1. Safety in Medication Administration
Chapter 8
Safety in Medication Administration
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Patient Safety
Patient safety practices during medication administration improve: In order to attract patients to healthcare facilities:
Competitiveness-funding services that are market competitive
Regulatory compliance-meeting requirements for accreditation
Patient outcomes-important to have high quality care with positive outcomes
How do patient safety practices improve competitiveness?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Patient Safety Fast-paced environment where care is given
Factors working against patient safety:
Fast-paced environment where care is given
Advanced technologies need more skills and attention
Decreased staffing in nursing and pharmacy
Aging population
Chronic diseases
Declining financial resources
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Patient Safety Centers for Medicare & Medicaid Services (CMS)
External pressures for patient safety:
Centers for Medicare & Medicaid Services (CMS)
The Joint Commission
The Leapfrog Group
State agencies
What is the role of each of these groups?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Negative Patient Outcomes
Potential negative outcomes for patients include:
Increased costs of care
Complications delaying healing or ability to return to home
Serious physical or psychological harm
Death
Potential negative outcomes for the patient range from increased cost to death.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Safety Precautions for Patients
Review scenarios:
Scenario A:
A 6-year-old girl is admitted with suspected pyelonephritis and dehydration caused by nausea and vomiting.
Scenario B:
A 46-year-old woman is admitted for surgery.
How could these errors have been avoided?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Quality and Safety Education for Nurses (QSEN)
The QSEN project aims to prepare student nurses with the knowledge, skills, and attitudes needed to improve the quality and safety of patient care.
The QSEN project looks at six areas of patient care, including safety and informatics.
Safety refers to reducing the risk of harm to patients.
Informatics is the technology used to mitigate errors.
Describe how informatics mitigate medication errors.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Methods to Promote Safety During Medication Administration
To reduce medication errors, it is the responsibility of each health care provider to:
Practice within the scope of his or her position.
Observe correct safety practices.
Adhere to established standards of care.
Visit The Institute for Safe Medication Practice’s (ISMP’s) website is dedicated to education, awareness, and tools for prevention of medication errors.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Six Rights of Medication Administration
Right drug
Right dose
Right patient
Right route
Right time
Right documentation
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Strategies to Promote Patient Safety
Knowledge of patient’s medical history:
Drug allergies
Medication history
Knowledge of the “do not use” abbreviations
Awareness of look-alike/sound-alike medications
Use of electronic intravenous pumps
What medication errors can be caused by using one of the “do not use” abbreviations?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. Personal Safety Eye goggles Mask Gown Gloves
Personal protective equipment:
Eye goggles
Mask
Gown
Gloves
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. Personal Safety Ways to reduce risk of injury:
Consistent use of personal protective equipment (PPE)
Consistent and appropriate use of safety devices
Proper disposal techniques
Consistent safety practices
Monitoring of the environment for safety hazards
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Automated Medication Dispensing Systems
Special cabinet that houses medications to be dispensed to a specific patient care unit
Cabinets connected to the central pharmacy
Advantages
Disadvantages
Automated medication dispensing systems are one of the ways used to improve the accuracy and efficiency of delivering medications to patients.
How do automated medication dispensing systems increase safety for patients?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. Medication Errors With the Elderly
Omission
Incorrect dosage
Wrong time
Misunderstanding of directions
Decrease in gross and fine motor skills
Problems handling packaging of medications
Hearing impairment
Abuse of alcohol high among elderly adults
What is the most common medication error made by elderly patients?
The most common medication error made by elderly patients is omission, and more medication errors occur in the home than in health care facilities. Omission can be a product of forgetfulness or may be caused by the patient’s concerns about the financial cost of taking the prescription as frequently as ordered.
Other medication errors result from patients taking incorrect dosages or taking doses at incorrect times.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Minimizing Medication Errors for the Elderly
Nurse must make sure patient understands directions for taking medications.
Have the patient repeat back instructions.
Medication labels and directions should be in large print.
Use of daily or weekly containers can organize medications.
Use an appointment book to plan medications and times to be taken each day.
Explain the reason for each medication, its importance, and how it works.
Elderly adults at home are more prone to medication errors than those in health care facilities.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.