NUR141#5.txt

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NUR141#5.txt
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  1. Drugs and Medications
    · Any substance that modifies body function when taken into the body
    Any substance that modifies body function when taken into the body
  2. Drug nomenclature:
    • · Chemical name – identifies drug’s atomic and molecular structure
    • · Generic name – assigned by the manufacturer that first develops the drug, non proprietary ex: acetemenophin
    • · Official name – name by which the drug is identified in official publications USP and NF
    • · Trade name - brand name copyrighted by the company that sells the drug, proprietary name ex: Tylenol, 17 years = 10 years for research, 7 years on market
  3. Categories of Medications:
    • Prescription-NP, Dr. licensed personnel
    • · Nonprescription-Zantac, be careful, can do damage if you mix with prescription
    • · Dietary and Herbal Supplements-again, be careful, no control from FDA
  4. Nursing Concepts of Medication Administration
    • · Knowledge
    • · Experience
    • · Attitudes
    • · Accountability and responsibility
    • · Standards of care
  5. Medication Knowledge:
    • · Nursing Implications and Assessments Before/After Administration
    • · Name of Medication (Generic/Trade Names)
    • · Classification-general category, pharmacological (broad description)and therapeutical (tells how drug works)
    • · Action/Desired Effects
    • · Dosage and Safe Range
    • · Route of Administration
    • · Side Effects/Adverse Reactions
    • · Drug Interactions
  6. Patient Knowledge:
    • · Medication History (Taylor p. 786, Focused Assessment Guide)-can get a pretty good picture just by looking at the meds being taken.
    • · Current and Past Illnesses
    • · Patient’s Health Status
    • · Laboratory Test Results
    • · Known Drug Allergies-what was the problem?
    • · Patient Assessment is Ongoing
    • · Before, during, and after Medication Administration
  7. Medication Orders:
    • · No medication may be given without a written medication order from a licensed practitioner
    • · Physician Order Form – Hand Written
    • · Computer-generated Pharmacy Order-can receive by fax
    • · Computer Prescriber Order Entry (CPOE)-more clear because handwriting is not involved
    • · Verbal Orders
    • · Phone Orders

    Nursing students are not allowed to take verbal or phone orders.
  8. Types of Medication Order
    • · Routine or Standing Order - ongoing prescription to be administered until discontinued by physician, each floor may have their own.
    • · P.R.N. Order - prescription to be administered when necessary for a specified problem or condition
    • · Single or One-time Order - prescription to be administered only once, not necessarily for an emergency
    • · STAT Order – prescription to be administered immediately; frequently for an emergency situation
    • · Standing Protocol Order – prescription written for use in specific situation
  9. Seven parts of order:
    • · Patient’s Name - full name and ID number
    • · Date and Time - when the order is written
    • · Name of Drug - to be administered
    • · Dosage of the Drug
    • · Route by which the drug is to be administered (Taylor p. 780,Table 29-2)
    • o Oral
    • o Parenteral
    • o Topical
    • o Pulmonary
    • · Frequency of Administration – time and frequency stated in standard abbreviations
    • o a.c. and p.c. drugs - depends on the time that meals are served
    • o Pre-op and STAT orders administered at the designated hour
    • · Signature of person writing the order – including their title (prescriber)
  10. Checking Medications Orders:
    • · Medication orders are copied onto patient’s MAR or CMAR
    • · Nurse is responsible for checking:
    • o Medication Order was transcribed correctly by comparing it to the original order
    • o 7 parts of the medication order are present for each medication that has been ordered
    • o Dose of medication is appropriate
    • o Medication is appropriate for patient
    • o Patient is not allergic to medication ordered
  11. Medication Administration Record
    • · Legal document – handwritten or computerized
    • · Patient’s full name, date of birth, allergies, and room number
    • · Scheduled, unscheduled, discontinued medications
    • · Medication name, dosage, route, frequency & time of administration
    • · Parameters for administration of medication-always initial if you didn't give
    • · Order date, start date, end date
    • · Nurse’s signature and initials
  12. Questioning Medication Orders
    • · Nurses are legally responsible for all drugs they administer, therefore:
    • o always know what you are giving and why
    • o drug allergies should be clearly labeled – question orders that may be inadvertently prescribed
    • o question any drug order suspected to be in error with the person who wrote the order (prescriber)
    • o never guess what an order may read
    • · Nurses have the right to refuse to administer any medication that may be harmful to a patient
  13. Types of Medication Distribution Systems
    • · Stock Supply-not seen so much anymore, pain meds, Tylenol in a bottle
    • · Unit-Dose-individually packed
    • · Individual Supply-long term care, two weeks at a time
    • · Computerized Automated Dispensing Cabinet (ADC)-right drawer automatically opens, don’t put peds and similarly named drugs next to each other. Follow policy.
    • · Medication Cart- little pods with enough drawers for all your patients. privacy screens need to be used.
    • · Bar Code System-you are scanning your badge, then your patient
  14. Safe Medication Administration:
    Errors can cause 150 deaths per day
    • · Accurate medication order and MAR/CMAR-
    • · Accurate patient identification
    • · Accurate verification of patient’s drug allergies
    • · Accurate drug calculation
    • · Accurate administration of medication using the 5 Rights and 3 Checks
    • · Accurate patient assessment and explanation
    • · Accurate documentation
  15. Accurate Medication Order and MAR/CMAR
    • · Patient’s Name, Date of Birth
    • · Check each drug in the order they appear on the MAR/CMAR - always read from the top to the bottom of the MAR/CMAR
    • · Do Not Skip Around!
    • · Verify that the drugs transcribed in the MAR or CMAR are correct by comparing them with the original physician order
    • · Question orders with the prescriber
  16. Patient Identification:
    • · all patients must wear a legible identification bracelet (ID band)
    • · identify the patient by examining the identification bracelet
    • · ask patient to state their full name and one other identifier (date of birth) If he can't reply ask another nurse on the floor.
    • · compare with MAR/CMAR for confirmation of name and date of birth
    • · staff can assist in identifying confused or nonverbal patients
  17. Verification Drug Allergies:
    • · Check the patient’s medical record for any drug allergies
    • o All drug allergies must be clearly identified on the MAR or CMAR
    • · Verify that patient is not allergic to any medications to be administered
    • · Beware of patients allergic to a class of drugs
    • o Tetracyclines – tetracycline, doxycycline, minocycline
    • o Cephalosporins – many – refer to Davis Drug Guide
  18. Accurate Dose Calculation:
    · Drugs may not be packaged in the needed amount – BE PREPARED TO DO DRUG CALCULATIONS
  19. 7 rights of administerng medication:
    • The Right:
    • 1. drug
    • 2. dose
    • 3. time
    • 4. patient
    • 5. route
    • Additional Rights
    • 6. reason
    • 7. documentation
  20. The Three Safety Checks
    · Drug label should be read 3 times during preparation
  21. When do you do the three checks? (Check for 5 rights)
    • · Check 1: when you reach for the container or unit dosage package (Check each drug in the order they appear on the MAR)
    • · Check 2: recheck each unit dose medication with the MAR as you place in the medication cup - do not open packet until at the bedside
    • · Check 3: recheck each drug with the MAR at the patients bedside prior to administration
  22. Accurate Patient Assessment and Explanation:
    • · Have you done all necessary assessments prior to giving the medication?
    • · Have you explained to the patient what they are receiving?
    • · Have you done all necessary follow-up assessments?
  23. Accurate Documentation:
    • · Medication record is a legal document
    • · Record administration of medications immediately after they are given, especially STAT doses, never before
    • · Always done by the person who administered the medication
    • · Keep empty drug packet(s) with MAR as you sign for the medication as back up
  24. Accurate Documentation:
    • · Report and record drugs that were not given
    • · MAR – nurse’s initials recorded; full name and title are recorded for identification of initials
    • · CMAR – electronic signature attached to each medication administered
    • · Patient assessments – apical pulse, BP
    • · If patient on I & O, record amount of fluid taken with the medication
  25. Correct administration process:
    • · Locate MAR – see what you will be giving – do any prior assessment that is needed (HR, BP)
    • · Check patient drug allergies
    • · Starting at the top - remove 1st medication – Do 1st check / 5 rights – set aside
    • · Continue above until all medications have been removed
    • · Do 2nd check – place unopened medications into cup
    • · Take medications, MAR, and necessary equipment to patient’s bedside
    • · Check patient identification using 2 identifiers
    • · Do 3rd check at the bedside prior to administration
    • · Administer medications
    • · Document
    • · Follow up with any necessary assessment
  26. General Safety Measures:
    • · wash hands before preparing medications
    • · do not pour drugs into your hand
    • · prepare medications with good lighting and in quiet environment
    • · nurse should work alone to avoid distractions and interruption
    • · prepared medications should never be left unattended
    • · prepare medications for only one patient at a time
  27. General Safety measures:
    • · do not give medications poured by another staff member
    • · do not pour drugs from containers with labels that are difficult to read or are partially removed or have fallen off
    • · stay with the patient until all medications are taken (never leave drugs at the bedside or with visitors or other staff to give)
    • · discard unused portions of drugs in the sink or toilet, never in a trash can
  28. General Safety Measures:
    • · medication cart or drawer should be kept locked when not in use
    • · do not use drugs that have sediment, are discolored or are cloudy (and should not be)
    • · do not give the drug if the patient states it is different from the one they have been receiving (verify drug first)
    • · do not transfer drugs from one container to another
  29. General Safety Measures:
    • · remember to check the expiration date of the medications you are preparing
    • · you have a 1 hour window – ½ hour before the scheduled time to ½ hour after
    • · Example: an 0800 med may be given as early as 0730 and as late as 0830
  30. REMEMBER!!!
    • · The nurse who prepares the medication
    • · Is the nurse who administers the medication
    • · Is the nurse who documents the medication
  31. Medication Refusal
    • · Determine WHY
    • · Educate patient about medication
    • · Patient’s have the right to refuse
    • · Report to physician
    • · Document !!!
  32. NPO
    • · Nothing by mouth”
    • · May be ordered “except meds” or “except meds with small amount of water”
    • · Consider alternative routes especially for certain medications
  33. Holding Ordered Medication:
    • · Written parameters for medication on MAR
    • · Prudent nursing assessment
    • · NPO status
    • · Suspected allergy
    • · Document omitted medication and reason - Requires circled initials on written MAR
  34. Medication Reconciliation
    • · Process of obtaining an accurate list of the patient’s current medications
    • · Medication list is compared with those ordered for the patient to avoid medication errors such as duplications, omissions, dosing errors, or drug interactions
    • · Medications must be reconciled upon:
    • o Admission
    • o Transfer to another setting or level of care
    • o After surgery
    • o Discharge
  35. Medication Error:
    • · Any preventable inappropriate use of medications
    • · Any event that could cause or lead to a patient receiving inappropriate medication therapy or failing to receive appropriate medication therapy
    • · May or may not cause harm
  36. Common medication orders:
    • · Inappropriate prescribing of the drug
    • · Extra, omitted, or wrong dose
    • · Administration of a medication to the wrong patient
    • · Administration of a drug by the wrong route or rate
    • · Failure to give medication within prescribed time interval
    • · Incorrect preparation of a drug before administration
    • · Improper technique when administering a drug
    • · Giving a drug that has deteriorated
  37. Preventing medication errors:
    • · Do not allow the automatic habits of preparing medications or the use of technology to replace constant thinking, purposeful action, and repeated checking for accuracy.
    • · Observe the three checks and the five rights of medication administration
    • o Always read the label three times and check the medication order before administering
    • · Accurate and timely documentation
  38. More preventing errors:
    • · Medication reconciliation performed at points of transition in patient care
    • · When in doubt, always check an order with the prescriber, a pharmacist or the literature
    • · Do not try to decipher illegibly written orders
    • · Avoid dosage and product abbreviations
    • · Never assume route of administration
    • · Be alert; never too busy to stop and check
  39. When an error is made:
    • · Need to immediately acknowledge the error
    • · Monitor patient condition and observe for adverse effects
    • · Follow established protocols for reporting
    • o Notify nurse manager and physician
    • o Complete form used for reporting errors
  40. Controlled substance:
    • · Controlled substances (narcotics) are kept in a a double locked draw or container
    • · Federal law requires that a record must be kept of each narcotic administered
    • · Narcotics are counted when each drug is removed from the drawer and at the end of each shift
    • · Incorrect narcotic counts must be reported immediately
    • · Secure Identification Code = Nurses Signature
  41. Discarded Narcotics:
    • · Unused narcotics are either returned to the pharmacy or discarded
    • · Discarded narcotics must be witnessed by another nurse
    • · Both nurses sign the narcotic sheet
    • · Consult the policy of the facility for specific guidelines
  42. Medication and home:
    • · Nurses need to educate patients and families about medications
    • o General information about medications
    • o How to take medications
    • o Special instructions
    • · Every patient should know and understand what they are taking prior to discharge
    • · Provide oral and written information about medications
    • · Teaching to Promote Health at Home - Medications (Taylor p. 816)

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