NURS 2873 - Medication Management & Error Prevention
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At what points in the medication-use process can medication errors occur?
Procuring, prescribing, transcribing, dispensing, administering, and monitoring.
What happened in the Navane vs. Norvasc medication-error case?
A 71-year-old woman accidentally received thiothixene (Navane), an antipsychotic, instead of amlodipine (Norvasc), her antihypertensive, for 3 months.
What type of medication is thiothixene (Navane)?
An antipsychotic.
What type of medication was the patient supposed to receive instead of Navane?
The antihypertensive amlodipine (Norvasc).
How long did the patient in the Navane vs. Norvasc case receive the wrong medication?
3 months.
What physical and psychological harm occurred in the Navane vs. Norvasc case?
Ambulatory dysfunction, tremors, mood swings, and personality changes.
What important systems issue occurred in the Navane vs. Norvasc case?
Multiple health care providers overlooked the patient's symptoms despite many opportunities for intervention.
What medication-safety problem is illustrated by drug names such as Navane and Norvasc?
Look-alike/sound-alike medication names can contribute to medication errors.
What medication-safety problem is illustrated by ampicillin and amoxicillin bottles with similar packaging?
Similar medication names and packaging can increase the risk for selection errors.
What medication-label examples on the safety slide illustrate why nurses must read labels carefully?
Pantoprazole, Synthroid, ibuprofen, and Mucinex labels with similar packaging/appearance.
Why must nurses pay attention to syringe type and size during medication preparation?
Syringes can differ in size, markings, and intended use, so selecting the wrong syringe can cause dosing errors.
Which look-alike/confused drug pair shown in the ISMP example includes Abelcet?
Abelcet and amphotericin B.
Which look-alike/confused drug pair shown includes Accupril?
Accupril and Aciphex.
Which two drug names shown are confused because of similar spelling involving ZOLAMIDE and HEXAMIDE?
acetaZOLAMIDE and acetoHEXAMIDE.
Which two forms of acetic acid are listed as a potentially dangerous confused pair?
Acetic acid for irrigation and glacial acetic acid.
Which look-alike drug is Aciphex confused with besides Accupril?
Aricept.
Which medication is Activase confused with because of a related product name?
Cathflo Activase.
Which thrombolytic is Activase also confused with?
TNKase.
Which two osteoporosis/diabetes-related brand names are shown as a confused pair?
Actonel and Actos.
Which two vaccines are listed as a confused medication-name pair?
Adacel (Tdap) and Daptacel (DTaP).
Which medication is Adderall confused with on the ISMP example?
Inderal.
Which two formulations of Adderall can be confused?
Adderall and Adderall XR.
Which biologic names are shown as a potentially confused pair?
ado-trastuzumab emtansine and trastuzumab.
Which respiratory/lipid drug brand names are shown as a confused pair?
Advair and Advicor.
Which medication is Advicor also confused with?
Altocor.
Which two Afrin products are shown as potentially confused?
Afrin (oxymetazoline) and Afrin (saline).
Which medication is Amikin shown as being confused with?
Kineret.
Which two drugs use Tall Man lettering to distinguish aMILoride and amLODIPine?
Amiloride and amlodipine.
Which medication is amiodarone shown as being confused with?
Amantadine.
Which antifungal medication name is shown as being confused with Abelcet?
Amphotericin B.
Which antifungal medication name is also shown as being confused with Ambisome?
Amphotericin B.
Which two analgesic brand names are shown as a confused pair?
Anacin and Anacin-3.
Which drug name is antacid shown as being confused with?
Atacand.
Which two anticoagulant citrate solutions are listed as potentially confused?
Anticoagulant Citrate Dextrose Solution Formula A and Anticoagulant Sodium Citrate Solution.
Which medication is Antivert shown as being confused with?
Axert.
Which medication is Anzemet shown as being confused with?
Avandamet.
Which insulin is shown as being confused with Spiriva?
Apidra.
Which medication is Apresoline shown as being confused with?
Priscoline.
Which anticoagulant is argatroban shown as being confused with?
Aggrastat.
Which other medication is argatroban shown as being confused with?
Orgaran.
Which medications are shown as potential confused names with Aricept?
Aciphex and Azilect.
What is the nurse's role in medication-error prevention according to the presentation?
RNs are the last layer of defense against medication errors.
Why should a nurse minimize distractions when preparing or administering medications?
Distractions can contribute to medication errors, so medication work requires attention and vigilance.
What are the 9 Rights of Medication Administration listed from Lilley?
Right drug, dose, time, route and form, patient, documentation, reason, response, and right to refuse.
What is the first medication-administration right in the Lilley list?
Right drug.
What is the second medication-administration right in the Lilley list?
Right dose.
What is the third medication-administration right in the Lilley list?
Right time.
What is the fourth medication-administration right in the Lilley list?
Right route and form.
What is the fifth medication-administration right in the Lilley list?
Right patient.
What is the sixth medication-administration right in the Lilley list?
Right documentation.
What is the seventh medication-administration right in the Lilley list?
Right reason.
What is the eighth medication-administration right in the Lilley list?
Right response.
What is the ninth medication-administration right in the Lilley list?
Right to refuse.
What are the AMSN 10 Rights of Medication Administration?
Right medication, dose, time, route, patient, documentation, patient education, refusal, assessment, and evaluation.
Which medication-administration right specifically requires teaching the patient?
Right patient education.
Which medication-administration right requires assessing the patient before medication administration?
Right assessment.
Which medication-administration right requires determining the effect after administration?
Right evaluation.
Why should a nurse ask, "Why am I giving this medication?"
The nurse must verify that the medication is appropriate for the patient's diagnosis/history and has a valid reason.
For what conditions may metoprolol be prescribed according to the presentation?
HTN, MI, CHF, angina, atrial fibrillation, SVT, and migraine.
For what conditions may prednisolone be prescribed according to the presentation?
RA, COPD exacerbation, Bell's palsy, radiculopathy, and ulcerative colitis.
For what conditions may hydrochlorothiazide be prescribed according to the presentation?
Edema associated with heart failure, HTN, and nephrotic syndrome.
For what conditions may metformin be prescribed according to the presentation?
Type 2 diabetes mellitus and polycystic ovarian syndrome.
For what conditions may gabapentin be prescribed according to the presentation?
Seizures, peripheral neuropathy, and chronic pain.
For what conditions may fluoxetine be prescribed according to the presentation?
Depression, anxiety, OCD, and fibromyalgia.
What special action is emphasized for high-alert medications?
Stop and double-check.
What resources/tools are depicted for preventing medication errors with high-alert drugs?
Smart infusion pumps, medication-dispensing systems, barcode scanning, pharmacists, double checks, and the policy/procedure manual.
Why should a nurse consult the facility's policy and procedure manual when administering medications?
Facility policies provide approved procedures and safety requirements for medication administration.
What medication-reference resources are depicted as appropriate clinical tools?
Medscape, drug reference books such as Abram's Clinical Drug Therapy, and Lexicomp.
What source is specifically shown with a "no" symbol for medication research?
A general Google search.
Why should nurses use reliable medication-reference resources rather than a general internet search?
Medication decisions should be based on trusted clinical drug references.
A client takes metoprolol, furosemide, metformin, lisinopril, and fluvastatin; HR is 51 and K is 3.1. Which medications should be held?
Metoprolol and furosemide.
Why should metoprolol be held when a patient's HR is 51 bpm according to the presentation?
Metoprolol should be held and the HCP notified when HR is less than 60 bpm.
What heart-rate parameter is given for holding metoprolol?
HR less than 60 bpm.
Why should furosemide be held when potassium is 3.1 mEq/L?
Furosemide is a loop diuretic that can cause electrolyte imbalance, including potassium loss.
What adverse effects of furosemide are specifically listed?
Hearing impairment, tinnitus, and electrolyte imbalance, including potassium abnormalities.
Why would metformin not be held in the HR 51/K 3.1 scenario?
The information given does not indicate a reason to hold it, and metformin does not affect HR or BP.
Why would fluvastatin not be held in the HR 51/K 3.1 scenario?
It does not affect HR or BP, and no other information suggests holding it.
Why is lisinopril not held simply because the patient's HR is 51 bpm?
ACE inhibitors require BP monitoring but do not cause bradycardia.
A client is scheduled for an exercise stress test and an IV contrast CT. Which scheduled medications should be held?
Nebivolol and metformin.
Which medications from the stress-test/contrast scenario may be administered after nebivolol and metformin are held?
Atorvastatin, amlodipine, sertraline, and clopidogrel.
Why is metformin held before an IV contrast study according to the presentation?
Iodinated radiographic contrast may cause renal failure and has been associated with lactic acidosis in patients receiving metformin.
How long before a diagnostic contrast study does the presentation say metformin should be discontinued?
At least 48 hours before the test.
When does the presentation say metformin may be resumed after a contrast study?
48 hours after the test is completed.
Why should nebivolol be held before an exercise stress test?
Beta blockers slow the heart rate and may prevent the desired cardiac stress response.
What serious conduction effects can beta blockers cause according to the presentation?
Serious bradydysrhythmia and depression of the AV node.
A client has an irregular apical pulse of 101 bpm and K of 4.1 before digoxin. What should the nurse do?
Administer digoxin for the rapid heart rate.
Why can digoxin be administered when the apical rhythm is irregular at 101 bpm?
Digoxin is used for rate control in atrial fibrillation, which produces an irregular rhythm.
What type of medication is digoxin?
A cardiac glycoside.
What two major effects does digoxin have on the heart?
It slows and strengthens the heart.
For what dysrhythmia is digoxin used for rate control in the presentation?
Atrial fibrillation.
What normal potassium range is given in the digoxin rationale?
3.5-5.0 mEq/L.
Why is a potassium of 4.1 mEq/L acceptable before digoxin?
It is within the normal range of 3.5-5.0 mEq/L.
Why can low potassium increase risk when administering digoxin?
Hypokalemia may induce digoxin toxicity and dysrhythmias.
What signs/symptoms of digoxin toxicity are listed?
GI upset, fatigue, blurred vision, bradycardia, and dysrhythmias.
What electrolyte abnormality may induce digoxin toxicity?
Hypokalemia.
What laboratory level may be checked when digoxin toxicity is suspected?
Digoxin level.
What antidote is listed for digoxin toxicity?
Digibind.
What heart-rate assessment should be performed before administering digoxin?
Assess the apical heart rate.
At what heart rate should digoxin be held according to the presentation?
Less than 60 bpm.
What should the nurse do if the heart rate is below 60 before digoxin?
Hold the medication and notify the provider.