Preventing Medication Errors (p. 71) 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 Medication errors, while preventable, are a common cause of adverse health care outcomes. Effects can range from no significant effect to directly causing disability or death. There are possible consequences for nurses. NURSING APPLICATION: What abbreviations in Ms. Jackson's chart could cause problems with her medications? Copyright © 2011 by Elsevier Inc. All rights reserved.

Preventing Medication Errors (cont’d) (p. 72) 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 Always use a leading zero to distinguish decimals (i.e., 0.25 mg, not .25 mg) Avoid abbreviations, medical shorthand, and acronyms Some of the more common types of medical errors include misdiagnosis, patient misidentification, lack of patient monitoring, wrong-site surgery, and medication errors. NURSING APPLICATION: How can the computer cause medication errors? Copyright © 2011 by Elsevier Inc. All rights reserved.

Reporting Medication Errors (p. 74) 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 External reporting of errors is also important (i.e., USPMERP, ISMP, The Joint Commission) NURSING APPLICATION: Discuss the procedures for documenting medication errors. Copyright line.

Medication Reconciliation (p. 75) Should be done at each stage of health care delivery: Admission Status change Patient transfer within or between facilities/provider teams Discharge A procedure implemented by health care providers to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. Medication reconciliation is a Joint Commission requirement. Ongoing assessment and updating of information on patients’ medications Timely communication of this information to both patients and their prescribers NURSING APPLICATION: How can Ms. Jackson’s family help with reconciliation? Copyright © 2011 by Elsevier Inc. All rights reserved.

Use of Over the Counter (OTC) Medications (p. 87) May postpone effective treatment of more chronic disease states May delay treatment of serious and/or life-threatening disorders May relieve symptoms of a disorder but not the cause Use for short-term treatment of common minor illnesses Interactions with current prescription medications may occur Patient education There are currently more than 300,000 OTC products containing over 800 active ingredients. Health care consumers use OTC drugs to treat or cure more than 400 different ailments. Over 700 medications that formerly required a prescription are now available OTC. NURSING APPLICATION: What is a good method of determining what OTC medications were taken in addition to loratadine 10 mg? Copyright © 2011 by Elsevier Inc. All rights reserved.

Consumer Use of Herbs (p. 90) Therapeutic agents for treatment and cure of diseases Prophylactic agents for long-term prevention of disease Proactive agents to maintain health and wellness and “boost” one’s immune system "Dietary supplement" is a broad term for orally administered alternative medicines and includes the category of herbal supplements. Come from nature and include the leaves, bark, berries, roots, gums, seeds, stems, and flowers of plants. They have been used for thousands of years to help maintain good health. About 30% of all modern drugs are derived from plants. NURSING APPLICATION: What questions should be asked when assessing a patient for use of herbal medications? Copyright © 2011 by Elsevier Inc. All rights reserved.

Commonly Used Herbal Products (p. 92) Aloe Feverfew Gingko Goldenseal St. John’s wort Valerian Echinacea Garlic Ginseng Hawthorn Saw palmetto Manufacturers of herbal supplements do not have to provide the FDA with evidence to substantiate claims of safety or effectiveness of their products, except in the case of a new dietary ingredient. A false sense of security has been created by their widespread use, and the public tends to believe that if a product is “natural,” then it is safe. NURSING APPLICATION: Explain how the nurse should approach Ms. Jackson's family about her use of herbal products, considering Ms. Jackson’s ethnic background. Copyright © 2011 by Elsevier Inc. All rights reserved.

Nursing Assessment (p. 93) Obtain thorough medication history, documenting all medications used (prescription, OTC, herbal products, vitamins, minerals, other dietary supplements) Assess level of education and understanding Assess for information specific to various products Contraindications, cautions, and potential drug–drug/drug–food interactions should be considered before a patient uses herbal supplements. Past and present medical history, so that possible drug interactions, contraindications, and cautions may be identified Patients often assume that if a drug is sold OTC it is completely safe to take and without negative effects Patients may be taking certain medications that react adversely with these drugs, and laboratory testing may be needed. NURSING APPLICATION: How will the nurse gather information about Ms. Jackson's use of OTC? Copyright line.

Nursing Assessment (cont’d) (p. 93) Assess system functions (especially renal, liver, and cardiac) Assess for conditions that are contraindications Assess for potential drug–drug and drug–herb interactions The FDA has established the MedWatch program to track adverse events and/or problems related to drug therapy. NURSING APPLICATION: What conditions could be contraindications for OTC products? Copyright © 2011 by Elsevier Inc. All rights reserved.

Nursing Implications (cont’d) (p. 94) Herbal products may not be safe for pregnant or breastfeeding women, infants, children “Natural” does not necessarily mean safe Teach patients to monitor themselves for unusual or adverse reactions as well as therapeutic responses Emphasize the importance of patient awareness of all possible interactions and/or concerns associated with the use of herbal and OTC products. NURSING APPLICATION: Why would herbal products not be safe for pregnant patients? Copyright © 2011 by Elsevier Inc. All rights reserved.