Novant Health Medications Course

Examples of medication errors:

-An incorrect drug is administered. -A medication is administered by an incorrect route. -A medication is administered at the wrong time. -A dose of medication is administered to the wrong patient. -A dose of medication is administered without a written order. -The practitioner prescribed the incorrect dose. -The pharmacist dispensed an incorrect medication.

Medication formulary

-Formal list of medications that the organization determines will be routinely stocked and have available for prescribing -The Pharmacy and Therapeutics (P&T) committee continuously evaluates medications for the medication formulary.

Preparation of Sterile Medications for Immediate Use

-Sterile medications or compounded sterile preparations (CSP) may be prepared in patient care/perioperative/procedural areas when a delay in care may put patient at risk, when pharmacy is closed, or medication has limited stability.

High risk medications & hazardous drugs

Essential information: High-risk or high-alert drugs are medications that are more likely to cause harm if involved in an error.Special precautions may be used to prevent errors with high risk medications, such as: -Independent double checks. -Use of order sets.

How do I determine if a medication is on the formulary?

I-Connect: The medication formulary can be located from the I-Connect home page by following this path: I-Connect > Clinical Resources > Formulary medication list. Dimensions: Medication formulary may also be available within Dimensions as a reference link.

Examples of high risk medications

IV Heparin Precautions: Mitigation strategies include: Use of standardized order set(s) and heparin calculator. Daily pharmacy monitoring. Dual nurse verification of all new starts, boluses, and dose changes. BARCODE SCANNING Barcode scanning is an effective tool that helps ensure the correct medication or IV fluid is administered to the patient. When possible, utilize barcode scanning prior to administration of all medications and IV fluids.

What other information should I know about outside medications?"

If medications or other substances are brought into a Novant Health facility from the outside and are to be administered to the patient, certain conditions must be met: -A practitioner must enter an order in the patient's chart authorizing the patient to use his/her personal medication(s). The patient must complete the Medications/Substances Brought From Outside the Hospital Consent form. If the medication is a controlled substance, a form (such as the Medications Brought from Home Tracking Tool) must be completed to begin chain of custody for the controlled substance. -Prior to use, a pharmacist must confirm the medications are safe to use.

"What if I'm confused about re-using a vial?"

If you are uncertain about re-using a vial, contact pharmacy for clarification.

Reporting and tracking errors & near misses

Important items to remember: -Report all medication errors and near misses through the e-RL system to identify opportunities for process improvement. -Medication errors and near miss reports are evaluated to help prevent future occurrences and patient harm through optimization of system processes.

Medication timing

Medications should be administered as close to their scheduled administration times as possible.Our policies help guide medication administration and include specific parameters. Medications not eligible for scheduled dosing times include: -Antibiotic medications -Drugs prescribed on an as-needed (prn) basis -First time or loading doses -One-time doses -Post-operative orders -Stat doses -Time critical medications Scheduled dosing time eligibility Medications eligible for scheduled dosing times include: -Medications prescribed on a repeated cycle of frequency, such as daily, BID, or TID. -Medications which are regularly scheduled and non-time critical.

Proprietary Delivery Systems (Acute Care Only)

Overview Listed below are some key concepts to begin our review of proprietary delivery systems in the acute care setting: bullet Example of proprietary delivery systems may include but are not limited to addEASE, MINI-BAG Plus, Vial-Mate, Vial2Bag, and ADD-Vantage. bullet Sanitize vials, ports, or access points with sterile alcohol swabs following established procedures. bullet Each delivery system requires assembly and activation following manufacturer's instructions immediately before administration. bullet Scan both products (e.g., one bag and one vial) on administration.

The "8 Rights" of medication administration As a final topic for this course, let's review the 8 rights of medication administration. Adhering to these are essential for safety and accuracy:

1 Right patient 2 Right medication 3 Right dose 4 Right route 5 Right time 6 Right documentation 7 Right reason 8 Right patient education

Medication errors

A medication error is a preventable event that may cause or lead to inappropriate use or patient harm while a medication is in the control of the health care professional, patient, or consumer. If a medication error occurs but the mistake is intercepted before it reaches the patient, it is considered to be a "near miss" or "great catch".

Securing medications:

-In patient care areas, medications are securely stored in designated areas (e.g., automated dispensing machines, medication rooms), or are under constant surveillance by a qualified team member to prevent unauthorized access. -Any keys to medications or medication storage areas are kept secure (e.g., stored in Pyxis) and access codes are not disclosed.

Medications from the outside

-Patients are encouraged to send their personal medications home with the family once the appropriate team member has thoroughly reviewed the patient's medication history. -Only medications from a facility's pharmacy should be used, whenever possible, to ensure that patients receive medications which have been stored appropriately, are correctly labeled, and are not expired.

Medications include:

-Prescription medications including respiratory treatments -Sample medications -Vitamins and nutraceuticals -Over-the-counter (OTC) drugs -Vaccines -Diagnostic and contrast agents and radioactive medications -Parenteral nutrition -Blood derivatives -Intravenous solutions (plain, with electrolytes and/or drugs) -Any product designated by the Food and Drug Administration (FDA) as a drug

Look alike/sound alike medications

A problematic area in the safe management of medications is "look alike/sound alike" drugs. Sound-alike medications are drugs that have similar sounding brand or generic names. An example of this is: Phenylephrine and Phenergan Look-alike medications are problematic because tablets may look similar, the packaging or labeling may be the same, or the name of the drug when written out may resemble the name of another medication.Mix-ups may occur with these pairs at any point of the medication use process, including: -Initially when a practitioner enters an order. -When an order is dispensed or administered to a patient. Strategies to decrease look alike/sound alike errors Many strategies have been developed to decrease look alike/sound alike errors, such as: -Read back and affirm verbal/telephone orders (e.g., when entering a telephone order in Dimensions). -Use bar code scanning technology. -Never store medications with similar packaging or sound alike names on the same shelf in Pyxis tower or in the pharmacy. -Encourage providers to enter their own medication orders and avoid giving verbal orders (unless in a patient emergency).

Concentrated electrolytes

All medications, including concentrated electrolytes, should be stored safety to reduce the risk of medication errors. This includes, but is not limited to: -Potassium Chloride for Injection, in concentrations > 0.4 mEq/mL (for example, a 20 mEq/10 mL vial). -Potassium Phosphates for Injection, 3 mmoL/mL. -Sodium Chloride for Injection, in concentrations > 0.9%. -Magnesium Sulfate 50% solution for injection. Concentrated electrolytes are not routinely stored in patient care areas because there is great potential for patient harm if these medications are mishandled. In the very few exceptions where it may be necessary to store a concentrated electrolyte in a patient care area, extreme precautions must be taken to prevent inappropriate administration.

Allergies, height, and weight

Allergy and height/weight information is very important in determining appropriate medication therapy for our patients. The type of reaction and severity of the adverse reaction/allergy will influence what medications a patient may receive. Whenever possible, include the description of the reaction. Use of the reaction type "unknown" should be avoided. Height and weight measurements: The current height and weight of a patient should be documented prior to medications being ordered, because certain medication dosages may be calculated based on this information. To ensure that accurate weight-based medication doses are given, MEASURED weights should be documented (rather than "stated" or "estimated" weights) unless it is impossible to weigh the patient.

Additional items regarding medication reconciliation to consider

Carefully review these last items for medication reconciliation: -Required upon admission for all inpatient and outpatient patients. -When a transition in care (transfer) occurs, the next practitioner must receive a complete list of the patient medications. This process may include a fax to the practitioner's office when patients are discharged. -The patient must also receive a list of their medications at discharge from the hospital or at the conclusion of an office visit (if medications have been administered or changed).

Labeling medications outside of pharmacy

Clear & correct labeling technique. When should medications be labeled? -Any time the medication is reconstituted, compounded, or transferred from the original container and not used immediately. -Any time any medication is prepared by team members other than the person administering it. Can I pre-label a medication/solution? Pre-labeling is NOT acceptable. The label should be created and applied at the same time the medication or solution is prepared.

Expiration dates

Do not use expired medications! -Medications that are outdated/expired must not be distributed nor administered and must be returned for proper disposal. Only the month and year are provided... If only a month and year of expiration are provided on the drug, then the medication may be used through the last day of the month indicated. What is a medication expiration date? The date established by a drug manufacturer. If an expiration date is expressed only as a month and year, the date of expiration is the conclusion of the last day of the stated month. If an expiration date is expressed as a month, day, and year, the date of expiration is at the conclusion of the stated day. What is a "beyond use date"? The date after which a manipulated (repackaged or compounded) medication is not to be used, stored, or transported. The date or time is determined from the date the preparation was compounded or repackaged. The beyond use date (BUD) assigned does not include time for administration. Administration starts before the BUD, and may continue past the assigned BUD, unless labeling indicates otherwise.

Read back for verbal/telephone orders

It is the expectation that telephone/verbal order use should be avoided except in urgent or emergency situations. To prevent errors and patient harm due to miscommunication, all verbal and telephone orders must be accurately read back and affirmed by the person prescribing the order. The affirmation of the order by the provider must also include validation of the patient's identity to ensure the order is written for the right patient. -The authorized receiver of the order will enter the order directly into the EHR in real time while speaking with the provider. The order should not be written down on paper and transcribed later (Exception: downtime).

Labeling requirements

Labeling requirements when preparing medications out of pharmacy: Labels must contain the medication name, strength, amount of medication, diluent name, and volume: Immediate use Compounded Preparations are labeled using approved template and must also include preparation date on the label. Prepare and label one medication at a time (i.e., prepare, label, prepare, label). Include 4-hour beyond use date and time on label for IV medications (administration must start within 4 hours of the start of the preparation). Labels must be verified (verbally and visually) by two qualified team members if the person preparing the medication or solution is not the person administering the medication. Label verification includes checking and comparing the medication name, concentration, and expiration date against the information on the label of prepared product.

"What should I know about single dose vials?"

Medications in single dose vials lack antimicrobial preservatives and are therefore at greater risk of becoming contaminated and serving as a source of infection when used inappropriately - important items to remember, include: -Use a single dose/single-use vial for a single patient during the course of a single procedure. -Discard the vial after the single use. -Leftover contents are not combined for later use. IMPORTANT REMINDER: Apply aseptic technique with single-dose vials.

Security of medications

Medications must be properly and safely secured and stored. Some basics include: -All medications must be stored in a manner to prevent access by non-authorized team members or individuals such as patients or their visitors. -Controlled substances and narcotics require locked storage at all times. The administration, wastage, and return or destruction of all controlled substances is documented. -When medications are sent through the pneumatic tube system, they should immediately be given to the appropriate team member for administration or secure storage. -If unsecured medications are found, alert pharmacy or nursing team members. -Hazardous drugs are stored in a way to prevent spillage or breakage and include appropriate labeling.

Blanket orders

Obtain clarification from the prescriber. A blanket order is defined as a non-specific order such as: "Resume pre-op orders." "Resume home medications." "Transfer patient and resume prior orders." "Hold all blood pressure meds." Prescriber's clarification required: -Because these types of orders may lead to important medication information being overlooked, blanket orders will not be accepted and must be clarified by the prescriber.

Multi-dose/single dose

Specific procedures should be followed when handling multi and single dose vials. "What should I know about multi-dose vials?" -Multi-dose vials are assigned a BUD of 28 days after the initial opening, unless otherwise specified by the manufacturer (e.g., vaccines). -Apply aseptic technique with multi-dose vials. -Multi-dose vials are dedicated to a single patient whenever possible. If multi-dose vials are used for more than one patient, they are kept and accessed in a dedicated clean medication preparation area (e.g., medication room), away from immediate patient treatment areas (e.g., operating and procedure rooms, anesthesia and procedure carts, and patient rooms or bays). -If a multi-dose vial enters an immediate patient treatment area, it is dedicated for single patient use only. If multi-dose vials must be used, both the needle or cannula and syringe used to access the multi-dose vial must be new and sterile.

Medication reconciliation

The process of reviewing and confirming that the documented medication list is accurate and comparing that list against the provider's orders. What is a complete medication list? A complete medication list includes: -Prescription and over-the-counter (OTC) medications, vitamins, herbals, etc. -Name, dosage, frequency and route of each medication. -Date and time last dose of medication was taken so that future doses may be scheduled correctly.

MicroMedex

Various types of health care information are available online through MicroMedex. How to access: Open the Novant Health I-Connect home page, click on Clinical Resources, then click on MicroMedex. The following information can be obtained: -Drug Information - type drug name on the main screen to access all information about the drug (e.g., dose, side effects, and drug interactions). -Drug ID - identifies medications by markings on the pills. -Drug Interactions - information on drug interactions between various medications. -IV Compatibility - information on the compatibility of IV medications. -Care Notes - information for the patient about medications or disease states (available in English and Spanish). -Drug Comparison - compares drug information of multiple drugs. -NeoFax/Pediatrics - information about pediatric and neonatal medications.