Using Automated Medication Dispensing Systems

2. Which precaution should the nurse observe to ensure patient safety when using an automated medication dispensing system? A. Assess the patient's ability to swallow oral medications without difficulty. B. Ask the patient about his or her experience with this or similar medications. C. Prepare medications for one patient at a time. D. Evaluate the patient's understanding of the safety issues related to the specific drug.

. Prepare medications for one patient at a time.

Before using a medication dispensing system, review your patient's MAR for the following:

1. Patient's full name 2. Drug's name, dosage, and form (e.g., tablet, liquid, or suppository) 3, Route and frequency or timing of administration 4. Reason for administration (for a PRN medication) 5. Expiration date

DOCUMENTATION: Documentation Guidelines:

1. Record the name of the medication, the actual time of administration, the dose, and the route on the MAR immediately after administration. 2. Include your initials or signature. Do not chart medication administration until after the drug is given to the patient. (For details, see "Documenting Medication Administration.") 3. It is not necessary to document use of a medication dispensing system separately. 4. Document any medication dispensing discrepancy according to facility policy. *It is not necessary to record the discrepancy in the patient's medical record if the medication was not administered*.

Follow the correct procedure for using your agency's medication dispensing system:

1. To access the computer, enter your security code or perform bioidentification using your fingerprint. 2. Once you have logged in, select a patient's name and medication profile. 3. Using the touch screen, select the appropriate medication, as indicated on the MAR. Remove the medication from the dispensing compartment. 4. Check that you have the right drug and dose for your patient, comparing it again with the MAR. As an additional safety check, some dispensing systems require that the medication be scanned when it is removed. 5. Repeat these steps for all additional medications. 6. Log off the system and lock the storage area before walking away.

Use of bar codes

1. improves the accuracy of patient identification, 2. reduces the incidence of medication errors 3. improves medical record keeping.

Always compare the medication provided to

1. the medication administration record (MAR), 2. the prescriber's order, or 3. both **because no medication dispensing system is foolproof.

Once logged onto the AMDS,

1. you select a patient's name and medication profile. 2. Then you select the medication, dosage, and route from a list displayed on the computer screen. 3. The system opens the medication drawer or dispenses the medication to the nurse, records the event, and charges it to the patient. 4. If the system is connected to the patient's medical record, information about the medication (e.g., name, dose, time) and the name of the nurse who retrieved it from the AMDS is recorded in the patient's medical record.

ASSESSMENT AND PREPARATION

If possible, prepare medications in an area designed for that purpose or at a unit-dose cart. Perform hand hygiene. Ensure that medication preparation surfaces are clean. Minimize distractions and interruptions during medication preparation, close the door of the medication room, and do not try to perform other tasks while preparing a medication. Double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia) and verify with another nurse. Review any pre-administration assessments (e.g., vital signs, review of laboratory results). Keep tablets and capsules in their wrappers and open them at the patient's bedside. This allows you to review each medication with the patient. If a patient refuses medication, there will be no question which one was withheld.

Which statement or question best illustrates the nurse's understanding of the role of nursing assistive personnel (NAP) in using automated medication dispensing systems? A. "Does the patient need her pain medication?" B. "Let me know if she complains of any nausea." C. "Ask her to describe her pain and show you where it is." D. "Remember to log off of the system when you are finished."

Let me know if she complains of any nausea."

MONITORING AND CARE

Log out of the medication dispensing system properly, and keep medication storage areas locked when unattended. Stay alert for medication errors, drug incompatibilities, and medication allergies. Verify all medications dispensed for the correct dose and route. Report any discrepancy between what the physician ordered or what was requested from the dispensing system and what was supplied.

EXPECTED OUTCOMES

Medication is correctly administered according to the six rights of medication safety. Patient exhibits no adverse reactions or side effects. Patient experiences desired medication effect within reasonable or expected period from administration of medication. Patient denies any GI discomfort. Patient explains purpose of medication and medication dose schedule.

UNEXPECTED OUTCOMES

Medication is incorrectly administered. Medication is improperly documented. Patient exhibits adverse effects (toxic effect, allergic reaction) from medication. Patient is unable to explain medication information. Patient refuses medication.

Supplies Print Supplies

Medication unit-dose cart Medication administration record (MAR)

while preparing medication

Minimize distractions and interruptions, including questions from staff and family, equipment alarms, and personal conversations.

While preparing a patient's oral medication dispensed from an automated medication dispensing system, the nurse realizes that the pill dispensed is twice the correct dose. What is the nurse's best action at this time? A. Notify the health care provider and ask if the higher dose could be given. B. Access the dispenser again for the correct dose. C. Notify the pharmacy to determine if the accurate dose is available. D. Split the pill in half.

Notify the pharmacy to determine if the accurate dose is available.

4. Which action by the nurse is most important in protecting the safety of patients and staff when using an automated medication dispensing system? A. Refusing to share his or her individual security log-in code for the dispensing system B. Having another registered nurse check his or her mathematical calculations C. Reviewing a current drug book for dosing information D. Using two different mathematical formulas to cross-check a dosage calculation

Refusing to share his or her individual security log-in code for the dispensing system

What is the nurse's first step in preparing to administer a prescribed medication using an automated medication dispensing system? A. Establish the patient's ID using two identifiers. B. Review the medication administration record (MAR). C. Provide patient education. D. Review applicable nursing considerations.

Review the medication administration record (MAR).

Follow the six rights of medication administration:

Right medication Right dose Right patient Right route Right time Right documentation

Report immediately any discrepancies between what the physician ordered or what was requested from the dispensing system and what was supplied.

TRUE

DELEGATION

The skill of using medication dispensing systems may not be delegated to nursing assistive personnel (NAP).

(AMDS)

automated medication dispensing system

Keep medication storage areas______when unattended.

locked

Use of an automated medication dispensing system (AMDS)

may reduce the incidence of medication errors.

Prepare medications for

one patient at a time.

The use of AMDS has been shown to

reduce the chance of medication errors.

There is evidence of an increase in reported medication errors with use of the system and a

reduction in dispensing errors through the use of alerts that are embedded within the clinical decision support system.

Remember to

sign out of the automated medication dispensing system when finished.

AMDSs are variations of unit-dose and floor stock systems. The systems within the health care agency are networked with one another and with other computer systems in the agency (e.g., computerized medical record). AMDSs control

the dispensing of all medications, including narcotics

Never share

your automated medication dispensing unit security code or password.