CHAPTER 7 Safe Medication Administration

Transcription

1 64 SECTION 3 READING MEDICATION LABELS AND SYRINGE CALIBRATIONS CHAPTER 7 Safe Medication Administration Objectives The learner will: 1. read a MAR to identify medications to be administered. 2. record medications administered. 3. list and discuss the six rights of medication administration. 4. explain partnering with the patient in medication administration. 5. list common causes of dosage errors. 6. list the five steps to take when a dosage error occurs. 7. list the two major safety concerns addressed by The Joint Commission and ISMP. Suggested Review Questions 1. List the essential components of the medication order that are recorded on the MAR. 2. When are medications administered to patients to be recorded? Who is responsible for recording medications that have been administered? 3. Why is it essential to follow the six rights of mediation administration? When is it necessary to follow the six rights of medication administration? What are the potential outcomes if the six rights are not followed? 4. Explain the nurse s role in partnering with the patient in medication administration. 5. What are the most common causes of medication errors? 6. What actions can the nurse take to avoid making medication errors? 7. What are the appropriate actions for the nurse to take when a medication error occurs?

2 CHAPTER 7 SAFE MEDICATION ADMINISTRATION 65 Answers to Review Questions 1. Although the items from the medication order listed on the MAR may vary in each health care facility, the information listed on most MARs includes: Medication name (often the generic as well as trade name) Medication dose Frequency or schedule of administration Route for administration Date the drug was ordered and stop date (if specified in order) Additional items documented on the MAR that are not particularly part of the medication order include: Actual times for administration of the drug Precautions related to administration of the drug, including assessments needed prior to administering the drug (e.g., BP, pulse) Stop date for drug based upon health care facility protocol Initials of the individual transcribing the information onto the MAR Initials of the individual who checked the information for accuracy Initials of the individual who administered the medication The patient s name, room number, and any drug allergies are also on each page of the MAR. The one piece of information from the medication order that is often not documented on the MAR is the name of the prescriber. 2. Medications are to be recorded as given immediately AFTER they have been administered by the individual who administered the medication, witnessed the patient taking the medication, and verified that the medication was swallowed (if given orally). Stress to learners that medications are never to be recorded as given prior to actually administering them to the patient and that a nurse is not to record medications administered by another nurse. Computer-controlled records, such as bar code medication administration systems, minimize the potential for a delay in recording of medication administration and the recording of medication administration by individuals other than the individual who actually administered the medication.

3 66 SECTION 3 READING MEDICATION LABELS AND SYRINGE CALIBRATIONS 3. It is essential to follow the six rights of medication administration EACH time a medication is given to a patient. Doing so will help to minimize the risk for error and improve the quality of care provided patients. It is the nurse s ethical duty to provide safe care and patients have the right to expect that they will not be harmed by actions of those caring for them. 4. Partnering with the patient in medication administration recognizes the importance of a collaborative relationship between the patient and the nurse in delivery of the medical treatment plan. This collaborative relationship incorporates not only teaching the patient all the necessary information for safe and effective self-administration of medications, but also stresses listening to and responding appropriately to patients questions and concerns regarding their medications. 5. Medication errors can occur when the prescriber is ordering the medication, when the order is transcribed on to the MAR as well as during the preparation and administration of the medication. The most common causes of medication errors are the misinterpretation of the medication order and an error in order transcription. These errors are most frequently caused by the inability to decipher handwriting and confusion when reading the abbreviations; specifically abbreviations used for some drug names, frequency for drug administration, and route for drug administrations. Errors in writing and interpreting doses using the metric system are another common source of medication error. 6. Errors can be avoided by not using any of the abbreviations, symbols, and dose designations as identified by The Joint Commission and the ISMP. Additionally, nurses need to seek clarification of drug names, dosages, and frequency of medication administration when the prescriber s handwriting is illegible and/or orders are not within the usual or safe dosage range. Nurses also need to try to avoid fatigue and distraction when preparing medications and always follow the Six Rights of Medication Administration. 7. Once a medication error has been identified, the nurse should assess the patient for the physiologic response to the medication received and then proceed with the following steps: (1) Report the error to the prescriber and other appropriate persons as soon as possible. Include information as to the patient response in report.

4 CHAPTER 7 SAFE MEDICATION ADMINISTRATION 67 (2) Immediately implement necessary measures (if needed and as ordered) to modify the response experienced by the patient. (3) Determine the reason the error occurred and implement any measures to prevent a recurrence, (e.g., check other medications on the MAR to be sure they are transcribed correctly, check medication supply system to be sure medications are labeled correctly). (4) Complete an incident/accident report and other documentation according to institution policy. (5) Assess need for and implement when necessary corrective policies/procedures to prevent a recurrence of the error.

5 68 SECTION 3 READING MEDICATION LABELS AND SYRINGE CALIBRATIONS Name Date Chapter 7: Safe Medication Administration Additional Practice Problems Review the abbreviations related to medication administration listed below. Indicate if it is an approved or error-prone abbreviation. If it is an error-prone abbreviation, note what should be used on the line provided. Abbreviation Approved Error-Prone Use Instead 1. PRN 2. q.i.d. 3. q.o.d. 4. U 5. qhs 6. OD 7. IM 8. STAT 9. a.c. 10. PO 2010 Cengage Learning. All Rights Reserved. Permission to reproduce granted for classroom use only.

6 CHAPTER 7 SAFE MEDICATION ADMINISTRATION 69 Convert the Standard times listed below to International time. Standard Time International Time :45 AM 12. 4:15 PM :25 PM 14. 9:13 AM :00 PM Respond to each of the questions below on the line provided. 16. How many times should the nurse check the drug label against the drug order prior to administering the medication to a patient? 17. How many identifiers need to be used when identifying a patient to determine the Right Person for medication administration? 18. List examples of appropriate identifiers that can be used when identifying a patient to determine the Right Person for medication administration. 19. How would the nurse administer a medication ordered by the sublingual route? 20. The nurse is administering medication consisting of one green and two white pills to a patient. When viewing the pills, the patient states I do not take a green pill. Taking the time to discuss and clarify this issue with the patient is an example of which Right of Medication Administration? 2010 Cengage Learning. All Rights Reserved. Permission to reproduce granted for classroom use only.

7 70 SECTION 3 READING MEDICATION LABELS AND SYRINGE CALIBRATIONS Solutions to Additional Practice Problems 1. Approved 2. Approved 3. Error-Prone, every other day 4. Error-Prone, unit 5. Error-Prone, nightly 6. Error-Prone, right eye 7. Approved 8. Approved 9. Approved 10. Approved Three times: (1) when the medication is removed from the medication distribution system; (2) immediately before the unit dose package is opened; (3) immediately before actual administration of the drug. 17. At least two (2) identifiers. 18. Asking the patient to state his/her name; checking the name on the patient s ID bracelet (Identa-Band); checking the patient s birth date; comparing the patient s hospital or medical record number. The identifiers need to be matched with those listed on the patient s MAR and the patient s ID bracelet or the patient s verbal response. 19. Under the tongue. 20. Partnering with the patient.