Medication Administration & Preventing Errors M E A G A N R A Y, R N A M G S P E C I A L T Y H O S P I T A L

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Medication Administration & Preventing Errors M E A G A N R A Y, R N A M G S P E C I A L T Y H O S P I T A L

Principles of Medication Administration Talk with the patient and explain what you are doing before giving medications (answer questions) Help the patient to be as involved as possible in the process Provide patient privacy Give medication administration your complete attention - give medications in a quiet area, free of distractions - never leave medications unattended Wash your hands before and after giving medications Read the medication label at least 3 times (when picking up the medication, just prior to administering the medication, & just after administering the medication) Medications must be administered by the individual who prepared the dose, except for unit doses or sterile preparations from the pharmacy

Medication Reconciliation & Administration When ordering or administering drugs and biologicals, health care providers must include/review the following information: Name of the patient Allergy information Age, weight or other dose calculation requirements Date and time of the order Dose, frequency, and route Exact strength and/or concentration Quantity and/or duration Specific instructions for use, if applicable Name of the prescriber

Six Rights of Medication Administration Prior to administering medications, nurses must utilize the 6 Rights of Medication Administration: Right Patient Right Medication Right Dose Right Time Right Route Right Documentation

Right Patient Employees must compare the patient s name on the prescription label, the medication order and medication administration record (MAR). Acceptable patient identifiers include: - patients full name - identification number assigned by the hospital - date of birth Identifiers must be confirmed by patient wrist band, patient identification card, patient statement (when possible), or other means outlined without the hospital s policy Prepare medications for one patient at a time Give the medication as soon as you prepare it Avoid distractions

Right Medication In order to be sure that you are giving the right medication, you must: Read the medication label carefully (brand name/generic, look alike/sound alike) Ensure that the medication name on the label, order and MAR match before giving the medication Label medicines that are not labeled (syringes, cups and basins)

Right Dose The right dose is how much of the medication is to be administered to the patient. To determine the dose, you must first know the strength of each medication - In the case of liquid medications, you need to know the strength of medication in liquid measure The dose equals the strength of the medication multiplied by the amount Compare the dose on the prescription label, medication order and medication log

Right Time Some medications must be administered only at very specific times of the day: - Before meals - One hour after meals - Bedtime Compare the time on the prescription label, medication order and the medication log Medications must be given within a ½ hour of time that is listed on the medication log (does not apply to PRN medications)

Right Route The route means how and where the medication gets into the body. Most medication is taken into the mouth and swallowed, but others enter the body through the skin, rectum, vagina, eyes, ears, nose and lungs, through a g-tube or by injection/infusion Compare the route on the prescription label, medication order and the medication log

Right Documentation Each time a medication is administered, it must be documented Documentation must be done in black ink No pencil or white out may be used Never cross out or write over documentation If you make a mistake when you are documenting on the medication log, circle your mistake and write a note explaining what happened

Medication Errors Medication errors are among the most common health threatening mistakes that affect patient care (increased mortality rate, length of hospital stay, increased medical expenses, etc.) According to the Institute of Medicine of the National Academies, medication errors are among the most common medical errors, harming at least 1.5 million people each year Studies indicate that 400,000 preventable drug-related injuries take place in hospitals each year, as a result of errors that occur at various points in the medication administration process

Types of Medication Errors Medication errors include prescribing errors, dispensing errors, medication administration errors, and patient compliance errors Drug product nomenclature (look-alike or sound-alike) Illegible handwriting Improper transcription Inaccurate dosage calculation Inadequately trained personnel Inappropriate abbreviations used in prescribing Labeling errors Excessive workload Lapses in individual performance Medication unavailable

Common Causes of Medication Errors During Medication Administration Under Staffing Fatigued Nurses Vague Communications Medication Errors

Opportunities to Prevent Medication Errors Medication is Prescribed Medication is Administered Medication Administration Process Medication Order is Transcribed & Verified Medication is Dispensed

The Nurses Role in Preventing & Reporting Medication Errors Reporting medication errors is an ethical duty to maximize the benefits of patient care, thereby promoting patient safety and health. Report medication errors to the patient s physician and your nursing supervisor immediately or when the error is first identified (monitor & treat patient as needed) The medication administered in error or omitted in error and the action taken must be properly recorded in the patient's medical record. - the entry in the patient's medical record need not indicate that an error occurred. Complete the event reporting process (ActionCue) If a medication error causes an adverse drug reaction, a medication error report and an adverse drug reaction report must be completed

References ASHP Guidelines of Preventing Medication Errors in Hospitals. Iranian Journal of Nursing and Midwifery Research. Types and Causes of Medication Errors from the Nurses Viewpoint. Hospital National Patient Safety Goals 2014. Centers for Medicaid and Medicare Services. Medication Administration http://www/cms.gov

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