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• Pulmonary route (inhale the drug)
- i. Inhalation to the lungs
- 6. Frequency of administration of the drug
- • ADMINISTER DRUGS PUNCTUALLY, AS ORDERED!
- • When administering to multiple patients…
- i. A common policy to administer the drugs within a half-hour before or after the indicated hour (Drug 0900, should be admiinstered at 0830 or 0930)
- ii. PERIOPERATIVE medication
- a. If medication is supposed to be taken at 0730, drug MUST BE IMMEDIATELY GIVEN due to surgery standards
- b. These can also be administered when the nurse is given a call by the operating room to premedicate the patient
- 7. Signature of person writing the order
- • Prescribers can use a computer prescriber order-entry system (CPOE) with a username and password
- i. ID information of the prescriber, name and title are automatically recorded when the system is accessed - HANDWRITTEN SIGNATURE IS NOT NECESSARY WITH THIS METHOD
- • When It is necessary to handwrite an order, THE SIGNATURE, WITH TITLE, of the person writing the order follows the order
- • Some facilities also require the prescriber to PRINT THEIR NAME with the signature for reading purposes
- • THIS IS IMPORTANT FOR LEGAL REASONS, especially if the prescriber needs to be contacted
- • Medication orders require the drug, dose, rate, route, frequency, and when appropriate, duration to be explicit and specific to the needs of the patient in order to achieve the desired outcome
- • In effect, medication orders are sentences when an error or lack of precision in any of the elements of the order can result in unintended consequences
Recognize the vocabulary associated with drug frequency.
- • PRN: “as needed” The patient receives medication when it is requested or required. PRN orders are commonly written for treatment of symptoms
- • The time and frequency with which a drug is to be administered are usually stated in standard abbreviations in the medication order, although many abbreviations used in the past have been phased out due to error and safety concerns
- • Ambiguous medical abbreviation’s has been identified by The Institute for Safe Medication Practice (ISMP) and the U.S. Food and Drug Administration (FDA) as one of the most common buy preventable sources of medication errors
- • Consider the patient’s choice of time
- • Administer drugs punctually as ordered
- • Drugs should be administered a half-hour before or after the indicated hour
- • Administration times are set by individual facility policies.
- • Preoperative medication ordered to be given at that hour because the time was planned in relation to the time that surgery is to begin or when patients are given drugs before certain diagnostic procedures and with stat orders
Discuss the important of medical reconciliation, 764
- 1. Facility or agency policy specifies specific on the manner in which medications orders are checked.
- 2. The nurse is responsible for checking that the medications order was transcribed correctly by comparing it with the original order, depending on the type of system in use.
- 3. The nurse is also responsible for double checking the dosage and appropriateness of the medication. Confusion over the placement of a decimal point can lead to a medication error.
- 4. Never the less the nurse has the right to refuse to administer any medications that , based on their knowledge and experience , may be harmful to the patient.
4. Identify common medical errors and how to prevent them, 796
1. Inappropriate prescribing of the drug, extra omitted or wrong dose, administration of a medication to a patient that was not order for that patient, administrating of drug by an incorrect route or at an incorrect rate, failure to give a medication within the prescribed time interval , incorrect preparation of a drug before administrating, improper techniques when administering a drug, giving a drug has deteriorated
5. Discuss what type of information can be obtained from the Institute of Safe Medication Practice (ISMP website). 763
- 1. Purpose of the ISMP
- • They identified the use of ambiguous medical abbreviations as they are the most common but preventable sources of medication errors.
- • They attempt to ELIMINATE THE USE OF ERROR-PRONE ABBREVIATIONS, which can be found on their website - www.ismp.org/tools/abbreviations
- 2. What can be found on the website
- • Their Mission
- • To advance patient safety worldwide by empowering the healthcare community, including consumers, to prevent medication errors.
- We accomplish this through our interdisciplinary efforts to:
- • Collect and analyze reports of medication-related hazardous conditions, near-misses, errors, and other adverse drug events.
- • Disseminate timely medication safety information, risk-reduction tools, and error-prevention strategies.
- • Educate the healthcare community and consumers about safe medication practices.
- • Collaborate with other patient safety organizations, educational institutions, governmental agencies and other healthcare stakeholders.
- • Advocate the adoption of safe medication standards by accrediting bodies, manufacturers, policy makers, regulatory agencies, and standards-setting organizations.
- • Conduct research to provide evidence-based safe medication practices.
Identify the information the student nurse should obtain prior to administration of a drug. 762-767
- • Nurse must check the medication order
- CHECK THE MAR (medication administration record) of the patient
- • It is a complete list of all medications prescribed for the patient
- • The nurse is responsible for checking that the medication order was transcribed correctly by comparing it with the original order
- • The is also responsible for double-checking the dosage and appropriateness of the medication
- Nurses are legally responsible for checking the drugs they administer
- YOU MUST QUESTION ANY DRUG ORDER SUSPECTED TO BE IN ERROR!
- • Do the patient's condition, symptoms, and health status warrant receiving medication?
- • Does it make sense for the pt. to have this medication?
- • Is this the correct dose and preparation ordered?
- • LEGAL IMPLICATIONS ARE SERIOUS SO BE CAREFUL!
- • In some instances the may not think there is an error in the order but may not understand why the medication is prescribed. In such instances ask the prescriber how the order relates to the pt.'s plan of care
- • This may prevent a medication error if the wrong medication has been ordered
- • Drugs to which patients may be allergic may be order by accident
- • BEST PRACTICE is to question the patient about ever having received the medication and ask whether the patient is aware of any reaction to the medication
- A drug may be ordered that would potentially interact with another medication the patient is taking
- • Verify all medications that you the nurse are unfamiliar with BEFORE ADMINISTRATION
- • IF YOU HAVE DIFFICULTY READING AN ORDER DO NOT DO NOT DO NOT GUESS! - check with the person who wrote the order!
- E. Nurses have the right to refuse to administer any medication that they believe may be harmful to the patient
- • Patient safety is the primary objective in the administration of medications
- • Always notify the primary care provider of the refusal to administer any medication
- • Document any concerns with any medication orders in the pt. medical record, and note having contacted the primary care provider, the response of the primary care provider, and any related interventions
- • Three checks and the Rights of Medication Administration (Rights of medication administration, Question #8)
- • 3 Checks
- • Nurse must check the label on the medication package or container 3 TIMES DURING MEDICATION PREPARATION AN ADMINISTRATION
- • THE LABEL SHOULD BE READ:
- 1. When the nurse reaches for the unit dose package and container
- 2. After retrieval from the drawer and compared with the CMAR/MAR, or compared with CMAR/MAR immediately before pouring from a multi-dose container
- 3. Before giving the unit dose medication to the patient, or when replacing the multi-dose container in the drawer or shelf
- • Dosages
- • Nurses must measure out the correct dosages using the Metric system or household system
- • Must be familiar with conversions! STUDY this if needed!
7. Describe special practices taken to safeguard controlled substances
- • May be kept in a locked drawer or container as an added safety measure
- • Opioids or other controlled substances may be ordered by physicians
- • Following information usually is required
- • Name of patient receiving the controlled substance
- • Amount of substance used
- • Hour the controlled substance was given
- • Name of the physician or advanced practitioner who prescribed the substance
- • Name of the nurse who administered the substance
8. Discuss application of basic “Rights” and miscellaneous rights to medication administration
- • Basic Rights
- • Right Patient
- • Identify patient by asking patient their name and check armband
- • Compare name and medical record number on MAR with information on armband
- • Right Drug
- • Compare drug to MAR three times
- 1. Taking out of cassette, in med room, and at beside
- • Note expiration date
- • Know indication and nursing considerations
- • Right Dose
- • Validate calculations of divided doses with another nurse
- • Check heparin, insulin, and digoxin with another nurse
- • Know usual dose and question any dose outside of safe dose range
- • Right Route
- • Right route or method of administration
- • If change in route is needed, request new order from physician
- • Right Time
- • Medications may be given 30 minutes before or after time order
- • Refer to policy and procedure manual
- • Know last time administration for any PRN drug
- B. Miscellaneous
- • Right Reason
- • Ensure patients’ health status, symptom, or condition warrant receiving the med
- • Right documentation
- • Document name of drug, dose, route, and time administered
- • Document patient’s reaction
- • Right to Know
- • Patient have right to know about medication
- • Right to Refuse
- • Patient has right to refuse treatment, but must be notified of the risks, and notify MD
9. Describe the steps of medication preparation and post administration.
- • Check the label on the medication package or container 3 times during medication preparation and administration
- The label should be read:
- • When the nurse reaches for the unit dose package/container
- • After retrieval from the drawer and compared with the CMAR/MAR, or compared with the CMAR/MAR immediately before pouring from a multi-dose container
- • Before giving the unite dose medication to the patient, or when replacing the multi-dose container in the drawer or shelf
- Rights of Medication Administration
- Ensure that 1) right medication is given to the 2) right patient in the 3) right dosage (in the right form) through the 4) right route at the 5) right time for the 6) right reason based on the 7) right (appropriate) assessment data using the 8) right documentation and monitoring for the 9) right response by the patient.
- 10) the right to education
- 11) the right to refuse
- Post Administration
- 1. Record each medication immediately after it has been administered on the CMAR/MAR.
- 2. Include the date & time of administration
- 3. PRN medication require documentation of the reason for administration
- 4. If medication was refused, record this in the appropriate area of the medication record
10. Demonstrate the procedure for administering medications:
- PO (by mouth):772, 802
- Ophthalmic: 787
- Enteral: 774
- Inhalation: 792
- Topical: 786
- Intradermal: 778
- Subcutaneous: 778
- Intramuscular: 781
- Z-track: 784