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1. What are the five plus five rights of medication administration? Why is each step crucial?
- Right client: use 2 identifiers - name & birthday, check allergies
- Right drug: have they been given this before? does it make sense?
- Right dose: is it correct? look up meds you don't know, any labs or diagnostics, max dose?
- Right time: when was last dose administered, window of time to administer. is it really the right time? Ex. insulin scheduled to be taken long after breakfast, taken on an empty stomach but given at breakfast
- Right route: is it appropriate? Ex. Is pill the correct route if patient can't swallow
- Right assessment: Vital ? does it alter. know vitals before; labs = know most recent results; Parameters = Ex. HR range; Physical assessment findings = must know these before giving drugs.
- ** It is a medication error if you don't know these assessments
- Ex. BP at 0800 & you give meds at 1000 ? using 0800 BP depends on trends, how they are feeling, etc
- Right documentation: chart after giving; edit times as needed; agency policy if not given
- Right to education: applies to every drug; why receiving; side effects; directions to take; effects = desired results
- Right evaluation: - is it working; side/allergic/adverse reactions; check on if its working, timing depends on the route
- Right to refuse: informed; you must educate your patient about the risks of refusal & the benefits of taking it; document this per agency policy
How would you define Standing or protocol physician orders:
routine per agency and what doctors approve, preprinted orders written for specific populations
How would you define One time or single order:
1 hr to do it & chart from time written, single order, less urgent than STAT
PRN order :
as needed, usually symptom related.
immediately, single order. ER=verbal, Floor=written
How can the nurse foster a culture of safety when administering medications?
What abbreviations are on The Joint Commissions (TJC) do not use list? Why?
- 1. U or u (For Units): Potential Problem: Mistaken for "0" (zero), the number "4" (four), or "cc"
- Use instead: Write "unit"
- 2. IU or iu (For International Unit) ; Potential Problem: Mistaken for IV (intravenous)
- Use instead: Write "International Unit"
- 3. Q.D., QD, q.d., qd (daily), Q.O.D., QOD, q.o.d., qod (every other day): Potential Problem: Mistaken for each other Period after the Q mistaken for the "I" and the "O" mistaken for "I"
- Use instead: Write daily
- Write "every other day"
- 4. Lack of leading zero (.X mg): Use instead: Write 0.X mg
- 5. Trailing zero (X.0 mg): Potential Problem: Decimal point is missed
- Use instead: Write X mg
- 6. MS, MSO4 and MgSO4: Potential Problem: Can mean morphine sulfate or magnesium sulfate Confused for one another; Use instead: Write "morphine sulfate" Write "magnesium sulfate"
- 7. > (greater than)
- 8. < (less than)
- 9. abbreviations for drug names
- 10. apothecary units
- 11. @
- 12. cc
- 13. Ug
What abbreviations in the categories of drug measurements and forms, routes of administration, and times of administrations are acceptable by TJC?
What three National Patient Safety goals for hospitals are related to medication administration?
- Goal 1: Identify patients correctly
- Goal 2: Improve staff communication
- Goal 3: Use medications safely
What medications are considered to be high-alert?
- IV antiarrhythmics
- IV inotropic agents
- Dextrose (hypertonic >20%
- Dialysis solutions
- Epidural or intrathecal agents
- Liposomal forms of drugs
- Moderate sedation agents
- Neuromuscular blocking agents
- IV radiocontrast agents
- Total parental nutrition solutions
- Sterile water for injection, inhalation and irrigation containers of >100mL
- Sodium chloride for injection (hypertonic, >0.9% concentration)
How can the nursing process be applied to medication safety?
- Assessment: Vital ? does it alter. know vitals before; labs = know most recent results; Parameters = Ex. HR range; Physical assessment findings = must know these before giving drugs.
- ** It is a medication error if you don't know these assessments
- Nursing diagnoses
- Planning: Patient safety maintained related to administration and use of medication
- Nursing interventions: calculate dose correctly, give only meds you prepaired, remain with patient until med is taken, identify patient correctly, monitor response to med, discard needles correctly, use sterile technisue when appropriate, document well, follow up.
- Evaluation: evaluate effectiveness, patients understanding of expected results.
What are the FDA categories for medications delivered during pregnancy?
- A: Drugs that have been proven safe to use during pregnancy. (Penicillin)
- B: Animal data shows that there is no teratogenic potential, but there is no well controlled human data to show whether or not it has a teratogenic potential on humans. It is assumed that there is little to no risk in pregnancy.
- C: Animal studies have shown teratogenic potential, but there is no well controlled human data. Risk versus benefit must be weighed
- D: Drugs that have demonstrated human teratogenic potential, but can still be used if benefits to the mother outweigh the risk to the fetus. (Tetracycline)
- X: Drug demonstrates human teratogenic potential and the risk to the fetus far outweighs the benefit to the mother. Should not use in pregnancy (Accutane)
What are factors that modify a drugs response?
- ? Absorption
- ? Distribution
- ? Metabolism
- ? Excretion
- ? Age
- ? Body weight
- ? Toxicity
- ? Pharmacogenetics
- ? Route of administration
- ? Time of administration
- ? Emotional factors
- ? Preexisting disease state
- ? Drug history
- ? Tolerance
- ? Cumulative effect
What guidelines should the nurse follow for correct administration of medications? (Box 12-2)
- 1. Wash hands before preparing meds
- 2. Check for drug allergies; check assessment history and Kardex
- 3. Check med order with Dr orders, Kardex, med sheet or medicine card
- 4. Checl label on drug 3 Xs
- 5. Check expiration date on label, card and Kardex; use only if date correct
- 6 Recheck drug calculation of dose with another nurse as needed
- 7. Verify doses of drugs that are potentially toxic with another nurse or pharmacist
- 8. Pour tablet of capsule into cap of drug container. With unit dose open packet at bedside after verifying patient ID
- 9. Pour liquid at eye level. The meniscus should be at line of desired dose
What behaviors should the nurse avoid during medication administration? (Box 12-3)
- Do not give drugs prepared by others
- Check for sediment, spoilage, abnormal appearance
- Never leave at bedside
- Do not transfer drugs from one container to another
- Do not pour drugs into the hand
- Do not pour drugs from containers that are hard to read or whose labels are partially removed or have fallen off
- Do not be distracted when preparing medication
- Do not give expired medication
- Do not guess about drug dosages
- Do not leave prepared meds out of sight
- Do not recap needles
- Do not give if patient says he/she has allergy to drug
- Do not call patients name as the sole mean of identification
- Do not give rug if patient states it is different from rug he/she has been receiving. Check order.
- Do not mix drugs with large amounts of food or drink.
- Do not document prior to administration, document "given" in MAR after medication administration.
- *Exception: BCMA signs med given upon scanning the med's bar code.