Safe Medication Administration and Error Reduction

What you need to prevent medication errors

1. Nomenclature/background

2. 10 rights!

3. Work flow

4. Just culture

Chemical name

A medications chemical composition (N-acetyl-para-aminophenol)

Generic name

Official name the United states adopted names council gives medication. Each medication only has one generic name.

Trade name

brand or proprietary name the company that manufactures the medication gives it. One medication can have multiple trade names (tylenol, tempra)

Trade name + generic name examples

Trade name: Advil

Generic name: Iburpofen

Components of a prescription/order

The clients full name, the date and time of the prescription, the name of the medication (generic or brand), the strength and the dosage of the medication, the route of administration, the time and frequency of administration, the quantity to dispense and the number of refills, the signature of the prescribing provider.

Routine or standing

given on a regular schedule with or without a termination date

single or one-time

administration once at a specfic time or as soon as possible

Stat

Administration once and immediately

PRN

specifies at what dosage, frequency, and under what conditions a nurse can administer the medication. The nurse uses clinical judgement to determine the clients need for the medication.

Over the counter

Do not need a prescription

Uncontrolled substances

the medications require monitoring by a provider, but do not generally pose a risk of misuse/addiction.

Controlled substances

Medications that have a potential for misuse and dependence and have a schedule classification by federal government

Right client

Two client identifiers (includes name, MRN, telephone number, birthdate, photo or photo ID, bar code!!)

Right medication

read medication labels and compare them with the MAR three times: before removing the container, when removing the amount of medication from the container, and in the presence of the client before administering the medication. Leave unit-dose medication in its package until administration.

Right Dose

dose and calc! Use resources: pharmacist, EHR, double check

Right time

administer medication on time to maintain a consistent therapeutic blood level.

Right route

Oral, topical, inhalation, parenteral

Oral

tablets, capsules, liquids, suspensions, elixrs, lozenges

topical

Powers, sprays, creams, ointments, pastes, oil-and suspension-based lotions

Oral Sublingual

under the tongue

Buccal

between the cheek and the gum

Topical Transdermal

medication in a skin patch for absorption through the skin

Topical Instillation

drops, ointments, sprays

Inhalation

metered-dose inhalers (MDI) or dry-powder inhalers (DPI)

Parenteral

Intradermal, subcutaneous, intramuscular, intraenous

Right documentation

Before in EHR/ after in written documentation. In EHR we scan our meds before as a safety mechanism, but chart everything else.

Right client education

Client’s right to know; purpose, what to expect, how to take it, what to report. Ask first talk to your client!

Right to refuse

Respect and autonomy

Right evaluation

therapeutic effects

Right assessment

#1 safety assessment = allergies. #2 Assessment for medication + assessment for route.

Medication administration workflow

1. nurse receives and reviews order

2. Nurse prepares the medication: pull up medication on dispensing unit, follow machine orders.

3. Nurse administers the medication

Wasting

1. If the dose ordered is less than the dose available, then wastage must be done. Prepare the dose and document the waste with a witness at the time of removal.

2. Wasting of controlled substances must be witnessed and cosigned by another licensed healthcare practitioner

3. All controlled substances must be destroyed on the nursing unit by or placing in an authorized controlled substance waste management system.