CH 2 Safe Medication Administration & Error Reduction

Question 1

What are nurses responsible for when it comes to medication administration?

Answer 1

1. Having knowledge of federal, state, and local laws, and facilities’ policies that govern prescribing and dispensing meds
2. Preparing and administering meds
3. Evaluating client’s responses to meds

Question 2

What are the components of a medication prescription?

Answer 2

1. Client’s full name
2. Date and time of the prescription
3. Name of the medication
4. Strength and dosage of the medication
5. Route of Administration
6. Time and Frequency of administration
7. Quantity to dispense and the number of refills
8. Signature of the prescribing provider

Question 3

Types of Medication prescriptions

Answer 3

1. Routine or standing prescriptions
2. Single or one-time prescriptions
3. Stat prescriptions
4. PRN prescriptions

Question 4

What is medication reconciliation? When should it take place?

Answer 4

comparing the client’s current medications to new medication prescriptions and reconciling with provider to resolve any discrepancies.

it should take place at admission, when transferring clients bw units or facilities, and at discharge

Question 5

Knowledge Required prior to medication administration: Medication category/class

Answer 5

Medications have a pharmacological action, therapeutic use, body system target, chemical makeup, and classification for use during pregnancy.

Question 6

Knowledge Required prior to medication administration: Mechanism of Action

Answer 6

how medications produce their therapeutic effect

Question 7

Knowledge Required prior to medication administration: Therapeutic Effect

Answer 7

the expected effect (physiological response) for which the nurse administers a medication to a specific client. One medication can have more than one therapeutic effect.

Question 8

Knowledge Required prior to medication administration: Adverse effects

Answer 8

undesirable and potentially dangerous responses to a medication

Question 9

Knowledge Required prior to medication administration: Toxic effects

Answer 9

medications can have specific risks and manifestations of toxicity. They develop after taking a medication for a lengthy period of time or when toxic amounts build up due to a faulty metabolism or excretion

Question 10

Knowledge Required prior to medication administration: Medication interactions

Answer 10

medications can interact with each other, resulting in beneficial or harmful effects.

Obtain a complete medication hx and be knowledgeable of significant interactions

Question 11

Knowledge Required prior to medication administration: Precautions/Contraindications

Answer 11

conditions (diseases, age, pregnancy, lactation, etc.) that make it risky or completely unsafe for clients to take specific medications

Question 12

Knowledge Required prior to medication administration: Preparation, Dosage, Administration

Answer 12

it is important to know any specific considerations for preparation, safe dosages, dosage calculations, and how to administer the medications

Question 13

Knowledge Required prior to medication administration: Nursing implications

Answer 13

Know how to monitor therapeutic effects and adverse effects, provide comfort, and instruct clients about the safe use of medications

Question 14

What are the rights of safe medication administration?

Answer 14

1. Right Client
2. Right Medication
3. Right dose
4. Right time
5. Right route
6. Right documentation
7. Right client education
8. Right to refuse
9. Right Assessment
10. Right evaluation

Question 15

Right Client

Answer 15

Verify the client’s identification before each medication administration. Requirement of 2 client identifiers
check id bands for name and identification #
check for allergies

Question 16

Acceptable client identifiers include

Answer 16

client’s name, an assigned identification number, telephone number, birth date, or another person-specific indentifier (photo id)

Question 17

Right Medication

Answer 17

correctly interpret medication prescriptions, verifying completeness and clarity

Read medication labels and compare them with MAR 3 times: before removing the container, when removing the amount of medication from the container, and in the presence of the client before administering the medication

leave unit-dose medication in its package until administration

Question 18

Right Time

Answer 18

administer medication on time to maintain a consistent therapeutic blood level

administer time-critical meds 30 min before or after prescribed time

administer non-critical meds prescribed once daily w/in 2 hours of prescribed time

administer non-time critical meds prescribed more than once daily (but not more than every 4 hr) w/in 1 hr of the prescribed time.

Question 19

Right Route

Answer 19

select the correct preparation for the route the provider prescribed

most common routes are oral, topical, subQ, IM, and IV.

always use different syringes for enteral and parenteral medication administration

Question 20

Right documentation

Answer 20

immediately record the medication, dose, route, time, and any pertinent info, including the client’s response to the medication.

for some meds (esp. for pain relief) evaluate client’s response to med and document it

Question 21

Right client education

Answer 21

inform clients about the medication: its purpose, what to expect, how to take it, and what to report

Question 22

Right assessment

Answer 22

collect any essential date before and after administering any medication. For example, measure apical heart rate rate before giving digoxin

Question 23

Right evaluation

Answer 23

follow up with clients to verify therapeutic effects as well as adverse effects

Question 24

Common Medication Errors

Answer 24

1. Wrong med or IV fluid
2. Incorrect dose or IV rate
3. Wrong client, route, or time
4. Administration of an allergy-inducing medication
5. Omission of a dose or administration of extra doses
6. Incorrect discontinuation of a medication of IV fluid
7. Inaccurate prescribing
8. Inadvertently giving a med that has a similar name

Question 25

Using Nursing Process to Prevent Med Errors: Assessment

Answer 25

1. Be knowledgeable about the medication being administered. Use appropriate resources 2. Obtain info about medical diagnoses and conditions that affect med administration (ex: ability to swallow, allergies, heart, liver, and kidney disorders). 3. Obtain necessary pre-administration data (HR, BP, blood levels, etc.) to assess if the med is appropriate and to get baseline date for evaluating the effectiveness of med 4. Omit or delay doses as necessary due to client's status 5. Determine whether the medication prescription is complete 6. Interpret the med prescription accurately 7. Question the provider if the prescriptions is unclear or seem inappropriate for the client. Refuse to administer med if it feels unsafe. Notify charge nurse or supervisor. 8. Question providers about abrupt and excessive dosage changes

Question 26

Using Nursing Process to Prevent Med Errors: Planning

Answer 26

1. Identify client outcomes for med administration 2. Set priorities (which med to give first or before specific tx or procedures)

Question 27

Using Nursing Process to Prevent Med Errors: Implementation

Answer 27

1. Avoid distractions during med preparation 2. Prepare meds for one client at a time 3. Check the labels for the med's name and concentration 4. Measure doses accurately, and double-check dosages of high alert meds (insulin and heparin) w/ a colleague. Check expiration date 5. Question multiple tablets or vials for a single dose 6. Follow the rights of med administration. Take MAR to bedside 7. Don't administer meds that someone else prepared. 8. Encourage client's to become part of the safety net, teaching them about meds and the importance of proper identification before medication administration. Omit or delay a dose when clients question the size of a dose or appearance of medication 9. Follow correct procedures for all routes of administration 10. Follow all laws and regulations for preparing and administering controlled substances. Keep them in a secure area, Have another nurse witness the discarding of controlled substances 11. Do not leave meds at bedside 12. Educate the client and anyone who will be assisting in the client's care regarding medications. Provide verbal and written instructions

Question 28

Using Nursing Process to Prevent Med Errors: Evaluation

Answer 28

1. Evaluate clients' responses to medications, and document and report them. 2. Use knowledge of therapeutic effect and common adverse effects of medications to compare expected outcomes with actual findings. 3. Identify adverse effects, and document, and report them. 4. Notify the provider of all errors, and implement corrective measures immediately 5. Complete an incident report w/in the time frame the facility specifies (usually 24hr). Do not reference or include the incident report in the client's medical record 6. Report all errors to help the facility's risk managers to determine how errors occur and what changes to make to avoid similar errors in the future.

Question 29

An incident report should include what?

Answer 29

1. Client's identification 2. Name and dose of the medication 3. Time and place of the incident 4. Accurate and objective account of the event 5. Who you notified 6. What actions you took 7. Your signature (or that of the person who completed the report)

Question 30

A nurse is preparing a client's medications. Which of the following actions should the nurse take in following legal practice guidelines (Select all that apply) a. teach the client about the medication b. determine the dosage c. monitor for adverse effects d. lock compartments for controlled substances e. determine the client's insurance status

Answer 30

a, b, c, d

Question 31

A nurse is preparing to administer digoxin to a client who states, "I don't want to take that medication. I do not want one more pill." Which of the following responses should the nurse make? a. "Your physician prescribed it for you, so you should really take it." b. "Well, let's just get it over quickly then." c. "Okay, I'll just give you your other medications." d. "Tell me your concerns about taking this medication."

Answer 31

d

Question 32

A nurse is reviewing a client's prescribed medications. Which of the following situations represents a contraindication to medication administration? a. the client drank grapefruit juice, which could reduce a medication's effectiveness. b. the medication has orthostatic hypotension as an adverse effect. c. a medication is approved for ages 12 and older, and the client is 8 years old. d. an anti-anxiety medication that has an adverse effect of drowsiness is precribed as a preoperative sedative

Answer 32

c

Question 33

A nurse is assessing a client before administering medications. Which of the following data should the nurse obtain? (Select all that apply) a. use of herbal products b. daily fluid intake c. ability to swallow d. previous surgical hx e. allergies

Answer 33

a, c, e

Question 33

A nurse is working w/ a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as an indication that the newly hired nurse understands medication error prevention? a. taking all medications out of the unit-dose wrappers before entering the client's room b. checking the prescription when a single dose requires administration of multiple tablets c. administering a medication, then looking up the usual dosage range d. relying on another nurse to clarify a medication prescription

Answer 33

b