Math NURS111 Quiz 3

Special Instructions

Special instructions specific to this medication for this patient. -For example, "Hold if blood pressure less than 100 systolic" or "PRN for pain"

What information should be on a MAR?

***patient name and identifying information (birth date, medical record number), ***medication information for each drug the patient receives, the dosage, the route, the frequency (dates and times—including not only the time a medication should be administered, but the times it is actually administered—along with the ***initials of the individual who administered the medication). In addition, the MAR should document ***allergies, any refusals, administration delays, and all responses, especially adverse effects or any allergic reactions and special instructions. All entries should be initialed to help keep track of sources in case more information is needed, and to aid accountability.

MAR Key Points Medication Administration Record

-A record of each administration of a patient's medication is documented on a legal document called the medication administration record (MAR). -The MAR can vary in form from a nurse's handwritten notation to a computer-generated document. -Key components will always be the same: patient allergies, medication information—including dosage, route, frequency—and the initials of the individual who administered the drug. -Dates and times include not only the time a medication should be administered, but the times it is actually administered. -The MAR should document any refusals, administration delays, and adverse effects or allergic reactions and special instructions. -Documentation must be done immediately after administering a medication. -The greatly improved accuracy of electronic MARs (eMARs) has led many more pharmacies and healthcare systems to generate computerized records.

Time of Administration

-Based on the desired administration schedule stated on the order, such as TID -Enter the desired administration time and convert to time periods based on the institution's time intervals for scheduled or routine medications: For example, TID may mean 9 am, 1 pm, and 5 pm at one institution and 10 am, 2 pm, and 6 pm at another. -Recording of medication times for PRN and one-time dosages at the time of administration

Common Causes of Medication Errors

-Incomplete patient information (e.g., allergies, other medications the patient is taking) -Incomplete drug information -Lack of collaboration and communication or teamwork -Confusing sound-alike or look-alike drug names, drug labels, and packages -Missing or damaged drug labels -Inaccurate drug standardization -Incorrect storage or administration errors -Use of nonstandard, flawed, or unsafe delivery equipment -Dosage calculation errors -Incomplete orders -Miscommunication of orders -Omission of any of the seven rights of medication administration

Initials

-Initials of the person transcribing the medication to the MAR and the person administering the medication -Entering the initials under the signature section to identify who gave the medication -Including the title as well as the signature of the nurse, if required by institutional policy. The policy regarding initialing after each administration varies by institution and by charting system used

Medication Information

-Medication's Full Name -Dosage -Route -Frequency

Dates

-Written date of the order -Start date for administration (if different from order date) -End date (when to discontinue administration)

What are the 6 rights of medication administration?

1. RIGHT PATIENT2. RIGHT DRUG3. RIGHT DOSE4. RIGHT TIME5. RIGHT ROUTE6. DOCUMENTATION

When were barcodes first implemented and where?

1997, the. Veterans Health Administration (VHA) introduced an electronic medication administration record (eMAR), commonly referred to as the Veterans Health Information Systems and Technology Architecture (VistA). The FDA made it a rule in 2003 that all meds should have barcodes

KEY POINTS Medication Administration Records and Medication Errors

A record of each administration of a patient's medication is documented on a legal document called the medication administration record (MAR).The MAR can vary in form from a nurse's handwritten notation to a computer-generated document. Key components will always be the same: patient allergies, medication information—including dosage, route, frequency—and the initials of the individual who administered the drug.Dates and times include not only the time a medication should be administered, but the times it is actually administered.The MAR should document any refusals, administration delays, and adverse effects or allergic reactions and special instructions.Documentation must be done immediately after administering a medication. The greatly improved accuracy of electronic MARs (eMARs) has led many more pharmacies and healthcare systems to generate computerized records. The nurse who administers a drug is legally liable for any error that occurs. Common causes of medication errors include not following up on incomplete, confusing, or unclear information, poor storage or labeling, use of nonstandard delivery devices, calculation errors, and omission of any of the seven rights of medication administration. Most medication errors can be traced to the failure to follow one or more of the seven rights of safe medication administration. The Institute of Medicine (IOM) recommends that nurses can enhance efforts to prevent medication errors by encouraging a partnership between patients and their healthcare providers. The Joint Commission launched a Speak Up™ campaign that urges patients' more active and vocal roles and (of course) a nurse's willingness to listen and answer questions. At each stage of the administration process, there are ways to prevent medication errors, from clarifying orders, to taking steps to prepare drugs safely, checking patient information, practicing safe administration, and documenting properly. Nurses must adhere to the guidelines laid out by The Joint Commission, the Institute of Medicine, and by the Institute for Safe Medication Practices (ISMP) for preventing medication errors. When medication errors occur, they must be reported right away, following the facility's reporting procedures.

What is the 6th sixth right of medication administration?

All information in an MAR must be written or typed clearly and legibly and must be impeccably accurate. This careful documentation is the sixth right of medication administration.

Clarify Orders

Ask the healthcare provider to rewrite or clarify any unclear medication order. Use only abbreviations approved by the Joint Commission for medication dosages. Do not use abbreviations for medication names. Check medication orders against the MAR/eMAR. Check the dose sent from the pharmacy with the MAR/eMAR. Take advantage of technology by checking drug information references available for smartphones, PDAs, and other electronic devices. Limit interruptions when preparing and administering drugs. Have another nurse check the dosage preparation, especially if in doubt. Recalculate drug dosage, as needed.

A healthcare provider orders a new antibiotic for a patient. What should the nurse do to ensure patient safety before adding the medication to the MAR? Check for allergies on the patient record.Before the medication is placed on the MAR, the nurse should check to see if the patient has any allergies to the antibiotic to prevent an error that could cause harm to the patient. Calculate the amount to be given with another nurse.Calculating the amount to be given with another nurse would occur after the medication is placed on the MAR and no allergies had been found. Call the pharmacy to make sure the medication is in stock.Calling the pharmacy to make sure the medication is in stock would not ensure patient safety. The pharmacy would actually contact the prescribing healthcare provider if a new medication was not available and arrange for a substitute order. Read the label three times before administering it to the patient.Reading the label three times before administering it to the patient would occur after the medication is placed on the MAR and only after no allergies were found.

Check for allergies on the patient record. Before the medication is placed on the MAR, the nurse should check to see if the patient has any allergies to the antibiotic to prevent an error that could cause harm to the patient.

Check Patient Info & Administer the Drug Safely

Check the patient's ID band with the MAR/eMAR and bar code. Check patient allergies against all drugs prescribed. Check carefully for contraindications (both condition-related and drug interactions). Do not leave medication on the bedside. Stay with the patient until all medications are taken. Never administer a medication that has been prepared by another nurse.

Ways to Prevent Medication Errors

Clarify Orders Prepare Drugs Safely Check Patient Info & Administer the Drug Safely Document Information Properly

Zolpidem 5 mg is ordered PRN for a patient for insomnia. How are PRN orders documented? Incorrect As a one-time order on a separate MARPRN orders are not one-time orders. Correct On the MAR as unscheduled medicationsPRN orders are documented on the MAR as unscheduled medications. As a routine medication on the MAR schedulePRN orders are not routine medications and are not documented as such. On a regular schedule at certain intervals each dayPRN orders are not given on a regular schedule at certain intervals each day.

Correct On the MAR as unscheduled medicationsPRN orders are documented on the MAR as unscheduled medications.

After a drug is administered, who is required to initial the medication documentation? The nursing supervisor -The nursing supervisor is not required to initial the medication documentation. The facility pharmacist -The facility pharmacist is not required to initial the medication documentation. Correct The healthcare providerThe required initials are those of the healthcare provider who administered the drug. The healthcare prescriberThe healthcare prescriber is not required to initial the medication documentation.

Correct The healthcare providerThe required initials are those of the healthcare provider who administered the drug.

WHEN should you document medication administration?

IMMEDIATELY AFTER administering medication.

Reporting Errors

In addition to the strategies suggested in this lesson, nurses should become familiar with, and adhere to, the guidelines laid out by The Joint Commission, the Institute of Medicine, and by the Institute for Safe Medication Practices (ISMP) and their websites. All of these strategies for preventing medication errors are important components of the Quality and Safe Education for Nurses (QSEN) goal to improve the quality and safety of patient care. Errors can occur despite the best prevention efforts. When they do, they must be reported right away to prevent as much damage to the patient as possible; following the facility's reporting procedures. More specific guidance on reporting to the ISMP is available at this ISMP link. The ISMP gathers this information anonymously to study trends in errors in hopes of improving labeling, technique, etc. Any medication errors or hazards can be reported to ISMP using one of two secure methods found at the ISMP site.

MAR

In hospitals and other treatment facilities, the medication administration record (MAR) is a legal document that traces every time a medication is administered to a patient in that facility. Whether handwritten or computer-generated, all MARs must contain the same key components. There are 7

What action should be taken when a medication error is discovered? Inform the healthcare provider.The healthcare provider should be informed when a medication error is discovered so steps can be taken to ensure the safety and health of the patient after assessing and treating patient as needed. Document the error in the patient chart.Documenting the error in the patient chart is not the action that should be taken when a medication error is discovered. Tell the patient about the medication error.Telling the patient about the error is not the action that should be taken when a medication error is discovered. Call the pharmacy to send the correct medication.Calling the pharmacy to send the correct medication is not the action that should be taken when a medication error is discovered.

Inform the healthcare provider. The healthcare provider should be informed when a medication error is discovered so steps can be taken to ensure the safety and health of the patient after assessing and treating patient as needed.

Prepare Drugs Safely

Limit interruptions when preparing and administering drugs. Have another nurse check the dosage preparation, especially if in doubt. Recalculate drug dosage, as needed.

A child involved in a car accident was given an adult dose pain medication in the busy emergency department. What actions might have prevented this error? Looking up drug dosage information Checking the dose sent from the pharmacy Having another nurse check the dosage preparation Limiting interruptions when preparing and administering the drug Asking the child if he or she had any allergies to the medication ordered Asking the healthcare provider to rewrite or clarify any unclear medication order

Looking up drug dosage information Checking the dose sent from the pharmacy Having another nurse check the dosage preparation Limiting interruptions when preparing and administering the drug Asking the healthcare provider to rewrite or clarify any unclear medication order

According to the Institute of Medicine (IOM), what should nurses do for patients to enhance efforts to prevent medication errors?

Provide patient education The IOM asserts that nurses can enhance efforts to prevent medication errors by providing patient education. Encourage patients to speak up The IOM asserts that nurses can enhance efforts to prevent medication errors by encouraging patients to speak up. Suggest patients take notice of their care plans The IOM asserts that nurses can enhance efforts to prevent medication errors by suggesting patients take notice of their own care plans. Encourage patients to be active in their own care The IOM asserts that nurses can enhance efforts to prevent medication errors by urging patients to be active in their own care. Assist patients to partner with healthcare providers The IOM asserts that nurses can enhance efforts to prevent medication errors by partnering patients with healthcare providers.

Document Information Properly

Record medication administration on the MAR/eMAR immediately after medication is given. Report any adverse reactions. Report MEs immediately to the healthcare provider.

The nurse giving medications finds that the patient is in the bathroom and is not available to take the pills. What action should the nurse take next?

Return when the patient can be observed taking the medication. Observing the patient while all medications are taken is an important safety measure that prevents medication errors and patient harm.

Medication Administration Records and Medication Errors / Summary

Summary The nurse who administers a drug is legally liable for any error that occurs. The MAR/eMAR goes a long way in helping prevent errors by requiring the accurate and thorough recording of patient allergies, medication information—including dosage, route, frequency—and the initials of the individual who administered the drug. To that end, dates and times include not only the time a medication should be administered, but the times it is actually administered. In addition, the MAR/eMAR should document any refusals, administration delays, and adverse effects or allergic reactions and special instructions. Keeping accurate MARs/eMARs, however, is not enough to prevent all medication errors. Most of these can be traced to the failure to follow one or more of the seven rights of safe medication administration. At each stage of the administration process, there are strategies to help prevent medication errors, from clarifying orders and other unclear information, to taking steps to prepare drugs safely, checking patient information, practicing safe administration, and documenting properly. The Joint Commission, the Institute of Medicine (IOM), and the Institute for Safe Medication Practices (ISMP) all provide guidelines for preventing medication errors. When medication errors occur, they must be reported right away, following the facility's reporting procedures.

The Nurse's Role in Preventing Medication Errors

The Institute of Medicine (IOM) asserts that nurses can enhance efforts to prevent medication errors beyond the seven rights of medication administration by encouraging a partnership between patients and their healthcare providers with an emphasis not only on patient education, but on encouraging patients to speak up, take notice of their own care plans (and medication plans), and to take an active role in their own care. In response to the IOM recommendations, the Joint Commission launched a Speak Up™ campaign that urges patients to have more active roles and (of course) a nurse's willingness to listen and answer questions. In this program, patients are encouraged to ask questions, and nurses should be prepared to respond and to keep the dialogue going until the patient expresses satisfaction and a full comprehension. This generates a sense of teamwork and multiplies error prevention safety nets.

eMAR MAR

The greatly improved accuracy of this system has led many more pharmacies and healthcare systems to generate computerized MARs. All essential MAR data is incorporated into these forms—including the prescriber's name, patient allergies, medication, dosage, times and route of administration, and a method for recording the nurse's signature. PRN and one-time medications are not given on a routine schedule and may be entered on a separate MAR or may be incorporated into the eMAR.

Which statement(s) are true about the Institute for Safe Medication Practices' (ISMP's) error reporting system? The information is anonymous to encourage reporting.The ISMP's error reporting system keeps information confidential and voluntary to encourage reporting and track trends in medication errors. The reports are used to track patients with addictions.The ISMP's reports are not used to track patients with addictions. The information is used to discipline error-prone nurses.The ISMP's information is not used to discipline error-prone nurses. Facilities can help nurses named in the reports with further education.The information is not used by facilities to help nurses named in the reports with further education. Correct Reported errors are used in national studies to improve medication safety.Errors reported to the ISMP are used to understand their causes and share lessons learned with the healthcare community. Pharmacies can use the information to identify doctors who over-prescribe certain medications.Pharmacies cannot use the information to identify doctors who over-prescribe certain medications.

The information is anonymous to encourage reporting. The ISMP's error reporting system keeps information confidential and voluntary to encourage reporting and track trends in medication errors. Reported errors are used in national studies to improve medication safety. Errors reported to the ISMP are used to understand their causes and share lessons learned with the healthcare community.

Preventing and Reporting Medication Errors KEY POINTs

The nurse who administers a drug is legally liable for any error that occurs. Common causes of medication errors include not following up on incomplete, confusing, or unclear information, poor storage or labeling, use of nonstandard delivery devices, calculation errors, and omission of any of the seven rights of medication administration. Most medication errors can be traced to the failure to follow one or more of the seven rights of safe medication administration. The Institute of Medicine (IOM) recommends that nurses can enhance efforts to prevent medication errors by encouraging a partnership between patients and their healthcare providers. The Joint Commission launched a Speak Up™ campaign that urges patients' more active and vocal roles and (of course) a nurse's willingness to listen and answer questions. At each stage of the administration process, there are ways to prevent medication errors, from clarifying orders, to taking steps to prepare drugs safely, checking patient information, practicing safe administration, and documenting properly. Nurses must adhere to the guidelines laid out by The Joint Commission, the Institute of Medicine, and by the Institute for Safe Medication Practices (ISMP) for preventing medication errors. When medication errors occur, they must be reported right away, following the facility's reporting procedures. QUIZ ME NOW!

Is the MAR a legal document?

Yes. Although the form itself will vary from one institution to another, the key components of this important document will always be consistent, since this is a valuable medical and legal document. Accurate, legible recordings of every medication administration event are documented, leaving clues to a patient's progression or regression; but it also serves as a legal document. For both purposes, every medication transaction must be recorded accurately and in a timely fashion, with nothing left out or left to guesswork.

Can an MAR be handwritten?

a legal document called the medication administration record (MAR), which can vary in form from a nurse's handwritten notation to a computer-generated document.

What can most medical errors be traced to?

failure to follow one or more of the seven rights of safe medication administration

By encouraging nurse/patient dialogue, what does The Joint Commission's Speak Up campaign help to generate? A sense of teamwork The Joint Commission's Speak Up campaign helps to generate a sense of teamwork between nurses and patients. Less time spent in hospitals The Joint Commission's Speak Up campaign does not help patients to spend less time in the hospital. A decrease in medication use The Joint Commission's Speak Up campaign does not generate a decrease in medication use. More physician appointments The Joint Commission's Speak Up campaign does not generate more physician appointments.

sense of teamwork The Joint Commission's Speak Up campaign helps to generate a sense of teamwork between nurses and patients.