Safe And Quality Drug Administration PDF

SAFE AND QUALITY DRUG ADMINISTRATION MODULE 3 OBJECTIVES At the end of the discussion, the student will be able to: ▪ Enumerate and understand the importance of the six rights and the subsequent 4 additions of medication administration ▪ Apply the safety risks of handling, administering...

SAFE AND QUALITY DRUG ADMINISTRATION MODULE 3 OBJECTIVES At the end of the discussion, the student will be able to: ▪ Enumerate and understand the importance of the six rights and the subsequent 4 additions of medication administration ▪ Apply the safety risks of handling, administering, and disposing medication ▪ Develop a plan for medication administration utilizing appropriate preparation, administration, and documentation ▪List different terminologies related to drug calculations ▪Classify and convert a unit to an equivalent unit of measure Module 3 | Pharmacology ‘24-’25  SIX RIGHTS OF MEDICATION ADMINISTRATION 1 3 5 7 9 Right Right Right Patient Right Dose Right Time Assessment Evaluation 2 4 6 8 10 Right Right to Right Drug Right Route Documention Education Right to Refuse Note: The original six rights have included subsequent 4 additions that are important for safe drug administration  1. RIGHT PATIENT determining patient identification is an integral part of ensuring patient safety. Two important ways of identifying the patient: 1. Full name 2. birth date Then compare with the patient’s A. identification (ID) band and the medication administration record (MAR). NOTE: color-coded ID bands is for allergy, DNR, etc. B. Electronic health records (EHRs) that allow the If the patient is an adult with a cognitive disorder nurse to directly scan the bar code from the ID or a child, verify the patient’s name with a family band. member. If family member is unavailable, a photo ID on the band with the patient’s name and birth date Module 3 | Pharmacology ‘24-’25 could be affixed to the band.  2. RIGHT DRUG Scan medication label Check that order is prescribed by licensed health care provider (MD, dentist, podiatrist, CNP, APRN, physician assistant, veterinarian, chiropractor, optometrist, medical clinical psychiatrists, and pharmacists with prescriptive authority). Read drug labels three times (taking up meds, preparing, administering). Be familiar with the patient’s health record, allergies, lab results, and vital signs. Know why the patient is receiving medication and if correct for the patient’s diagnosis Check dose calculations Know the beginning and ending date of the medication Module 3 | Pharmacology ‘24-’25 Right Drug Doctor’s Order Prescriptions may be done by handwritten, telephone order or verbal order, or directly entered into the patient’s EHR. to ensure accuracy All T/O or V/O are either handwritten by the nurse taking the order or entered directly into a computer and “read back” before affixing a signature. If controlled drugs, 2 nurses are required to listen and affix their signature. After dictating a verbal order, the provider must sign it within 24 hours. Note: Nursing students are not Module 3 | Pharmacology ‘24-’25 allowed to accept or take provider orders Components of a Drug Order 1.Patient name and birth date 2. Date the order is written 3. Provider signature or name if an electronic order, T/O, or V/O 4. Signature of licensed staff who took the T/O or V/O, if applicable 5. HCPs who wish to prescribe controlled drugs must register with the Drug Enforcement Agency (DEA) or FDA. When prescribing controlled substances, the HCP’s DEA/FDA number must be on the prescription. 6. Drug name and strength 7. Drug frequency or dose (e.g., once daily) 8. Route of administration 9. Duration of administration (e.g., × 7 days, × 3 doses, when applicable) 10. Number of pills to be dispensed 11. Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness, or laboratory results Module 3 | Pharmacology ‘24-’25 Module 3 | Pharmacology ‘24-’25  How to avoid medication errors Drug label should be read three times: 1. When you pick up the medication and remove it from the drug cabinet 2. As you prepare the drug for administration 3. When you administer the drug Module 3 | Pharmacology ‘24-’25 3. RIGHT DOSE METHODS OF DISPENSING THE DRUG Verify dosage calculation Automated dispensing cabinets – the use of Verify that the drug is safe for the computerized drug storage cabinet that stores and patient dispense medications near the point of care Weigh patient if dose is dependent upon weight Unit dose (single dose) - has reduced dosage errors Validate dose of certain drugs like because no calculations are required insulin and heparin with 2 RNs Multidose vial - requires calculations to withdraw an exact amount of drug according to the dose required. Module 3 | Pharmacology ‘24-’25 4. RIGHT TIME includes the time the prescribed dose is ordered to be administered. To maintain therapeutic level of the drug in the blood plasma level, a daily prescribed order should have specified intervals Examples of specified intervals for the drug order include: 1. once a day (od) 2. twice a day (bid) or every 12 hours 3. three times a day (tid) or every 8 hours 4. four times a day (qid), or every 6 hours (every 6hrs) Note: Use of military time (24-hour clock) is Module 3 | Pharmacology ‘24-’25 recommended in the healthcare facility Types of Drug Order Module 3 | Pharmacology ‘24-’25 5. RIGHT ROUTE is necessary for adequate or appropriate absorption. It is ordered by the health care provider and indicates the mechanism by which the medication enters the body. Module 3 | Pharmacology ‘24-’25 6. RIGHT DOCUMENTATION requires the nurse to record immediately the appropriate information about the drug administered. Method of documenting drug administration: Paper medication administration record (MAR) - is the commonly used method specially in the Philippines as per observation Computerized charting - nurse enters a personal identification and password to get access into the system. Note: A drug that is given but not documented is considered not given and a drug that is not given but documented is considered given. It is important that nurses must remember that drugs should be signed immediately after the drug is administered Module 3 | Pharmacology ‘24-’25  Sample MAR Module 3 | Pharmacology ‘24-’25  7. RIGHT ASSESSMENT -requires the collection of appropriate baseline data before the administration of a drug. Example of right assessment 1. taking a complete set of vital signs 2. checking lab levels before drug administration 3. Identify high-risk patients so precautions to reduce risk could be given (e.g., patients with medication allergies, diabetic patients, cardiac and pulmonary patients, and the elderly and pediatric populations). Module 3 | Pharmacology ‘24-’25 8. RIGHT TO EDUCATION The nurse should accurately and thoroughly inform the patient about the drugs they are taking and how each drug relates to their condition. Teaching also includes: Why is the patient taking the drug, what is the expected result of the drug, its possible good /therapeutic effects, side effects and adverse effects, and if there are any dietary restrictions or requirements. Laboratory test result monitoring and the necessary skills of drug administration with return demonstration before discharge. This facilitate continuity of care at home upon discharge. Module 3 | Pharmacology ‘24-’25  9. RIGHT EVALUATION determines the drug's effectiveness based on the patient’s response to the drug. The nurse should ask the patient whether the medication improves the present health condition. The nurse should evaluate the therapeutic effect of the medication by assessing the patient's response to the drug. Example: Patient response to an antiemetic, antihypertensive, and antihistamine Module 3 | Pharmacology ‘24-’25 10. RIGHT TO REFUSE If the patient refuse the medication: The nurse’s is responsible to determine the reason for the patient refusal to medication The nurse should explain to the patient the “risks involved with refusal”, and reinforce the important benefits and reasons for taking the medication. When a medication is refused, the refusal must be documented immediately, and follow-up is always required. The primary nurse and healthcare provider should be informed because the omission may pose a specific threat to the patient (e.g., a change in the lab values with insulin and warfarin). Module 3 | Pharmacology ‘24-’25  Medication Errors Prescription Errors Module 3 | Pharmacology ‘24-’25  Medication Errors Dispensing Errors Module 3 | Pharmacology ‘24-’25  Medication Errors Administration Errors Module 3 | Pharmacology ‘24-’25  THE JOINT COMMISSION NATIONAL PATIENT SAFETY GOALS (TJC) Two important goals that have already become standards for all TJC 1. “Do not use” abbreviations - orders that should be written to avoid misinterpretation Module 3 | Pharmacology ‘24-’25  THE JOINT COMMISSION NATIONAL PATIENT SAFETY GOALS (TJC) 2. List of acceptable abbreviations - are abbreviations that are frequently used in drug therapy and must be known by the nurse Module 3 | Pharmacology ‘24-’25  DISPOSAL OF MEDICATION Appropriate disposals of used drugs are important to decrease the amount of controlled substances released into the environment, especially into water and sewage system. Module 3 | Pharmacology ‘24-’25 SHARPS SAFETY / NEEDLE-STICK INJURY Sharps safety prevent incidents of blood-borne related disease Module 3 | Pharmacology ‘24-’25  Safety Risks with Medication Administration Tablet splitting - not recommended by the FDA. The only time tablet splitting is advisable is when it is specified by the pharmacist on the label Buying drugs over the Internet - drugs sold online may be too old, too strong, or too weak to be effective and are unsafe to use with other medications Dosage Forms: To Crush or Not to Crush - Do not crush any extended- or sustained-release drugs because this will change the pharmacokinetic phase of the drug. High-Alert Medications - can cause significant harm to the patient if given with error Counterfeit drugs - May look like desired drug with wrong ingredient/dose. May be improperly packaged or contaminated. Module 3 | Pharmacology ‘24-’25 Examples of high alert drugs 1. Epinephrine 2. Insulin (all forms) 3. Magnesium sulfate injection 4. Opium tincture 5.Potassium chloride concentrates for injection Module 3 | Pharmacology ‘24-’25 Lists to reduce risk of errors in administering high alert medication: 1. Simplify the storage, preparation, and administration of high- alert drugs 2. Write policies concerning safe administration 3. Improve information and education 4. Limit access to high-alert medications 5. Use labels and automated alerts 6. Use redundancies (automated or independent double-checks) 7. Closely monitor the patient’s response to the medication (possibly the most important step) Module 3 | Pharmacology ‘24-’25 LOOK-ALIKE AND SOUND-ALIKE DRUG NAMES Nurses should be aware and give emphasis that certain drug names sound alike and are spelled similarly is prone to medication error and should not be practiced in the clinical settings Module 3 | Pharmacology ‘24-’25  LOOK-ALIKE AND SOUND-ALIKE DRUG NAMES Example: 1. glypizide (Glucotrol) with glyburide (Glyceron) 2. Glimepiride (Amaryl) with galantamine (Reminyl). Note: To prevent this incident, nurses should always practice the Six plus 4 Rights of medication administration Module 3 | Pharmacology ‘24-’25 TRANSCULTURAL DIFFERENCES IN INTERPRETATION OF RIGHTS 1. Environmental influence 2. Religion 3. Ethnic beliefs, rituals 4. Technology and economy 5. Gender considerations 6. Other form of inequalitie Module 3 | Pharmacology ‘24-’25 Thank You END OF MODULE 3 SEE YOU NEXT WEEK!