Medication Flashcards
1
Q
What is medicine?
A
Chemical substance given with intention of preventing, or alleviating disease, or enhancing mental and physical welfare
2
Q
A medication containing a substance in the NSW Poisons List;
A
- Schedule 2: “Pharmacy Medicine” (pharmacy ‘over the counter’ medication)
- Schedule 3: “Pharmacist Only Medicine” (pharmacist controlled ‘over the counter’ medication)
- Schedule 4: “Prescription Only Medicine” ( ‘restricted substance’) stored away from the patient, locked drawer/cabinet
- Schedule 8: “Controlled Drug” ( ‘drug of addiction’)
3
Q
Storage of Medications
A
- Schedule 2, 3, 4 and unscheduled medications must be stored out of patient and public areas
- Preferably in a locked room or cabinet securely attached to the wall or floor of the premises, with the following exceptions
- On a medication trolley used for medication rounds, which should be kept in a locked room when not in use
- In a secure cabinet (such as a bedside cabinet) including that used for patient self- administration in an approved program, in situations for which it may be impractical to attach the cabinet to the wall or floor of the premises
- Schedule 4 and Schedule 8 medications must be stored and locked behind 2 areas (locked door and in a secure safe)
4
Q
Types of medications required in the intra operative (pre and post op) stages
A
Analgesia- simple, Nonsteroidal anti- inflammatory drugs, opiates Antipyretic Antiemetics Anticoagulants Antithrombotic Antibiotics Regular medications- Antihypertensive
5
Q
Variety of routes- depends on patients conditions
A
Oral/ enteral- PO or enteric coated Rectal- PR Intravenous- IV Epidural- Epidural Subcutaneous/ Sub Intramuscular- IM Sublingual- subling Nebulised- neb Topical- topical Naso gastric- NG
6
Q
Trade Name
A
- Every medicine has a brand name, which is given by the pharmaceutical company that markets the drug
- (R) - registred trade mark symbol
7
Q
Generic Name
A
The drugs active ingredients that makes it work
8
Q
The advantage of using MIMs- role of the nurse (Medical Inventory Management System)
A
Composition Class Action Indication Contraindication Precautions Adverse reactions Dosage and administration
9
Q
High Risk Medications
The medications include (but are not limited to) the APINCH high-risk medicine groups
A
Anti-infective agents and Potassium and other electrolytes, and Insulin and Narcotics (opioids) and other sedative agents, and Chemotherapeutic agents, and Heparin and other anticoagulants
10
Q
Consumers at risk- examples of risk factors known to predispose people to adverse event
A
- Age 65 or older
- Currently taking 5 or more regular medications
- Taking more than 12 doses of medication per day
- Suspected non- compliance or inability to manage medication related therapeutic devices
- Literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties
- Patients attending a number of different doctors, both general practitioners and specialists
- Recent discharge from a facility/hospitals (in the last 4 weeks)
11
Q
Medication errors
A
- Second frequently reported incident type after falls
- Environmental factors→ Inadequate staffing levels, high workloads, noise, distractions, poor lighting, untidy, cluttered or inadequate workspace, working on call/shift/long hours
- Team Factors→ Accessibility of clinical info, layout of charts and records, availability of resources- guidelines references
- Individual factors→ Physical health, feeling hungry/thirsty, tired, mental health- stressed/distracted/having low morale, insufficient knowledge and skills/training/experience to perform tasks required
- Patient factors→ Familiarity with the patient, condition of the patient, ability of the patient to communicate, acuity of problem
12
Q
Causes of wrong drug errors
A
- Confusion between drug names, labels and packaging are important sources of medication error
- Drug names often sound similar when spoken and may look similar when written down
- The packaging and labelling of different products may look similar and cause confusion
13
Q
General pathway of medication use
A
- Those administering medicines also play an important role in identifying, prescribing and dispensing errors before they reach the patients
- Adverse drug reaction (ADR): a harmful, unintended reaction to medicines that occurs at doses normally used for treatment
- Near misses- i.e. labelling issues
14
Q
The National Inpatient Medication Chart (NIMC)
A
- The NIMC standard published by the Australian Commission on Safety and Quality in Health Care is adopted as policy in all NSW Health Facilities
- The NIMC (acute) is a medication chart designed for patients in acute care. It is used across health service organisations in medical and surgical wards, emergency departments and intensive care units
15
Q
National Inpatient Medication Chart (NIMC)
A
- A medication order on a medication chart must clearly specify
- The medication’s active ingredients and/or proprietary name (where approved for use at the facility) with the strength, form and route of administration and
- The indication for treatment (if applicable) and
- For a ‘regular’ medication
- The dose to be administered
- The frequency and times for administration to the patient
- The maximum number of doses or the maximum duration of treatment with the medication (except where the prescriber’s intention is for the duration of the medication chart)
16
Q
Prescribing- medication selected and prescribed
A
- Comprehensive medicines assessment prior to any decision to prescribe a new medicine
- Patient’s GP
- Patient’s community pharmacy
- Patients own medications
- The patients family members or carers
- Info from previous admissions
- The patient’s medication list
- The history is used as the basis for therapeutic decision making, for ensuring continuity of regular medicines while a patient is in hospital and to identify adverse medicines events
17
Q
Dispense
A
- Review prescription by pharmacist
- Prepare and dispense medication
- Deliver medication
- Pharmacy review in green
18
Q
Administering
A
Review prescription- clear, legible and not open to misinterpretation
Prepare medication
Administer medication to patient
19
Q
Administering: Always remember the following safety checking list
A
- Right patient that matches the patient ID on the NIMC, the label on the dispensed medicine and is confirmed by the patient using three identifiers
- Right drug (that matches the order and the patient’s condition)
- Right route (that matches the order and is appropriate for the medicine and the patient
- Right dose (that matches the order and is safe for the patient)
- Right time (that matches the order and its frequency and administration time directions
- Right documentations- Ensuring it is correctly dated/time and initials
20
Q
First check of administration (speak to the patient and check the chart and ID band)
A
- Checks patient’s identity against medication chart
- Ask patient to state name and DOB
- Checks patient name, Medical Record Number and DOB on arm-band against details on the medication chart
- Ask patient for allergies
- Checks medication order for legality- Right drug, route, dose, time (confirm it hasn’t been given to patient)
- If concerned, stop and clarify
21
Q
Second check - Against medication chart and medication
A
- Correct medication is selected to dispense
- Performs 5 rights by checking the medication against the medication order- Right patient + allergy status, drugs, route, dose and time and expiry date of the drug
- Calculates the required dose and ensures correct dosage is dispensed using proper hygiene
- After dispensing the medication, check the medication against the order a final time- right drug, route, dose, time and expiry date
22
Q
Avoiding product selection errors
A
- A final double- check is essential
- After you have selected and prepared the product, the very last thing you should do is a re-check thoroughly against the prescription
- Always check your own work, regardless of whether a second person is checking
- Individual bedside medication lockers have been shown to dramatically reduce medication errors caused by incorrect selection
23
Q
Third check
A
- Checks patient’s identity: ask patient to state name and DOB
- Checks patient name, medical record number (MRN) and DOB on arm-band against details on the medication chart
- Ask patient for allergies/ previous adverse drug reaction and verifies this info with medication chart
- If medication has allergic consequences student to withhold
24
Q
Post administration- nurses responsibility
A
- Documenting the administration
- Monitoring the effect of the medication
- Proper and complete entries on the medication chart
25
Safety checklist
- Doses must be prepared for only one patient as a time and immediately before the intended use
- Due to risks of contamination, potential instability, potential mix up with other medications
- Maintain security of the medication
- Oral liquid medications must be administered in a medication cup or the use of the ‘orange syringe’
26
What are the 2 most common types of medication incidents that occur in hospitals?
```
Omission of a required drug
Under dose
Overdose
Medication given to wrong patient
Medication given by the wrong route
```
A: Omission and overdose are the most common types of medication incident
27
Omissions
```
Might not be administered
Oversight
The nurse is unaware of the order
The medication cannot be physically administered
No stock is available
```
28
What do you think is the most common cause of medication errors
- Failing to read or mislead the medication chart
- Failing to consider the patient's renal function
- Similar sounding drug names
- Similar looking packaging of different medications
A: Failing to read or mislead the medication chart. Prescription or order errors and unclear or incomplete order are the next 2 categories
29
Wrong dose
- Doses must be written using metric and Arabic e.g. 1,2,3 etc systems
- Never use Roman numerals eg. i, ii, iii etc
- Always use zero before a decimal point. Eg. 0.5g otherwise the decimal point may be missed
- However if possible, it is preferable to state the dose in whole numbers, not decimals e.g. write 500mg instead of 0.5g or write 125 microgram instead of 0.125mg
- Never use a trailing zero (.0) as it may be misread if the decimal point is missed (e.g. 1.0 misread as 10)
- Don’t use U or IU for units because it may be misread as zero. Always write units in full.
30
Error prone Abbreviations
- Ug, mcg mistaken for ‘mg’ → you should write “microg”, “microgram” instead
- O.d or OD- once daily- mistaken for BD → you should write “daily” instead
31
Consequences of medication errors
- 20% result in some degree of harm, 3% significant harm, including death
- It can be difficult to deal with errors without apportioning blame to one individual. When an incident or near miss occurs it is easy to put it down to “human error”
- But this is too simple, this approach does not address the reasons why the person made the error
- Usually failures or shortcomings within the organisation (system failure) can be identified as factors that contributed to the error. By acknowledging and acting on system failures we can prevent future errors from occurring
32
Open Disclosure
- When any clinical incident has an adverse outcome, the patient and family should be informed. The process of open disclosure uses a structured format to assist senior staff member to discuss incidents with patients
- Open discussion of an incident that has resulted in harm to a patient receiving care. You should always speak with your supervisor before discussing a clinical incident with a patient.
33
Points to remember
- The same person should select, prepare, administer and record the administration
- On 3 occasions confirm the 5 rights and ensure you have a legal order- check your patient, chart and ID band and medication
- Preparing the medication including checking the medication's name, strength, route of administration and expiry date against the order
- Re-checking the point of administration to the patient with the patient's identification, known allergies and other appropriate patient parameters
- Documenting the administration
- Monitoring the effect of the medication
- Proper and complete entries on the medication chart
34
Administration Times: Morning
Mane
35
Administration Times: Night
Nocte
36
Administration Times: Twice a Day
BD
37
Administration Times: 3 Times a Day
TDS
38
Administration Times: 4 Times a Day
QID
