ST Medication Administration PDF

Medication Administration NURS 1090  Unit Outcomes Explain principles of safe medication preparation, administration and documentation Demonstrate safe preparation and administration of oral medications. Apply the six rights/three safety checks of medication administration Describe locatio...

Medication Administration NURS 1090  Unit Outcomes Explain principles of safe medication preparation, administration and documentation Demonstrate safe preparation and administration of oral medications. Apply the six rights/three safety checks of medication administration Describe location and storage of medications on a nursing division Apply National Patient Safety Goals related to medication administration  Knowledge gained from NURS 1060 needed for understanding and applying content in NURS 1090 Nurses play an important role in SAFE medication preparation, administration AND evaluation Introductio n Medication Legislation and Standards Federal State and Local Health Care Institutions Nurse Practice Acts  Introduction An adverse drug event (ADE) is defined as harm experienced by a patient as a result of exposure to a medication As of 3/2018: 2,216,000 Adverse Drug Reactions (ADR’s) in hospitalized patients leading to 106,000 deaths annually ADRs are the 4th leading cause of death — ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths. This is very concerning, considering most, if not all medication errors could be prevented Medication errors prolong a patient’s length of stay ◦Negative impact on reimbursement ◦Increase cost of hospital stay  Medication Errors Types of Medication Errors ◦American Hospital Association lists one of the most common types of medication errors as miscommunication: ◦poor handwriting (not an issue w/ EMR) ◦misuse of zeroes/decimal points, ◦confusion of metric dosing/conversions, ◦inappropriate abbreviations (FDA, 2011) ◦“It would be unfortunate if the only difference between life and death had to do with a misplaced decimal point or an inaccurate conversion related to dosing for a weight-based medication” (rightdiagnosis.com)  National Patient Safety Goals (NPSG) (The Joint Commission) 2022 – Seven Hospital Goals ◦Identify Patients Correctly ◦Improve Staff Communication ◦Use Medications Safely ◦Uses Alarms Safely ◦Prevent infection ◦Identify patient safety risks ◦Prevent mistakes in surgery  National Patient Safety Goals (NPSG) (The Joint Commission) NPSG’s directly related to medication administration Identify the patients correctly ◦NPSG.01.01.01 - USE AT LEAST TWO WAYS TO IDENTIFY PATIENTS ◦Example: use the patient name and date of birth and/or medical record number ◦To verify each patient receives the correct medicine and treatment  NPSG’s directly related to medication National administration Use medicines safely Patient ◦NPSG.03.04.01 – Label Safety Medicines That Are Not Labeled Goals ◦Example: medicines in syringes and cups. Do this in the area (NPSG) where the medicines are prepared ◦NPSG.03.05.01 – Take Extra (The Joint Care With Patients Who Take Commissio Medicine To Thin Their Blood (Anticoagulants) n)  National Patient Safety Goals (NPSG) (The Joint Commission) USES MEDICINES SAFELY (cont.) ◦NPSG.03.06.01 – RECORD AND PASS ALONG CORRECT INFORMATION ABOUT A PATIENT’S MEDICINES ◦FOR EXAMPLE: ◦Determine which medicines the patient is taking. Compare those medicines to new medicines given to the patient. ◦Make sure the patient knows which medicines to take when they are home. ◦Tell the patient it is important to bring their up-to-date list of medicines every time they visit the doctor ◦Use the Teach-back Method when educating patients about their medications  National Patient Safety Goals (NPSG) (The Joint Commission) A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Such events are called "sentinel" because they signal the need for immediate investigation and response. A “Never” Event – sometimes called this because it NEVER should have happened How can these occur with Medication Administration?  Nursing Responsibilities for Medication Administration Know and understand the patient’s diagnosis(es) Understand action and side effects of drugs Know why THIS patient is receiving THIS medication Monitor/evaluate patient’s response to the medication Provide education to patient and family about medication Help patient administer drugs correctly and knowledgeably Inform healthcare provider: -if the medications are effective or ineffective -if the medications are not longer necessary -the patient’s condition changes Patient’s Rights: The Patient Care Partnership (AHA) Be informed of the drug name, purpose, action and potential undesirable effects Right to refuse a medication, regardless of consequence Have qualified nurses or physicians assess a drug history, including allergies Be properly advised of the experimental nature of a drug therapy and give written consent for its use  Patient’s Rights Receive labeled medications safely without discomfort in accordance with the “six” rights of medication administration Receive appropriate supportive therapy in relation to drug therapy Not receive unnecessary medications Be informed if medications are a part of a research study  Steps to Take to Prevent Medication Errors Prepare meds for one patient at Review allergies a time Use at least two patient Follow 6 rights identifiers ◦Will talk about 2 other rights Do not allow any other activity Read labels at least three (3) interrupt preparation or times while preparing med administration of medication ◦Comparing label with Medication Administration Double check all calculations Record (MAR) and other high-risk medication ◦And…confirming 5 of the administration processes with rights another nurse  Take Steps to Prevent Medication Errors, cont. Address patient’s concerns about medications before administering Follow established policies and procedures when using technology to administer meds ◦ Bar coding, automated dispensing systems If you make a medication error, reflect what went wrong and how you could have prevented the error Evaluate the context or situation in which a medication error occurred Report the medication error following facility protocol  Steps to Take to Prevent Medication Errors, cont. Question unusually large or small doses Involve patient with med administration Ensure you are well rested when caring for patients Document administration immediately If you make a medication error, reflect what went wrong and how you could have prevented the error Evaluate the context or situation in which a medication error occurred Nursing Actions if a What are the nurse’s Medication responsibilities? Error Occurs  Types of Medication Errors Inaccurate prescribing Infraction of any of the six (6) rights of medication preparation and administration ◦ RIGHT PATIENT ◦ RIGHT DRUG (MEDICATION) ◦ RIGHT DOSE ◦ RIGHT ROUTE ◦ RIGHT TIME ◦ DOCUMENT And also: ◦ Right Reason ◦ Right Response Administering extra doses or omitting doses (Right Dose) Medication Reconciliation What is this? Why is it important? When is it completed?  Medication Reconciliation Process: Verify: obtain comprehensive and current list of patient’s medications Clarify: Make sure list of medications, dosages, and frequencies is accurate. ◦Clarify with as many people as necessary to ensure accuracy Reconcile: Compare new medication orders with the current list ◦Check any discrepancies with PCP Transmit: Communicate the updated and verified list to caregivers and the patient ◦Teach patients to carry list of current medications  How Has Technology and Informatics Improved Medication Safety?  How Has Technology Improved Medication Safety? Computer Prescribed Order Entry ◦Orders are entered directly in to the patient’s Electronic Health Record (EHR) ◦May be able to integrate with online resources and pharmacy and other departments Automated Dispensing Cabinet  How Has Technology Improved Medication Safety? Workstation on Wheels Bar Coding System  How Has Technology Improved Medication Safety? HOWEVER: WHEN USING A BAR CODING SYSTEM (OR ANY TECHNOLOGY SYSTEMS)--- IT DOES NOT TAKE THE PLACE OF PERFORMING ALL OF THE SAFETY CHECKS THAT ARE IN PLACE FOR MEDICATION PREPARATION OR ADMINISTRATION!!!!  General Guidelines for Safe Medication Administration Read drug labels carefully Question administration of multiple tablets/capsules or need to use more than one vial Be aware of drugs with similar names ◦ISMP – LIST OF CONFUSED DRUG NAMES ◦Look for TALL MAN letters  General Guidelines for Safe Medication Administration Check the decimal point ◦2.5 mg is quite different than 25 mg Always know the class and action of the drug, side effects and expected outcome Check patient with 2 identifiers EVERY TIME you administer a drug or treatment Know that there is a difference between: mEq mcg mg Do not administer drugs ordered by nicknames or unofficial abbreviations Avoid interruptions during medication preparation and administration  Pharmacology and Older Adults (Refer to NURS 1060 content as it relates to pharmacokinetics) Factors that affect medication Nursing interventions to decrease risk: therapy ◦Obtain a complete med hx ◦Impaired memory or altered mental status ◦Start therapy at lowest possible dose ◦Changes in vision and hearing ◦Assess/monitor for therapeutic ◦Decreased mobility and and adverse effects dexterity ◦Assess/monitor for med-med and ◦Poor adherence med-food interactions ◦Reduced financial resources ◦Notify HCP of adverse effects ◦Polypharmacy Review Beer’s Criteria or STOPP Tool  Give clear and Interventions to concise promote instructions, adherence verbally and in writing Ensure the dosage Provide clearly Pharmacolog form is appropriate Liquid form for those marked containers y and Older with difficulty swallowing pills that are easy to open Adults Assist the patient Suggest that the to set up a daily patient obtain calendar with the assistance from a use of pill friend, neighbor, or containers relative  Pharmacology and Older Adults EXAMPLE A nurse is providing teaching to an older adult patient to promote adherence with medication administration. Which of the following instructions should the nurse include? Choose all that apply. a. Adjust dosages according to daily weight b. Place pills in daily pill holders c. Provide liquid forms if the client has difficulty swallowing pills d. Ask a relative to assist periodically e. Request child-guard caps on medication containers  The Process for Administering Medications  The Process for Administering Medications Review the Medication Order All orders must have: ◦ Patient’s full name ◦ Date and time order is written ◦ Name of drug ◦ Dose to be administered and any special instructions for administration ◦ Frequency of administration ◦ Route of administration ◦ Signature of health care provider Types of orders are based on the frequency and/or urgency of medication administration Example: Mary Brown 2/19/22 0800: docusate sodium 100mg by mouth daily. Take with a full glass of water M. Grey, MD  TYPES OF ORDERS Routine Order or Standing Order The order is carried out until it is discontinued by the prescriber OR a The prescribed number of days has elapsed TETRACYCLINE 500 mg by mouth every Process for 6 hours Administerin DECADRON 10 mg daily for 5 days g Single (One-Time) Order Medications To be given ONE time at a specific time ANCEF 1 g IVPB on call to OR Now Order A single dose of a medication to be given asap VANCOMYCIN 1 g IVPB now  Types of Orders, cont. STAT Order A single dose of medication to be given IMMEDIATELY and only ONCE The furosemide 40 mg IV stat Process for prn Orders (prn = pro re nata – as Administerin needed; as required) g Medication is to be given when a patient Medications requires it or needs it acetaminophen 325 mg by mouth every 4 hours prn temperature greater than 38 morphine sulfate 2 mg IV every 2 hours prn incisional pain The patient needs to wait for the prescribed amount of time between doses  The Process for Administering Medications Medications Pharmacists review the orders and dispense the medications to the divisions Nurses distribute the medications Usually, there are special areas where medications are stored and prepared MEDICATION ROOMS LOCKED CARTS COMPUTERIZED MEDICATION DISPENSING SYSTEMS Medication areas need to be locked when unattended  The Process for Administering Medications Medication Process 1. There must ALWAYS be a Healthcare Provider order to administer medication ◦ If medication order is incomplete, prescriber needs to be notified before administering the medication ◦ Telephone & verbal orders require read-back by the nurse ***Student nurses are NEVER permitted to receive verbal or telephone orders 2. Pharmacists and nurses must check all medication orders for accuracy SEVERAL times ◦ Consider current medical problem, medical history, labs, other prescribed medications, vital signs, etc. 3. Order placed on MAR The Process for Administering Medications Storage and Distribution Unit-dose System ◦Medications individually packaged ◦Pharmacy usually supplies 24- hour supply for each patient ◦Nurse will obtain individual, wrapped doses from locked medication dispensing unit The Process for Administering Medications Storage and Distribution Stock Supply ◦Bottles of packages containing medications for multiple patients ◦Uncommon in acute care facilities The Process for Administering Medications Medication Administration Record (MAR) Provides the information needed to administer medication(s) safely Legal Document Paper or Electronic ◦MAR or e-MAR  The Process for Administering Medications Components of MAR or e-Mar PATIENT INFORMATION MEDICATION INFORMATION ◦Patient’s name ◦Medication Name ◦Medical Record Number ◦Medication Dose ◦Frequency to be Administered ◦Date of Birth ◦Route to be Administered ◦Diagnosis ◦Time of Administration ◦Allergies EACH TIME A MEDICATION IS ◦Age ADMINISTERED, THE NURSE MUST BE ◦Gender USING THE MAR TO VERIFY THE ACCURACY OF THE MEDICATION ◦Physician’s Name ◦If the medication order is incomplete, ◦Sometimes Room and Bed incorrect, or inappropriate, consult with Number the prescriber  The Process for Administering Medications Correct Medication Administration Dosage Calculations: Precise dosage calculation is necessary to provide your patient with the correct amount of ordered medication Double check with another nurse if you are EVER in doubt With some HIGH RISK medications, you may be REQUIRED to have another nurse double check your calculations and preparation ◦Insulin ◦Heparin or other anticoagulants  Correct Medication Administration Nurses MUST follow the eight (6) rights of The medication administration EVERY time Process ◦Right Patient ◦Right Drug for ◦Right Dose Administeri ◦Right Route ng ◦Right Time Medication ◦Correct Documentation s ◦ (“P D D R T”) Also, need to verify: Right Reason for administering drug Right Response – evaluation  The Process for Administering Medications Correct Medication Administration: P D D R T Right patient ◦Check the name on the order and the patient ◦Use 2 identifiers ◦Patient name, Birthdate and Medical Record Number ◦Check the name band with the MAR ◦Ask patient to identify himself/herself. ◦When available, use technology (for example, bar-code system) Right drug ◦Check the medication label with the MAR  The Process for Administering Medications Correct Medication Administration: P D D R T Right dose ◦ Confirm appropriateness of the dose using a current drug reference ◦ If necessary, calculate the dose and have another nurse calculate the dose as well. Right route ◦ Check appropriateness of the route ordered. ◦ Confirm that the patient can take or receive the medication by the ordered route Right time ◦ Check the frequency of the ordered medication ◦ Double-check that you are giving the ordered dose at the correct time ◦ Confirm when the last dose was given  The Process for Administering Medications Correct Medication Administration: P D D R T Right documentation ◦ Document administration AFTER giving the ordered medication ◦ Chart the time, route, and any other specific information as necessary ◦ For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug. Some sources recommend some additional Rights to think about ◦ Right Reason ◦ Right Response ◦ Right Assessments (part of our universal steps for a procedure, right!!) ◦ Right Education ◦ Right to Refuse  The Process for Administering Medications Correct Medication Administration THREE safety checks MUST be performed during medication preparation EVERY time The safety checks consist of checking: ◦ Patient ◦ Medication (Drug) ◦ Dose ◦ Route ◦ Time Allergy (x2) Expiration Scan Dennis Quaid Video