Ch 9 Safety and Quality

What does QSEN stand for?

Quality and Safety Education for Nurses.

What are the QSEN competencies listed in the PowerPoint?

Patient-family centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

What are the six rights of medication administration listed in the PowerPoint?

Right patient, right drug, right dose, right time, right route, and right documentation.

What additional medication right is also listed in the PowerPoint?

Right indication.

How should the nurse verify the right patient?

Use two forms of identification and compare the patient’s stated name and birthdate with the ID band and medication administration record (MAR).

What other patient-identification checks may be used?

Scan the ID-band barcode, follow facility ID-band procedures, verify with a family member when appropriate, and check for a name-alert sticker if patients have similar names.

Ways to check medicine before administration

Check the medication label, confirm a valid order from an authorized prescriber, read the label three times, and review allergies, health history, labs, and vital signs.

What else should the nurse verify when checking the right drug?

That the medication matches the patient’s diagnosis and indication, dose calculations are correct, and the medication’s start and end dates are appropriate.

How does the nurse verify the right dose?

Check the calculation, ensure the dose is safe for the patient, and weigh the patient when dosing depends on weight.

Which medications does the PowerPoint give as examples of drugs whose doses may need verification by two RNs?

Insulin and heparin.

What should the nurse consider when checking the right time?

Facility policy, food timing, scheduled procedures, expiration dates, even intervals for antibiotics, and any ordered instructions to hold medications.

According to the slides, when are drugs affected by food given?

One hour before meals (ac) or two hours after meals (pc), as directed.

What should the nurse do with medications that irritate the stomach?

Give them with food when appropriate to the medication instructions.

Why does military time help medication safety?

It reduces time-related errors and ambiguity.

What should the nurse check before giving an oral medication?

The patient’s ability to swallow safely.

Why should a nurse not crush or mix medication without checking first?

The dosage form may be altered, affecting medication release, absorption, or safety.

What is an important route-related consideration for iron?

The slides note that iron may be taken with orange juice; otherwise, offer water rather than juice when giving medications, following drug-specific instructions.

What should the nurse document after medication administration?

Medication name, dose, route, time, date, and the nurse’s signature or initials according to facility policy.

which medication groups specifically require the nurse to document the patient’s response in the slides?

Analgesics, sedatives, and antiemetics.

When should the nurse document medication administration?

Immediately after administration, according to facility policy.

What is a “Just Culture”?

A safety approach that encourages reporting errors so system problems can be identified and corrected.

Why should medication errors be reported

Reporting helps identify risks and improve systems to prevent future errors.

What is the role of risk management in medication safety?

To help identify, review, and address risks and safety problems.

What is medication reconciliation?

Developing an accurate list of the patient’s medications and checking it when care changes or is transferred.

What should patients be taught about their medication lists?

Keep a current list, update it whenever medications change, carry it for emergencies, and bring it to healthcare appointments.

What does the Joint Commission focus on regarding patient safety?

Identifying healthcare safety problems and establishing approaches to address them, including standards for selected abbreviations.

What are FDA “black box warnings”?

Prominent warnings used to communicate serious risks associated with certain medications.

How should unused medications generally be disposed of according to the slides?

Use a community drug take-back program when available; consult a pharmacist if unsure, and do not flush medications unless specifically instructed.

What do the slides say about disposal when a take-back option is not used?

They describe mixing medication with an undesirable substance, sealing it in a container, and removing identifying information from the empty container label.

What is the purpose of the OSHA Needlestick Safety and Prevention Act?

It requires safer medical devices, a safe workplace and education, and written policies to help prevent sharps injuries.

why is buying medication from an unlicensed online source dangerous?

Counterfeit drugs may contain the wrong ingredient or dose, or be improperly packaged or contaminated.

Where should patients purchase prescription medications?

From licensed pharmacies.

What should the nurse do before splitting a tablet?

Confirm that splitting is safe for that specific medication and dosage form.

Why should extended-release or sustained-release medications not be crushed?

crushing can alter the intended drug release and create safety risks.

What should the nurse do if unsure whether a medication can be crushed?

Check with a pharmacist, healthcare provider, or reliable medication reference.

What are high-alert medications?

Medications that can cause significant harm if given incorrectly.

Which high-alert medications are listed in the PowerPoint?

Epinephrine, insulin, nitroprusside, and potassium chloride injection.

How can healthcare facilities reduce risks from high-alert medications?

Simplify storage, preparation, and administration; improve policies and education; limit access; use labels and automated alerts; and monitor patient responses.

What are look-alike and sound-alike medications?

Medications with names that look or sound similar and can be confused with one another.

Which look-alike or sound-alike pairs are listed in the PowerPoint?

Ephedrine/epinephrine, diazepam/diltiazem, Depo-Medrol/Solu-Medrol, and Zyrtec/Zyprexa.

How can nurses reduce errors involving look-alike and sound-alike medications?

Check the exact spelling and label, verify the order, and avoid relying on memory or a medication’s general appearance.

What is a medication safety zone?

A designated area intended to reduce interruptions and distractions during medication preparation.

Why should medication preparation be distraction-free?

Distractions increase the chance of errors in medication selection, dose calculation, and administration.

Which resources for medication-error prevention are listed in the PowerPoint?

The Institute for Safe Medication Practices, the Medication Error Reporting Program, and the FDA medication-error database.

What should the nurse do before preparing and administering medication?

Use relevant medication references, calculate doses accurately, perform hand hygiene, and avoid distractions.

Why should a nurse never administer medication prepared by another nurse?

The nurse administering the medication must verify its safety and accuracy rather than rely on another person’s preparation.

How can nurses minimize their own exposure to medications during preparation?

Avoid skin contamination and inhalation of medication substances.

What is the purpose of pregnancy medication categories and subsections in the slides?

To explain available information about medication benefits and risks for the mother, fetus, and breastfeeding child, including labor and delivery and nursing mothers.

Who may have authority to prescribe medications under applicable laws?

The PowerPoint’s practice question identifies physicians (MDs), dentists (DDSs), and advanced practice registered nurses (APRNs) as authorized prescribers; LPNs and CNAs are not listed as having this authority.

The patient states their name, but the ID band is missing. Should the nurse administer the medication?

No. Follow identification policy and obtain the required forms of identification before administering.

The prescribed dose seems unusually high. What should the nurse do?

Hold administration while verifying the order and calculation with an appropriate source or prescriber.

A patient cannot swallow a tablet. What should the nurse do?

Assess swallowing safety and check with a pharmacist or provider before crushing or changing the medication form.

A medication is labeled extended-release, and the patient requests that it be crushed. What should the nurse do?

Do not crush it; verify a safe alternative with the pharmacist or provider.

A nurse is interrupted repeatedly while preparing medications. What is the safest response?

Use the medication safety zone and reduce distractions before continuing

A nurse notices a medication error. What does a Just Culture support?

reporting the error promptly so the patient can be assessed and the system can be improved.

A patient receives an analgesic. What should the nurse document beyond giving the drug?

The patient’s response to the medication, according to policy.

A patient’s medication name looks similar to the name on the prescription but is not an exact match. What should the nurse do?

Stop and verify the exact drug name and order before administering.

What are signs of a possible medication allergy?

Signs can include rash, itching, hives, swelling, or breathing difficulty; assess promptly and follow emergency procedures for severe reactions.

What is the nurse’s role in safe medication administration across the healthcare team?

Verify orders, assess the patient, monitor effects, communicate concerns, document accurately, and use appropriate medication resources.

What is a drug-nutrient interaction?

Food or nutrients change a medication’s effect, or a medication changes nutrient absorption or use.

What is a drug-disease interaction?

A medication worsens a condition or a condition changes the medication’s effects or safety.

What is a drug-drug interaction?

One medication changes the effect of another medication.

What is the difference between a side effect and an adverse effect?

A side effect is an additional effect beyond the intended action; an adverse effect is an unwanted or harmful response.

What is an antagonistic effect?

One substance reduces or blocks the effect of another.

What is a potentiating effect?

One substance increases the effect of another.

What is a synergistic effect?

Two substances together produce a greater effect than expected from their individual effects.

What is an additive effect?

Two substances produce a combined effect equal to the sum of their individual effects.

What is the effect of antacids on drug absorption?

Antacids can change absorption of some medications; check the specific drug instructions and timing because the effect varies by medication.