Safe single or double checking Flashcards
One of the first things I had to do was give my patients their medication. One of my patients was prescribed morphine slow release tablets, which I didn’t know much about.
The ward was really busy. The staff worked in teams, but I really couldn’t find any of my team members for a medication check. I asked some staff but they said, “I’m not on your team; find one of your team members”.
I noticed that on this ward double checking occurred in the medication room but only one staff member went to the patient bedside to check they have the right patient.
The medication room was small and hot and seemed noisy because there were other staff also preparing medications.
I couldn’t find medication resources to identify how to administer the medication and everyone seemed too busy to help.
There are a number of context factors in this situation could lead to a medication error. You should…
a) Wing it and omit the drug
b) Do a single check to save time
c) Insist on a proper independent check
c) Insist on a proper independent check
No matter how many perceived obstacles you encounter, you have to make sure you carry through the correct independent double check with every patient, every time.
In this example, the context included many obstacles that could compromise the independent double checking process. These include busyness, the small hot room, difficulty finding someone to check with, and a poor medication safety culture in the unit.
Once we are finished preparing the medication, which is a slow release morphine tablet, we go to the patient to check her ID.
The patient just asks for the pottle before I have a chance to go through the medication with her. She asks if I can crush her morphine SR tablet as she is having trouble swallowing. What will you do?
a) Explain “slow release”
b) Crush the tablet
c) Give the medication with no explanation
a) Explain “slow release”
Once you have identified the patient correctly, and checked about any known allergies, you must always let the patient know what the medication is and what it action it is expected to have.
In this case you need to explain why the slow release morphine tablet must be taken whole, but you also need to find out more about her difficulty with swallowing.
What should a staff member do if they witness an error or potential error about to be made in regard to the checking, administration or monitoring of a medication?
a Complete a Datix incident report online about the event
b) Stop the process by alerting the colleague or seek the intervention of a senior colleague to stop the process and also complete a Datix report online
c) Do nothing, the staff member is not responsible for other staff member
b) Stop the process by alerting the colleague or seek the intervention of a senior colleague to stop the process and also complete a Datix report online
1.2g of Amoxicillin + Clavulanic acid is equal to
a) 1200 mg
b) 0.0012 kg
c). 1200 mcg
a) 1200 mg
1.2 x 1000
500 mg of Ceftriaxone is equal to
a) 500000 mcg
b) 0.005 kg
c) 0.5 g
c) 0.5 g
500/1000
5mg of Metoclopramide has been ordered. Metoclopramide comes as a 10mg in 2mL polyamp. How many mLs of Metoclopramide would you administer?
a) 2mLs
b) 1mL
c) 0.5 mLs
b) 1mL
5/10 x 2/1
750mcg of Digoxin has been ordered. Digoxin is supplied as 0.25mg tablets. How many tablets would you administer?
a) 5 tablets
b) 2 tablets
c) 3 tablets
c) 3 tablets
750/1000
= 0.75
0.75/0.25
Digoxin 0.25mg is prescribed. The tablets available for the patient are 62.5micrograms. How many will you administer?
a) 1/2 a tablet
b) 1 tablet
c) 4 tablets
d) 2 tablets
c) 4 tablets
0.25 x 1000
=250
250/62.5
As a registered nurse, which statement is most true about direction and delegation?
a) Direction and delegation is left to the coordinator or nurse/midwife in charge of the ward/unit or service
b) Enrolled nurses are not permitted to make any form of assessment and therefore must be directed and delegated by a registered nurse in all situations
c) Seeks advice from a senior registered nurse if unsure about the role and competence of enrolled nurses and others when delegating work
c) Seeks advice from a senior registered nurse if unsure about the role and competence of enrolled nurses and others when delegating work
As EN you have been delegated to care for Ms Dittmer with her uncontrollable pain, warfarin that requires titration and her pulse is 48. Due to the complexity of the patient and the unknown cause of her uncontrollable pain the EN able to decline the delegation of care for Ms Dittmer?
a) True
b) False
a) True
Ms Dittmer has been commenced on warfarin. She is having daily INR blood testing completed and the dose of warfarin is being adjusted every day. Is it true or false whether the RN/RM is able to delegate to the EN to independently use the warfarin protocol to calculate the dose of warfarin and then administer the warfarin independently?
a) True
b) False
b) False
Ms Dittmer has atrial fibrillation which Is being treated with digoxin 0.25 mg daily. The only tablets that are available are 62.5 micrograms.. As the EN, you are preparing to give Ms Dittmer her dose. You check her pulse, which is 48 bpm. What are the appropriate steps?
a) Make a note of the pulse on the prescription chart and observation record, inform the RN of the findings. RN may choose to reassess Ms Dittmer and if the findings are the same, administer the medication using an independent double checker.
b) Give Ms Dittmer her medication, remembering to let the RN know of the pulse at handover, documenting in the medical record and on the prescription chart
c) Make a note of the pulse on the prescription chart and observation record, inform the RN of the findings. RN may choose to reassess Ms Dittmer and if the findings are the same, withhold the medication document on the prescription chart, in the medical record, and inform the prescriber
d) Tell the RN about Ms Dittmer pulse and ask the RN to administer the medication independently, with a note in the medical record of your actions
e) Inform the RN of the pulse then give Ms Dittmer the digoxin with out an independent second checker.
c) Make a note of the pulse on the prescription chart and observation record, inform the RN of the findings. RN may choose to reassess Ms Dittmer and if the findings are the same, withhold the medication document on the prescription chart, in the medical record, and inform the prescriber
Ms Dittmer has been requesting regular paracetamol for abdominal pain. Her pain score has consistently remained high. What do you do as the EN?
a) As the EN , using the SBARR tool discuss with your RN/RM partner the situation. Together in partnership perform a full patient assessment and plan a way forward in managing Ms Dittmer’s pain management
b) Nothing, Ms Dittmer is not permitted any further pain relief
c) Give an extra dose of paracetamol, just once won’t matter
d) Call the prescriber and have new pain medicine prescribed. No need to discuss with RN/RM partner
e) As the EN there is no need to complete a full assessment of Ms Dittmer. But using the SBARR tool discuss with your RN/RM partner the situation.
a) As the EN , using the SBARR tool discuss with your RN/RM partner the situation. Together in partnership perform a full patient assessment and plan a way forward in managing Ms Dittmer’s pain management
Patients own medicines are not to be used after admission except when?
a) The hospital pharmacy is closed
b) You cant find a family member to give the medication to take home
c) The medicines are not immediately available in the hospital
d) You haven’t got time to send the medication chart to pharmacy
c) The medicines are not immediately available in the hospital
Patients own medicines are not to be used after admission, except when the medicines are not immediately available in the hospital.
During hospital hours contact the pharmacy or after hours contact the duty manager who will help locate the medication you require.
Patient medicines ( including controlled medicines) should be sent home with family/carer. Lock in the drug cupboard until family is available to take medicines home (or the patient is discharged) and record action in the clinical record.
Where patients own medications are not to be returned to the patient, these must be sent back to pharmacy following patient discharge.
Your patient has gone into heart failure and is prescribed 80mg of Frusemide STAT. You have Frusemide available in 20mg in 2mLs. How many mls of Frusemide is to be administered?
a) 6mLs
b)10mLs
c) 8mLs
d) 0.8mLs
c) 8mLs
80/20 x 2
