Drug Administration Safety Module 3 PDF

Drug Administra.on Safety Module 3  Medica.on ok so by Orders Toccoa some A paramedic requires an order from a medical direc2on physician to administer a medica2on. Medical direc.on is the process by which physicians direct and monitor the care...

Drug Administra.on Safety Module 3  Medica.on ok so by Orders Toccoa some A paramedic requires an order from a medical direc2on physician to administer a medica2on. Medical direc.on is the process by which physicians direct and monitor the care given in the prehospital environment within an EMS system. Medical direc2on can be provided either online or offline. Online medical direc.on, some2mes referred to as online medical control, occurs when the prehospital provider is able to consult and obtain direc2on and orders in real 2me by radio or telephone communica2on. Offline medical direc.on occurs when the physician medical director is not available for real-2me interac2ons. guideline  Medica.on Orders The majority of medical direc2on cases are offline. The medical director approves a series of protocols detailing the care that the prehospital professional is to provide in a given clinical scenario.  Parts of a Medica.on Order Full name of the pa2ent Date and 2me the order wriEen Name of drug to be administered Dosage Frequency of administra2on Route of administra2on Signature of person wri2ng the order  Types of Medica.on Orders A stat order indicates that the medica2on is to be given otic immediately and only once (e.g., Demerol 100 mg IM stat). The single order or one-2me order is for medica2on to be given once at a specified 2me (e.g., Seconal 100 mg before h surgery). The standing order may or may not have a termina2on date, may be carried out indefinitely (e.g., mul2ple vitamins daily) ariv iikrayaprorenataclarinphrasesutryfournou.rs un2l an order is wriEen to cancel it, or may be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h × 5 days). A prn order or as-needed order permits the nurse to give a e who medica2on when, in theme HCP s judgment, the pa2ent requires it (e.g., Amphojel 15 mL prn). Tacia  Examples – Stat order Demerol 100 mg IM stat – Single order Seconal 100 mg hs before surgery – Standing order Mul2vitamin 1 capsule po daily Oaterminarian Demerol 100 mg IM q 4 h x 5 days date – prn order Amphojel 15 mL prn  Pa.ent Safety To ensure pa2ent safety regarding medica2on administra2on, a checklist known as the nine pa.ent rights of drug administra2on is used. Running through this checklist before drug administra2on will reduce the likelihood of a medica2on error and improve pa2ent safety.  1- Right Pa.ent Is the person to whom you will administer the medica2on the person you think he or she is? This ques2on is perhaps more relevant in a seXng where one provider may be caring for several pa2ents. You must ensure that the medica2on you will administer is meant for the correct pa2ent. If administering or assis2ng with prescrip2on medica2ons, read the medica2on label and check whether the name on the medica2on boEle is the name of the pa2ent you are trea2ng.  2- Right Drug and Right Indica.on There are two considera2ons when confirming whether you are administering the correct medica2on. 1. The name of the medica2on you are preparing to administer. Before administering a drug, confirm that the drug in your hand is the drug you have been ordered to give. 2. Whether the medica2on order or protocol is appropriate for this par2cular clinical situa2on or pa2ent condi2on. Ask yourself, “Why are we giving this medica2on?” If you do not know the answer, then you must pause to consider the overall clinical situa2on.  2- Right Drug and Right Indica.on In tense moments and uncontrolled environments, it is easy for protocols and treatment algorithms to overlap or blend together. Inexperienced providers frequently focus on memorizing protocols without having the depth of understanding to recognize the indica2ons and implica2ons of each proposed interven2on. This is also the op2mal 2me to consider pa2ent allergies or other contraindica2on(s). As you consider administering a proposed medica2on, do a brief review of any significant contraindica2ons that might be present in this par2cular pa2ent or situa2on.  3- Right Dose Ensure that the pa2ent is geXng the correct dose of the medica2on. Repeat the dose verbally before administra2on. If you are not directly administering the medica2on, listen to the dose being administered. If you ques2on the dose, call for a “stop” or “2meout” to confirm the dosage. Pa2ent safety is everyone’s responsibility.  4- Right Route Check the route of administra2on and whether the route is accessible. If the ordered route is oral, can the pa2ent swallow the medica2on? Can the medica2on be crushed? Some oral medica2ons formulated as a sustained-released medica2on cannot be crushed to assist in oral administra2on. Administering a sustained-release oral medica2on in a crushed form may result in overdose.  5- Right Time For hospital providers, the right 2me typically refers to administering a medica2on at the right 2me of day. This usually is not a significant problem for the prehospital professional. However, the 2me can also refer to the 2me it takes to safely administer a bolus of an IV medica2on. When administering an IV medica2on as a bolus, ques2oning over what period the bolus should be given is in the interest of pa2ent safety. In general, any medica2on ordered as slow IV push (SIVP) should be administered over at least 2 minutes, with the HCP actually using a watch or 2mer to administer it safely.  6- Right Educa.on Inform the pa2ent of the medica2on name and indica2on prior to administra2on whenever possible. This may not be possible in true emergency situa2ons. Include any an2cipated side effects or adverse effects of the medica2on as well as any unusual sensa2ons the pa2ent may experience during or following administra2on. This is also an excellent opportunity to reconfirm any pa2ent allergies (or significant contraindica2ons) immediately prior to administra2on. Make sure to include the likely implica2ons for the pa2ent if he or she chooses to decline or refuse a par2cular medica2on or treatment op2on.  7- Right to Refuse Pa2ents, the parents or legal custodians of most minor pa2ents, or the pa2ent’s designated healthcare decision maker may consent to or refuse medica2on administra2on. Failure to follow refusal from a pa2ent with decision-making capacity can result in malprac2ce claims.  8- Right Response and Evalua.on Observe how the pa2ent tolerated the medica2on. Did a change in the cardiac rhythm or vital signs occur? It is important to document follow-up vital signs ader administering any medica2on that is known to alter heart rate, blood pressure, respira2ons, or oxygena2on. Consider a medica2on’s 2me of onset and dura2on of ac2on when monitoring vital signs and overall pa2ent condi2on. Did the medica2on improve the pa2ent’s condi2on, did it have no effect, or did it possibly make the situa2on worse? Did new signs or symptoms such as nausea, vomi2ng, rash, itching, or changes in mental status occur?  8- Right Response and Evalua.on Observe the IV site for signs of infiltra2on or occlusion, which may indicate poten2al harm to a pa2ent ader many prehospital IV medica2ons such as dextrose, vasopressors, and certain an2eme2cs. Be sure to alert receiving facility personnel that the medica2on has been administered so appropriate pa2ent monitoring will con2nue ader pa2ent handoff.  9- Right Documenta.on Document the medica2on given, dose, 2me of administra2on, route, and any changes in the pa2ent’s condi2on. Document any orders received from online medical direc2on, and indicate which EMS provider actually administered the medica2on.  Preven.ng Medica.on Errors Minimize verbal or telephone orders: – Repeat order to prescriber – Spell drug name aloud – Speak slowly and clearly Avoid medical shorthand, including abbrevia2ons and acronyms. Never assume anything about items not specified in a drug order (i.e., route). Do not hesitate to ques2on a medica2on order for any reason when in doubt. Do not try to decode illegibly wriEen orders; contact prescriber for clarifica2on.  Preven.ng Medica.on Errors NEVER use trailing zeros with medica2on orders. - Do not use 1.0 mg; use 1 mg. - 1.0 mg could be misread as 10 mg, resul2ng in a tenfold dose increase. ALWAYS use a leading zero for decimal dosages - Do not use.25 mg; use 0.25 mg. -.25 mg may be misread as 25 mg. -.25 is some2mes called a naked decimal. Check medica2on order and what is available while using the 9 rights. Take 2me to learn special administra2on techniques of certain dosage forms.  Preven.ng Medica.on Errors Always listen to and respect any concerns expressed by pa2ents regarding medica2ons. Check pa2ent allergies and iden2fica2on.  Abbrevia.ons BD: twice a day TDS: three times a day QID: four times a day STAT: give immediately PRN: when required (when necessary) ac: before meals pc: after meals q.h. or 1/24: every hour q2h or 2/24: every two hours q4h or 4/24: every four hours  Abbrevia.ons BUC: inside cheek PO or O: oral/per oral SL: Sublingual ID: intradermal IM: intramuscular SC: subcutaneous IV: Intravenous NEB: nebuliser PR: per rectum TOP: topical/skin VAG: vaginal  Provider Safety The first rule of providing emergency care in the field is to ensure your personal safety. A fundamental concept taught to all prehospital providers is scene safety. The prac2ce of wearing appropriate personal protec2ve equipment (PPE) and following standard precau2ons is designed to reduce the likelihood that a provider will be infected by a pathogen when exposed to infec2ous blood, body fluids, or respiratory droplets.  Provider Safety These efforts are meant to protect providers from the pathogens with no cure: human immunodeficiency virus (HIV), hepa22s B virus (HBV), and hepa22s C virus (HCV). Standard precau2ons are designed with the assump2on that all blood, body fluids, and pa2ent materials are contaminated with HIV, HBV, or HCV. When observing standard precau2ons, a provider PPE, specialized clothing or equipment to protect the provider from contamina2on.  Provider Safety Gloves are a standard component of PPE. Gloves will not prevent needle s2cks, but they will act as a barrier between a contaminated body fluid and an open wound on the provider’s hand. Masks are another element of PPE; they should be worn when a splash of the pa2ent’s body fluids may get into the eyes, nose, or mouth of the provider. When a provider wears a mask, the mucous membranes of the eyes must be protected with goggles. A mask is required when intuba2ng a pa2ent, dealing with a pa2ent who is ac2vely bleeding, or drawing blood.  Provider Safety Goggles must have side shields to prevent blood from entering the eye from the side. If prescrip2on glasses are used as eye protec2on, those glasses must have side shields, and a plan must be in place to decontaminate the glasses if they become contaminated.  Provider Safety The most obvious risk of blood contamina2on to a provider is being accidentally stuck by a needle, scalpel, or other sharp object. A provider should never a.empt to recap or bend a needle. Immediately ader using a needle or sharp, it should be placed in an approved puncture-resistant and leak- proof needle box. Never should the sharp be set on the ground, stuck into a maEress, or led loose on the ambulance bench The End