Report on Medication Errors

1.5 million americans harmed or killed by preventable medication errors annually

reported:

wrong medications or does in iv

dangerous interactions

wrong dose dispensed by pharmacy

wrong dose given by nurses

Joint commission national patient safety goals

improve the accuracy of patient identification-2 identifiers

improve the effectiveness of communication

improve the safety of using medications

accurately and completely reconcile medication across the continuum of care

Joint commission national safety goals

2011

immediately discard and medication or solution found unlabeled

use only oral unit-dose products, prefilled syringes, or premixed infusion bags when types of products are available

before starting a patient on warfarin, assess the baseline coagulation status...

at the time the pt enters the hospital , a complete list of medications the pt is taking at home is created and documented

any descrepancies are reconciled and documented while the pt is under the care of the hospital

key to safety is preparation assessment

know what and why before administration-use critical thinking

generic and trade name

dose

route

frequency

time

allergies/other meds on MAR

specific orders to hold (BP, pulse, etc)

stop order

high alert-anticoagulants, narcotics, hypoglycemic meds

acceptable window of timely med administration

Rights of Medication Administration

right:

drug

patient

dose

 route

time

documentation

procedure for medication administation

clean hands

prepare only one pts meds

remove meds per MAR

check medication label with MAR

check medication label with MAR again

place unopened package into med cup

procedure for medication administration at bedside

proceed to bedside with MAr and meds

identify the patient-2 identifiers-name and birth date

reconfirm any allergies verbally and with band

always perform appropriate pt teaching

open and administer meds

never leave meds at bedside

position pt if needed

assess pt swallows the medication

wash hands

document medication was given via protocol

document med held or refused per facility policy and why

-at test

-NPO for surgery

_not needed (labs, vitals)

notify physician if needed-use critical thinking

procedure for administering oral medications

forms:

solids 

capsules

enteric coated-do not crush

liquids

crushed meds-place in soft foods

sublingual

buccal

eye drops/ointment

ear drops-adults pull up and outward

kids-pull down and back

nasal spray

inhalers

topical/transdermal-wear gloves

rectal-adults insert 4 in

children insert 2 in

parenteral

parenteral medication administration

equipment needed

syringes for injection-.3 to 3ml

insulin marked in units

needles-

hub, shaft, bevel

1/4-3 inches

vials

ampules

alcohol swabs

assessment-all meds, assess circulation, adipose tissue and muscle atrophy

prepare medication-asceptically

wash hands/gloves

select site

place pt in comfortable position

cleanse site-center outward

remove cap or slide safety barrel back

hold syringe as a dart

inject as per procedure

discard in sharps container

skin testing

small syringe

hypodermic 25-27g

3/8-1/2 inch

injection into the dermis, inner aspcet of arm

.01-.1 ml

angle needle 5-15 degrees

pull skin taut bevel up

do not aspirate

inject slowly, small bleb

Subcutaneous injections

purpose:slow absorption, sustained effect

syringe:.5-3 ml, 25-27g, 3/8-5/8

sites:upper arm, abdomen, thigh, back, ventrodorsal gluteal area

1 ml or less

choose and cleanse site

pinch skin

insert 45-90 degree angle

release tissue and inject slowly

remove and apply gentle pressure

discard in sharps container

special considerations

insulin

administered subq

controls blood glucose levels

ordered in units-stading order and sliding scale

verify blood sugar before giving

insulin must be verified with another licensed nurse

know the onset and peak-

NPH-long acting (cloudy)

regular- short acting (clear)

mixing-clear into cloudy

Special considerations

anticoagulants

if drawing up-change needle after

lower abdomen fat pad

avoid ecchymotic areas, scars, lesions

do not aspirate

inject slowly, 90 degree angle, wait 10 sec before withdrawing

press gently, do not massage

intramuscular injections

Purpose:promote rapid absorption

syringe-1-5 ml, deltoid: 23-25g 5/8 to 1 in

vastus/ventrogluteal 18-23g 1-1 1/2 in

sites:ventrogluteal, vastus lateralis, deltiod

up to 3 ml adults

2ml older adults and thin pts

1ml infants and small children

procedure

intramuscular injections

choose and cleanse site

pull skin taut-z track

90 degree angle

ASPRIRATE-if no blood inject slowly

remove needle and apply gentel pressure

discard syringe in sharps container

special considerations

intramuscular injections

deltoid

-upper arm 1-2 in below acromion process

-faster absorption, easily accessible, less pain

-disadvantage:small muscle, limited amounts, .05-1 ml, radial nerve, axillary nerve

vastus lateralis

-supine position, inject 90 degree into mid 3rd and anterior lateral aspect of thigh

-children under 2

-large muscle, larger amount of fluid, easily accessible

-disadvantage: thrombosis of femoral artery, more painful

ventrogluteal

-pt on side, form v from greater trochanter to iliac crest, thumb toward belly button

-90 degree angle, free of important nerves and vessels, easily identified, large amount of fluid, less painful

disadvantage:nurses unfamiliar with site