Chapter 5 MEDICATION ERRORS PREVENTING AND RESPONDING DSN

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Chapter 5 MEDICATION ERRORS: PREVENTING AND RESPONDING DSN KEVIN DOBI, MS, APRN Copyright ©

Chapter 5 MEDICATION ERRORS: PREVENTING AND RESPONDING DSN KEVIN DOBI, MS, APRN Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Adverse Drug Event 2 �Medication errors Institute of Medicine studies (1999, 2006) �Adverse drug

Adverse Drug Event 2 �Medication errors Institute of Medicine studies (1999, 2006) �Adverse drug reactions Allergic reaction Idiosyncratic reaction Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

3 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

3 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question 4 In the 2006 Institute of Medicine Study, it was estimated

Classroom Response Question 4 In the 2006 Institute of Medicine Study, it was estimated that some form of medication error resulted in harm to how many patients? A. B. C. D. 400, 000 800, 000 1 million 1. 5 million Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Medication Errors 5 �Preventable �Common cause of adverse health care outcomes �More potential for

Medication Errors 5 �Preventable �Common cause of adverse health care outcomes �More potential for harm with “high-alert” medications Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Issues Contributing to Errors 6 �Errors can occur during any step of medication process:

Issues Contributing to Errors 6 �Errors can occur during any step of medication process: Procuring Prescribing Transcribing Dispensing Administering Monitoring Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Issues Contributing to Errors (cont’d) 7 �Organizational issues �Educational system issues �Sociologic factors Copyright

Issues Contributing to Errors (cont’d) 7 �Organizational issues �Educational system issues �Sociologic factors Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Types of Medication Errors 8 �No error, although circumstances or events occurred that could

Types of Medication Errors 8 �No error, although circumstances or events occurred that could have led to an error �Medication error that causes no harm �Medication error that causes harm �Medication error that results in death Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors 9 �Multiple systems of checks and balances �Legible and correct orders

Preventing Medication Errors 9 �Multiple systems of checks and balances �Legible and correct orders �Appropriate consultation �Check medication order three times �“Six Rights” of medication administration Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 10 �Minimize verbal or telephone orders Repeat order to prescriber

Preventing Medication Errors (cont’d) 10 �Minimize verbal or telephone orders Repeat order to prescriber Spell drug name aloud Speak slowly and clearly �List indication next to each order �Avoid medical shorthand, including abbreviations and acronyms Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 11 �Never assume anything about items not specified in a

Preventing Medication Errors (cont’d) 11 �Never assume anything about items not specified in a drug order (e. g. , route) �Do not hesitate to question a medication order for any reason when in doubt �Do not try to decipher illegibly written orders; contact prescriber for clarification Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 12 �NEVER use a “trailing zero” with medication orders Do

Preventing Medication Errors (cont’d) 12 �NEVER use a “trailing zero” with medication orders Do not use 1. 0 mg; use 1 mg 1. 0 mg could be misread as 10 mg, resulting in a tenfold dose increase Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 13 �ALWAYS use a “leading zero” for decimal dosages Do

Preventing Medication Errors (cont’d) 13 �ALWAYS use a “leading zero” for decimal dosages Do not use. 25 mg; use 0. 25 mg may be misread as 25 mg Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 14 �Take time to learn special administration techniques of certain

Preventing Medication Errors (cont’d) 14 �Take time to learn special administration techniques of certain dosage forms �Always verify new medication administration records Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Preventing Medication Errors (cont’d) 15 �Always listen to and honor any concerns expressed by

Preventing Medication Errors (cont’d) 15 �Always listen to and honor any concerns expressed by patients regarding medications �Check patient allergies and identification Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question 16 The nurse is administering a drug that has been ordered

Classroom Response Question 16 The nurse is administering a drug that has been ordered as follows: “Give 10 mg on odd-numbered days and 5 mg on even-numbered days. ” When the date changes from May 31 to June 1, what should the nurse do? A. Give 10 mg because June 1 is an odd-numbered day B. Hold the dose until the next odd-numbered day C. Change the order to read “Give 10 mg on evennumbered days and 5 mg on odd-numbered days” D. Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd- or even-numbered Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Reporting Medication Errors 17 �Report to prescriber and nursing management �Document error per policy

Reporting Medication Errors 17 �Report to prescriber and nursing management �Document error per policy and procedure �Factual documentation only Medication administered Actual dose Observed changes in patient condition Prescriber notified/follow-up orders Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Reporting Medication Errors (cont’d) 18 �External reporting of errors USP MERP (United States Pharmacopeia

Reporting Medication Errors (cont’d) 18 �External reporting of errors USP MERP (United States Pharmacopeia Medication Errors Reporting Program) Med. Watch, sponsored by the FDA Institute for Safe Medication Practices (ISMP) The Joint Commission Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question 19 The nursing student realizes that she has given a patient

Classroom Response Question 19 The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient’s blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first? A. B. C. D. Notify the patient’s physician Notify the clinical faculty Take the patient’s blood pressure Continue to monitor the patient Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Medication Reconciliation 20 �Continuous assessment and updating of patient medication information Verification Clarification Reconciliation

Medication Reconciliation 20 �Continuous assessment and updating of patient medication information Verification Clarification Reconciliation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Medication Reconciliation (cont’d) 21 �Should be done at each stage of health care delivery:

Medication Reconciliation (cont’d) 21 �Should be done at each stage of health care delivery: Admission Status change Patient transfer within or between facilities/provider teams Discharge Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Ethical Issues 22 �Notification of patients �Possible consequences for nurses Copyright © 2014 by

Ethical Issues 22 �Notification of patients �Possible consequences for nurses Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CHAPTER 5 Medication Errors Preventing and Responding NDEGCHAPTER 5 Medication Errors Preventing and Responding NDEG
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