Chapter 7 Safe Medication Administration Copyright 2010 Delmar

Medication Administration Record (MAR) • Although some differences among health care facilities, MARs are

MAR Similarities • Large column usually on left-hand side of MAR form that contains:

MAR Similarities • Usually three columns designated for documenting medication administration for day, evening,

MAR Similarities • Space for precautions related to administration, such as checking: – Pulse

MAR Similarities • Column for initials of person transcribing medication from order sheet to

MAR Similarities • Area where all staff initials identified with full name and title

Six Rights of Medication Administration • • • Right drug Right dosage Right route

Right Drug • Check every drug three times: – When drug is located –

Right Dosage • Compare to average dosages • Metric dosages containing decimals are of

Right Route • Oral • Sublingual – Under tongue • Drops – For eye,

Right Route • • Transdermal Inhalation Creams Suppositories Copyright © 2010 Delmar, Cengage Learning.

Right Route • Parenteral routes – Intravenous (IV) • Most common – Intramuscular (IM)

Right Time • Standard time – 12: 00 a. m. for midnight to 11:

Right Time • Military time – 0001 for one minute after midnight to 2359

Right Time • Military time – After one o’clock in the afternoon, 12 hours

Right Person • Most important nursing intervention • Check ID band read both surname

Right Documentation • When medication administered, must be documented immediately • Never record before

Right of Refusal • Partner with client • If client questions medication, consider client

Medication Errors • Estimated 100, 000 people die each year from medication errors •

JC “Do Not Use” List • U – Write “unit” • IU – Write

Joint Commission “Do Not Use” List • QOD, Q. O. D. , q. o.

JC “Do Not Use” List • Omit trailing zero – e. g. , write

ISMP List • More in-depth listing developed by Institute for Safe Medication Practice (ISMP)

Errors in Abbreviations • Use of abbreviations identified by Joint Commission and ISMP as

Errors in Writing Metric Dosages • Using trailing zero • Failing to place zero

Actions When Medication Errors Occur • Report as soon as discovered • Institute necessary

Preventing Medication Errors • Avoid two biggest factors in medication errors: – Distraction –

Preventing Medication Errors • Always use Six Rights of Medication Administration • “Routine” medication

Preventing Medication Errors • MARs are immediate reference for medication administration – Must be

Medication Errors • Can be held legally responsible if wrong drug or dosage given

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Medication Administration Record (MAR) • Although some differences among health care facilities, MARs are more similar than they are different Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

MAR Similarities • Large column usually on left-hand side of MAR form that contains: – Drug names • Both scheduled and as needed (prn) – Drug dosage – Frequency of drug administration Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

MAR Similarities • Column for initials of person transcribing medication from order sheet to MAR • May include “start” and “stop” columns – Indicate what day and time medication is to be started and stopped Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

MAR Similarities • Area where all staff initials identified with full name and title • May be one sheet (front and back) or two sheets to separate scheduled and prn medications Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right Drug • Check every drug three times: – When drug is located – Just before opening or pouring medication – Immediately prior to administration Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right Time • Standard time – 12: 00 a. m. for midnight to 11: 59 p. m. for one minute before midnight – Times are duplicated during 24 -hour period – Only a. m. and p. m. differentiate Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right Time • Military time – After one o’clock in the afternoon, 12 hours added to each time until midnight – e. g. , 1300 = 1: 00 p. m. , 1700 = 5: 00 p. m. , 2200 = 10: 00 p. m. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right Person • Most important nursing intervention • Check ID band read both surname and first name – Perform every time medication given • No exceptions Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right Documentation • When medication administered, must be documented immediately • Never record before administered • MARs are immediate reference for medication administration – Must be maintained up-to-the-minute Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Right of Refusal • Partner with client • If client questions medication, consider client correct until proven otherwise • Client also has right to refuse medication Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Medication Errors • Estimated 100, 000 people die each year from medication errors • Occur during: – – Prescribing Transcribing Calculating Administering Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Joint Commission “Do Not Use” List • QOD, Q. O. D. , q. o. d. , or qod – Write “every other day” • MS – Write “morphine sulfate” • MSO 4 or Mg. SO 4 – Write “magnesium sulfate” Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

JC “Do Not Use” List • Omit trailing zero – e. g. , write X. 0 mg as X mg • Use zero before decimal number – e. g. , write. X mg as 0. X mg Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

ISMP List • More in-depth listing developed by Institute for Safe Medication Practice (ISMP) in cooperation with Food and Drug Administration (FDA) • Can be located at: www. ismp. org/tools/errorproneabbreviations. pdf Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Errors in Abbreviations • Use of abbreviations identified by Joint Commission and ISMP as error-prone – e. g. , write drug frequency q 2 h as “every 2 hours” Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Actions When Medication Errors Occur • Report as soon as discovered • Institute necessary remedial measure immediately • Determine reason for error • Prepare incident/accident report • Institute corrective policies/procedures to prevent recurrence, if possible Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Preventing Medication Errors • Avoid two biggest factors in medication errors: – Distraction – Fatigue • Exercise extreme caution when administering medications Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Preventing Medication Errors • Always use Six Rights of Medication Administration • “Routine” medication administration should never be routine Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.