Week 3 Medication Safety Objectives
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University of California, Davis *
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Course
102
Subject
Medicine
Date
Feb 20, 2024
Type
docx
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3
Uploaded by faizanashraf0710
Medication Safety
1.
Identify and discuss drug classification and drug formularies (e.g., tablet, solution, elixir, etc.) and routes (non-parenteral versus parenteral).
(Follow the latest guidelines, and the labels on the drugs, the prescriber orders, and MAR for the classification and drug information. Ensure the dose where you might have to split
the tab or crush it, dilute it according to label vs available doses and route for administration. Parenteral means the medications that are injectable use only).
2.
Identify components of provider order for administration of medications.
A medication order should include:
1.
Pt full name
2.
Drug
3.
Dosage
4.
Route of administration
5.
Frequency or time of administration
6.
Indications for use (PRN orders only)
7.
Date of order expiration
8.
Prescriber’s signature
3.
Describe and demonstrate the “six rights” and “three checks” involved in medication administration.
Right medication
: check MAR three times (when taking medication out of dispensing system or drawer, before placing medication in med cup or taking it to pt room, and before administering). If requires preparation and is not in its original container, label it with name, strength, amount, and expiration. Calculate the dose if prescriber’s orders differ from availability from pharmacy. Double check med calculations. Right Dose
: follow the latest guidelines. If preparing liquid med, use standard measuring devices such as syringe or graduated medication cup. Ask pharmacy to split tablets use splitting device – discard uneven tabs. Mix crushed tab with food or liquid. Never crush SL,
enteric-coated, or extended-release meds. Right patient
: two identifiers are used. MAR is checked. DO NOT use room number for identification. A wireless bar code scanner can be used.
Right route: go with orders for route and if route is missing on order, consult with prescriber. For injections, use only a preparation intended for parenteral use (mediations labeled as “for injectable use only”). Right time:
follow agency’s recommended schedule. For non-time critical medicines, administer within 1 to 2 hours of scheduled time. For time-critical meds; give STAT doses immediately, give NOW within 60 mins of order, for as needed, use clinical judgement about
timing, for “on call” drug, administer as OR requests it, and for PRN (when necessary), administer per pt’s request. Check MAR to ensure appropriate time based on last PRN meds.
Right documentation:
document med name, dose, route, time given, and any assessments obtained right after administering. Document pt response, teach pt about his meds. First check:
read MAR and then take out med, verify pt room number and name and DOB with MAR, compare label on meds and MAR to determine if calculations are needed, and check expiration date.
Second check:
while preparing meds, compare and verify both med label and MAR.
Third check:
recheck label on container before opening it at bedside or returning container back to storage. 4.
Describe multidisciplinary roles (e.g., prescriber, pharmacist, nurse) to prevent drug administration errors.
Verify order with MAR and that it is complete and accurate (must have pt full name, drug name, dosage, route, frequency included time intervals)
Consult prescriber if unusual dosage (large or small), route is other than the recommended one, order seems inappropriate for pt, and the handwritten order if it
is illegible.
Withhold med while you consult the prescriber, pharmacist, or drug guide.
If an order is received over telephone, enter it in MAR and read the entire order back to the prescriber. Lastly, write TO (telephone order) or VO (verbal order) with
prescriber name who must sign is later.
Due to high risk, TO/ VO must be done in emergent reasons.
Identify pt with two identifiers.
Ask about any allergies.
Document right after administering the meds.
Follow 6 rights in medication administration.
5.
Describe guidelines for administration and waste of controlled substances and narcotics.
When administering insulin, a narcotic, a sedative, or an anti-coagulant follow current guidelines for administering high-alert medications. And make sure to have your calculations double checked with another RN or helper if needed to resolve any errors. In addition, double check MAR before administrating any of the high-alert drugs. 6.
Demonstrate and/or describe components of patient education including medication purpose and side effects prior to administration of medication.
Guidelines for documenting the medication administration:
a.
Enter only medications you yourself administered or witnessed the patient self-
administer.
b.
If handwriting, comply with the standardized list of abbreviations, acronyms, symbols, and dose designations approved by your agency policy.
c.
Use Tall Man lettering (a mix of capital and lower-case letters) to help emphasize dissimilarities between look-alike and sound-alike drugs, such as TEGretol and TRENtal.
d.
When entering a drug dosage, never add a trailing zero after a whole number (e.g.,
1.0 mg) and always include a zero preceding a decimal value of less than 1 (e.g., 0.5 mL).
e.
Record allergy information in several places including the MAR, electronic medical record, or the front of the patient’s chart. The patient must also wear a color-coded allergy band.
Immediately after medication administration, document the following in the patient’s MAR:
a.
Drug name.
b.
Dosage.
c.
Route of administration and location of the injection site, if applicable.
d.
The exact time, the medication was given.
e.
For PRN medications, include the indication for administration and the patient’s therapeutic response.
f.
For medications that were held, document the time, and reason for withholding the medication, and any additional action taken, such as notifying the prescriber.
g.
For medications that require a pre-assessment, include information on the MAR such as BP, heart rate, or pertinent lab values.
h.
Mark each entry with your initials or signature per agency policy.
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