharmacy Medicine)
- Purchased off the shelf from a pharmacy (i.e. antihistamines).
- May be registered nurse or midwife initiated depending on hospital policy.
Schedule 3 (Pharmacist Only Medicine)
- Purchased from a pharmacy but requires advice from a pharmacist prior to administration (i.e. salbutamol).
- May be registered nurse or midwife initiated depending on hospital policy.
Schedule 4 (Prescription Only Medicine)
Medications that require a prescription from a doctor, nurse practitioner or certified midwife (i.e. antihypertensives, antibiotics, sleeping tablets).
Schedule 8 (Controlled Drug)
Supply, storage, prescription and disposal are controlled by law (i.e. morphine, methadone, pethidine, fentanyl, oxycodone, cocaine mouthwash, cannabis [new]).
Schedule 9 (Prohibited Substance)
Usage is restricted to analytical laboratories and trials (i.e. heroin, cannabis [old], MDMA).
Schedule 11 (Drugs of Dependence*)
Includes some S4 and S8 medications that have the potential for abuse and dependence (i.e. midazolam, temazepam, tramadol).
Schedule 4
– Stored in a locked facility e.g. medication room, cupboard, trolley or patient bedside draw.
– Administered by registered nurses, enrolled nurses or midwives and may involve single or double checking.
Schedule 8 and 11
– Stored in a locked medication safe which is affixed to the wall or the floor to prevent theft (*restrictions on access/type).
– Partially used medication can be destroyed by two (2) nurses or midwives or a nurse/midwife and a doctor or pharmacist.
- Whole unused or out of date medication must be disposed of by a hospital pharmacist.
Medication Names
- Generic Name = abbreviated scientific name
- Trade Name = brand or marketing name
Roles and Responsibilities
- Doctor, nurse practitioner or certified midwife prescribes
- Pharmacist stores, dispenses and reviews medication
- Nurses and midwives administer medication
- Critically review each prescription and medication order
- Ensure a complete and legal prescription
- Check appropriateness / right clinical scenario
- Assessment of patient condition
- Does the patient need monitoring before or afterwards?
- Review changes in the patients circumstances
- Dosage – does it need to be adjusted for any reason?
- Route and frequency?
- Patient willingness to take the medication
- Major drug-to-drug interactions
Questioning Medication Orders
- Nurses and midwives are legally accountable for the drugs they administer to patients.
- Suspected errors MUST be escalated to the prescriber for clarification.
- Poor prescription and administration practices should not be tolerated under any circumstance.
– Guessing a difficult to read medication order is an example of gross carelessness. - You have a right to refuse to administer any medication that, based on your knowledge may be harmful.
Single vs Double Checking
- Most Schedule 4 medications are checked and administered by one (1) nurse or midwife.
– Hospital policy may dictate that some Schedule 4 medications are checked by two (2) nurses or midwives (i.e. warfarin).
– Medications administered by the parenteral route are checked by two (2) nurses or midwives. - Most Schedule 8 and 11 medications are checked by two (2) nurses or midwives.
– Some hospitals dictate that nurses with significant experience and after accreditation can single check medications. - Medications administered to paediatric patients are ALWAYS checked by two (2) nurses or midwives.
Medication Orders
- Medication orders are usually written on a medication drug chart or drug prescription electronic order .
– Medication orders can also be given verbally from a prescriber to a nurse or midwife and confirmed in writing at a later stage.
– A student nurse or midwife is not permitted to accept a verbal medication order from a prescriber. - A National Inpatient Medication Chart was adopted for adults and children in 2019 to reduce errors.
- Electronic medication record systems are now commonplace but often not inter-connected.
- Standing order
– Medication is administered according to this order until it is cancelled by another order or is ceased. - Pro re nata (PRN) order
– Medication is administered as needed or requested according to the limits set in the medication order. - STAT order
– A single medication order that is carried out immediately, often during an emergency. - Verbal or telephone order
– Medication order is provided verbally by the prescriber when they are unable to attend to the patient directly.
Valid Legal Prescription
- Patient’s full name, DOB and UR number
- Date and time the order was written
- Generic name of medication to be administered
- Dosage
- Route of administration
- Frequency of administration
- Name, signature and contact number of prescriber
- Indication (reason for prescription)
- Legible and clear with no errors or omissions
Medication Administration
- Medication administration should be recorded on the drug chart as soon as possible after the medication is given.
– Medication should never be signed as being administered until the full dose has been given to the patient. - The route of administration should be recorded if variable routes were available on the prescription.
– If an injection is administered or a patch is applied the site of administration should be recorded. - Relevant assessments may need to be documented on the medication chart or in the patient notes.
– Cardiovascular medications that are given when the patient’s pulse rate is higher than a predetermined rate.
Common Medication Errors
- Inappropriate prescribing of the drug (i.e. incorrect dose, quantity or route).
- Extra, omitted or wrong doses of medication.
- Administration of a medication to a person that was not ordered for them.
- Administration of a drug by an incorrect route or at an incorrect rate.
- Failure to give a medication within a prescribed timeframe.
- Incorrect preparation of a medication prior to administering to a patient.
Causes of Medication Errors
- Interruptions.
- Poor communication and unclear orders.
- Environmental factors.
- Stress, fatigue and nurse/patient ratios.
- Inadequate level of knowledge to protect against errors.
- Pressure from other health professionals to administer medication (real or perceived).
- Lack of compliance with 8 Rights of medication administration or taking short cuts.
High Risk Medications and Systems
- Antimicrobials
- Potassium
- Insulin
- Narcotics
- Chemotherapy
- Heparin and anticoagulants
- Systems
Responding to Medication Errors
- Immediately check the patient’s condition and observe for the development of adverse effects.
- Notify the nurse/midwife in charge and the prescriber that the error has occurred.
- Write a description of the error in the patient’s medical record, including the remedial steps taken.
- Record the incident in the hospital’s incident and risk management system and follow-up as required.
- Document in the patient medical record incident report number if required by hospital policy.
Medication Calculations
Drug calculations may be done using two main methods:
1. Specific dosage formulae i.e. paediatric calculations.
2. Using general mathematics (often using a ratio/proportions method of determining dosage).
Benefits of the mathematical approach:
– Only one standard approach to all medication calculations.
– Removes the need for remembering complex formulae
