Fundamentals of Nursing Model 5 PDF

**The Role of the Nurse in Safe Medication Administration** **Medication Administration Basics** +-----------------------------------+-----------------------------------+ | | -Having knowledge of federal, | | | state (nurse pr...

**The Role of the Nurse in Safe Medication Administration** **Medication Administration Basics** +-----------------------------------+-----------------------------------+ | | -Having knowledge of federal, | | | state (nurse practice's take), | | | and local laws, and facílities\' | | | policies that govern the | | | prescribing, dispensing, and | | | administration ofmedications | | | | | | -Preparing and administering | | | medications, and evaluating | | | clients\' responses to | | | medications· -Developing and | | | maintaining an up-to-date | | | knowledgebase of medications they | | | administer, including | | | uses,mechanisms of action, routes | | | of administration,safe dosage | | | range, adverse effects, | | | precautions,contraindications, | | | and interactions | | | | | | -Maintaining knowledge of | | | acceptable practice and skill | | | competency | | | | | | ·Determining the accuracy of | | | medication prescriptions | | | | | | ·Reporting all medication errors | | | | | | ·Safeguarding and storing | | | medications | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | - - - | Excretion: **Metabolism**: Drugs | | | taken orally are metabolized | | | primarily in the liver. | | | First-pass metabolism can greatly | | | affect the drug's potency before | | | it reaches systemic circulation. | | | **Excretion**: The majority of | | | orally administered drugs are | | | excreted via the kidneys in urine | | | or via feces. | +===================================+===================================+ | | #### **Absorption:** | | | | | | **Location**: Drugs are injected | | | into a muscle (e.g., deltoid, | | | vastus lateralis, or gluteus | | | muscle). | | | | | | Rate of absorption: Faster than | | | oral but slower than intravenous | | | due to the vascularity of muscle | | | tissue. Absorption is generally | | | quicker than subcutaneous due to | | | the greater blood supply in | | | muscles. | | | | | | Factors affecting absorption: | | | Blood flow to the muscle, muscle | | | activity, and the formulation of | | | the drug (e.g., aqueous vs. oily | | | solutions). | | | | | | #### **Distribution:** | | | | | | Once absorbed into the | | | bloodstream, IM drugs are | | | distributed throughout the body | | | via systemic circulation. | | | | | | Similar to other parenteral | | | routes, distribution is affected | | | by tissue perfusion, plasma | | | protein binding, and | | | lipophilicity of the drug. | | | | | | #### **Excretion:** | | | | | | Metabolism: Many IM drugs are | | | metabolized in the liver, though | | | some may undergo metabolism in | | | the site of injection. | | | | | | Excretion: Drugs administered | | | intramuscularly are generally | | | excreted via the kidneys (urine) | | | or bile. | +-----------------------------------+-----------------------------------+ | | #### **Absorption:** | | | | | | - - - | | | | | | #### **Distribution:** | | | | | | - - | | | | | | #### **Excretion:** | | | | | | - - | +-----------------------------------+-----------------------------------+ | | #### **Absorption:** | | | | | | - - - | | | | | | #### **Distribution:** | | | | | | - - - | | | | | | #### **Excretion:** | | | | | | - - | +-----------------------------------+-----------------------------------+ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ·The client\'s full name·The date and time of the prescription·The name of the medication (generic or brand)The strength and dosage of the medicationThe route of administration·The time and frequency of administration: exact time or number of times per day (according to the facility\'s policy or the specific qualities of the medication)·The quantity to dispense and the number of refills·The signature of the prescribing provide -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ +-----------------------------------+-----------------------------------+ | | A routine or standing | | | prescription identifies | | | medications nurses give on a | | | regular schedule with or without | | | termination date. Without a | | | termination date,the prescription | | | will be in effect until the | | | provider discontinues it or | | | discharges the client. | | | | | | Providers must re-prescribe some | | | medications (opioids and | | | antibiotics) within a specific | | | amount of time or they will | | | automatically discontinue. | +-----------------------------------+-----------------------------------+ | | A single or one-time prescription | | | is for administration once at a | | | specific time or as soon as | | | possible. These Prescriptions are | | | common for preoperative or pre | | | procedural medications. For | | | example, a one-time prescription | | | instructs the nurse to administer | | | warfarin 5 mg PO at 1700. | +-----------------------------------+-----------------------------------+ | | A stat prescription is only for | | | administration once and | | | immediately.For example, a stat | | | prescription instructs the nurse | | | to administer digoxin 0.125 mg IV | | | bolus stat. | +-----------------------------------+-----------------------------------+ | | A now prescription is only for | | | administration once, but upto 90 | | | min from when the nurse received | | | the prescription.For example, a | | | now prescription instructs the | | | nurse to administer vancomycin 1 | | | g intermittent IV bolus now | +-----------------------------------+-----------------------------------+ | | A PRN (pro re nata) prescription | | | specifies at what dosage, what | | | frequency, and under what | | | conditions a nurse can administer | | | the medication. The nurse uses | | | clinical judgment to determine | | | the client\'s need for | | | themedication. For example, a PRN | | | prescription instructs the nurse | | | to administer morphine 2 mg IV | | | bolus every hourPRN for chest | | | pain | +-----------------------------------+-----------------------------------+ | | Providers might write | | | prescriptions for specific | | | circumstances or for specific | | | units. Forexample, a critical | | | care unit has standing | | | prescriptions for treating | | | clients who have asystole. | +-----------------------------------+-----------------------------------+ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking---including name, dosage, frequency, and route---and comparing this list against the physician's orders at each transition of care. This process is critical for ensuring patient safety by identifying and preventing medication errors, such as omissions, duplications, dosing errors, or drug interactions, particularly when patients are admitted, transferred, or discharged from healthcare settings. -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- The Joint Commission requires policies and procedures for medication reconciliation. Nurses compile a list of each client\'s current medications, including all prescription medications, over-the-counter medications, vitamins, and supplements,with correct dosages and frequency. They Compare the list with new medication prescriptions and reconcile it to resolve any discrepancies. This process takes place at admission, when transferring clients between units or facilities, and at discharge. -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- +-----------------------------------+-----------------------------------+ | Rights patient | Verify clients\' identification | | | before each medication | | | administration. The Joint | | | Commission requires two client | | | identifiers. Acceptable | | | identifiers include the client\'s | | | name, an assigned identification | | | number, telephone number, birth | | | date, or other person-specific | | | identifier(a photo identification | | | card). Nurses also use | | | bar-codescanners to identify | | | clients. Check for allergies by | | | asking clients, checking for an | | | allergy bracelet or medal,and | | | checking the MAR. | +===================================+===================================+ | Rights medication | Correctly interpret medication | | | prescriptions, verifying | | | completeness and clarity. Read | | | medication labels and compare | | | them with the MAR three times: | | | before removing the container, | | | when removing the amount of | | | medication from the container, | | | and in the presence of the client | | | before administering the | | | medication. Leave unit-dose | | | medication in its package until | | | administration | +-----------------------------------+-----------------------------------+ | Rights dose | Use a unit-dose system to | | | decrease errors. If not | | | available,calculate the correct | | | medication dose; check a drug | | | reference to make sure the dose | | | is within the usual range.Ask | | | another nurse to verify the dose | | | if uncertain of the calculation, | | | or to confirm the calculation is | | | correct.Prepare medication | | | dosages using standard | | | measurement devices (graduated | | | cups or syringes). Some | | | medication dosages require a | | | second verifier or witness. | | | Automated Medication dispensing | | | systems use a machine to control | | | the dispensing of medications. | +-----------------------------------+-----------------------------------+ | Rights time | Administer medication on time to | | | maintain a consistent therapeutic | | | blood level. Refer to the drug | | | reference or the facility\'s | | | policy for exceptions;general | | | recommendations follow. | | | | | | ·Administer time-critical | | | medications within 30 min of the | | | prescribed time. Facilities | | | define which medications are | | | time-critical; usually this | | | includes medications that require | | | a consistent blood level | | | (antibiotics). | | | | | | ·Administer non-time-critical | | | medications prescribed once | | | daily, weekly, or monthly within | | | 2 hr of the prescribed time. | | | | | | ·Administer non-time-critical | | | medications prescribed more than | | | once daily (but not more than | | | every 4 hr)within 1 hr of the | | | prescribed time. | +-----------------------------------+-----------------------------------+ | Rights route | The most common routes of | | | administration are oral, topical, | | | subcutaneous, intramuscular (IM), | | | and intravenous (IV). Additional | | | administration routes include | | | sublingual, buccal, intradermal, | | | transdermal, epidural,inhalation, | | | nasal, ophthalmic,otic, | | | rectal,vaginal,intraosseous, and | | | via enteral tubes. Select the | | | correct preparation for the route | | | the provider prescribed (otic | | | vs.ophthalmic topical ointment or | | | drops) | +-----------------------------------+-----------------------------------+ | Rights documentation | Immediately record pertinent | | | information, including the | | | client\'s response to the | | | medication. Document the | | | medication after administration, | | | not before | +-----------------------------------+-----------------------------------+ | Rights education | Right client educationInform | | | clients about the medication: its | | | purpose,what to expect, how to | | | take it, and what to report. | | | Toindividualize the teaching, | | | determine what the client already | | | knows about the medication, needs | | | to know about the medication, and | | | wants to know about the | | | medication | +-----------------------------------+-----------------------------------+ | Rights right to refuse |.Right to refuseRespect clients\' | | | right to refuse any medication. | | | Explainthe consequences, inform | | | the provider, and document the | | | refusal. | +-----------------------------------+-----------------------------------+ | Rights assessment | Right assessmentCollect any | | | essential data before and after | | | administering any medication. For | | | example, measure apical heart | | | rate before giving digoxin | +-----------------------------------+-----------------------------------+ | Rights evaluation | Right evaluationFollow up with | | | clients to verify therapeutic | | | effects as well as adverse | | | effects. | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | | Wrong medication or IV fluid | | | | | | Incorrect dose or IV infusion | | | rate | | | | | | Wrong client, route, or time | | | | | | Administration of a medication to | | | which the clientis allergic | | | | | | Omission of a dose or extra doses | | | | | | Incorrect discontinuation of | | | medication or IV fuid | | | | | | Inaccurate prescribing | +===================================+===================================+ | | Precautions taken to avoid | | | errors when administering | | | therapeutic agents | | | | | | -do not allow automatic habits of | | | preparing medications or | | | technology to replace nursing | | | judgement | | | | | | -use references when lacking | | | medication knowledge | | | | | | -understand causes of medication | | | errors and related prevention | | | methods | | | | | | Medication errors often occur | | | at points of transition in care | | | | | | -medication reconciliation | | | | | | Check label on medication | | | package or container three times | | | during medication preparation and | | | administration | | | | | | 1\. compare medication label to | | | MAR when medication removed | | | from storage area | | | | | | 2\. compare medication label to | | | MAR as | | | | | | medication prepared\ | | | 3. compare medication label to | | | MAR at patient's bedside before | | | medication administered | +-----------------------------------+-----------------------------------+ **Medication Administration** +-----------------------------------+-----------------------------------+ | - - - | For liquids, suspension, and | | | elixirs, follow directions for | | | dilution and shaking. To prepare | | | the medication,placea medicine | | | cup on a flat surface before | | | pouring, andensure the base of | | | the meniscus (lowest fluid line) | | | is at the level of the dose. | | | Contraindications for oral | | | medication administration include | | | vomiting, decreased GI motility, | | | absence of gag reflex, difficulty | | | swallowing, and a decreased level | | | of consciousness.Have clients sit | | | upright at a 90° angle to | | | facilitate swallowing. Administer | | | medications, such as analgesics, | | | that irritate the gastric mucosa | | | with small amounts of food if not | | | contraindicated.Do not mix with | | | large amounts of food or | | | beverages incase clients cannot | | | consume the entire quantity.Avoid | | | administration with interacting | | | foods or beverages (grapefruit | | | juice decreases the metabolism of | | | certain medications increasing | | | the risk of toxicity). | +-----------------------------------+-----------------------------------+ | | Directly enters the bloodstream | | | and bypasses the | | | liverSublingual:under the | | | tongueBuccal:between the cheek | | | and the gum | | | | | | CLIENT EDUCATION | | | | | | ·Keep the medication in place | | | until complete absorption occurs. | | | | | | · Do not eat or drink while the | | | tablet is in place or until it | | | has completely dissolved. | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | | Medication in a skin patch for | | | absorption through the skin, | | | producing systemic effects | | | | | | CLIENT EDUCATION | | | | | | ·Apply patches as prescribed to | | | ensure proper dosing. | | | | | | ·Wash the skin with soap and | | | water and dry it thoroughly | | | before applying a new patch. | | | | | | Place the patch on a hairless | | | area and rotate sites to prevent | | | skin irritation. | +===================================+===================================+ | Safe administration of topical | Medications directly applied to | | medication | the mucous membranes or skin. | | | Includes powders, sprays, creams, | | | ointments, pastes,oil-and | | | suspension-based lotions | | | | | | Painless | | | | | | · Limited adverse effects | | | | | | NURSING ACTIONS | | | | | | ·Apply with a glove, tongue | | | blade, cotton-tipped applicator. | | | | | | Do not apply with a bare hand. | | | | | | For skin applications, wash the | | | skin with soap and water. Pat dry | | | before application. | | | | | | ·Use surgical asepsis to apply | | | topical medications to open | | | wounds | +-----------------------------------+-----------------------------------+ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ·Use medical aseptic technique when instilling medications in eyes.·Have clients sit upright or lie supine, tilt their head slightly, and look up at the ceiling.Rest your dominant hand on the clients\' forehead, hold the dropper above the conjunctival sac about 1 to 2 cm,drop the medication into the sac, avoid placing it directly on the cornea, and have them close the eye gently.If They blink during installation, repeat the procedure.Apply gentle pressure with your finger and a clean facial tissue on the nasolacrimal duct for 30 to 60 seconds to prevent systemic absorption of the medication. · If instilling more than one medication in the same eye,wait at least 5 min between them.·For eye ointment, apply a thin ribbon to the edge of the lower eyelid from the inner to the outer canthus. ·Use medical aseptic technique when administering medications into the ears.·Warm the ear drops to room temperature.Have clients sit upright or lie on their side.· Straighten the ear canal by pulling the auricle upward and outward for adults or down and back for children less than 3 years of age. Hold the dropper 1 cm above the ear canal, instill the medication, and then gently apply pressure with your finger to the tragus of the ear unless it is too painful.·Do not press a cotton ball deep into the ear canal. Ifnecessary, gently place it into the outermost part of the ear canal.·Have clients remain in the side-lying position if possible, for 2 to 3 min after installation of ear drops. ·Use medical aseptic technique when administering medications into the nose.·Have clients lie supine with their head positioned to allow the medication to enter the appropriate nasal passage.Use your dominant hand to instill the drops,supporting the head with your nondominant hand.· Instruct clients to breathe through the mouth, stay in a supine position, and not to blow the nose for 5 min afterdrop instillation.·For nasal spray, prime the spray if indicated, insert tip into nare, and point nozzle away from the center of the nose.· Spray into nose while the client inhales and instruct the client not to blow their nose for several minutes -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ +-----------------------------------+-----------------------------------+ | | ·Elevate the client\'s head of | | | bed to reduce the risk of | | | aspiration.·Verify tube placement | | | by observing aspirate, checkingpH | | | of aspirate (Gastric pH is less | | | than 5).·Use a 60 mL asepto | | | syringe or an enteral-only | | | connector syringe and allow the | | | medication to flow by gravity or | | | push it in with the plunger of | | | the syringe. | | | | | | GENERAL GUIDELINES·Use liquid | | | forms of medications; if not | | | available,consider crushing | | | medications if appropriate | | | guidelines allow.· Do not | | | administer sublingual | | | medications.Do not crush | | | specially prepared oral | | | medications(extended/time-release | | | , | | | fluid-filled,enteric-coated).·Adm | | | inister | | | each medication separately.·Do | | | not mix medications with enteral | | | feedings.·Completely dissolve | | | crushed tablets and capsules | | | contents in 15 to 30 mL of tepid | | | water prior to administration. | | | ·To prevent clogging, flush the | | | tubing before and after each | | | medication with 15 to 30 mL | | | water.·Flush with another 30 to | | | 60 mL of water after installing | | | all the medications.·Use sterile | | | water for immunocompromised or | | | critically ill clients.·If tube | | | is connected to suction, clamp | | | the tube for 20 to30 min after | | | administration | +-----------------------------------+-----------------------------------+ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ·Position clients in the left lateral or lateral semi-prone recumbent position.·Insert the suppository just beyond the internal sphincter.· Instruct clients to remain flat or in the left lateral position for at least 5 min after insertion to retain a suppository. Absorption times vary with the medication -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Safe administration of medications through parenteral routes ·Use a needle size and length appropriate for the type of injection and the client\'s size. Syringe size should approximate the volume of medication.Use a tuberculin syringe for solution volumes less than 0.5 mL.Rotate injection sites to enhance medication absorption and document each site.Do not use injection sites that are edematous, inflamed,or have moles, birthmarks, or scars.·Discard all sharps (broken ampule bottles, needles) inleak-and puncture-proof containers. -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ·Use for tuberculin testing or checking for medication allergy sensitivities.·Use small amounts of solution (0.01 to 0.1 mL)ina tuberculin syringe with a fine-gauge needle (25-to27-gauge) in lightly pigmented, thin-skinned, hairless sites (the inner surface of the mid-forearm or scapular area of the back) at a 5° to 15° angle.Insert the needle with the bevel up. A small bleb should appear.·Do not massage the site after injection. ·Use for small doses of non irritating, water-soluble medications (insulin and heparin).· Use a 3/8- to 5/8-inch, 25- to 27-gauge needle or a 28-to 31-gauge insulin syringe. Inject no more than 1.5 mLof solution.·Select sites that have an adequate fat-pad size (abdomen,upper hips, lateral upper arms, thighs).·For average-size clients, pinch up the skin and injectat a 45° to 90° angle.For clients who are obese, use a 90°angle. ·The vastus lateralis is recommended for infants 1 year and younger.·The ventrogluteal site is preferable for IM injections and for injecting volumes up to 3 mL. ·The deltoid site has a smaller muscle mass and can accommodate 1 to 2 mL of fluid.· Use for irritating medications, solutions in oils,and aqueous suspensions.·The most common sites are ventrogluteal, deltoid,and vastus lateralis (pediatric). The dorsogluteal is no longer recommended as a common injection site due to its proximity to the sciatic nerve.·Use a needle size 18- to 25-gauge (usually 22-to25-gauge), s/8- to 1.5-inch long, and inject at a 90° angle.Solution volume is usually 1 to 3 mL. Divide large volumes into two syringes and use two different sites.Use the Z-track technique for IM injections of irritating fluids or fluids that can stain the skin (iron preparations). This method prevents medication from leaking back into subcutaneous tissue. Reference Guidelines to determine whether this technique is recommended for a given medication. Use for administering medications, fluid, and blood products.·Vascular access devices can be for short-term use(catheters) or long-term use (infusion ports).o Use 16-gauge devices for clients who have trauma.Use 18-gauge during surgery and blood administration.o Use 22- to 24-gauge for children, older adults,and clients who have medical issues or arestable postoperatively.· Peripheral veins in the arm or hand are preferable. Ask Clients which site they prefer. For newborns, use veins in the head, lower legs,and feet.After administration, immediately monitor for therapeutic and adverse effects +-----------------------------------+-----------------------------------+ | | Blood glucose assessment is the | | | process of measuring the | | | concentration of glucose in a | | | person\'s blood. It is commonly | | | done to monitor glucose levels in | | | individuals with diabetes or | | | suspected blood sugar | | | abnormalities. Blood glucose can | | | be assessed using a glucometer | | | with a small blood sample | | | obtained via a fingerstick. | | | | | | 1.Prepare the meter: Before using | | | the meter for the first time, | | | you\'ll need to set the time, | | | date, and target blood glucose | | | range | | | | | | 2.Wash your hands: Wash and dry | | | your hands well to avoid | | | inaccurate readings | | | | | | 3.Prick your finger: Use the | | | lancet that comes with the test | | | kit to prick the side of your | | | fingertip. Avoid pricking the pad | | | or too close to your nail | | | | | | 4\. Apply the test strip: Touch | | | the edge of the test strip to | | | the drop of blood. The meter | | | will display your blood sugar | | | level after a few seconds | | | | | | 5\. Dispose of the strip: Put | | | the used test strip in a sharp | | | container for proper disposal. | | | | | | 6\. Clean the puncture site: | | | Wipe the puncture site with a | | | clean, dry tissue | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | | **Clean the tops of both insulin | | | vials**: | | | | | | **Inject air into the NPH vial**: | | | | | | **Inject air into the regular | | | insulin vial**: | | | | | | **Draw up the regular insulin**: | | | | | | **Draw up the NPH insulin**: | +===================================+===================================+ | | #### **Choosing the Injection Sit | | | e:** | | | | | | **Preferred sites**: Abdomen (2 | | | inches away from the navel), | | | upper arm, thigh, or buttocks. | | | | | | **Rotate injection sites**: To | | | prevent lipodystrophy (localized | | | tissue changes), alternate | | | injection sites within the same | | | general area. | | | | | | **Avoid** scar tissue, areas with | | | bruising, or areas with | | | irritation. | | | | | | #### **Procedure for Administerin | | | g Insulin:** | | | | | | **Clean the injection site**: | | | | | | **Pinch the skin** (for | | | subcutaneous injection): | | | | | | **Insert the needle**: | | | | | | **Inject the insulin**: | | | | | | **Apply light pressure**: | | | | | | **Dispose of the needle**: | +-----------------------------------+-----------------------------------+ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Avoiding recapping needles. Planning for safe handling and disposal of needles before using them. Promptly disposing of used needles in conveniently placed and appropriate sharps disposal containers. Reporting all needlestick and sharps-related injuries promptly to ensure that you receive appropriate follow-up care. -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- +-----------------------------------+-----------------------------------+ | | **Assessment** | | | | | | Medication history | | | | | | -Previous and current drug use, | | | medication schedule, response to | | | medications, attitude toward | | | drugs and use of drugs, | | | compliance with regimen, and | | | storage | | | | | | Health status | | | | | | ‒ current and past illnesses | | | | | | Laboratory test results | | | | | | Known medication allergies | | | | | | Religious beliefs, ethnic | | | practices | | | | | | **Diagnoses/Problems** | | | | | | ** **Related to medication | | | administration | | | | | | -constipation | | | | | | -deficient knowledge | | | | | | -ineffective health maintenance | | | | | | -noncompliance with medication | | | regimen | | | | | | -risk for aspiration | | | | | | **Outcome Identification and | | | Planning** | | | | | | Patient goals regarding | | | medications | | | | | | -expected change in symptoms | | | | | | -expected therapeutic effects | | | within specified time frame | | | | | | -maintenance of therapeutic blood | | | levels of medications | | | | | | -patient knowledge regarding | | | medications | +===================================+===================================+ | Document medication | MAR is legal document | | administration | | | | -record medications during or as | | | soon as possible after | | | administration | | | | | | -do not record medications before | | | administration | | | | | | -document | | | | | | name of medication and person, | | | administering, dosage, route, | | | time, sites for injections (if | | | applicable) | | | | | | Omitted and refused medications | | | | | | -omitted: inadvertently or | | | intentionally (diagnostic test, | | | problem resolved, suspected | | | allergy) | | | | | | -refused: report promptly, | | | determine reason, help patient | | | accept needed medications, | | | document | +-----------------------------------+-----------------------------------+ | | Prompt acknowledgment of errors | | | may minimize possible detrimental | | | effects | | | | | | Patient safety is immediate | | | priority | | | | | | Responding to medication errors | | | | | | -check patient's condition | | | immediately, observe for adverse | | | effects | | | | | | -notify nurse manager and primary | | | care provider | | | | | | -document error and remedial | | | steps taken in medical record | | | | | | -complete form used for reporting | | | errors per facility policy | | | (Safety Event Report, Incident | | | Report) | | | | | | Precautions taken to avoid | | | errors when administering | | | therapeutic agents | | | | | | -do not allow automatic habits of | | | preparing medications or | | | technology to replace nursing | | | judgement | | | | | | -use references when lacking | | | medication knowledge | | | | | | -understand causes of medication | | | errors and related prevention | | | methods | | | | | | Medication errors often occur | | | at points of transition in care | | | | | | -medication reconciliation | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | | Ongoing process that should | | | begin when patient admitted to | | | health care facility | | | | | | Teaching topics | | | | | | -take medications exactly as | | | prescribed | | | | | | -drug abuse | +-----------------------------------+-----------------------------------+