Safe Meds & Error Reduction

National Patient Safety Goals

improve the accuracy of patient identification

improve the effectiveness of communication among caregivers

improve the safety of using medications

Med Error Causes

transcription, prescribing, and documentation

not adhering to the medication rights

trailing zeros and not placing a zero in front of a decimal

confusing names (similar names)

inappropriate use of abbreviations

distractions → poor lighting, heat, noise, interruptions, and wrong meds (expired, discontinued, contaminated)

National Patient Safety Goals

improve the accuracy of patient identification

improve the effectiveness of communication among caregivers

improve the safety of using medications

Med Error Causes

transcription, prescribing, and documentation

not adhering to the medication rights

trailing zeros and not placing a zero in front of a decimal

confusing names (similar names)

inappropriate use of abbreviations

distractions → poor lighting, heat, noise, interruptions, and wrong meds (expired, discontinued, contaminated)

Provider Responsibilities

obtaining clients medical history and preforming a physical exam

diagnosing

prescribing medications

monitoring the response to therapy

modifying medication prescriptions as necessary

Nurse Responsibilities

having knowledge of federal, state (nurse practice act), and local laws, and facilities policies that govern the prescribing, dispensing, and administration of meds

preparing and administering meds and evaluating clients responses to meds

developing and maintaining an up to date knowledge base of meds they administers like mechanisms of action, routes of administration, safe dosage range, adverse effects, precautions, contraindications, and interactions

maintaining knowledge of acceptable practice and skills competency

determining the accuracy of med prescriptions

reporting all med errors

safeguarding and storing meds

Principles of Med Administration

no med can be administered without being prescribed by a licensed practitioner

safe practice dictates that a nurse follows only a written, types, or order entry

under certain circumstances such as an emergency will a verbal order to a RN or pharmacist be permitted → legal implications for this

student nurses are not permitted to accept verbal orders

med reconciliation → process specifying and maintaining an accurate list of medications

First Check

med check when retrieving the med from the storage area

Second Check

med check when preparing the med, before pouring, mixing, or drawing it up

Third Check

med check just before administering the med to the patient, at the bedside or point of care

Right Patient

ensure that the patients full name is used

ask the patient to state their full name and date of birth

compare MAR to identification bracelet and patients stated name and birth date

verify allergies each time and ask specific reactions

be aware the prescriber could have entered an order in the wrong patients medical record

Right Medications

preform triple checks of all the rights and the med label

know the brand versus the generic name

be aware of names that sound familiar

be familiar with the medication

never administer meds prepared by another person

never administer medications that are not labeled or has been tampered with

Right Dose

check the label for med concentration

compare doses with med order

triple check all med calculations

verify the dosage is within appropriate dose range → safe for patient and therapeutic range for med

Right Route

verify med route with med order before administering

med may only be administered route specified

identify and use the appropriate med administration tools needed

ex: length of needle, appropriate syringe, or oral syringe

Right Time

verify the schedule of med within the order

date → check for stop date, is it scheduled for a certain number of doses or days?

time → maybe dependent on policy, is possible administer on patients care plan, administer med punctually as ordered, policies vary but generally half hour before or after indicated hour

specified frequency → always check last doses of med given to the patient

evaluation of patient within 30 mins or sooner per med or policy

Right Reason

confirm the rationale for the ordered med

what is the patients history?

why are they taking this med?

revisit the reasons for long term med use

Right Assessment

properly assess the patient to determine if the med is safe and appropriate

if unsafe of inappropriate, notify the provider immediately

in med was not administered document and report it

Right Documentation

complete documentation per facility policy immediately after administration

document and report the appropriate provider any related signs and symptoms

Right Response

monitor the patient

detect and prevent complications

evaluate any health changes

assess lab values and detect changes

document patients response to medication

provide patient education

Right to Education

assess patients knowledge level

provide education regarding → dosing, administration times, med side effects, and contraindications

Right to Refuse

the legal responsible party for the patients care has the right to refuse any meds

inform patient or responsible party for consequence of refusing

ensure that the patient understand the consequences of refusal

notify the provider that the ordered med was not given and document

document refusal and that they fully understand the consequence

Med Administration

do not administer outdated or expired meds

do not administer beyond the stop date

do not administer a med that has some chemical change (color, odor, or consistency)

administer only meds that are labeled correctly and not tampered with

Med Errors

report all med errors and near misses per facility policy

never hide an error → patient safety comes first

errors can reveal system issues and drive improvement in patient safety

When to Not Administer Meds

ensure the order is completed and signed by a provider

hold meds if the patient has abnormal physical systems

verify all 11 rights are met

do not administer if the patient or their representative refuses

if anything is unclear, double check before proceeding

Med Infection Control

wash hands thoroughly and scrub for at least 15-30 secs

one needle, one syringe, and one patient every time

always use a new sterile needle and syringe for each vial entry

avoid multi dose vials whenever possible

Safe Med Administration

avoid distractions → stay in the red zone (time you get to administer meds)

follow policy for co-signing meds

never pre-pour meds

document immediately, not later

verify all rights three times

always double check allergies

never leave meds at the bedside

Med Considerations

elevate head and ensure the patients swallows

asses for oral motor issues like difficulty swallowing, aspiration risk, and tonic biting

consider age related changes and special needs

use proper landmarking for injections

reconcile meds regularly and per facility policy

monitor continuously for safety

watch for delirium signs (confusion, disorientation)

chronic illness and infection can affect med metabolism and absorption