Week 2 - Medication Safety

Question 1

What is standard 4?

Answer 1

Aims to ensure that clinicians safely prescribe, dispense and administer appropriate medicines, and monitor medicine use.

Question 2

What are the common errors in medication?

Answer 2

• Incorrect admission documentation
• Errors in prescription; incorrect dose
• Administration of medication when there is an allergy
• Errors in documentation
• Failure to recognise adverse side effects
• Lack of patient education

Question 3

Why do nurses make mistakes while giving medications?

Answer 3

• Similar names and packaging
• Distractions on medication rounds
• Rushing the task
• Not understanding medications and their uses
• Dangerous abbreviations
• Not documenting at the time of administration

Question 4

How can we prevent mistakes?

Answer 4

• Medication history, medication management plan, reconciliation
• National Standard Medication Chart
• Generic names
• Tall man lettering
• Terminology, abbreviations and symbols

Question 5

How to improve our medication knowledge

Answer 5

• Valid order
• Allergy
• ask patient, check medication chart and look for arm band
• AusDI & Australian Injectable Drug Handbook
  – Indication, contraindication, adverse effects,
  precautions, recommended dose …

Question 6

What is red in injectables medicines?

Answer 6

Target tissue - Intra-arterial
Route of administration - Intra-arterial

Question 7

What is blue in injectables medicines?

Answer 7

Target tissue - Intravenous
Route of administration - Intravenous

Question 8

What is yellow in injectables medicines?

Answer 8

Target tissue - Neural tissue
Route of administration - Epidural, intrathecal and regional

Question 9

What is beige in injectables medicines?

Answer 9

Target tissue - Subcutaneous tissue
Route of administration - Subcutaneous

Question 10

What is pink in injectables medicines?

Answer 10

Target tissue - Miscellaneous
Route of administration - Any other route not specified above

Question 11

What are the other medication routes?

Answer 11

1. Ophthalmic medication
2. Rectal medication
3. Topical medication (Transdermal patches)
4. Inhaled medication (nebuliser and inhaler)
5. Enteral medication (NGT)

Question 12

Explain pharmacokinetics of absorption

Answer 12

the process by which a medication passes from the source of administration into the bloodstream.

Question 13

What factors can influence absorption

Answer 13

It is influenced by factors such as:
* body surface area, blood flow, presence of food, ability of
medication to dissolve, lipid solubility of medication
* the route of administration, such as: oral, inhalation, topical, IM, IV
* medication form, such as: liquid, capsule, tablet, enteric coated, sustained release, suppository, transdermal patches

Question 14

Explain pharmacokinetics of distribution

Answer 14

• is the transportation of a drug from its site of
  absorption to its site of action.
• blood circulation, protein binding, membrane permeability

Question 15

Explain pharmacokinetics of metabolism

Answer 15

• the process by which a drug is transformed
  into a less active or inactive form.
• occurs in the liver, but also lungs, kidney, intestines

Question 16

Explain pharmacokinetics of excretion

Answer 16

• the process by which metabolites and drugs are
  eliminated from the body.
• mainly via the kidneys, but also intestines, lungs, skin, breastmilk

Question 17

What are some considerations when giving out medications?

Answer 17

Medication doses for the very young and older adult need to be adjusted due to pharmacokinetic variations such as:
* immature or age affected organs
* skin, intestine, liver & kidneys
* poor peripheral tissue perfusion
* higher (very young) or lower (older adult) water content
* composition of body fat
* lower plasma proteins (albumin)
* Weight

Question 18

What are some paediatric medication consideration?

Answer 18

Variables impacting on the calculation of a medication dose:
* height/length, weight, age, body surface area
* Liquid forms
* Use disposable syringe to prepare dose < 10 mL

Question 19

What are some geriatric medication consideration?

Answer 19

Precautions associated with comorbidities
* Polypharmacy – prescription, over the counter drugs, ‘sharing’
* Interactions between drugs
* Higher rate adverse effects
and mortality
* Increase risk falls, frailty
and disability

Question 20

What is the meaning of the following abbreviation - CD

Answer 20

• CD Controlled Dose

Question 21

What is the meaning of the following abbreviation - EC

Answer 21

• EC Enteric Coated

Question 22

What is the meaning of the following abbreviation - SR

Answer 22

• SR Slow Release

Question 23

What is the meaning of the following abbreviation - LA

Answer 23

• LA Long Acting

Question 24

What is the meaning of the following abbreviation - ER/XR

Answer 24

• ER/XR Extended Release

Question 25

What is the meaning of the following abbreviation - MR

Answer 25

* MR Modified Release

Question 26

What is the meaning of the following abbreviation - CR

Answer 26

* CR Controlled Release

Question 27

Where should medications be stored?

Answer 27

All medications must be stored in a locked cupboard, room, drawer or trolley when not in immediate use 1 Except for emergency trolley medications 2 All medications must be stored in same container as received from Pharmacy 3 Medications must be stored in manner that minimizes medication error 4 Medication keys must be kept separate from other ward keys

Question 28

Where should Schedule 8 and Schedule 4 Appendix D Medication be stored?

Answer 28

* Drugs of addiction * Stock levels of S8 and S4D/R medications should be kept to lowest level practicable * Must be stored in separate medication storage unit: – Metal safe – Securely attached to floor or wall – Kept locked – Lock should be five lever lock – Close to CCTV monitoring

Question 29

What is the cold chain management?

Answer 29

* System of transporting and storing vaccines within the temperature range of +20C to +80C * Ideal is + 50C * Staff in hospitals/clinics responsible for: – receiving – stocking – storing – administering * Must ensure cold chain is maintained at all stages