N101 Unit 3

The National Patient Safety Goals were formulated to punish hospitals for medication errors. True False

False

Point-of-care

Medical services provided directly to patients.

The Joint Commission

Requires accredited facilities to comply with safety-related activities, such as those outlined in the National Patient Safety Goals.

Transcribe (transcription)

To transfer information from one source to another.

Which dosage is written incorrectly? a. 0.2 mg b. 2.0 mg c. 2.02 mg d. 0.02 mg

b. 2.0 mg

Which right is not one of the six rights of medication administration? a. right patient b. right place c. right dose d. right route

b. right place

q

every

subcut

subcutaneously

Reducing Medication Errors

-Reading back verbal and telephone orders -Clarifying illegible or incomplete handwritten orders -Spelling back the name of the medication -Using the metric system for dispensing and administering medications -Having complete knowledge of the medication being administered

Explain the six rights.

1. The Right Patient 2. The Right Drug 3. The Right Dose 4. The Right Route 5. The Right Time 6. The Right Documentation

Explain the three checks of medication administration.

1. When collecting the medications 2. Prior to entering the patient's room 3. At the patient's bedside *Three checks are reliable only if the medication has been correctly transcribed to the MAR!

Medication Error

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. (National Coordinating Council for Medication Error Reporting and Prevention, 2018)

One-Time-Only Orders

A provider may wish to order a medication to be given only once. Medications for nausea or pain may be ordered as a one-time-only dose, with the intent to limit the quantity received by the patient.

Nomenclature

A system of naming that is particular to an industry. In the pharmaceutical industry, nonproprietary (generic) medication names are assigned by the United States Adopted Names Council.

Healthcare Facility

An organization that provides healthcare services to patients, including hospitals, infirmaries, clinics, home health agencies, and long-term care facilities.

The Institute for Safe Medication Practices (ISMP)

Dedicated to safe medication use and the prevention of errors.

Unit Dose Medications

Dispensed one dose at a time in prepackaged containers or syringes that are easy to use.

DEA

Drug Enforcement Agency

U.S. organizations that are involved with ensuring medication safety.

FDA ISMP NCCMERP II-II Joint Commission State Practice Acts Healthcare Institutions

16. Adhering to the six rights and three checks of medication administration ensures that the nurse will not make a mistake when giving medications to patients. True False

False

17. The purpose of "tall man" letters is to differentiate sound-alike drugs from one another. True False

False

19. The nurse should document administration of a medication on the medication administration record before it is given. True False

False

The Center for Drug Evaluation and Research is a division of the Institute for Healthcare Improvement. True False

False

The Institute for Healthcare Improvement (II—II)

Focuses on improving patient safety and preventing injury from high-risk medications.

Healthcare Institutions

Formulate policies and procedures that guide nurses in carrying out procedures in a safe manner.

Medication Orders

Generated inside an organization such as a hospital or long-term care facility and are valid only inside that facility.

Evidence-Based-practice

Healthcare provided to patients that is based on valid, research-derived evidence.

Continuum of Care

Healthcare services that are provided over a period of time.

State Nurse Practice Acts

Laws enacted to protect the public from harm related to nursing practice.

Electronic Medication Order (CPOE)

Many advantages: -Prescribers have access to information regarding patient identification, allergies, dosage recommendations, anticipated adverse reactions, drug interactions, and necessary laboratory tests. -Because orders are typed instead of handwritten, the occurrence of illegible orders is reduced and patient safety is enhanced. -Physicians, pharmacists, and nurses can review orders immediately, allowing for faster processing of orders. The transcription process does not occur in facilities that use CPOE. However, the nurse is still responsible to make sure the MAR is accurate.

PRN Orders

Medications are sometimes ordered on an as-needed basis. These orders are called PRN (pro re nata) orders. Common PRN orders include medications needed to treat pain, anxiety, or nausea. PRN orders should be written with the medication name, dosage, frequency, and medical indication for the drug with PRN or as needed clearly indicated. Most facilities also require the nurse to write a progress note in the patient's chart that addresses the patient's problem, the nurse's assessment, the action taken, and the re-evaluation of the problem after the intervention.

Describe how point-of-care barcode technology improves the accuracy of medication administration.

Point-of-care barcode technology can improve the accuracy of the medication administration process, but it is expensive and cannot reduce all types of errors.

Reason for Prescriptions

Prescriptions are required for medications that require provider supervision, such as antibiotics, anticoagulants, or drugs that have a potential to cause abuse or addiction.

Prescription

Prescriptions are written by licensed healthcare providers and contain instructions to a pharmacist about compounding, dispensing, and administering a patient's medication

Medication Reconciliation (Med Rec)

Process of gathering, verifying (comparing), and communicating a patient's drug information. Is necessary to prevent the inadvertent omission of a needed drug. Check for: -allergies -duplications -omissions -interactions -contraindications -need

Automated Medication Dispensing System

Provide additional security for medications along with the advantages of easier control over inventory, better tracking, and faster access to medications for nurses.

Verbal orders

Provider orders that are received in person or over the telephone.

Telephone orders

Provider orders that are received over the telephone.

The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP)

Researches the causes of medication errors and develops prevention strategies.

The Food and Drug Administration (FDA)

Responsible for overseeing the safety, efficacy, and security of medications manufactured and sold in the United States.

STAT Orders

STAT orders must be carried out right away as they take priority over routine orders. Most STAT orders are for a single, one-time-only dose of medication.

Standing Orders

Standing orders are pre-written, standardized instructions for patients whose medical care is similar. Standing orders are individualized to the patient based on the patient's medical status and must be approved and signed by the patient's provider.

Multiple Dose Medications

Supplied in bulk containers. The disadvantage to multiple dose medications includes the risk of contamination; however, it is not practical to package all medications in unit dose form.

Inscription

The inscription is the body of the prescription and contains the name of the medication, the dosage strength, and the dose form (for example, capsules, tablets, or elixir).

Prescriptive authority

The legal authority to write prescriptions.

Outdated Systems of Measurement

The metric system of measurement for dispensing and administering medications is preferred to the apothecary or household systems of measurement.

US Pharmacopeia

The organization responsible for setting the standards for the quality, purity, strength, and consistency of medicines, food ingredients, and dietary supplements

NCC MERP

The organization that has the authority and resources to tackle the complex nature of medication errors and develop appropriate solutions

Medication Administration Record (MAR)

The paper or electronic form used by nursing staff to document medications administered to a patient.

Compounding

The process of mixing drug ingredients to form a medication. With the advent of mass production of medications, pharmaceutical compounding is less common these days.

Look-Alike/Sound-Alike Medications

The purpose for the medication should be included in the medication order if the potential for confusion exists.

Signatura

The signatura, or signa, gives instructions to the patient. It tells the patient the number of units to take per dose, the route of administration, the frequency of dosing, the purpose of the prescription, and any special warnings or instructions.

Subscription

The subscription gives directions to the pharmacist.

Superscription

The superscription consists of the traditional symbol for prescription Rx, which means take thou or recipe.

18. The abbreviation "NPO" means "nothing by mouth." True False

True

Human factors, such as knowledge deficits, contribute to medication errors. True False

True

One of the missions of the Food and Drug Administration is to protect public health by ensuring the safety, efficacy, and security of drugs. True False

True

Differentiate between the various medication delivery systems.

Unit Dose Systems Multiple Dose Systems Automated Medication Dispensing Systems

Medication Administration Record (MAR)

Used to document the administration of medications Contain: -Patient information -Patient allergies -Information about medications -Special instructions -Room for documenting drug administration

Receiving Verbal Orders

Verbal orders carry an inherent danger of error and should be used only in urgent situations.

1. According to the 2001 study by Phillips et al., what was the most common cause of medication errors? a. human factors b. system factors c. communication factors d. manufacturing factors

a. human factors

9. A medication is ordered to be given parenterally. The medication will be: a. injected into tissues or a vein. b. applied directly to the skin. c. given by mouth. d. inserted into a body cavity.

a. injected into tissues or a vein.

1. The signatura on a prescription: a. provides instructions for the patient. b. provides instructions for the pharmacist. c. is the signature of the provider who prescribed the medication. d. consists of the body of the prescription.

a. provides instructions for the patient.

15. Which of the following statements most accurately describes the function of a lozenge? a. to apply medication topically to the oral cavity b. to apply medication throughout the body c. to apply medication directly into a vein d. to apply medication deep into a muscle

a. to apply medication topically to the oral cavity

pc

after meals

adlib

as desired

5. A nurse is teaching a patient about medications. Which of the following statements by the nurse demonstrates that the nurse needs additional education regarding medication administration? a. "This medication may cause nausea and drowsiness. These side effects can be managed by eating crackers with the medication and taking the medication at night." b. "I can't answer any questions about your medications. That's your physician's job." c. "This medication must be taken on an empty stomach to be fully absorbed. It is best to take it before breakfast." d. "You will need to have blood drawn every 2 weeks to monitor the blood level of the medication."

b. "I can't answer any questions about your medications. That's your physician's job."

8. A nurse is preparing to give a medication to a patient. In reviewing the dosage information for the medication, the nurse notes that the dose prescribed by the provider is outside the manufacturer's recommended safe dosage range. Which of the following actions is appropriate? a. Give the medication as prescribed by the provider. b. Call the provider to question the accuracy of the order. c. Ignore the order. d. Have another nurse give the medication as ordered.

b. Call the provider to question the accuracy of the order.

14. Which statement regarding medication reconciliation is false? a. The purpose of medication reconciliation is to improve communication between providers. b. Medication reconciliation serves to reduce the number of medications a patient is receiving. c. Nurses are responsible for verifying the patient's medications with the patient and family. d. When a patient is discharged from the hospital, the nurse ensures that the patient has a copy of his or her current list of medications.

b. Medication reconciliation serves to reduce the number of medications a patient is receiving.

2. Which organization develops and publishes the National Patient Safety Goals? a. The Institute for Healthcare Improvement b. The Joint Commission c. The U.S. Pharmacopeia d. The Food and Drug Administration

b. The Joint Commission

The nurse removes a tablet from a bottle of acetaminophen. This is an example of a(n): a. unit dose delivery system. b. multiple dose delivery system. c. automated delivery system. d. dual dose delivery system.

b. multiple dose delivery system.

4. When receiving a telephone order from a provider, the nurse must: a. have another nurse verify the order with the provider. b. read back the order to the provider. c. have the pharmacist co-sign the order. d. ask the provider to come in to write the order because nurses cannot take telephone orders.

b. read back the order to the provider.

ac

before meals

7. Which dosage is written incorrectly? a. 18 mcg b. 1.8 mcg c. 180.0 mcg d. 0.18 mcg

c. 180.0 mcg

The nurse is preparing to administer a single-dose medication to a patient. Which of these actions is correct? a. The nurse opens the unit dose package outside the patient's room. b. The nurse takes the medication from a bottle that the patient brought from home. c. The nurse opens the unit dose package at the patient's bedside. d. The nurse opens the unit dose package inside the patient's room.

c. The nurse opens the unit dose package at the patient's bedside.

12. The second check of a medication should be conducted: a. at the patient's bedside. b. as the medication is being pulled from the storage cabinet. c. after the medication has been obtained, but prior to entering the room. d. after the patient has taken the medication.

c. after the medication has been obtained, but prior to entering the room.

3. A STAT medication order must be carried out: a. within 15 minutes. b. after routine medications have been given. c. immediately. d. as soon as the nurse can get to it.

c. immediately.

3. The purpose of a state's Nurse Practice Act is to: a. protect the nurse from unsafe patients. b. safeguard the practice of nursing from lawmakers. c. protect the public from unsafe nurses. d. punish nurses who make errors.

c. protect the public from unsafe nurses.

13. Which abbreviation should not be used in charting dosages? a. subcut b. unit c. q.d. d. mcg

c. q.d.

10. A drug that is ordered to be administered t.i.d. should be given: a. once per day. b. twice per day. c. three times per day. d. four times per day.

c. three times per day.

Which drug route refers to a drug that is applied directly to the skin? a. intramuscular b. subcutaneous c. topical d. intravenous

c. topical

A nurse makes the decision to withhold a medication for a patient. Which action should the nurse take next? a. Notify the patient's next of kin. b. Notify the nursing supervisor. c. Notify the pharmacy. d. Notify the patient's provider.

d. Notify the patient's provider.

Which statement is incorrect regarding the nurse's role in medication reconciliation? a. Upon admission to the hospital, the nurse must gather and verify the patient's list of medications taken at home. b. The nurse must notify the provider about any discrepancies noted between the medications ordered for the patient while in the hospital and those that are on the patient's list from home. c. The nurse must give the patient a complete list of medications upon discharge from the hospital. d. The nurse is not involved in the process of medication reconciliation; that is the provider's responsibility.

d. The nurse is not involved in the process of medication reconciliation; that is the provider's responsibility.

One disadvantage of a multiple dose delivery system is: a. increased risk of contaminating the contents of the container. b. reduction in time to administer the drug. c. increased risk of mixing more than one medication in one container. d. a and c.

d. a and c

2. Medication orders must provide which of the following information? a. name of the medication b. name of the provider ordering the medication c. name of the patient d. all of the above.

d. all of the above.

Factors that may lead to giving the wrong medication to a patient include: a. look-alike medication names. b. sound-alike medication names. c. errors in transcribing the medication to the medication administration record. d. all of the above.

d. all of the above.

4. Which patient identifier is inappropriate? a. patient's name b. patient's address c. patient's date of birth d. patient's room number

d. patient's room number

11. The law that organized narcotic drugs into separate categories based on medical need and potential for addiction is: a. the Pure Food and Drug Act. b. the Durham-Humphrey Amendment. c. the Orphan Drug Act. d. the Controlled Substance Act.

d. the Controlled Substance Act.

6. Which of the following is not one of the three names that a medication might have? a. generic name b. trade name c. chemical name d. therapeutic name

d. therapeutic name

gtt

drop

STAT

immediately

IM

intramuscular

IV

intravenously

NKDA

no known drug allergies

PR

per rectum

b.i.d.

twice per day

Handwritten Medication Order Components

• Patient identifying information. • Date and time that the order was written. • Name of the medication. • The medication's dosage. • The route of administration. • The frequency and/or time of administration. • The prescriber's name and credentials. • Name of the person transcribing the order.

Prescription Components

• The date the prescription was written • Information about the patient (name, address, date of birth) • Information about the prescriber (name, address, phone number, qualification or degree held, DEA registration number). • Signature lines • Number of refills allowed

"Do Not Crush" Medications that are:

• enteric coated or have other specialized coatings. • extended-, sustained-, controlled-, or slow-release. • effervescent (fizzy) tablets when placed in liquid. • foul tasting in the patient's mouth. • a cause of mucous membrane (mouth, esophagus, stomach, or small intestine) ulceration. • meant to be given buccally or sublingually.