NUR 139 Chp 5
CPOE
Computerized Provider Order Entry Emilia test handwriting and standardizes many prescribing functions
What are some possible consequences of medication errors?
Continued edu Refresher training Disciplinary action (suspension or termination) Revolving of nursing license
In a 2006 IOM study, it was estimated that some fm of medication error results in harm to how many patients? A.400,000 B. 800,000 C. 1 million D. 1.5 million
D. 1.5 million
The nurse is administering a drug that a has been ordered as follows: " give 10 mg on odd-numbered days and 5 mg on even numbered days". When the date changed from May 31 to June 1, what should the nurse do? A. Give 10 mg bc June is an odd number day B. Hold the dose until the next odd numbered day C. Change the order to read : Give 10 mg on even numbered days and 5 mg on odd numbered days" D. Consult the prescriber to verify that the dose should alternate each day, no matter where the days are odd or even numbered.
D. Consult the prescriber to verify that the dose should alternate each day, no matter where the days are odd or even numbered. Although option C seems reasonable , the nurse doesn't have prescriptive authority to change the order. Therefore, the prescriber should be consulted to verify the order, which can be written in clear terms. The other options would result in a change in the alternating dose schedule.
Transition of care
Describes the movement of a patient from one care facility to another facility or to home
What are other ways to prevent mediation errors?
Do an assessment Use two patient identifiers Don't administer if you didn't draw up and prepare it yourself Minimize verbal or telephone orders Repeat order to prescriber Spell drug name out loud Speak slow and clear List indications next to each other Never assume anything a/b items not specified in a drug order Don't hesitate to question med order for any reason when in doubt NEVER use a trailing zero w medication orders use a leading zero Learn special administration techniques for certain dosage forms Read labels Use generic names Always verify MAR
What are some ways you can prevent medication errors?
Do multiple system checks and balances Prescribers must write legible orders that contain correct information , or orders entered electronically Authoritative resources, such as pharmacists or current (within past 3-5 years) drug reference or literature must be consulted for clarity Nurse needs to always check the medication order THREE times before giving the drug The basic 9 rights of administration should be used always
Which action by the nurse helps to prevent possible medication errors ? Ask the patient what condition the medication is before administering Administer the patients medications using his or her own supply of medications while in the hospital Encourage the patient to ask question if the medication order is different than expected Administer any medications that the patient had on admission or transfer
Encourage the patient to ask question if the medication order is different than expected The nurse would encourage patients to question any medication that they are not familiar with or are not expecting to take or have not discussed with their health care provider.
What are some specific high alert drugs?
Epinephrine Epoprostenol Insulin Magnesium sulfate injection Methotrexate Opium tincture Oxytocin Nitroprussside sodium injection Potassium chloride Potassium phosphate injection Promethazine Vasopressin if or intraossesous
What are the high alert medications?
Epinephrine Epoprostenol Insulin magnesium sulfate injection Methotrexate Opium tincture OxyContin Nitroprusside odium Potassium chloride Potassium phosphate Promethazine Vasopressin Phenylephrine Norepinephrine Propranolol Metoprolol Labetalol
Near miss
Even or situation that didn't produce patient injury but only bc f chance A situation that isn't distinguishable from a preventable adverse event except for the outcome
Who requires bar codes for all prescriptions and over the counter medications
FDA
Antiarrhythmics
IV Ex. Lidocaine , amiodarone
"High alert" medications
Identified as those that, because of their potential toxic nature, require special care when prescribing, dispensing and/or administering Potential for patient harm is high
When does patient begins where?
In the educational process with nursing students and faculty members
What don't you document on a patients chart ?
Incident report Incident reports should offer opinion of anonymity. This may help to foster improved error reporting and safe med practices
Antithrombotic agents
Includes warfarin ,Low molecular weight heparins, IV unfractionated heparin , facto XAX inhibitors Ex. (Fondaparinux , apixaban, rivaroxaban) Thormbolytics Ex. (Alterplase, reteplase, tenecteplase) Glycoprotein llb/llla inhibitors Ex. (Eptifibatide)
What brought medial errors to the publics attention?
Institute of Medicine (IOM) in 1999
When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors? Instruct the patient or family to bring in all medications the patient was taking at home Call the primary care physician to verify current medications Ask the patient to provide you with a written lists of all medications being taken at home Have the patients family verify medication the patient was taking at home
Instruct the patient or family to bring in all medications the patient was taking at home The USP recommends the use of "brown bagging" sessions of medications to identify drugs that patients are taking. Patients, family, or the primary care physician may not always accurately report all medications a patient is taking. Actual examination of the medications and containers provides the most accurate assessment of current medications and allows for appropriate medication reconciliation.
Classifications of disruptive behavior
Intimidation and violence Inappropriate language or comments Sexual harassment Inappropriate responses to patient needs or staff requests
Disruptive behavior
Is a personal, verbal or physical conduct that affects or potentially may affect patient care in a negative fashion
LASA
Look alike sound alike Ex: prednisone and predniosolone
Where do many serious medication errors occur?
Many serious medication errors occur in the home.
What are high alert medications?
Medications that have been identified through national literature as having the greatest frequency of misuse, coupled with the highest severity of harm when administered improperly.
What are widely recognizable and common causes of errors?
Misunderstanding of abbreviations Illegibility of prescribers handwriting Miscommunication during verbal or telephone orders Confusing drug nomenclature
What drugs are commonly involved in severe mediation errors ?
Nervous system drugs Anticoagulants Chemotherapeutic drugs
What are the types of medication errors?
No error, although circumstances or events occurred that could lead to an error Medication error that causes no harm Medication error that causes harm Medication error that results in death
The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error? Documents the medication error. No further action is required Notify the health care provider and document a mediation error indication report Assess the patient for an adverse reaction and report if an adverse event occurs Report the error and document the medication on the patients chart
Notify the health care provider and document a mediation error indication report All medication errors that involve a patient need to be called to the health care provider's attention and documented on an incident report. Documentation of errors helps identify system issues and assist in possible future education or prevention.
What are the ways to prevent pediatric medication errors?
Obtain a& document accurate weight in kg Report all med errors Know the drug thoroughly Follow the 7 rights of medication administration Avoid verbal orders in general Avoid distractions Communicate w everyone
A patient is transferred from an intensive care unit (ICU) to a general medical-surgical unit. Which nursing action is most appropriate to prevent medication errors? Contact the heath care provider to rewrite all the drug prescriptions Ask the patient what medications need to be taken while in the hospital Communicate a verbal report face-to face from the transferring nurse Perform a medication reconciliation of the patients chart during care transition
Perform a medication reconciliation of the patients chart during care transition Medication reconciliation is a process of identifying the most accurate list of all medications a patient is taking at each point of care (e.g., transfer from an ICU to a general medical unit) and is an important nursing action to prevent medication errors. Reports should be written for better documentation. Patients may not remember or be aware of specific medications they received. Asking the health care provider to rewrite medication prescriptions can only prevent errors if the health care provider also performs a medication reconciliation to verify that the correct medications are reordered. d\\ication reconciliation of the patient's chart during care transition.
In which step of the medication process can a medication error occur? Select all that apply Prescribing Transcribing Administration Procurement Verification
Prescribing Transcribing Administration Procurement
Medication reconciliation
Processing which medications are " reconciled" at all points of entry and exit to/from a health care facility Continuous assessment and updating of a patients medication history Requires patient to provide list of all meds they are taking Prescriber assesses the meds to see if they can continue to be taken Designed to ensure that there aren't discrepancies b/t what the patient was taking at home and in the hospital
What are the different contributions to errors can occur in the medication process?
Procuring Prescribing Transcribing Dispensing Administering Monitoring Organization issues Edu system issues Sociologic factors Use of abbreviations
QSEN
Quality and safety education for nurses a project preparing future nurses with knowledge, skills, and attitudes to continuously improve the profession.
The nurse knows that the medication reconciliation process involves which steps? Select all that apply. Reconciliation Reporting Verification Administration Clarification
Reconciliation Verification Clarification
What are the keys to prevent medication errors?
Report the errors Reporting of potential errors Non-punitive approach to error reporting or "Just Culture" QSEN initiatives
What are some ways you can report a mediation error??
Report to the prescriber and nursing management Document error per policy and procedure Factual documentation only i.e. med administered, actual dose , observed changed in patient condition, prescriber notified and follow up orders External reporting error U.S pharmacopeia Medication Error Reporting Program (USPMERP) Med watch, sponsored by the FDA Institute for safe med practices The Joint Commission
What is once key to preventing medication errors?
Reporting errors and potential errors. Reporting and sharing of errors can prevent the same error from occurring again
SALAD
Sound alike, look alike drugs Ex: buspirone and bupropion
USPMERP
The US pharmacopeia medication error reporting program Nationwide database of medication errors and their causes as well as potential errors
Joint Commission speak up campaign
The goal of Speak Up is to help patients become active in their care (provides pamphlets in various different areas to bring awareness for the patient to be educated and ask question), used to decrease mistakes within the hospital
One very important issue brought fourth in the IOM report is what ?
The notion that most medication errors occur as a breakdown in the medication use system, as opposed to being the fault of the individual
Just after the nurse administers an oral antihypertensive drug, the patient asks, "Wasn't that supposed to be a half-tablet? I just took the whole tablet!" The nurse realizes that the patient was given twice the ordered amount. The order was for 25 mg, a half-tablet, and the entire 50-mg tablet was given. At this time, what would the nurse need to say to the patient? What are the nurse's propriety actions?
The nurse must acknowledge the wrong dose immediately and honestly, rather than trying to ignore or cover up the error. This patient was aware of the error from the start. The nurse has an ethical and legal responsibility to acknowledge and report the error. The supervisor and the patient's prescriber must be notified, and the appropriate protocol for a medication error must be completed. In addition, monitor the patient's blood pressure closely and instruct the patient to get up slowly in case of orthostatic blood pressure changes. Patient safety is most important in this situation, and the patient needs to be told what happened.
The nurse is reviewing the orders on a newly admitted patient and reads this order: "Humalog insulin, 4 U q.d.? What problems, if any, would the nurse identify in this order?
The order is written as follows: Humalog insulin, 4U q.d. The nurse notes the following issues: The U needs to be written out as units because this abbreviation could be mistaken for a zero (0), a four (4), or cc. The q.d. needs to be written out as every day because the period after the q can be mistaken for an i, meaning that a medication would be given qid (four times daily) instead of once daily. No route is specified. Humalog insulin is on the high-alert medication list, and these orders must be checked carefully. Humalog insulin is also on the look-alike, sound-alike drug list and must be carefully noted because it can be confused with Humulin insulin. The nurse needs to clarify this order with the prescriber before administering the insulin.
What is the nurses highest priority at all times during the med admin process and during med error?
The patients physiologic status and safety
Why are specific medications identified as "high-alert" medications? Registered nurses must administer these medications State require that these drugs be on the high alert list These drugs have increased potential for significant patient harm These medications are responsible for adverse drug events
These drugs have increased potential for significant patient harm. High-alert medications have been identified as such because of their potentially toxic nature and their need for special care when prescribing, dispensing, or administering them. Thus, the potential for patient harm is higher with high-alert medications.
What is the first priority when an error occurs?
To protect the patient All errors are RED flags
True or false All errors should serve as red flags that warrant further reflection , detailed analysis, and future preventative actions on the part of the nurses HCP and even the patient
True
True or false Effective communications among all members of the health care team contributes to improved patient care
True
True or false Encourage patients to always carry drug allergy information on their persons and to keep a current list of medications in their wallets or purses and on their refrigerators. This list should include the drug's name, reason the drug is being used,vusual dosage range and dosage prescribed, expected adverse effects and possible toxicity of the drug, and the prescriber's name and contact information.
True
True or false Encourage patients to ask questions about their medications and to question any concern about the drug or any component of the medication administration process.
True
True or false Health care organizations can choose to proactively apologize and accept responsibility for obvious errors and even offer needed financial support
True
True or false High alert medications are not necessarily involved in more errors than other drugs, however the potential for patient harm is higher
True
True or false Measures to help prevent medication errors include being prepared and knowledgeable and taking time to always triple-check for the right patient, drug, dosage, time, and route. It is also important for nurses always to be aware of the entire medication administration process and to take a systems analysis approach to medication errors and their prevention.
True
True or false Report medication errors. It is important to include in this documentation assessment of patient status before, during, and after the medication error, as well as specific orders carried out in response to the error.
True
True or false To prevent medication errors from misinterpretation of the prescriber's orders, avoid abbreviations. Medication errors include giving a drug to the wrong patient, confusing sound-alike and look-alike drugs, administering the wrong drug or wrong dose, giving the drug by the wrong route, and giving the drug at the wrong time.
True
True or false Documentations of medical errors should always be accurate, thoroughness and objective
True Don't use judgmental words like error in the documentation
What organization announced implanted regulations requiring bar codes for all prescriptions and over the counter (OCT) medications ? Drug Enforcement Agency (DEA) U.S. Food and Drug Administration (FDA) Federal Bureau of Investigation (FBI) Department of Health and Human Services (DHHS)
U.S. Food and Drug Administration (FDA) In February 2004, the FDA passed legislation requiring bar codes for all prescription and OTC medications.
Adverse drug reaction
Unexpected unintended or excessive responses to medications given at therapeutic dosages (as opposed to overdose) one type of adverse drug event
What are common nursing student errors ?
Unusual dosing times MAR issues Failure to review record before admin Admission of discontinued or held meds Failure to monitor vitals/lab results Administration of oral liquids as injections Preparation of meds for multiple patients at the same time
What are the 3 steps involved in medication reconciliation?
Verification- collection of patients med info w focus on current meds being taken Clarification- profession review of this info to ensure that meds and dosages are appropriate for patient Reconciliation- further investigation of any discrepancies and changes in medication errors
AHRQ (Agency for Healthcare Research and Quality)
a federal agency established to improve the quality, safety, efficiency, and effectiveness of health care for Americans
The nurse is administering medications. Examples of high-alert medications include: Select all that apply a. Chemotherapeutic agents b. Antibiotics c. Opiates d. Antithrombotics e. Potassium chloride for injection
a. Chemotherapeutic agents d. Antithrombotics e. Potassium chloride for injection
The nurse is performing medication reconciliation during a patient's admission assessment. Which question by the nurse reflects medication reconciliation? a. "Do you have any medication allergies?" b. "Do you have a list of all the medications, including over-the-counter, you are currently taking?" c. "Do you need to take anything to help you to sleep at night?" d. "What pharmacies do you use when you fill your prescription?"
b. "Do you have a list of all the medications, including over-the-counter, you are currently taking?
The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: "Digoxin, 250 mpg stat." Which action is appropriate? a. Give the medication immediately (stat) by mouth because the patient has no intravenous (IV) access at this time. b. Clarify the order with the prescribing physician giving the drug. c. Ask the charge nurse what route the physician meant to use. d. Start an IV line, then give the medication IV so that it will work faster, because the patient's status is NPO at this time.
b. Clarify the order with the prescribing physician giving the drug.
The nurse keeps in mind that which measure is used to reduce the risk of medication errors? a. When questioning a drug order, keep in mind that the prescriber is correct. b. Be careful about questioning the drug order a board-certified physician has written for a patient. c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. d. If the drug route has not been specifies, use the oral route.
c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error.
During the medication administration process, it is important that the nurse remembers which guideline? a. When in doubt about a drug, ask a colleague about it before giving the drug. b. Ask what the patient knows about the drug before giving it. c. When giving a new drug, be sure to read about it after giving it. d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns.
d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns.
If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept? a. The student bears no legal responsibility when giving medications. b. The major legal responsibility lies with the health care institution at which the student is placed for clinical experience. c. The major legal responsibility for drug errors lies with the faculty members. d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable.
d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable
The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. digoxin .25 mg b. digoxin .250 mg c. digoxin 0.250 mg d. digoxin 0.25 mg
d. digoxin 0.25 mg
Anesthetic agents
general, inhaled and IV Ex. Propofol, ketamine
Adrenergic agonists
intravenous (IV) Ex. Epinephrine, phenylalanine,norepinephrine
Adrenergic antagonist
intravenous (IV) Ex. Propranolol, metoprolol , labetalol
Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes.
0.25 mg
Medical errors
A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm "To err is human"
ISMP (Institute for Safe Medication Practices)
A nonprofit organization that is well known as an education resource for the prevention of medication errors.
Medication reconciliation
A procedure to maintain an accurate and up to date list of medications for all patients between all phases of health care delivery.
What is the most common point in the process at which medication errors occur? A. Prescribing B. Dispensing C. Administering D. Monitoring
A. Prescribing
A nurse discovers that a client receives an incorrect dosage of a morning medication. Which of the following actions should the nurse take first? A. Collecting data from the client to determine the clients condition B. Reporting the incident to the nursing supervisor C. Completing and file a facility incident report D. Notify the clients provider of the incident
ANS. A. Collecting data from the client to determine the client condition The first action the nurse should take when using the nursing process is collections data from the client to determine the clients condition and safety.
A nurse is preparing to administer to a client who has gout. The nurse discovers that an error was made during the previous shift in which the client received atenolol instead of allopurinol. Which of the following interventions is the nurses priority? A. Measure the clients apical pulse B. Administer the allopurinol to the client C. Inform the nurse manager D. Complete and incident report.
ANS. A. Measure the clients apical pulse The first action the nurse should take using the nursing process is to assess the client by measuring the clients apical pulse. Atenolol is a beta blocker and can decrease the clients heart rate
A nurse enters a client's room and finds the client sitting o the floor and leaning against the side of the bed. The client states she slipped while getting out of bed. Which of the following actions should the nurse take first? A. Complete an incident report B. Check the client for injuries C. Make sure the client has skid free foot ware D. Remind the client to ask for help with getting out of bed
ANS. B. Check the client for injuries The first action the nurse should take using the nursing process is to evaluate the client for ant injuries or physiological changes. The nurse should also notify the provider to determine the need for any further examination or intervention
A nurse is administering medications to 4 clients. Which of the following situations requires the completion of an incident report? A. A beta blocker was help for an apical heart rate of 50/min B. A client vomited immediately after receiving his oral medications C. An extended release capsule was crushed before being given D. A client who is anemic refused blood transfusion
ANS. C. An extended release capsule was crushed before being given Extended Reese capsules are designed to metabolize over a period of time. If crushed, the mediation can absorb too quickly and can lead to toxicity. The situation requires the completion of an incident report because a mediation error occurred.
A nurse is reviewing the medication administration record for a client and notes that the nurse from the previous shift gave a double dose of antihypertensive medication prescription to the client. Which of the following actions should the nurse perform first? A. File an incident report with factual information about the error B. Report the incident to the nursing supervisor C. Check the clients condition D. Notify the clients provider about the incident
ANS. C. Check the clients condition The greatest risk to a client is an injury from low BP due to a double dose of antihypertensive medication. Therefore the first action the nurse should take is to check on the clients condition and obtain the clients vital signs, including BP
A nurse discovers that a client received the wrong medication . Which of the following actions should the nurse take first? A. Complete a medication error report B. Notify the prescribing provider C. Collect data from the client D. Notify the charge nurse
ANS. C. Collect data from the client The greatest risk to the clients safety is adverse effect from either receiving the wrong medication or not receiving the prescribed medication. The nurse should collect data from the client first to assess for any possible adverse effects. The evaluation also serves as a baseline for further monitoring for adverse effects
A nurse has administered a medication to a client. Which of the following circumstances should the nurse identify as a medication error that resulted from a performance deficit by the nurse? A. A medication safety coordinator was not present B. A verbal prescription was transcribed incorrectly C. A medication with a similar name was dispensed instead of the correct medication D. A intramuscular injection was given instead of a subcutaneous injection
ANS. D. A intramuscular injection was given instead of a subcutaneous injection Performance deficits such as using an improper route of administration for a medication are the most common caused of medication errors that result from human error. The nurse can effectively reduce medication errors in clinical practice by implementing a safety checklist and diligently using the rights of medication administration. If the nurse is still following the rights of medication administration, then the nurse has a a performance deficit.
A charge nurse is discussing medication administration policy with a newly licensed nurse. The newly licensed nurse shows an understanding of the policy by identifying which of the following situations as requiring the completion of an incident report? A. A nurse obtained a clients blood for culture testing prior to beginning antibiotic therapy B. A client refused to take her morning medication C. A nurse used a clients telephone number as a client identifier prior to medication administration D. A stat prescription for a mediation administration was initiated 2 hours after it was released.
ANS. D. A stat prescription for a medication administration was initiated 2 hours after it was released Stat prescription are often written for emergencies and should be initiated immediately the situation requires the completion of an incident report because this medication error violates the rights of "right time".
A nurse is completing medication reconciliation for an order adult client who is receiving multiple medications. Which of the following actions should the nurse take first? A. Clarify the clients list of mediations with the pharmacist B. Compare the current list against the new medication prescriptions C. Investigate any discrepancies on the list D. Ask the client about over the counter medications she is taking.
ANS. D. Ask the client about over the counter medications she is taking. The nurse should apply the nursing process priority setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, to notify the prover of a change in the clients status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. When performing medication reconciliation, the nurse should collect a list of all medications the clients takes in order to compare a full list of medications against any new medications. The list should include prescriptions, over the counter medications and herbal and nutritional supplements.
A nurse in an acute care facility is preparing a reconciled list of mediations for a client who is being discharged home. Which of the following actions should the nurse take? A. Give the client a handwritten medication list to take to the next care provider following discharge B. Include a list of medications the client received during care at the facility C. Inform the client that he can get a complete list of his medications from he provider who will be in charge of caring for him after discharge D. Provide the client and the next care provider with a list of medications the client will take after discharge
ANS. D. Provide the client and the next care provider with a list of medications the client will take after discharge The nurse should provide a reconciled medication list that includes any medication the provider prescribes at the time of discharge for the client to take after discharge. The list should also include any other medications the client will be taking, including over the counter medications and supplements. If the client was taking other prescription medications before admission to the acute care facility and didn't receive them during treatment in the facility, the provider should confirm whether the client should resume taking them after discharge
Levothyroxine is available in 88-mcg tablet form. Convert this dose to milligram strength. (do not round)
ANS: 0.088 mg One mg equals 1000 mcg. To convert 88 mcg to mg, divide 88 by 1000 to equal 0.088 mg, or move the decimal point to the left three spaces. Do not forget to include the leading zero.
Digoxin is available in 0.125-mg tablet form. Convert this dose to microgram strength. (do not round)
ANS: 125 mcg One mg equals 1000 mcg. To convert 0.125 mg to mcg, multiply by 1000 to equal 125 mcg, or move the decimal point to the right three spaces.
During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time? a. Ask a colleague what the order says. b. Contact the prescriber to clarify the order. c. Wait until the prescriber makes rounds again to clarify the order. d. Ask the patient what medications he takes at home.
ANS: B contact the prescriber to clarify the order If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. Asking a colleague is not useful because the colleague did not write the order. Waiting for the prescriber to return is incorrect because it would delay implementation of the order. Asking the patient about medications is incorrect because this question will not clarify the current order written by the prescriber.
The nurse can prevent medication errors by following which principles? (Select all that apply.) a. Assess for allergies after giving medications. b. Use two patient identifiers before giving medications. c. Do not give a medication that another nurse has drawn up in a syringe. d. Minimize the use of verbal and telephone orders. e. Use trade names instead of generic names to avoid confusion.
ANS: B, C, D Measures that prevent medication errors include using two patient identifiers, giving only medications that you have drawn up or prepared, and minimizing the use of verbal and telephone orders. Assessment for allergies should be done before medications are given. Generic names should be used to avoid the many sound-alike trade names of medications.
The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dos of the drug ordered? a. Digoxin .125 mg b. Digoxin .1250 mg c. Digoxin 0.125 mg d. Digoxin 0.1250 mg
ANS: C Digoxin0.125 mg Digoxin 0.125 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Digoxin .125 mg and digoxin .1250 mg do not have the leading zero before the decimal point. Digoxin 0.1250 mg has a trailing zero, which also is incorrect.
When taking a telephone order for a medication, which action by the nurse is most appropriate? a. Verify the order with the charge nurse. b. Call back the prescriber to review the order. c. Repeat the order to the prescriber before hanging up the telephone. d. Ask the pharmacist to double-check the order.
ANS: C- repeat the order to the prescriber before hanging up the telephone For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone. The other options are incorrect.
1. The nurse is reviewing medication errors. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after having started an IV antibiotic 24 hours earlier. d. A patient complains of severe pain still present 60 minutes after a pain medication was given.
ANS: b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. The other options are not preventable. The patient's refusing to take medications and complaining of pain after a medication is given are patient behaviors, and the development of hives is a possible allergic reaction.
What steps should be done at each stage of health care delivery?
Admission Status change( from. Critical to stable) Patient transfer within or b/t facilities provider teams Discharge (the latest medications lists should be provided to the patient to take to his/ her next heath care facility.)
What are the classifications for high alert medications?
Adrenergic agonists Adrenergic antagonist Anesthetic agents Anti arrhythmic Antithrombotic agents IV unfractionated heparin, factor XA inhibitors Cardioplegic solutions Chemotherapeutic agents Dextrose Dialysis sol Epidural Hypoglemics oral Insulin Inotropic meds Liposomal drugs Moderate sedation agents Narcotics/opiates Neuromuscular blocking agents Parenteral nutrition prep Radiocontrast agents Sterile water for injection/inhalation/irrigation Sodium chloride for injection
What are two types of adverse drug reactions?
Allergic reaction (predictable) Idiosyncratic reaction (unpredictable)
What are some more ways to prevent medication errors ?
Always listen to and honor any concerns expressed by patient regarding meds Check allergies and id Know where to find info on meds, preparations, side effect Mandatory 2nd nurse verification of high risk meds &/or patient population RED ZONE- no distractions when preparing/ delivering meds
What is Just Culture?
An environment where after a systematic review of errors disciplined is applied appropriately
Close call
An event or situation or error that took place but was identified and captured prior to reaching the patient
Allergic reaction
An immunologic reaction resulting from an unusual sensitivity of a patient to certain mediation ; a type of adverse drug event and a subtype of adverse drug reactions
When given a scheduled morning medication, the patient states, ―I haven't seen that pill before. Are you sure it's correct?‖ The nurse checks the medication administration record and verifies that it is listed. Which is the nurse's best response? a. ―It's listed here on the medication sheet, so you should take it.‖ b. ―Go ahead and take it, and then I'll check with your doctor about it.‖ c. ―It wouldn't be listed here if it were not ordered for you!‖ d. ―Let me check on the order first before you take it"
Ans. d. ―Let me check on the order first before you take it When giving medications, the nurse should always listen to and honor any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order and/or check with the prescriber. The other options illustrate that the nurse is not listening to the patient's concerns.
What are the common drugs involved in severe medication errors: central nervous system drugs?
Anticoagulants Chemotherapeutic
Idiosyncratic reaction
Any abnormal and unexpected response to a mediation, other than an allergic reaction, that is peculiar to an individual patient
Medication errors
Any preventable adverse drug events involving inappropriate medication used by a patient or health care professionals; they may or may not cause the patient harm
Adverse drug effect
Any undesirable occurrence related to administration of or failure to administer a prescribed medication
What are some applicable assessment and edu tips regarding medication reconciliation ?
Ask the patient open ended questions, gradually move to yes/ no questions to help determine specific med info Avoid the use of med eras Prompt the patient to try to remember all meds/supplements Clarify unclear info Records all info on patients chart Emphasize to the patient the importance of always maintaining a current and complete med list and brining it to each health care encounter
What are some strategies to minimize errors?
Awareness (" speak up) Computerized prescriber order entry (CPOE) Bar codes and scanning devices Automated dispensing machines Effective communication
The nursing student realizes she has given a patient a double dose of an anti hypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administer the entire tablet. The patient's blood pressure before the dose was 146-98 mm Hg. What should the student do first? A. Notify the patients physician B. Notify the clinical faculty C. Take the patients blood pressure D. Continue to monitor the patient
B. Notify the clinical faculty The patients blood pressure will need to be monitored, but it was just taken and the medication dose will not have an immediate effect. The student should notify the clinical instructor immediately
When should a nurse check for medication errors?
Before administering it Double check info before proceeding
