NURS 321: Ch 2, Safe Medication Administration and Error Reduction (part one)

What is the NURSE'S ROLE in DRUG ADMINISTRATION?

last safety checkpoint; has to verify that it is safe and appropriate before administration

Why is the nurse considered a final safety checkpoint in medication administration?

The nurse is the last person to verify the medication, dose, route, timing, allergies, and client condition before the drug reaches the patient.

Why is safe medication administration more than just giving a drug?

It includes assessment, prescription verification, correct preparation, patient education, documentation, and follow-up evaluation.

Who is ALLOWED to WRITE A PRESCRIPTION?

physicians, advance practice nurses, dentists, physician assistance

What SIX things is a PROVIDER RESPONSIBLE for in medication?

1.) Obtaining medical history

2.) Physical examination

3.) Diagnosis

4.) Prescribing medication

5.) Monitoring response to therapy

6.) Modifying prescriptions as necessary

What FOUR things is a NURSE RESPONSIBLE for in medication?

1.) Knowing policy

2.) Preparing medication

3.) Administering medication

4.) Evaluating client response

What should nurses KNOW about medication?

Needs an up-to-date knowledge of

- use

- mechanism of action

- route of administration

- safe dosage range

- adverse effects

- precautions

- contraindications

- interactions

Why can't nurses blindly give a medication just because it was ordered?

Nurses are responsible for verifying safety and appropriateness before administration

What should the nurse do if a medication order seems unsafe?

Clarify the order with the provider and follow facility policy before administering

In what SIX ways can a NURSE help REDUCE ADVERSE EVENTS related to medication?

1.) Determining the accuracy of medication prescriptions

2.) Reporting medication errors

3.) Safeguarding and storing medications

4.) Following legal mandates when administering controlled substances

5.) Calculating medication dose accurately

6.) Understanding responsibilty of other members of health care teams

What are the NURSES FIVE ROLES in MEDICATION ADMINISTRATION?

1. Administering the drug

2. Assessing drug effects

3. Intervening to make the drug regimen more tolerable and promoting best outcomes

4. Patient education about drugs and drug regimens

5. Monitoring patient care plan to prevent medication errors

What is MEDICATION RECONCILIATION?

process of documenting a complete list of all medications the patient is taking so errors do not happen during admission, transfer, or discharge

What FOUR details must be included in MEDICATION RECONCILIATION?

medication name, specific dosage, route, and frequency aka last time it was taken

WHEN is MEDICATION RECONCILIATION required?

upon admittance, during transfers between units or facilities, and when discharged

What does the JOINT COMMISSION REQUIRE for MEDICATION RECONCILIATION?

policies and procedures; health care facilities must have a system for checking medication lists

What can happen if medication reconciliation is not done correctly?

The client may receive duplicate medications, miss needed medications, receive the wrong dose, or experience harmful interactions

Why should OTC medications and supplements be included?

They can interact with prescription medications or affect the client's condition

What is a DISCREPANCY?

a mismatch or difference in medication reconciliation that needs to be resolved

What should the nurse do if they find a medication discrepancy?

Clarify the discrepancy with the provider before administering questionable medications

What are the GOALS of MEDICATION RECONCILIATION?

prevent errors and medication interactions

What are the FOUR STEPS of MEDICATION RECONCILIATION?

1.) Complete list of all prescription, OTC, and supplements

2.) Review medication accuracy and client compliance

3.) Compare medication in medical record with a client's at home medication list and identify discrepancies

4.) Communicate changes to client and health care team

WHO are the members of the HEALTH CARE TEAM?

provider, pharmacist, nurse, assistive personnel

What is the role of the PROVIDER?

Provide clear, accurate, and complete medication prescriptions; specifying units of measure, route of administration, and duration of treatment

What is the role of the PHARMACIST?

Review prescription information; verify allergies, current medications, dosages, drug interactions, and contraindications to medication therapy

What is the role of the NURSE?

- Conduct final verification prior to administration of the medication to the client.

- Ensure that medication administration is being distributed in accordance with the rights of medication administration.

- Provide client education about the medication

What is the role of the ASSISTIVE PERSONNEL?

perform administrative tasks

Why is PRIORITIZATION important in MEDICATION ADMINISTRATION?

interruptions, emergencies, time-sensitive meds, and PRN meds can all affect when and how medications are given

How do INTERRUPTIONS affect MEDICATION ADMINISTRATION?

they increase the risk for medication errors

What are examples of INTERRUPTIONS in MEDICATION ADMINISTRATION?

A change in the client's condition

A medication order that needs clarification

A client asking questions

A family/support person asking questions

An emergency on the unit

A medication that is missing or unavailable

A need to check allergies, labs, or vital signs

When would a nurse administer a drug WITHOUT finishing the full medication reconciliation list first?

If the client has an urgent life-threatening issue

What should nurses CONSIDER when PRIORITIZING medication administration?

scheduled timing

What is SCHEDULED TIMING?

the strict window of time in which a nurse can legally and safely give the medication

What are TIME-CRITICAL MEDICATIONS?

medications that must be administered within 30 minutes of the due time

What if a TIME-CRITICAL MEDICATION is DELAYED?

they become unsafe or less effective

When are PRN medications ADMINISTERED?

based on the client's individualized status and needs instead of administered at scheduled intervals

How should NURSES decide when to ADMINISTER PRN medication?

use autonomy and clinical decision-making skills to understand client needs and prioritize PRN medication administration

What are ABCs?

prioritization framework;

Airway

Breating

Circulation

What are examples of AIRWAY PROBLEMS?

Choking

Tongue blocking airway

Severe swelling from allergic reaction

Secretions blocking airway

Vomiting with aspiration risk

Stridor or signs of airway obstruction

What are examples of BREATHING PROBLEMS?

Shortness of breath

Wheezing

Low oxygen saturation

Respiratory distress

Slow respirations after opioid medication

Asthma attack

COPD exacerbation

What are examples of CIRCULATION PROBLEMS?

Chest pain

Severe bleeding

Hypotension

]Weak pulse

Signs of shock

Poor perfusion

Dysrhythmias

What are THREE reasons why TIME MANAGEMENT is important?

1.) ETMs

2.) Management of nurse responsibilities

3.) Organization of Medication Tasks

What are EMTs?

"electronic task management systems"; coordinate multiple tasks across the client care continuum into one location and ensure tasks are not missed throughout client care

Why is MANAGEMENT OF NURSING RESPONSIBILITIES important?

Nurses must understand how to prioritize care and have strong time management skills in order to focus on providing client care

Why is ORGANIZATION OF MEDICAL TASKS important?

Medications are timed in health care record and nurses must be mindful of time-sensitive medication

What is INPATIENT CARE?

client is admitted to a hospital or facility and is staying there for care

What is the NURSE'S ROLE in INPATIENT CARE?

follows the medication reconciliation process, reviews

and verifies medication information, and administers medication to

the client

What is the NURSE'S ROLE in INPATIENT CARE during TRANSITIONS IN CARE?

during discharge, the nurse does medication reconciliation, working as a partner with the client and the provider and educating the client about discharge medications

What is OUTPATIENT CARE?

client receives care without being admitted to the hospital

What are examples of OUTPATIENT CARE?

Clinics

Provider offices

School settings

Community health settings

Why is STRONG MEDICATION EDUCATION important in OUTPATIENT CARE?

the client may be more likely to adjust their medications on their own because there is less frequent interaction

What is OUT-OF-HOSPITAL CARE?

any medical treatment, rehabilitation, or support service that does not require an overnight hospital stay

What is an example of OUT-OF-HOSPITAL CARE?

nursing homes

What is the role of the nurse in OUT-OF-HOSPITAL CARE?

governed by multiple regulatory bodies, and health care can be very unpredictable

Who is the cliental in OUT-OF-HOSPITAL CARE?

Clients in these settings may have complex needs, multiple medications, chronic conditions, and higher risk for medication interactions or adverse effects

What is a BRAND/TRADE NAME?

name given to a drug by the pharmaceutical company that sells it

What is a PROPRIETARY NAME?

company owns or markets the name of a drug

What is a GENERIC NAME?

medication's nonproprietary name, not owned by one compary

Who gives a medication its GENERIC NAME?

United States Adopted Name Council

What is a CHEMICAL NAME?

describes the medication's chemical composition and molecular structure

What are OTC DRUGS?

"over the counter" drugs; medications that can be bought without a prescription

When are OTC drugs used? Are they safe?

used for self-treatment of different complaints; are considered safe when used as directed

What is an example of BRAND NAME DRUGS?

advil, motrin

What is an example of GENERIC DRUGS?

Ibuprofen

What is an example of CHEMICAL NAME?

Isobutylphenyl propanoic acid

What is an example of OTC DRUGS?

Claritin

What is the relationship between Claritin and loratadine?

Claritin is the brand name, and loratadine is the generic name/active ingredient

Can OTC medication cause harm?

They do not require a prescription but can cause harm if used incorrectly

What does it mean if a OTC drug is "grandfathered in"?

they were allowed to stay available even though they may not have gone through the same level of testing that newer drugs go through today

What is a potential dangers of OTC medication?

OTC medications can hide symptoms without treating the actual cause because it causes temporary relief

How can OTC medication affect the effect of prescription drugs?

It can can interact with prescribed medications and change how it works

Why is PATIENT TEACHING critical?

Patients need to know how to use OTC medications safely, follow dosing instructions, and know when to seek care

What is a UNCONTROLLED SUBSTANCE?

Requires monitoring by a provider, but do not generally pose risks of misuse and addiction

What is a CONTROLLED SUBSTANCE?

Have a potential for misuse and dependence and have a "Schedule" classification

UNCONTROLLED OR CONTROLLED SUBSTANCE: antibiotics

uncontrolled

UNCONTROLLED OR CONTROLLED SUBSTANCE: heroin

controlled

What is a SCHEDULE I DRUG?

no accepted medical use and a high risk for misuse

What are SCHEDULE II TO V DRUGS?

have actual medical use, but they are controlled because they still have risk for misuse or dependence

Why are controlled substances scheduled?

They are scheduled to regulate use based on their medical purpose and risk for misuse or dependence

What does SCHEDULE NUMBER indicate?

the higher the schedule number, the lower the risk for misuse and dependence

How is SCHEDULE I DRUGS classified?

High abuse potential, no accepted medical use

How is SCHEDULE II DRUGS classified?

High abuse potential, severe dependence liability

How is SCHEDULE III DRUGS classified?

Less abuse potential than schedule II, moderate dependence liability

How is SCHEDULE IV DRUGS classified?

Less abuse potential than schedule III, limited dependence liability

How is SCHEDULE V DRUGS classified?

Limited abuse potential.

How are SCHEDULE V DRUGS used?

Primarily small amounts of narcotics used as antitussives or antidiarrheals

What is the FEDERAL LAW for SCHEDULE V DRUGS?

limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. Purchaser must be at least 18 years of age and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist.

WHAT TYPE OF SCHEDULE?: heroin, LSD

Schedule I

WHAT TYPE OF SCHEDULE?: narcotics, amphetamines, and

barbiturates

WHAT TYPE OF SCHEDULE?: nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics

Schedule III

WHAT TYPE OF SCHEDULE?: some sedatives, antianxiety agents, and nonnarcotic analgesics

Schedule IV

What is the ROLE of the FDA in medication?

evaluates new medications for safety and effectiveness before they are approved

What must be done to all drugs tested by the FDA?

new drugs in development go through rigorous testing procedures by the FDA before approval to determine effectiveness, safety, adverse effects, dosing, warnings, and precautions

What is the NURSES role when handling NEW MEDICATION?

Nurses observing adverse drug effects and can report them to MedWatch on the FDA's website

What are PREGNANCY CATEGORIES?

describe how much risk a medication may have for the fetus during pregnancy

How are medications CLASSIFIED in PREGNANCY CATEGORIES?

categories go from A to X, with A being the safest and X being contraindicated because risk outweighs benefit

What is CATEGORY A?

adequate studies in pregnant people have not shown risk to the fetus in the first trimester, and there is no evidence of risk later in pregnancy

What is CATEGORY B?

animal studies have not shown fetal risk, but there are not enough adequate studies in pregnant people OR animal studies may have shown some adverse effect, but studies in pregnant people have not shown risk during the first trimester

What is CATEGORY C?

animal studies have shown adverse fetal effects, but there are not enough adequate human studies

Should CATEGORY C medication still be used?

the medication may still be used if the potential benefit justifies the risk

What is CATEGORY D?

there is evidence of human fetal risk