PHARM Chapter 2 - Safe Medication Administration and Error Reduction

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Questions and Answers

Which healthcare provider is NOT typically authorized to independently write prescriptions in the United States?

  • Registered Nurse (correct)
  • Dentist
  • Physician
  • Physician Assistant

A medication's trade name reflects its chemical composition and molecular structure.

False (B)

What is the official, nonproprietary name given to a medication by the United States Adopted Names Council?

Generic name

Medications with a potential for misuse and addiction require more stringent supervision and are referred to as ______ substances.

<p>controlled</p> Signup and view all the answers

A nurse administering medication should have up-to-date knowledge except for which of the following?

<p>Client's preferred pharmacy (D)</p> Signup and view all the answers

Which of the listed actions is least likely to reduce adverse events related to medications?

<p>Consulting on insurance authorization (D)</p> Signup and view all the answers

Antibiotics are classified as controlled substances due to their high risk of addiction.

<p>False (B)</p> Signup and view all the answers

Match the following medication names with their appropriate type:

<p>Ibuprofen = Generic Name Advil = Trade Name Isobutylphenylpropanoic acid = Chemical Name</p> Signup and view all the answers

Which schedule of controlled substances includes medications with legitimate medical applications but also a high potential for misuse and dependence?

<p>Schedule II (A)</p> Signup and view all the answers

Nursing students are permitted to accept verbal or telephone prescriptions in emergency situations under the supervision of a registered nurse.

<p>False (B)</p> Signup and view all the answers

What is the primary purpose of medication reconciliation as required by The Joint Commission?

<p>prevent discrepancies in medication orders</p> Signup and view all the answers

A medication order that is to be given immediately and only once is known as a ______ prescription.

<p>stat</p> Signup and view all the answers

Match the following components with their importance in a medication prescription:

<p>Client’s full name = Ensures correct patient identification Medication name and dosage = Ensures correct medication and quantity Route of administration = Ensures correct method of delivery Prescriber's signature = Validates the prescription's legitimacy</p> Signup and view all the answers

A client is prescribed a medication known to cause drowsiness as an adverse effect. What nursing intervention is most important for the client's safety?

<p>Advising the client not to drive or operate heavy machinery (B)</p> Signup and view all the answers

The 'Pregnancy and Lactation Labeling Rule' (PLLR) primarily focuses on the safe disposal of unused medications to prevent environmental contamination.

<p>False (B)</p> Signup and view all the answers

What information should a nurse provide to MedWatch when reporting an adverse effect of a new drug?

<p>detailed description of the adverse effect</p> Signup and view all the answers

The expected physiological response for which a medication is administered is known as its ______ effect.

<p>therapeutic</p> Signup and view all the answers

A client with a history of renal impairment is prescribed vancomycin. What is the nurse's priority action?

<p>Monitoring renal function and vancomycin levels closely (A)</p> Signup and view all the answers

Which component of a medication prescription ensures the correct medication is dispensed to the patient?

<p>Name of the medication and dosage (B)</p> Signup and view all the answers

Medications with a Schedule V classification have a higher potential for misuse and dependence compared to medications with a Schedule II classification.

<p>False (B)</p> Signup and view all the answers

What essential information must a nurse know about a medication before administering it to ensure patient safety.

<p>intended therapeutic effects</p> Signup and view all the answers

Conditions such as diseases, age, pregnancy, or lactation that make administering a medication risky or unsafe are known as ______/contraindications.

<p>precautions</p> Signup and view all the answers

Match each medication type to its corresponding schedule based on the potential for misuse and dependence:

<p>Schedule I drugs = High potential for misuse and no accepted medical use Schedule II drugs = High potential for misuse but with accepted medical use Schedule III drugs = Moderate potential for misuse and abuse Schedule IV drugs = Low potential for misuse and abuse</p> Signup and view all the answers

Which strategy is LEAST likely to be effective in preventing medication errors?

<p>Relying solely on the prescriber's knowledge and experience (D)</p> Signup and view all the answers

The SDOH accounts for 90% of health outcomes.

<p>True (A)</p> Signup and view all the answers

Besides strategies like limiting access and using auxiliary labels, name one more strategy to avoid medication errors.

<p>Automated double checks</p> Signup and view all the answers

Clients who have a low level of education might be suited for educational materials with ______ for better understanding.

<p>visuals</p> Signup and view all the answers

Match the following medication categories with a specific example drug:

<p>Adrenergic Agonists, IV = Epinephrine Neuromuscular Blocking Agents = Succinylcholine Thrombolytics/Fibrinolytics, IV = Tenecteplase Inotropic Medications, IV = Digoxin</p> Signup and view all the answers

The Joint Commission requires how many client identifiers before medication administration?

<p>Two (B)</p> Signup and view all the answers

Which of the following medications requires extra caution due to its classification as a high-alert medication?

<p>Insulin, subcutaneous or IV (C)</p> Signup and view all the answers

Incident reports should include personal opinions regarding why the incident occurred to provide a comprehensive understanding.

<p>False (B)</p> Signup and view all the answers

Medications should be documented before administration to ensure accurate record-keeping.

<p>False (B)</p> Signup and view all the answers

What should a nurse do if a patient refuses a medication?

<p>Explain the consequences, inform the provider, and document the refusal.</p> Signup and view all the answers

Name one social determinant of health (SDOH) that can affect medication administration.

<p>Economic Stability</p> Signup and view all the answers

Clients without adequate housing may not be able to store medications such as ______ that require refrigeration.

<p>insulin</p> Signup and view all the answers

Administer time-critical medications within ______ minutes before or after the prescribed time.

<p>30</p> Signup and view all the answers

A client with limited access to transportation may face challenges in obtaining medications. What intervention addresses this SDOH?

<p>Offering prescription delivery options (B)</p> Signup and view all the answers

Match the following actions with the corresponding 'Rights' of medication administration:

<p>Verifying client's identity = Right client Checking medication label against MAR = Right medication Calculating the correct dosage = Right dose Documenting medication administration = Right documentation</p> Signup and view all the answers

A nurse is preparing to administer medication. What is the most important action to take immediately prior to administration?

<p>Compare the medication label with the MAR in the presence of the client. (D)</p> Signup and view all the answers

Collecting data regarding SDOH is solely the responsibility of the nurse.

<p>False (B)</p> Signup and view all the answers

It is acceptable to pre-document medication administration to save time during a busy shift.

<p>False (B)</p> Signup and view all the answers

What is one action a nurse can take during the 'assessment' phase of the nursing process to prevent medication errors?

<p>Medication history reconciliation</p> Signup and view all the answers

Clients who are food insecure will need assistance with medications that should be taken ______.

<p>with food</p> Signup and view all the answers

What is the function of a unit-dose system in medication administration?

<p>To decrease medication errors.</p> Signup and view all the answers

During incident reporting, which action is most important for a nurse to prioritize?

<p>Describing actions taken after the incident. (A)</p> Signup and view all the answers

If a unit-dose system is not available, the nurse should ________ the correct dose.

<p>calculate</p> Signup and view all the answers

Which of the following is the most appropriate nursing response when a client questions taking a medication?

<p>Acknowledge the client’s concerns and provide open opportunity to discuss it. (A)</p> Signup and view all the answers

Which SDOH is MOST directly addressed by providing culturally tailored educational materials to a client?

<p>Education (C)</p> Signup and view all the answers

Administering a medication via the correct route is essential for its proper absorption and distribution.

<p>True (A)</p> Signup and view all the answers

Name three common types of medication errors.

<p>Wrong medication, incorrect dose, wrong time.</p> Signup and view all the answers

The ISMP is a nonprofit organization working to educate healthcare providers and consumers about ______ medication practices.

<p>safe</p> Signup and view all the answers

Why is it crucial to check a patient's allergy history before administering medications?

<p>To avoid administering an allergy-inducing medication. (D)</p> Signup and view all the answers

Match the following resources with their primary purpose in medication administration:

<p>Physicians’ Desk Reference = Compilation of drug product package inserts Poison control (1-800-222-1222) = Information and treatment advice for poisonings Nursing pharmacology textbooks = Comprehensive information on medication actions and effects Professional websites = Up-to-date guidelines and best practices</p> Signup and view all the answers

Which organization maintains a list of medications that, if administered incorrectly, pose a high risk of significant harm to patients?

<p>Institute for Safe Medication Practices (ISMP) (D)</p> Signup and view all the answers

According to guidelines, prescriptions for medications should always be considered safe, and nurses should not question them to avoid delaying treatment.

<p>False (B)</p> Signup and view all the answers

To prevent medication errors with look-alike and sound-alike drugs, healthcare providers should use ______ labels and automated alerts in pharmacy systems.

<p>auxiliary</p> Signup and view all the answers

A provider prescribes multiple tablets for a single dose of an oral medication. What action should the nurse take first?

<p>Question the prescription with the provider (C)</p> Signup and view all the answers

Match the following strategies with their purpose in preventing medication errors:

<p>Limiting access to high-alert medications = Reduces the opportunity for unauthorized or incorrect use. Standardizing prescription, preparation, and administration = Minimizes variability and potential for confusion in the medication process. Using automated or independent double checks = Provides a safety net to catch potential errors before they reach the patient. Questioning unclear or inappropriate prescriptions = Ensures that medication orders are safe and appropriate for the patient's condition.</p> Signup and view all the answers

A client questions the appearance of a newly prescribed medication compared to what they usually take. What is the nurse's most appropriate action?

<p>Omit or delay the dose and verify the prescription. (C)</p> Signup and view all the answers

What critical information should a nurse include in an incident report following a medication error, besides client identification and medication details?

<p>An accurate and objective account of the event, who was notified, and actions taken.</p> Signup and view all the answers

An incident report about a medication error should be referenced and included in the client's medical record for transparency.

<p>False (B)</p> Signup and view all the answers

Which of the following is the primary reason for reporting all medication errors within a healthcare facility?

<p>To determine how errors occur and implement changes to avoid similar errors. (A)</p> Signup and view all the answers

When discarding controlled substances, a nurse must have another nurse ______ the discarding process.

<p>witness</p> Signup and view all the answers

Which of the following medication pairs are commonly mistaken for each other due to their similar names?

<p>Dobutamine and Dopamine (C)</p> Signup and view all the answers

Besides checking the medication label, what other crucial step can prevent errors, especially with high-alert medications like insulin or heparin?

<p>Double-checking the dosage with a colleague.</p> Signup and view all the answers

It is acceptable practice for a nurse to prepare medications for multiple clients at the same time to improve efficiency.

<p>False (B)</p> Signup and view all the answers

A nurse finds a medication left at a client's bedside. Which action should the nurse take?

<p>Follow facility policy regarding medication administration and client safety. (A)</p> Signup and view all the answers

Nurses should encourage clients to become part of the safety net by teaching them about their medications and the importance of proper ______ before administration.

<p>identification</p> Signup and view all the answers

Flashcards

Prescribers

Providers legally authorized to prescribe medications, including physicians, advanced practice nurses, dentists, and physician assistants.

Nurse's medication responsibilities

Ensuring accuracy of prescriptions, reporting errors, proper storage, following controlled substance laws, calculating doses accurately, and understanding team roles.

Essential medication knowledge

A medication's adverse effects, mechanism of action, and contraindications.

Chemical name

The name reflecting a medication's chemical composition and molecular structure.

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Generic name

The official, nonproprietary name given by the United States Adopted Names Council; each drug has only one.

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Trade name

The brand or proprietary name, can have multiple names for one medication.

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Uncontrolled substances

Medications requiring provider monitoring, but do not pose high risks of misuse or addiction.

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Example of uncontrolled substance

Antibiotics are an example of uncontrolled substances that still require a prescription.

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Controlled Substance Schedules

Classification system for drugs with potential for misuse/dependence; Schedules I-V exist, with I having the highest potential and no accepted medical use.

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MedWatch

The FDA's system of reporting adverse drug effects observed by nurses, accessible on the FDA website.

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Pregnancy and Lactation Labeling Rule (PLLR)

FDA labeling rule with pregnancy, lactation, & reproductive potential sections.

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Medication Reconciliation

A comprehensive review of a patient's medications to avoid discrepancies that occurs at admission, transfer, and discharge.

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Medication Category/Class

Medication's group based on similar characteristics (pharmacological action, therapeutic use, etc.).

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Mechanism of Action

How a drug works in the body to produce its therapeutic effect.

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Therapeutic Effect

The desired physiological response from a medication.

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Adverse Effects

Undesirable or dangerous responses to a medication.

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Toxic Effects

Harmful effects that occur from prolonged use or buildup of medication.

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Medication Interactions

How medications can impact each other, both positively and negatively.

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Precautions/Contraindications

Conditions that make it risky or unsafe to use certain medications.

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Routine or Standing Prescriptions

Medication order given for routine administration.

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Single or One-Time Prescriptions

Medication order given only once.

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Stat Prescriptions

Medication order given immediately, 'stat'.

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PRN Prescriptions

Medication order given as needed, 'PRN'.

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Right Client

Verifying the right patient before medication administration.

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Right Medication

Confirming the correct medication by comparing the label to the MAR.

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Right Dose

Administering the medication in the prescribed amount.

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Right Time

Administering medication within defined time windows to maintain blood levels.

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Right Route

Using the method of delivery specified in the prescription.

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Right Documentation

Recording medication details immediately after administration.

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Right Client Education

Informing patients about the medication's purpose, usage, and potential side effects.

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Right to Refuse

Respecting the patient's autonomy to decline medication.

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Right Assessment

Gathering necessary patient info (e.g., heart rate) before giving the medication.

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Right Evaluation

Monitoring patient response to the medication.

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Common Medication Errors

Errors involving the wrong drug, dose, patient, route, or time.

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Look-Alike, Sound-Alike Medications

Mistakes due to similar drug names.

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Medication Information Resources

Using resources like drug handbooks to understand medications.

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Conditions Affecting Medication

Considering the patient's conditions that affect drug use.

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Complete Medication Prescription

Checking prescriptions for completeness and accuracy.

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Medication Error Prevention

Strategies to avoid medication errors: Limiting access, labels, alerts, standardization, and double checks.

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High-Alert Medications

Examples include IV adrenergic agonists, general anesthetics, chemotherapeutic agents, and hypertonic dextrose.

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Incident Report Information

Time, who was notified, actions taken, and client identification.

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Purpose of Incident Reports

These reports help identify error patterns and system weaknesses.

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Medication Error Context

Nursing should identify errors related to systems, procedures, communication, and human factors.

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Social Determinants of Health (SDOH)

Conditions in the environment that affect health and daily life.

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Economic Stability (SDOH)

Poverty level, employment, and housing instability.

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Education (SDOH)

Level of education, language, and literacy skills.

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Health and Health Care (SDOH)

Access to care, primary care and health literacy

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Neighborhood and Built Environment

Access to healthy foods, housing quality, and safety.

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Social and Community Context (SDOH)

Social cohesion, civic participation, discrimination, incarceration.

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Food Security

Adequate access to nutritious food vs. inconsistent access.

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SDOH Data Application

Gather data and act on findings to ensure safe medication practices.

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Nursing Process Stages

Assessment, planning, implementation, and evaluation.

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Nursing Assessment Actions

Three assessment actions: verify transcription, review allergies, validate calculations.

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Error-Prone Abbreviation List

Lists abbreviations prone to causing medication errors, compiled by ISMP and FDA.

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Confused Medication Name List

A list of medication names that sound or look alike, increasing chances of errors.

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High-Alert Medication List

Medications with a high risk of causing significant harm if administered incorrectly.

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Strategies to prevent medication errors

Limit access, use labels/alerts, standardize processes, double-check.

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Nurse's role in questionable prescriptions

Clarify unclear orders and refuse to administer unsafe meds.

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Essential pre-medication assessment data

Herbal products, allergies, ability to swallow

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Safe Medication Preparation

Medications for one at a time, check labels, measure carefully, double-check high-alert meds.

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Medication Administration Best Practices

Take to bedside, never give what others prepared, involve patients.

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Post-Administration Safety

Do not leave at bedside, educate clients and caregivers.

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Unsafe Medication Practice

Taking meds out of wrappers beforehand

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Medication error response

Implement corrective measures

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Incident Report Contents

Client ID, med name/dose, time/place, event account, actions taken, notifications, signature.

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Purpose of Reporting Medication Errors

Report errors to identify systemic issues and improve safety.

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Post-Medication Evaluation

Assess client responses, therapeutic/adverse effects; report/document.

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High-Alert Medications Examples

Insulin, heparin

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Study Notes

  • Providers who can legally prescribe medications include physicians, advanced practice nurses, dentists, and physician assistants.
  • Nurses must know federal, state, and local laws, as well as facility policies, regarding medication prescription, dispensing, administration, and client response evaluation.
  • Nurses must maintain current knowledge of medications, including uses, mechanisms of action, routes of administration, safe dosages, adverse effects, precautions, contraindications, and interactions.
  • Nurses reduce medication-related adverse events by verifying prescription accuracy, reporting errors, securing medications, adhering to controlled substance regulations, accurately calculating doses, and understanding team responsibilities.

Medication Category and Classification

  • The chemical name reflects the chemical composition and molecular structure of a medication.
  • The generic name is the nonproprietary name given by the United States Adopted Names Council; each medication has only one.
  • Trade names are brand names assigned by manufacturing companies; a medication can have multiple trade names.
  • Uncontrolled substances require monitoring but generally do not pose misuse or addiction risks (e.g., antibiotics).
  • Controlled substances have misuse and dependence potential, classified into "Schedules" with decreasing risk from Schedule II to V; Schedule I (e.g., heroin) has no medical use.
  • The FDA tests new drugs for effectiveness and safety; nurses report new adverse effects to MedWatch.
  • The Pregnancy and Lactation Labeling Rule (PLLR) includes sections for pregnancy, lactation, and reproductive potential.
  • Verify medication safety during pregnancy before administering it to pregnant clients.
  • Facilities have policies on medication prescriptions, including authorized prescribers and transcription procedures.
  • Verbal prescriptions are for emergencies only; nursing students cannot accept them.

Types of Medication Prescriptions

  • Routine or standing prescriptions
  • Single or one-time prescriptions
  • Stat prescriptions
  • PRN prescriptions

Components of a Medication Prescription

  • Client’s full name
  • Date and time of the prescription
  • Medication name (generic or brand)
  • Strength and dosage
  • Route of administration
  • Time and frequency of administration
  • Quantity to dispense and refills
  • Prescriber's signature

Medication Reconciliation

  • Medication reconciliation involves compiling a list of current medications with dosages and frequency, comparing it with new prescriptions, and resolving discrepancies with the provider.
  • Medication reconciliation should occur at admission, during transfers, and at discharge.

Knowledge Required Prior to Medication Administration

  • Medication category/class includes pharmacological action, therapeutic use, body system target, chemical makeup, and pregnancy classification.

Mechanism of Action

  • The mechanism of action explains how medications produce their therapeutic effects.

Therapeutic Effect

  • The therapeutic effect is the expected physiological response after medication administration.

Adverse Effects

  • Undesirable and potentially dangerous responses to a medication are adverse effects.

Toxic Effects

  • Toxic effects result from prolonged medication use or accumulation due to metabolism or excretion issues.

Medication Interactions

  • Medications can interact with each other, with food, or with herbal supplements, causing beneficial or harmful effects.

Precautions/Contraindications

  • Precautions and contraindications are conditions where specific medications should be used cautiously or avoided altogether.

Preparation, Dosage, Administration

  • It’s crucial to know specific considerations for preparation, safe dosages, dosage calculations, and administration techniques.

Nursing Implications

  • Monitor therapeutic and adverse effects, prevent and treat adverse effects, provide comfort, and educate clients on safe medication use.

Rights of Safe Medication Administration

  • Right client: Verify identity using two identifiers and check for allergies.
  • Right medication: Verify prescription completeness and clarity.
  • Read medication labels and compare them with the MAR three times.
  • Right dose: Use a unit-dose system or calculate the correct dose, double-checking with another nurse if needed.
  • Right time: Administer medications on time to maintain consistent blood levels.
  • Right route: Select the correct preparation for the prescribed route.
  • Right documentation: Immediately record medication details and client response.
  • Right client education: Inform clients about the medication's purpose, expectations, instructions, and reportable issues.
  • Right to refuse: Respect the client's right to refuse, explain consequences, inform the provider, and document the refusal.
  • Right assessment: Collect necessary data before and after administration.
  • Right evaluation: Follow up to verify therapeutic and adverse effects.

Common Medication Errors

  • Wrong medication or IV fluid
  • Incorrect dose or IV rate
  • Wrong client, route, or time
  • Administration of an allergy-inducing medication
  • Omission of a dose or administration of extra doses
  • Incorrect discontinuation of a medication or IV fluid
  • Inaccurate prescribing
  • Giving a medication with a similar name

Using the Nursing Process to Prevent Medication Errors

  • Assessment: Be knowledgeable about medications, medical diagnoses, and necessary pre-administration data.
  • Planning: Identify client outcomes and set priorities for medication administration.
  • Implementation: Avoid distractions, prepare medications one at a time, check labels, measure doses accurately (double-check high-alert medications), follow rights of administration, educate clients.
  • Evaluation: Evaluate client responses, identify adverse effects, notify the provider of errors, and complete an incident report.
  • Incident reports should include client identification, medication details, incident time and place, an objective account, who was notified, actions taken, and the reporter's signature.
  • Report all errors to help identify and correct system issues.

High-Alert Medication List

  • High-alert medications require specific safeguards like limiting access, using auxiliary labels and automated alerts, standardizing processes, and using double checks.

Social Determinants of Health (SDOH)

  • SDOH significantly impact health outcomes; nurses should consider them for safe medication administration.
  • Economic Stability: Clients at a low socioeconomic level may not be able to afford medications or proper storage.
  • Education: Clients with low literacy might benefit from visual aids for understanding.
  • Health and Health Care: Clients with low literacy may not be able to comprehend written information and may need alternative education methods.
  • Neighborhood and Built Environment: Clients lacking transportation need information on prescription delivery.
  • Social and Community Context: Consider social factors affecting medication adherence.
  • Food Security: Support clients needing assistance with medications requiring food intake.

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