WK 1 Medication Administration Part 2

Medication Administration and the Nursing Process of Drug Therapy

Part Two: Rights, Legal Responsibilities & Medication Errors

Chapter 3: Rights of Medication Administration

  • Core 8 Rights:

    • Right Drug

    • Right Dose

    • Right Patient

    • Right Assessment

    • Right Route

    • Right Time

    • Right Reason

    • Right Documentation

Additional Rights:

  • Right to refuse

  • Right to patient education

  • Right evaluation

General Principles of Accurate Drug Administration

  1. Follow the “rights” of medication administration.

  2. Know essential information related to medications.

  3. Accurately interpret medication orders.

  4. Perform readback for verbal orders to confirm understanding.

  5. Read drug labels accurately for dosage and indications.

  6. Use only approved abbreviations to avoid confusion.

  7. Calculate dosages correctly to prevent errors.

  8. Measure doses accurately to ensure appropriate administration.

  9. Use correct procedures and techniques for all routes of administration.

  10. Stay informed about drug information and maintain up-to-date skills.

  11. Verify patient identity prior to administration.

  12. Omit or delay medication doses when necessary for patient safety.

  13. Be aware of risks associated with medications for children.

  14. Report medication errors per institutional policy.

  15. Always assess for patient allergies before medication administration.

Legal Responsibilities

Safe and Accurate Administration

  • Healthcare professionals can be held liable for:

    • Administering the wrong drug

    • Administering the wrong dose

    • Failing to administer a drug

  • Nurses may refuse to administer a medication if deemed unsafe for a patient.

  • Nurses must delegate tasks appropriately to maintain safe practice.

Case Study: RaDonda Vaught

  • In 2017, a medication error led to a patient’s death:

    • Administered Vecuronium instead of Versed due to confusion in the automated medication supply system (pyxis).

    • Ignored multiple alarms and notifications indicating a mistake.

    • Did not recognize that Versed was a liquid while Vecuronium was a powder.

    • Stated: "I became complacent … and distracted by a trainee while operating the computerized medication cabinet. I know the patient is no longer here because of me."

Legal Nursing Considerations

  • Guidelines from professional nursing organizations, institutional policies, state and federal legislation are crucial.

  • Key components include:

    • Nurse practice acts outlining scope, educational requirements, and standards of care

    • Concepts of beneficence, autonomy, and veracity

    • HIPAA regulations regarding patient privacy

    • FDA guidelines on drug approval and regulation

Medication Errors

  • Estimated annual deaths related to medication errors vary between 44,000 to 98,000.

  • Contributing factors include:

    • Extended hours nurses work

    • Understaffing in healthcare settings

    • Mandated overtime for staff

  • Nurses are often the final check in the medication administration process.

Check System for Medication Administration

  1. Physician or advanced practitioner must provide orders.

  2. Pharmacist reviews and dispenses the medication.

  3. Nurse administers the medication properly.

Issues Contributing to Errors

  • Errors can occur during any step in the medication process, including:

    • Prescribing by physicians, PAs, or NPs

    • Transcribing errors from verbal orders

    • Dispensing errors at the pharmacy

    • Administration errors despite following “Rights to Medication Administration”

    • Failing to monitor therapeutic responses post-administration

Changes Made to Prevent Medication Errors

  • Implementation of:

    • Computerized Provider Order Entry (CPOE) systems

    • Bar Coding systems for medications

    • Point of care systems for administration verification

    • Limiting use of abbreviations that may lead to confusion

    • Regular medication reconciliation processes

Acceptable Abbreviations for Medication Administration

Routes:

  • IM: Intramuscular

  • IV: Intravenous

  • PO: By mouth (oral)

  • SL: Sublingual

  • Sub-Q: Subcutaneous

Timing:

  • ad lib: As desired

  • PRN: As needed

  • q4h: Every 4 hours

  • stat: Immediately

Doses:

  • g: Gram

  • mg: Milligram

  • mL: Milliliter

  • oz: Ounce

  • tbsp: Tablespoon

  • tsp: Teaspoon

Requirements for Medication Orders

  • Medication orders must include:

    • Full name of the patient

    • Full name of the drug (preferably generic)

    • Dose

    • Route of administration

    • Purpose if PRN

    • Frequency of administration

    • Date and time of the order

    • Signature of the provider

  • No exceptions to the inclusion of these details.

Preventing Medication Errors

  • Never make assumptions about unspecified items in drug orders (e.g., route).

  • Do not hesitate to question medication orders if there is any doubt.

  • Illegibly written orders must be clarified with the prescriber rather than interpreted inaccurately.

  • Address any concerns from patients regarding medications immediately.

  • Always check patient allergies and identification prior to administration.

  • Do not administer medications prepared by another nurse outside of your presence.

Notable Guidelines:

  • Always use a leading zero for decimal dosages to prevent misreading (e.g., use 0.25 mg instead of .25 mg).

  • Never use a trailing zero with medication orders (e.g., write 1 mg, not 1.0 mg).

Patient's Role in Medication Safety

  • Patients should:

    • Keep an up-to-date list of medications they are taking.

    • Understand the reason for taking each medication.

    • Read labels and follow prescribed directions.

    • Store medications properly.

    • Speak up regarding any questions or changes observed in medications or side effects.

What to Do if an Error Occurs

  • Follow institutional policies regarding incident reporting.

  • Document the incident per policy that does not include details in the patient’s chart.

  • Only include factual information in the incident report.

  • Notify the manager and physician of the error for further orders.

  • Report to internal and external agencies as required, including the U.S. FDA, drug manufacturers, and Institute for Safe Medication Practices.

Think Like a Nurse! Scenarios

  • Example 1: Patient requests pain medication. The nurse should assess the patient’s pain level first instead of administering immediately.

  • Example 2: A patient claims the night nurse did not administer medication. The nurse should check the medication administration record first.

  • Example 3: Understanding odd/even days for medication is crucial; consult the prescriber for verification if there’s uncertainty.

  • Example 4: If a nurse finds a documented medication order that appears too high (e.g., levothyroxine sodium 50 mg instead of 50 mcg), the nurse should call the prescriber to question the order.

  • Example 5: Before administering an anti-infective agent, priority assessment is to check for allergies to any anti-infective agents.