Week 10: Medication Administration and Safety

Which CRNA safety standards are highlighted for medication administration and safety

-Standard 1: Safety

-Standard 2: Authority

-Standard 3: Knowledge

-Standard 4: Ethics

Outline CRNA Standard 1: Safety

Regulated members are responsible and accountable to provide safe medication management

Outline CRNA Standard 2: Authority

Regulated members follow current legislation, standards, and policies on medication management

Outline CRNA Standard 3: Knowledge

Regulated members are knowledgeable about the medications they administer and those that their clients are taking, whether prescribed, over the counter, or natural health products

Outline CRNA Standard 4: Ethics

Regulated members follow the code of ethics for registered nurses and ethical principles in all aspects of medication management

List the medication rights

-Medication

-Dose

-Patient

-Route

-Time

-Frequency

-Site

-Reason

-Documentation

-Patient education

-Technique

-Approach

-Assessment

-Evaluation

-Right to refuse

List the three medication checks

-Compare the medication label to the MAR when retrieving the medication from the storage area

-Compare the medication label to the MAR as you prepare each medication (remove from container)

-Compare the medication label to the MAR at bedside before administering the medication to the patient

How long is the time window before and after the scheduled medication administration time?

30 minutes

Define medication reconciliation

A structured process in which healthcare professionals partner with the patient, family, and caregiver for an accurate and complete transfer of medication information at transitions of care

What is the information gathered from medication reconciliation used for?

Used to verify/validate the patient's admission, transfer, referral, or discharge medication orders to reduce medication errors and adverse medication events at all points of care

List the three steps of medication reconciliation?

Step 1: Generate a best possible medication history (BPMH)

Step 2: Reconcile the BPMH at care transitions

Step 3: Document and communicate the medication information

What components should be included in a medication order?

-The patients first and last name

-Unique identification number

-Date and time the order is written

-Medication name

-Dose

-Route of administration

-Time and frequency of administration

-Signature of prescriber

What abbreviations and symbols should never be used when communicating medical information because they have been frequently misinterpreted?

-U (unit)

-IU (Internation unit)

-Abbreviation for drug names

-QD (every day)

-QOD (Every other day)

-OS (left eye)

-OD (right eye)

-OU (Both eyes)

-D/C (Discharge)

-CC (cubic centimetere)

-µg (microgram)

- < and >

-@

-Trailing zero

-Lack of a leading zero

True or False: You should abbreviate drug names?

False

1 multiple choice option

How should you represent a trailing zero or lack of a leading zero?

Trailing zero: Never use a zero by itself after a decimal point (X.050mg)

Leading Zero: Always use a zero before a decimal point (0.50mg)

What are high alert medications?

A drug known to cause significant harm to human health when administered incorrectly

List the types of high alert medications

-Anticoagulants (Heparin)

-Insulin

-Narcotics

What is the independent double check policy?

A consistent process for the activity of an independent double checks prior to medication administration

What does the independent double check policy consist of?

Two health professionals (student nurse would be a 3rd) independently verify a series of information

What information is verified during the independent double check?

-The most current order or MAR

-Patient's relevant lab values and or diagnostic results

-Medication dosage calculations (if required)

-The medication rights

Does the initial healthcare professional communicate with the second checker before or after the second verification is completed?

The first health care professional shall not communicate to the second until the second has finished verification, each will then share results

How do you proceed if there are discrepancies between the two independent verifiers?

A third health care professional verifies prior to medication administration

What is the co-signature procedure?

Some medications require a co-signature from a regulated health care professional

Can students co-sign a medication?

Yes, the student is the third signature alongside two other regulated health care professionals

What medication types require a co-signature, direct observation during preparation, and initial direct observation during administration?

-All IV medications

-Controlled substances

-High alert medications

-Pediatric fractional dosages (all routes)

-Other medication as determined by local/unit policy

List the types of medication distribution systems

-Stock supply

-Unit dose

-Automated dispensing systems, or computer controlled dispensing systems (i.e. Pyxis med station)

What is AHS patient identification policy?

Two or more patient identifiers are used to confirm the patient’s identity prior to a health service being provided, to confirm that the correct patient receives the intended health service

List the approved patient identifiers

-BOTH the patients first and last name (considered 1)

-Full date of birth (Y/M/D)

-Unique lifetime identifier (ULI)

-Medical record number (MRN)

-Patient ID barcode

-Patient's home address (If the address is provided by the patient)

-Photograph

-Facial recognition

-Offender record correctional administration (ORCA) number

In an emergency situation how is a patients identify verified?

In an emergency situation when the patient's identity cannot be immediately verified services are not refused or delayed and the patient is assigned an anonymous name and a unique identifiable number until their identity can be verified

List the types of medications routes addressed in NURS 221

-Oral (PO)

-Topical

-Instillation (nasal, eye, ear, vaginal, and rectal)

-Inhalation

What is oral (PO) route of administration?

Medications given by mouth

What is the easiest and most desirable route to administer medication?

Oral route (PO)

What forms does the oral route come in?

-Liquid

-Tablets

-Capsules

-Sustained release

-Buccal

-Sublingual

What are requirements for oral med admin?

-Patients must be able to swallow well (prevent aspiration)

-Have no contraindications

-No GI alterations that would prohibit intake

Is fluid intake allowed after buccal or sublingual tablets?

No

1 multiple choice option

Why should you stay at a patients bedside during oral med admin?

To watch the patient consume the medication, because you should never leave the medication unattended

What should you do after the patient has consumed the oral medication?

Evaluate for therapeutic and adverse effects

What medications cannot be crushed

-Certain capsules

-Sustained release

-Enteric coated meds

Which oral forms of a medication can be crushed?

Tablets

What procedures are required prior to med admin?

Hand hygiene and possible PPE such as gloves or the use of an applicator

What is topical route of administration?

Medications applied to the surface of intact skin or mucous membranes

What forms does topical medication come in?

-Pastes

-Lotions

-Ointments

-Patches

Does the topical route have a local or systemic effect?

Can be local or systemic in effect (maybe timed release)

When documenting topical med admin what should you note?

Note the area that the topical medication was applied, and the old patch was removed

For topical med admin should you leave the old patch in place or remove it?

Never leave old patches in place, remove once done

What is instillation route of administration?

Administration of a medicine, generally in liquid form either drop by drop or with a catheter into a body space or cavity

What forms does instillation medication come in?

-Nasal: Sprays, drops, tampons

-Eyes: Drops, ointments

-Ears: Drops

-Vaginal: Suppositories, foam, jellies, and creams

-Rectal: Suppositories, enemas

What is inhalation route of administration?

Medications that are inhaled and penetrate the lung airways

Are inhalation medication rapid or slow absorption?

Rapid absorption

1 multiple choice option

What forms does inhalation medication come in?

-Metered dose inhalers (MDI's)

-Dry powdered inhalers (DPI's)

-Slow stream inhalers

What are the requirements for metered dose inhalers (MDI's) and dry powdered inhalers (DPI's)?

Patient's are given the device to administer the medication while the nurse observes. The patient needs adequate hand strength and dexterity, as well as the ability to follow directions.

What additional device may be needed for the MDI?

May need a spacer device for the MDI

When should you document med admin?

Document on the dedicated form (MAR) immediately after or as soon as possible after administering medications

Documentation of med admin needs to be _______ and _______

Timely, accurate

What should be included in the documentation of med admin?

-Patient's name, and ID number

-Order written out in full with dose, route, and frequency

-Prescriber's name

-Date of start and stop (if applicable)

-Time administered

-Signature of who administered the medication

-Others: Such as location of where applied patch

-On progress notes reason (i.e. pain), teaching, effectiveness

What are controlled substances?

Any drug that the government has categorized as having a potential for abuse or addiction

What are adverse drug events?

Client injury that occurs after receiving the wrong medication or after not receiving a required medication

What is a medication profile?

A comprehensive record of all medications that a patient is currently taking. It includes details about prescription medications, over-the-counter drugs, herbal supplements, and vitamins. The profile is needed for medication reconciliation and to prevent medication errors

Medication reconciliation is done in which of the following situations (Select all the apply)?

A. When patient leaves the unit for an x ray

B. When patient is admitted to the unit

C. When patient is discharged from the unit

B and C