Pharmacology 9&10 Study

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)

1. Documenting immediatly after administering medication

2. Checking drug dose from the pharmacy w/ medical record

3. 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)

1. Recognizing medication incompatibilities

2. Identifying safe dosage ranges

3. Preventing incorrect transcription

4. 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

1. Provides clear communication

2. Prevents dosing errors or drug interactions

3. Allows immediate transmission to the pharmacy

4. 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