1. Preventing Medication Errors
Chapter 9
Preventing Medication Errors
READ ARTICLE ABOUT SN’S HAVING A KEY ROLE IN CULTURE OF SAFETY
Medication admin. Is one of the primary functions of the nurse in most health care settings.
ANY health care practitioner is at risk for making an error.
Several studies indicate there is no relationship between years of service and making errors….ask WHY??

2. Medication Errors Medication administration errors are common
Account for 10% to 18% of hospital injuries
Account for 44,000 to 98,000 deaths in U.S. hospitals annually
Note: The incidence of medication errors and the characteristics of the nurse (years practicing and education) have no relationship.
Ask: what do you think some of the effects are of med error

3. Medication Errors Effects: Increased length of stay Increased cost
Patient disability
Death
Harm to nurse’s personal and professional status, confidence, and practice
The Institute of Medicine estimates that hospitalized patients are subjected to one medication error a day.

4. Medication Errors
Medications that have been designated as high-alert drugs have the highest risk of causing injuries due to errors.
The Joint Commission identified these drugs as high alert medications

5. These drugs are: Insulin Opiates Narcotics Injectable potassium
Intravenous anticoagulants
The term opiates refers to natural or slightly modified components of opium such as codeine, morphine and heroin.\
Narcotics are a subclass of opiates

6. Steps in Safe Medication Administration
Complete prescription
Accurate transcription
Correct administration
The delivery process is complex. It involves many individuals and departments.
SAFE ADMINISTRATION BEGINS WITH: read slide

7. Rule
The wise nurse ALWAYS verifies the safety of the drug order by consulting a reputable drug reference!!
Examples/resources for reference guides: ask class

8. Complete Prescription
Licensed providers must have authority within their state to write prescriptions
Includes verbal orders
Repeat and verify all verbal orders for accuracy
Write down and read back all telephone orders
MD’S, DDS, DO, PODIATRITS, NP’S, PA’S all have authority to write prescriptions

9. Complete Prescription
Nurses play an important role in preventing errors at prescription step
Practitioner who administers drug shares liability for injury
Even if medical order was incorrect
Verify safety of drug order by checking reliable drug reference
Ask class to state seven parts of drug order
Reliable references include: hospital formulary, MAR, etc

10. Verbal Orders Seven parts of all drug orders: Patient’s name
Date and time of order
Name of drug
Dosage of drug
Route
Frequency or administration schedule
Prescriber’s name and licensure
As with written med orders, it is necessary for the nurse to be sure all 7 parts of the drug order have been included and are accurate.
WHAT if there is confusion or an inaccuracy???

11. Verbal Orders
Write or enter verbal or telephone order into patient’s medical record
Read order back to prescriber to ensure clarity
Receive confirmation that order is correct
Use example of playing telephone to illustrate communication errors.
The joint commission states for emergencies ie, a code, a “repeat back” is acceptable

12. Alert Verbal orders can easily lead to medication errors
Nurses must understand their responsibility
Caution: Verbal orders are a major responsibility and
a situation that can easily lead to medication errors. You should be informed about the policies in the health care facilities where you work.
Most health care facilities have rules re verbal orders

13. Accurate Transcription
Institute for Safe Medication Practices (ISMP) identifies unsafe:
Abbreviations
Acronyms
Symbols
also, the MD’s handwriting can be a source for concern
Both the JC and ISMP have published these lists due to common errors associated with above
JC published do Not Use List page 183

14. ISMP
Suggests that health care facilities identify unsafe abbreviations within organization
Know own organization’s policies
Pages
Initially the JC issued its DO NOT USE LIST IN at the same time the ISMP designated a list of potential error causing abbreviations. Now, JC advices hc organizations to look at ISMP list.
Nurses need to stay abreast to guidelines and restrictions according to both of these organizations

15. Do Not Use U (unit) IU (international unit)
Q.D., QD, q.d., or qd (daily)
Q.O.D., QOD, q.o.d., or qod (every other day)

16. Do Not Use Trailing zero (X.0 mg) Lack of leading zero (.X mg)
MS or MSO4 (morphine sulfate)
MgSO4 (magnesium sulfate)

17. Computerized Order Entry
Many health care institutions are utilizing a computerized physician/prescriber order entry (CPOE) system to help eliminate transcription sources of error.
Helps to alleviate questionable handwriting from prescribers

18. Safe and Correct Administration
Six Rights
Right patient
Right drug
Right amount
Right route
Right time
Right documentation

19. Right Patient
Correctly identify patient using two identifiers prior to medication administration
Compare armband with medication administration record
Ask patient to state name and DOB
Compare picture to patient
Use electronic identification technology coding
One of three most common causes of med error…The failure of the nurse to accurately id a a pt is the most common cause for error

20. Right Patient
Tell patient at time of administration what medication and dosage is being administered
Patient may question drug or dosage
Provides opportunity to do medication teaching
May prevent an error if patient questions drug or amount

21. Right Drug 1st!! Check your medication order from prescriber
Check medication label against MAR three times during administration:
On first contact with drug
Prior to measuring
Pouring, counting, or withdrawing
After preparing drug, just prior to administration

22. Right Drug Be aware of distractions
Do not multitask during administration
Use barcode scanning when available
Be knowledgeable about drug’s actions, indications, and contraindications
Distractions have been id’d as a key reason for error for obtaining the right drug

23. Right Amount Carefully read and clarify drug orders Recheck labels
Have two nurses double-check potent medications
Common sources of errors
Insulin
Narcotics

24. Right Amount Consult drug references
Conduct accurate dosage calculations

25. Right Route
Consult drug information source to confirm correct route

26. Right Route
May need to change or clarify forms or routes of drug for safe medication administration
Nil per os (NPO) status
Nasogastric or surgically inserted tubes
Time-release or enteric-coated medications
Only prescriber can change route
A common error relates to the nurse and his/her lack of knowledge of a drug

27. Right Time Order should include frequency of administration
Use safe abbreviations
Page 193…read

28. Right Documentation
Document as soon as possible after administration. “REAL TIME CHARTING” is best practice.
Omitting documentation can result in over- or under-medication

29. Reminders Check labels carefully
Follow Six Rights of medication administration
Be aware of and adhere to facility’s policies on medication administration
Refer to reputable drug reference resources to validate the safety of the medication as ordered and transcribed

30. Reminders Check medication three times before administering
Identify if form is appropriate for route
If unsure of order, clarify prior to administration
Ask class: WHAT ARE THE 3 CHECKS YOU MAKE BEFORE ADMINISTERING MEDICATION???
FIRST CONTACT WITH DRUG
PRIOR TO MEASURING THE DRUG
AFTER PREPARING THE DRUG, JUST PRIOR TO ADMINISTRATION

31. Summary:
THE NURSE who administers a medication is legally liable for medication errors! Whether the primary cause was an unsafe order, an incorrect transcription, a wrong drug, an inaccurate dosage calculation, an improper preparation, or an administration error!
Med admin is a critical nursing skill!

32. DONE MIDTERM APRIL 9, 2019 Chapters 1-9
Homework due: chapters 8-9 and self evaluation