Week 3 Nursing Process, Med Errors and Risk Reduction, Drug Admin, Drug Response

Clinical Judgement Measure Model CJMM

1. recognize cues

2. analyze cues

3. prioritize hypotheses

4. generate solutions

5. take action

6. evaluate outcomes

Healthcare provider factors contributing to med errors

omitting right of drug admin, failing to take into account pt variables, giving meds based on verbal/phone/illegible orders, unclear directions given to patient, stressful work conditions

How do we make med errors?

omission, wrong dose, extra dose, unordered drug, wrong route, wrong time

Patient/caregiver factors contributing to med errors

drugs prescribed by several practitioners, prescriptions filled at 1+ pharmacy, not filling or refilling prescriptions, taking meds incorrectly, taking left over meds, taking someone else’s meds

Documentation of med errors

must include specific interventions to protect patient, everyone informed of error, outcome of error, what med given/omitted

Why do we use incident/occurrence reports?

helps us identify factors that may have contributed to error

Sentinel and patient safety events

unexpected outcomes involving death or serious injury, or risk of always investigated

Root cause analysis

seeks to prevent reoccurences of med errors, asks why it happened, what happenened, what can prevent it again, when it happened

When is medication reconciliation done?

on admission, during transfers, on discharge

What is medication reconciliation?

process of tracking patient’s medications as they proceed from one healthcare provider or department to another, important for POLYPHARMACY

Methods to reduce med errors

EHRs, barcode-assisted med admin, risk-management departments, automated dispensing cabinets, root-cause analysis

How is absorption of drugs affected during pregnancy?

hormonal changes affect absorption, inhaled drugs may be absorbed faster

What affects distribution and metabolism during pregancy?

changes in cardiac output, plasma volume, regional blood flow

How does drug excretion change during pregancy?

rate of excretion may increase

Pregnancy drug categories

A - human studies proven safe

B - animal studies proven safe but human studies contradicted

C - fetal abnormalities noted in animal studies or no studies available

D - evidence of fetal risk but benefits may outweigh risks

X - severe fetal deformities

Recommendations for drug use during lactation

-administer after feeding

-avoid alcohol, drugs, tobacco

-drugs with shorter half-life preferable

-select drugs with high protein-binding ability

-avoid all OTC herbal, dietary supplements

True or false: for breastfeeding women, drugs with a longer half-life are recommended?

FALSE - shorter half life safer

Which conditions require drug administration to be continued even during pregnancy?

epilepsy, hypertension, gestational hypertension, gestational diabetes, infections

True or false: older adults are at less of a risk for polypharmacy contradictions because they have been taking medications for longer.

FALSE - more at risk because usually taking more than one med at a time, more adverse drug events, remind aids for admin may be necessary

Why is drug absorption slower in older adults?

decreased gastric motility, decreased blood flow to digestive organs, increased gastric pH

Why does increased gastric pH affect drug absorption in older adults?

oral tablets/capsules require high levels of acid to dissolve/absorb so may take longer to become available to tissues if pH is more alkaline

Why is drug distribution diminished in older adults?

increased body fat, reduced plasma level, less body water (dehydration), liver produces less albumin, decreased cardiac output

Why does the liver producing less albumin affect distribution of drugs in older adults?

decreased plasma protein-binding ability, increased levels of free drugs (increases potential for drug-drug interaction)

Metabolism reduced in older adults

reduced first-pass metabolism, decreased liver enzyme production, plasma level elevated, half-life of drugs increased, tissue concentrations increased

Excretion reduced in older adults

reduced renal blood flow, reduced glomerular filtration rate, decreased active tubular secretion, decreased nephron function, decreased drug excretion for drugs processed by kidneys

What’s the most important lab to check due to older adult’s decreased excretion?

kidney labs

Pharmacogenetics

study of genetic variations that give rise to differences in drug response

Cultural and ethnic influences on pharmacotherapy

ethnicity (biologic and genetic similarities), culture (beliefs, values, norms), dietary considerations, alternative therapies, beliefs about health/illness, genetic differences