P REVENTING M EDICATION E RRORS The Center For Life Enrichment October 2009

T HE P ROBLEM Medication errors can occur: between brand names, generic names, and brand- to- generic names like Toradol and tramadol. abbreviations, acronyms, dose designations, and other symbols used in medication prescribing also have the potential for causing problems. illegible handwriting, unfamiliarity with drug names, newly available products similar packaging or labeling, incorrect selection of a similar name from a computerized product list, communicated verbally,

F OR E XAMPLE …. Several errors have occurred involving mix-ups with the oral diabetes drug Avandia and the anticoagulant Coumadin. Although they don’t look similar when typed or printed, the names have been confused with each other when poorly written in cursive. The first letter “A” in Avandia, if nor fully formed, can look like a “C”, and the final “a” has appeared to be an “n”. Another example is, the abbreviation “D/C” means both “discharge” and “discontinue”. The National Coordination Council for Medication Errors Reporting and Prevention (NCCMERP) notes that patients’ medications have been stopped prematurely when D/C- indented to mean discharged was misinterpreted as discontinue because it was followed by a list of drugs.

W HAT IS A “ MAR ”? MAR stands for Medication Administering Record It is a record of medications given daily to a client for any reason. On the front of the MAR you will find: Client’s name List of medications with dose instructions Name of their Physician Any known allergies An area to initial each day that you give the medication On the back of the MAR you will find: An area to fill out why PRN (as needed medicines) were given An area to explain any mistakes that were made (wrong time, medication, dose…) An area to explain any omissions or changes(client was not here, there was no medication, the doctor called the nurse with different instructions …) A place to have a record of your initial along with your name

“T O A LL CMT S ” This kindly reminder is in the nurse’s office located by the sign off board and will help you fill out the MAR. On weekends and on days that the Center is Closed put a slash in the appropriate box on the MAR Under omission write an explanation (Center Closed meds given out at home) When the Center is open and the Client does not come in or goes home before the medication should have been given– put a circle with your initials on the MAR and write on the back under omission the explanation Write the bubble number you use on the blister pack on the MAR under your initials. Controlled meds will be counted at the end of the day by 2 CMTs and documented on the Control Sheet. Outings- all meds checked out of the building must be in “double” locked box Meds removed by home staff, must sign meds out and back in

L OW R ISK M EDICATION E RRORS Using write-out or erase a mistake Failure to initial administered medications Failure to document reason/ results for PRN medication administration on the back of MAR MAR block circled without an explanation on the back of the MAR Failure of include a start date for a prescribed medication on the MAR Failure to fill out clients information at the bottom of the MAR Any other medication error not mentioned which does not result in harm to the client

H IGH R ISK M EDICATION E RRORS Failure to administer any prescribed medication without instruction from the nurse to do so. Administration of the incorrect medication Administration of medication at the incorrect time without the permission of the nurse Medication administered to the client via the wrong route ( mouth, g-tube, topical) Administration of a dose of medication other than that which has been ordered Administration of an expired medication Administration of a medication to which a client is allergic, when the allergy is documented on the MAR Failure to give medication for that day Any other medication error not mentioned which could potentially result in harm to the clinet

Medical Errors 48,000 to 98,000 people die each year as a result of preventable medical error

6 B ASIC T YPES OF A DMINISTRATION E RRORS 1. Error of Omission 2. Error of Commission 3. Incorrect Dose Preparation Error 4. Incorrect Administration Technique 5. Deterioration Error 6. Unordered or Extra Dose Medication Error

R EVIEW OF C OMMON MISTAKES Not remembering your consumers who take daily meds. Not filling the MAR out entirely Not writing the bubble number (if applicable) Waiting until the client has 3 days of meds left Not signing the back of the MAR Not writing an Omission on the back of the MAR Not giving the med at the scheduled time Rushing at the end of the day to give meds One-on-ones need to delegate their responsibility of giving meds should they leave for the day

S OME H ELPFUL THINGS WE CAN DO Only one person at a time in the nurses office Ask the nurse any questions or concerns Letting the nurse know when a mistake has been made. It is better to acknowledge a mistake right away. No one is perfect, we all have days when things don’t go right. Even for staff who are not med-certified, they are still responsible to make sure the clients in their room have received their medication before they leave for the day. One way to make sure this doesn’t happen is creating a check list for your individuals so at the end of the day you can check the list to make sure all their needs are met before they leave.

B EING ACCOUNTABLE FOR YOUR MISTAKES CMT’s will be written up for the following offences. After 3 offences the CMT will be suspended from giving meds until a review is scheduled. Not bringing in a client to receive their meds Not filling out the MAR completely Not following the procedure for dispensing “controlled meds” Not signing meds out on the “check-out” sheet when going on an outing Not sending medicine renewal sheet home when there’s 3 days left of a medication

7 RIGHTS 1. The right individual 2. The right medication 3. The right dose (E.g. 1mg, vs.. 3mg …. ) 4. The right time that the medication is to be given 5. The right route (E.g. mouth vs. topical…) 6. The fight form (E.g. liquid, pill, powder ….) 7. The right documentation

H OW TO DISPOSE Guidelines for Drug Disposal Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so. If no instructions are given, throw the drugs in the household trash, but first: Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash. Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag. Take advantage of community drug take-back programs Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information. Do not give medications to friends. Doctors prescribe drugs based on a person's specific symptoms and medical history. A drug that works for you could be dangerous for someone else. When in doubt about proper disposal, talk to your pharmacist

I MPORTANT THINGS TO REMEMBER …. A three way check is used to ensure you give the medication in a safe and secure manor, by checking 3 things the MAR Doctors Orders, Pharmacy Label Checking the bottle at least 3 times ensures you have the right person right medication right route

T O R EMEMBER ….. Many medications come in Generic form. Checking the generic with the brand is very important to make sure you have the right medication. When disposing expired meds remember to mix it with something undesirable and place it in a plastic baggy before dumping it in the trash. At times when a new medication is started their maybe some mild side affects such as lightheadedness or nausea that disappear after a short while Consumers who attend TCLE that self-medicate will have to meet with the nurse to ensure they are taking the medication in a safe manor. Direct Care Staff will then monitor them while they take their medication to ensure it is taken safely.

A LSO TO REMEMBER …. TCLE and the DDA require you to be med-certified if you are administering medications to our consumers When a consumer goes on an outing their medication is to be double locked in their box or blue bag and locked in the car Some consumers take medication that is considered a narcotic. All narcotics and a few other medications are controlled by the state to ensure that the medication is monitored and counted daily. Any medication that is Expired should NOT be given to a consumer. If you come across an expired drug notify the nurse and caregiver.

QUIZ 1.You should check the medicine bottle at least 3 times before giving the med. True or False: _________________________________ 2. Generic medications and Brand name medications can have names that are very similar, so it would be easy to give the wrong medicine. How would you know you are giving the right medicine to the right person, list 3 things you should do prior to giving the medication. _________________________________________________ 3. What is the best way to dispose of medication? _________________________________________________ 4. When you are aware a client is taking a new medication there may be some side affects, such as light-headedness or stomach upset this is normal. True or False: _________________________________ 5. Clients who are self-mediators take their own medications. The direct care staff should monitor them. True or False: _________________________ 6. Becoming a CMT is mandatory by the DDA and TCLE if you are administering medications to our consumers? True or False: ___________________________ 7. When on an outing with clients who take medications, where do you keep the medications? ________________________________________________ 8. What consist of the 3-way check when giving a medication, list the 3 things: _______________________________________________ 9. A controlled medication is a medication such as a narcotic, why is it called controlled? _______________________________________________________________________ _______________________________________________________________________ 10. You’re about to give a medication and see that it is expired, what should you do? __________________________________________________________________ Name:____________