Notes 10 Chapter 09 Safety and Quality.pdf

Chapter 09: Safety and Quality NOTES: s ∙ The “six rights” of medication administration are important goals for medication safety. The nurse following these guidelines will verify the following: (1) the right patient, (2) the right drug, (3) the right dose, (4) the right...

Chapter 09: Safety and Quality NOTES: s ∙ The “six rights” of medication administration are important goals for medication safety. The nurse following these guidelines will verify the following: (1) the right patient, (2) the right drug, (3) the right dose, (4) the right route, (5) the right time, and (6) the right documentation. ∙ The original six rights have included subsequent additions, throughout the years, in an attempt to maintain safety, e.g., right assessment, right education, right evaluation, and right of the patient to refuse. ∙ The right patient determination is essential. The Joint Commission (TJC) requires at least two forms of identification before drug administration. ∙ The nurse must accurately determine the right drug prior to administration. ○ When working with an EHR, once the bar code on the patient’s wristband has been scanned, the patient’s drug profile will appear on the computer screen. ○ The nurse will then scan the patient’s medication label, and it will automatically validate the time, date, and the nurse administering the patient’s medication. ○ If it is not the correct medication, the nurse will receive an alert and will be unable to proceed in the MAR until the correct medication is scanned. ∙ It is the nurse’s responsibility to administer the drug as ordered by the provider, and if the drug order is incomplete, the drug should not be administered. Verification of a questionable order must be done in a timely manner. ∙ Nurses are legally liable if they give a prescribed drug and the dosage is incorrect, or if the drug is contraindicated for the patient’s health status. ∙ The right dose refers to a verification by the nurse that the dose administered is the amount ordered and that it is safe for the patient for whom it is prescribed. The right dose is based on the patient’s physical status. ∙ The right time is the time the prescribed dose is ordered to be administered. Every drug cannot be given exactly when ordered; therefore, health care agencies have policies that specify a range of times within which drugs can be administered before or after the appointed time. ∙ The right route is necessary for adequate or appropriate absorption. The right route is ordered by the health care provider and indicates the mechanism by which the medication enters the body. ∙ The nurse determines if the drug is safe to administer according to the drug’s pharmacodynamics (action) and the patient’s vital signs. ∙ Prior to drug administration, it is important that the nurse carefully review the patient’s most current lab results. ∙ Renal and hepatic functions are important considerations because many drugs are cleared through the kidneys and metabolized by the liver. ∙ The right documentation requires the nurse to immediately record the appropriate information about the drug administered. This includes (1) the name of the drug, (2) the dose, (3) the route, (4) the time and date, and (5) the nurse’s initials or signature. Documentation of the patient’s response to the medication is required with a variety of medications.  NCM 106 IDC CON Amuan/ Porque Chapter 09: Safety and Quality NOTES: ∙A medication error may be defined as “any preventable event that may cause or lead to inappropriate medication use or harm to a patient.” ∙ Most organizations have a risk management department staffed with nurse managers and risk managers who conduct root cause analysis (RCA), a method of problem solving used to identify potential workplace errors. Such analysis presents opportunities for learning and focuses on strategies that can be put in place to correct problems. ∙ If a patient dies as the result of a drug error, it is called a sentinel event. ∙ The National Patient Safety Goals (NPSGs) focus on problems in health care safety and how to solve them. ∙ When a prescription drug is known to be effective for some patients but may cause serious side effects in others, the FDA will require the drug’s printed materials to carry a warning about the adverse effects surrounded by a black box. ∙ Drug reconciliation is an important component of the culture of safety. It is defined as the process of identifying the most accurate list of all medications that the patient is taking at transitions in care, which includes admissions and discharges from a hospital to another health care setting such as long-term care. ∙ The Secure and Responsible Disposal Act encourages both public and private entities to develop secure, convenient, and responsible methods for collecting and destroying medications and controlled substances. ∙ The Needlestick Safety and Prevention Act (NSPA) requires that employers implement safer medical devices for their employees, provide a safe and secure workplace environment with educational opportunities, and develop written policies to help prevent sharps injuries. ∙ Most medication errors occur in the transcription stage (56%), followed by the nurse administration stage (41%), and finally the doctor prescribing stage (39%). ∙ Although some drugs can be used crushed, some should not be crushed; do not crush any extended- or sustained-release drugs because this will change the pharmacokinetic phase of the drug. ∙ High-alert drugs can cause significant harm to the patient. If a high-alert medication is given in error, it can have a major effect on the patient’s organs. ∙ Nurses should be aware that certain drug names sound alike and are spelled similarly. ∙ Creating a distraction-free environment is critical to safe administration of medications. ∙ The FDA Pregnancy Categories & Subsection Labeling System provides a broader explanation based on current available information of the benefits and risks medications can have to the mother, the fetus, and the breastfeeding child. NCM 106 IDC CON Amuan/ Porque