1. N3702W Module One Legal Issues Video – Group 3
Topic 7:  Chapter 18:  Medication Administration
By Jesus Herrera, Ashley McCaw, and Tanya Morgan

2. Medication Administration Facts
Westrick (2014) states that nurses spend 40-60% of their time administering medications while at work. 
The Institute of Medicine (2000) reported that 44, ,000 deaths occur due to preventable medication administration errors (Westrick, 2014).
These errors occur from failure to follow the basic standards of care for safe administration.

3. Medication Administration Standards of Care for Safe Administration
 Negligence to Follow 6 Rights
 Medication Error
 Patient Harm
Follow the "6 Rights" of medication administration:
Right patient
Right drug
Right dose
Right time
Right route
Right documentation 
(Westrick, 2014)

4. Other Reasons For Medication Errors
Failure to follow "6 Rights" of medication administration
The large amount of medications a nurse is responsible for
Multiple medication dosing for individual patients
Failure to update knowledge of drugs and their contraindications and implications
Poor product labeling
Understaffing
Distractions
Poor communication
Underlying system failures
Increased nurse- patient ratios
(Westrick, 2014)

5. Standards of Care for Safe Administration
The Joint Commission goals include:
Using two patient identifiers and the 3 checks
"Read back" verbal or telephone orders
Standardized lists of abbreviations (can be found on Website)
Improving timeliness of reporting
Implementing standardized "hand off" communication approaches when care transitions from one person to another
Identify a list of all sound- alike drugs and take action to prevent errors of these drugs
Complete list of medications must be communicated when the patient is transferred
(Westrick, 2014)

6. Medication Administration Risk Management Considerations
Risk Management is the process or processes by which risks are assessed, minimized or prevented through the use of safety measures (Westrick 2014)
Individual accountability is paramount in risk management because the nurse is the last safety barrier between the patient and the medication (Westrick 2014)
Approximately 34% of preventable medication-related adverse effects occur at administration stage (Ghenadenik, Rochais, Atkinson, & Bussières, 2012)

7. Medication Administration Risk Management Considerations
Risk Management analysis for system failures:
Risk management analysis is the job of every nurse, all facility safety measures must be followed by every nurse for every medication administration (Ghenadenik, Rochais, Atkinson, & Bussières, 2012)
Nurses must report all medication concerns, incidents and near misses so that corrective action may take place, also to prevent similar errors from occurring in the future (Westrick 2014)

8. Medication Administration Risk Management Considerations
Corrective steps in systems:
Problem identification through trends and patterns
Solution identification and implementation, i.e.: dual signoff policy, high-alert medication notifications
Evaluation of solution effectiveness, have error/near misses decreased? Do other changes need to be made? (Ghenadenik, Rochais, Atkinson, & Bussières, 2012)

9. Medication Administration Risk Management Considerations
Individual education: nurses are responsible for familiarizing themselves with medications commonly used in their department
Nurses are responsible utilizing references for medications that they are unfamiliar with as is their duty to administer medications in a safe manner
Nurses must question "high risk" medication orders for verification and clarity, furthermore, if a nurse does not agree with the order or feels unsafe, it is their duty to refuse to administer it
(Ghenadenik, Rochais, Atkinson, & Bussières, 2012)

10. Medication Administration Error Reduction Through Technological Advances
Automated Dispensing Cabinets (ADCs):
ADCs allow medical personnel to obtain individual medications per specific patient orders.
ADCs employ an assortment of mechanisms to improve safety during administration of medications.
(Westrick, 2014)

11. Medication Administration Error Reduction Through Technological Advances
Benefits of ADCs:
Medications can be reviewed and approved via a screening process by the pharmacist prior to administration.
ADCs reduce or completely eliminate missed doses and the improve the availability of medications.
Inventory control and charging for medications have shown improvement with the implementation of ADCs.
Built-in safety alerts for medications and locked-lidded compartments for high-alert drugs is of particular importance to nurses.
(Westrick, 2014)​

12. Medication Administration Error Reduction Through Technological Advances
Drawbacks of ADCs:
Patient safety can be compromised if medical personnel use system overrides to obtain medications.
According to Stachowiak (2013), time-consuming procedures can lead to risky work-arounds.
One work-around included pulling all patients' meds at one time and putting them into cups or bags.
Another work-around involved administering meds then documenting them later in the shift.

13. A nurse working in the ICU at a major medical center is preparing to administer an IV antibiotic medication that he is unfamiliar with.  The nurse should:
A.  Familiarize himself with the medication by using a drug reference book he used in nursing school five years ago
B.  Ask another nurse to prepare and administer the drug since he should not do it
C.  Check for any hospital formulary IV medication instructions / information to ensure correct administration and current information about the medication
D.  Ask another nurse if she has given this medication and if so, to fill him in on what she knows about the medication

14. Medication Administration Error Reduction Through Technological Advances
Smart Infusion Pumps:
The use of smart infusion pumps is another technological advance that has improved patient safety greatly.
It has become standard practice to utilize electronic pumps to administer IV solutions and medications.
The addition of computer software has coined the phrase of "smart pumps" due to the addition of medication libraries with dosage alerts, maximum dose guidelines, and profiles for specific patient needs by diagnosis.
kwipped.com 
(Westrick, 2014)

15. (Mansfield and Jarret, 2015)
Medication Administration Error Reduction Through Technological Advances
Benefits of Smart Infusion Pumps:
Alerts generated by intravenous (IV) infusion pump safety software can prevent life threatening situations.
Drug library updates are scheduled several times a year or when deemed immediately necessary.
Manual dosage calculation errors have become an error of the past with the implementation of smart IV pumps and computer software.
(Mansfield and Jarret, 2015)

16. (Mansfield and Jarret, 2015)
Medication Administration Error Reduction Through Technological Advances
Disadvantages of Smart IV Pumps:
Health care workers can become desensitized to clinically insignificant alerts and discount their importance.
Many studies have documented the harm resulting from audible alarms being ignored by nurses and other healthcare providers in a phenomenon called alarm fatigue.
Infusion rates that don't match for medications can create confusion and interfere with the nurse effectively programming the pump.
(Mansfield and Jarret, 2015)

17. All of the following are results that a nurse might expect related to a medication error except one.  Which is not an expected result of a medication error?
A.  The employer can discharge the nurse from employment
B.  A state board may discipline the nurse's license
C.  The nurse may be criminally charged by the state if there is extreme recklessness involved with the error
D.  The nurse may be sued by the injured patient, but the employer will be found liable if the nurse is employed as a contract employee.

18. Nurse Leaders' Role as it Relates to Liabilities in Medication Administration
As stated by Cooper (2016), if a nurse manager/supervisor allows a medication to be administered that is being questioned as unsafe by a subordinate nurse the supervising nurse can be held responsible if a poor outcome is attained.
Nurse leaders are expected to apply their extensive knowledge base and critical thinking skills to lead the less knowledgeable and less experienced staff if trepidation is noted.
Nurse leaders are also required to choose their staff to be reliable and dependable and to provide the education needed for them to be considered adequate.
When a deviation from the standard of care occurs, it is imperative that nurses follow the chain of command so that patient safety is the resounding factor.

19. References
Cooper, P. J. (2016, February). Nursing Leadership and Liability: An Analysis of a Nursing Malpractice Case. Nurse Leader, doi: /j.mnl
Blegen, A., Hughes, R. G. (April, 2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 37-  Medication Administration Safety. Retrieved from 
Ghenadenik, A., Rochais, É., Atkinson, S., & Bussières, J.-F. (2012). Potential Risks Associated with Medication  Administration, as Identified by Simple Tools and Observations. Canadian Journal of Hospital Pharmacy, 300*307. Retrieved from
Mansfield, J., & Jarrett, S. (2015, February). Optimizing Smart Pump Technology by Increasing Critical Safety Alerts and Reducing Clinically Insignificant Alerts. Hospital Pharmacy, 50(2), doi: /hpj
Stachowiak, M. E. (2013, May). Automated Dispensing Cabinets: Curse or Cure? American Journal of Nursing, 113(5), 11. doi: /01.NAJ f
Westrick, S. J. (2014). Essentials of Nursing Law and Ethics. Burlington, MA: Jones and Bartlett Learning.