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Safe Medication Administration and Error Reduction

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الكلية كلية التمريض     القسم قسم العلوم الطبية الاساسية     المرحلة 3
أستاذ المادة عمار عباس شعلان الحميري       08/12/2015 09:14:22
Safe Medication Administration and Error Reduction
Medication Category and Classification
Nomenclature:
Chemical name: is the name of the medication determined by its chemical composition.
Generic name is the official or nonproprietary name that is given by the United States Adopted Names Council. Each medication has only one generic name.
Trade name is the brand or proprietary name given by the company that manufacturers the medication. One medication may have multiple trade names.



Medication Prescriptions
Each facility has written policies related to medication orders. Policies include which health care providers can write, receive, and transcribe medication orders.


Types of medication orders
Routine order/standard order
A routine/standard order is an order that identifies medications that are given on a regular schedule. It may or may not have a termination date. Without a specified termination date, the order will be in effect until the provider discontinues it or the client is discharged.
Certain medications such as opioids and antibiotics must be reordered within a specified amount of time or will automatically be discontinued.
Single/one-time order
A single/one-time order is to be given once at a specified time or as soon as possible. For example, a one-time order instructs the nurse to give warfarin (Coumadin) 5 mg PO at 1700.
Stat order
A stat order is only given once, and it is given immediately. For example, a stat order instructs the nurse to give digoxin 0.125 mg IV bolus stat.
PRN (pro re nata, or “as required”) order
A PRN order stipulates at what dosage, what frequency, and under what conditions a medication may be given. The nurse uses clinical judgment to determine the client’s need for the medication. For example, a PRN order instructs the nurse to give morphine sulfate 2 mg IV bolus q 1 hr PRN for chest pain.
Standing orders
Standing orders may be written for specific circumstances and/or for specific units. For example, the critical care unit has standing orders to treat a client with asystole.
Components of a medication order include
The client’s name
Date and time of order
Name of medication (may be generic or brand)
Dosage of medication
Route of administration
Time and frequency of medication administration – exact times or number of times per day (dictated by facility policy or specific qualities of the medication).
Signature of prescribing provider.
Communicating Medication Prescriptions
Origination of Medication Prescriptions
Medication prescriptions are written on the client’s medical record by the provider or a nurse who takes a verbal or telephone prescription from a provider.
If the nurse writes a medication prescription on the client’s medical record, facility policy specifies how much time the provider has in which to sign the prescription (usually 24 hr).
Medication prescriptions are transcribed to the medication administration record (MAR) by a nurse or other health care provider.
Communicating Medication Prescriptions
Taking a telephone order
If possible, have a second nurse listen on an extension.
Ensure that the prescription is complete and correct by reading back to the provider: the client’s name, the name of the medication, the dosage, the time to be given, frequency, and route.
Remind the provider that the prescription must be signed within the specified amount of time.
Write the prescription in the client’s medical record.
Preassessment for Medication Therapy
The following information should be obtained prior to the initiation of medication therapy, and updated as necessary.
Preassessment for Medication Therapy
Health History
Age
Diagnosed health problems and current reason for seeking care
All medications currently being taken (prescription and nonprescription): name, dose, route, and frequency of each medication.
Any symptoms possibly related to medication therapy
Use of herbal or “natural” products for medicinal purposes
Use of caffeine, tobacco, alcohol, and/or street drugs
Client’s understanding of the purpose of the medications
All known medication and food allergies
Preassessment for Medication Therapy
Physical Examination
A systemic physical examination provides a baseline to evaluate therapeutic effects of medication therapy and detect possible side and adverse medication effects.
Six Rights of Safe Medication Administration
Right Client
Verify the client’s identification each time a medication is given.
Acceptable identifiers include the client’s name, an assigned identification number, telephone number, birth date, or another person-specific identifier.
Check identification bands for name, identification number, and/or photograph.
Check for allergies by asking the client, looking for an allergy bracelet, and reviewing the medication administration record.
Bar code scanners may be used to identify clients.

Right Medication
Correctly interpret the medication order (verify completeness and clarity).
Read the label three times: when the container is selected, when removing the dose from container, and when the container is replaced.
Leave unit-dose medication in its package until administration.

Right Time
Give medication on time to maintain consistent therapeutic blood level.
It is generally acceptable to give the medication 1 hr before or after the scheduled time. However, refer to the drug reference or institution policy for exceptions.

Right Route
Most common routes of administration are oral, topical, subcutaneous, intramuscular (IM), and intravenous (IV).
Select the correct preparation for the ordered route (for example, otic vs ophthalmic topical ointment or drops).
Know how to administer medication safely and correctly.

Right Documentation
Immediately record pertinent information, including the client’s response to the medication.
Additional Considerations
Assessment
Collect appropriate data before administering medication (for example, checking apical heart rate before giving digitalis preparations).
Assess the client for physical and psychosocial factors that may affect medication response.
Education
As part of informed consent, provide accurate information about the medication therapy and its implications (therapeutic response, side/adverse effects).
To individualize the teaching, determine what the client already knows about the medication, needs to know about the medication, and wants to know about the medication.
Evaluation
Determine the effectiveness of the medication based on the client’s response, as well as the occurrence of side/adverse effects.
Medication Refusal
Clients have the right to refuse to take a medication.
Determine the reason for refusal, provide information regarding the risk of refusal, notify the appropriate health care personnel, and document refusal and actions taken.
Resources for medication information
Nursing drug handbooks
Pharmacology textbooks
Professional journals
Physicians’ Desk Reference (PDR)
Professional Web sites
Medication Error Prevention
Common medication errors include:
Wrong medication or IV fluid
Incorrect dose or IV rate
Wrong client, route, or time
Administration of known allergic medication
Omission of dose
Incorrect discontinuation of medication or IV fluid

Use the nursing process to prevent medication errors
Assessment
Ensure knowledge of the medication to be administered. Use appropriate resources
Health care providers including nurses, physicians and pharmacists.
Poison control centers
Sales representatives from drug companies
Nursing pharmacology textbooks and drug handbooks
Physicians’ Desk Reference
Newsletters including The Medical Letter on Drugs and Therapeutics (bimonthly) and Prescriber’s Letter (monthly)
Professional journals
Professional Web sites
Assessment
Obtain information about the client’s medical diagnoses and conditions related to medication administration such as ability to swallow, allergies, and heart, liver, and/or kidney disorders).
Identify client allergies.
Obtain necessary preadministration data (heart rate, blood pressure).
Omit or delay doses as indicated by the client’s condition.
Assessment
Determine if the medication prescription is complete – to include name of client, date and time, name of medication, dosage, route of administration, time, frequency, and signature of prescribing provider.
Assessment
Interpret the medication prescription accurately.
The Institute for Safe Medication Practices is a nonprofit organization working to educate health care providers and consumers regarding safe medication practices. Tools have been developed to decrease the risk of medication errors. Go to http://www.ismp.org/ for a complete list.
Error-Prone Abbreviation List – Abbreviations that have been associated with a high number of medication errors
Confused Medication Name List – Sound alike and lookalike medication names
High-Alert Medication List – medications that, if given in error, have a high risk for resulting in significant patient harm
Assessment
Question the provider if the prescription is unclear or seems inappropriate for the client’s condition. Refuse to give a medication if it is believed to be unsafe. Notify the charge nurse or supervisor.
Assessment
Dosage changes are usually made gradually. Question the provider if abrupt and excessive changes in dosages are made.
Planning
Identify client outcomes for medication administration.
Set priorities.
Implementation
Avoid distractions during medication preparation (poor lighting, ringing phones). Interruptions may increase the risk of error.
Check the labels for the medication name and concentration. Read labels carefully. Measure doses accurately and double-check high-alert medications, such as insulin and heparin, with a colleague.
Doses are usually 1 to 2 tablets or one single-dose vial. Question multiple tablets or vials for a single dose.
Follow the Six Rights of Medication Administration consistently.
Take the medication administration record (MAR) to the bedside.
Do not give medications that were prepared by someone else.
Implementation
Encourage clients to become part of the safety net, teaching them about medications and the importance of proper identification before medications are administered. Omit or delay a dose if the client questions the size of a dose or appearance of a medication.
Follow correct procedures for all routes of administration.
Communicate clearly both verbally and in writing.
Use verbal orders only for emergencies and follow facility protocol for telephone orders.
Omit or delay doses as indicated by the client’s condition, and document and report appropriately.
Follow all laws and regulations regarding controlled substances when preparing and administering medications. Keep controlled substances in a locked area. Discarding of an excess of a controlled substances should be witnessed by a licensed health care provider.
Only leave medication at the bedside if allowed by facility policy (for example, topical medication).
Evaluation
Evaluate client response to a medication and document and report appropriately.
Recognize side/adverse effects and document and report appropriately.
Evaluation
Report all errors and implement corrective measures immediately.
Complete an unusual occurrence report within the specified time frame, usually 24 hr. This report should include:
The client’s identification
The time and place of the incident
An accurate account of the event
Who was notified
What actions were taken
The signature of the person completing the report
This report does not become a part of the client’s permanent record and the report should not be referenced in another part of the record.


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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