pharm 2.2- PINCH

sentential event

preventable errors causing serious injury or death

high alert medication

medications that can pose significant harm if given incorrectly, usually have policies in place to try to decrease potential risk of error

PINCH drugs always are given

with an IV pump to control flow rate

P in PINCH

parental nutriton or potassium

TPN

(total parental nutrition) hypertonic solution, always on infusion pump, 2 nurses must check TPN label against the order

Potassium risk

can be given multiple routes, so the route given plays a huge role in the risk level

danger of oral potassium

significant less danger than IV potassium, does not require double checks

potassium IVF safety measures

always on a pump, verify correct order and available, if premixed no double check needed for, if mixed by an RN must check with another RN

potassium IVPB safety

always on a pump, 2 nurses must check patient, 2 nurses must verify potassium level, 2 nurses must check flow rate on pump

difference between IVPB and IVF

IVPB has a smaller volume and higher overall concentration

I in PINCH

insulin

insulin infusions

always injection (SQ or IV), IV is for more severe patients, can also be seen as IVPB

insulin safety measures

always check blood sugar levels prior to giving, 2 nurses verify initial set up, any rate change and if it is an IVPB check pump rate

N in PINCH

narcotics

narcotic safety measures overall

all routes must be verified and documented by 2 nurses, all waste must be documented and signed by a witness nurse (everything has to be accounted for)

narcotics though a PCA or infusion safety measures

always using a locked pump to ensure correct flow, 2 nurses double check: flow rate, initial set up, any bag/syringe change, any rate change, very shift change

PCA

(patient controlled analgesia) patient can control medication dispensed, but always in a prefixed amount- with narcotics

C in PINCH

chemotherapy (PO or IV)

chemotherapy PO safety measures

specialized nurses to administer it, policies can vary from each facility for PO

chemotherapy IV safety

always on a pump, at a certified facility, 2 nurses must check label against order, and infusion rate

H in PINCH

heparin

heparin

anticoagulant, SQ or IV, must always check PTT value prior to administering it

PTT

partial thromboplastin time

heparin IVP safety

verify PTT, 2 nurses must check

heparin IV gtt (Heparin drip)

always on a pump, 2 nurses check prior to hanging bag, and with nay rate change, and must verify lab results

SQ heparin flush

used to keep Iv catheters open, very diluted solution, no need to double check