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NCCMERP
A preventable medication error that can result in patient harm or death
Medication error
Most common cause of client injury
ISMP
Institiute for Safe Medication Practices
USP
United States Pharmacopeia
TJC
The Joint Commission
FDA
United States Food & Drug Administration
QSEN
Quality & Safety Education for Nurses
NQF
National Quality Forum
Autonomy
Willingness to challenge incorrect orders and get clarification
Distinguishing
Irrelevant from relevant information
Reasoning
Selection of right tools and client assessment
Who’s legally liable for the error of an administered medication?
The nurse
Age group that’s expected to become 21.7% of the population by 2040
65+
Physiological changes due to age (3)
Slowed function, unexpected medication reactions or increased sensitivity
Physiological changes also include:
Weight loss, mental status, circulation, absorption, metabolism changes
What age range should demonstrate back what they’ve been taught?
Every age
Six “RIGHTS” of Medication Administration
CLIENT, MEDICATION, DOSE, ROUTE, TIME AND DOCUMENTATION
Right Client
Two unique identifies (Name, DOB, Phone #)
Right Medication
Check thrice before administering, compare MAR w/ order
Right Dose
Check calculations and labels
Right Route
How it’s administered (mouth, injection), order guides, special feeding tube considerations
Right Time
Time of day & frequency. 30 minute rule
Right Documentation
Outcomes of medications, Do-Not-Use abbreviations, avoiding double-dosing
Other “RIGHTS”
Indication, Know, Refuse, Response
Medication Reconciliation
Comparing medications before admission with newer medications.
Client Education
Brand/generic names, explanation of amount, timing for doses, appropriate measuring devices, and route
Nurse’s Role in Preventing Errors
Report them per policy, adhere to safety standards, take advantage of new technology to help prevent errors
Oral (p.o)
Swallowed tablets, capsules or liquid solutions
Sublingual (SL)
Placed under tongue
Buccal
Placed in mouth against cheek
Enteric coated
Dissolves in the small intestine
Parenteral
IV, IM, Subcut, or ID
Insertion
Placed into body cavity such as rectal or vaginal suppositories
Instillation
Placed in eye, nose or ear
Inhalation (INH)
Administered into respiratory track (metered-dose inhalers, nublizers, spacers)
Intranasal
Solution instilled into the nostrils
Topical
Applied to skin (lotions, ointments, pastes)
Percutaneous
Applied to skin or mucous membranes
Transdermal
Topically applied medicated patches or discs
Medicine cup
Used for small amounts of liquid medications (5-20mL)
Souffle cup
Used for solids such as tablets or capsules
Calibrated dropper
Used to administer small amounts of liquid medication
Nipple Medication Administration
Adapted for some infant meds
Oral Syringe
Liquid medications orally
Parental syringe
Used for IM, Subcut, ID, IV Meds, Needle attached, plunger pushes medication thru needle
Mr. Ross is to receive 2 L of Dextrose 5% in ½ normal saline through a 20-gauge peripheral IV located on the right forearm. The IV fluid will run at a rate of 125 mL/hr. Which route of administration will be used?
Parenteral
What is medication reconciliation?
Comparing medications taken at home w/ newly administered medications
What’s required prior to implementation?
A legal written order or prescription from a health care provider
Standing order: routine order
Ampicillin 1 g IV 96h for 4 doses
prn order: administered as needed
Tylenol 650 mg po q4h prn for temp greater than 101 *F
Stat order: administered immediately
Ativan 2 mg IM stat
Single (one-time) order: Administered only once
Tdap 0.5 mL IM x 1
Verbal orders
Should only be taken in an emergency
Seven Essential components
Full name, date and time written, medication name, dosage, route, time and frequency, and signature of prescriber or proxy
Caring for two clients with the same last name can lead to what medication error?
Right client
What route of administration should be used to directly deliver drugs to the lungs?
Inhalation
Route of administration for ear drops
Instillation
What process ensures safe medication administration? (PRIORITY)
Following the six basic rights of medication administration
Type of medication applied to the mucous membranes
Percutaneous
What is a “high-alert” medication?
A medication that presents a higher risk for patient harm
Nursing actions that can help prevent medication errors (EVOLVE)
Documenting immediatly after administering medication
Checking drug dose from the pharmacy w/ medical record
Using only approved abbreviations from TJC list
Tall man letter rule that reduces errors caused by sound-alike medications
DOPamine and DOBUTamine
How to prevent medical errors for a patient who commonly transfers units
Completing a medication reconciliation between units
Which route is NOT included in parenteral administration?
Transdermal
Appropriate identifier to confirm you have the right client in a home-care setting
Client’s address
TJC method of reducing errors during transition points
Medication reconciliation
Characteristic related to time-critical scheduled medication
Possibly harm or major impact if given outside of the 30-minute time frame
Accurate description of medication errors
May cause or lead to client harm
Physiological change recognizable in older clients due to drug therapy
Decreased ability to respond to stress
Correct abbreviation for QD
Daily
Which organization created the DO NOT USE list
The Joint Commission
Appropriate sequence of medication order
Name, dosage, route and frequency
Description of the SR abbreviation
Sustained release
Approved medication dosage abbreviation
mg
Advantages of CPOE (Computerized physician order entry)
Recognizing medication incompatibilities
Identifying safe dosage ranges
Preventing incorrect transcription
Identifying allergies
What makes a medication order legal
Prescriber signature
Abbreviation of D/C
Abbreviation is on the DNU list
SSI is the error-prone abbreviation of what
Sliding Scale insulin
Correct sequence for verbal orders
Write it down, read it back and receive confirmation
Description of medication dosage
Amount and strength of medication
Description of the frequency of a medication order
How often the medication is to be administered
What part of “LASIX 20mg po hs” is on the error-prone abbreviation list?
hs
Which abbreviation means “by mouth”?
PO
What abbreviation means “nothing by mouth”?
NPO
What must a nurse to when given verbal orders from a healthcare provider?
Repeated the orders back for verification
Identify the error in the order “Nitroglycerin .3 mg SL prn for chest pain every 5 minutes as needed up to 3 doses in 15 minutes”?
.3 (There should be a leading zero)
Correct interpretation of “Metoprolol 25 mg po q12h”?
Administer metoprolol 25 milligrams by mouth every 12 hours
Describe “Docusate 100 mg PO b.i.d”
Milligrams, orally, twice a day
Abbreviation “b.i.d” stands for what order?
Twice a day
Frequency of an order with the abbreviation “qh”
Hourly
The abbreviation “STAT” means
To be given ASAP
In what type of situation should a nurse accept a verbal order that wasn’t previously entered into the health record?
During emergencies or especially respiratory emergencies
Medication order that demonstrates a minimum time between doses
A prn medication order
The abbreviation “prn” means what
As needed
The purpose of CPOE
Provides clear communication
Prevents dosing errors or drug interactions
Allows immediate transmission to the pharmacy
Allows a electronic signature
At what time will a medication order of “aluminum hydroxide 30 mL ac 3x daily” be given
Before meals
The abbreviation “ac” means what
To be given before meals
Is the order “Insulin aspart 10 units before breakfast daily” acceptable?
No, there is no route of administration included
Is “Cefuroxime 1 g intravenously (IV) q8h” an acceptable order?
Yes, it has the drug, dose, route and time
Is “Furosemide 80 mg PO twice a day” an acceptable order?
Yes, it has the drug,dose,route and time
Note
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