Preventing+Medication+Errors+Self+Study

 = = //__ ** Preventing Medication Errors ** __// **Learning Objectives:** After reading the article "//Preventing Medication Errors//", the learner should be able to: 1. Discuss the five rights of medication administration. 2. Identify examples of poor communication that lead to medication errors. 3. Identify the importance of bioavailability in determining administration schedules for medications. 4. Calculate correct dosage for given medication orders. 1. Read the attached article. 2. Complete the post test and evaluation form. Return both to the Education Department. 3. With successful completion you will be given a certificate for 1.2 contact hours. o You must pass the test with at least 75% to receive continuing education credit. **//__ Preventing Medication Errors __//** Beth is having a busy day on the general medical/surgical unit where she works part-time. As a very conscientious and thorough nurse, Beth attempts to provide the highest quality of care to the 10 patients she is assigned. She receives an order for Actinomycin-D for her patient with Wilm's Tumor. Because Beth has never administered this drug, and is unfamiliar with its normal dosage range, she transposes the dosage from 2.7 mg to 7.2 mg. Her failure to confirm the dosage results in the death of her 34-year-old patient. Beth's situation is similar to that of thousands of other nurses who face the same stressors everyday. Her lack of familiarity with the prescribed medication, failure to refer to the unit drug reference, double check the order with the doctor or call the hospital pharmacist resulted in tragic circumstances. ** Medication Error Defined ** The Food and Drug Administration estimates that medication errors cause at least one death every day and injure nearly 1.3 million people in the United States every year. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as "Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of the health care professional, patient or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education monitoring and use." It is important to note that this definition includes all aspects and systems related to drug administration, from manufacturing to the patient's bedside; from the bedside to the patient's home. ** The Five Rights ** Nurses are legally responsible for applying the five rights of medication administration as a standard of care.
 * Directions: **

//__ Right Drug __// Administration of the wrong drug is the most common error that occurs. Factors that contribute to wrong drug error include similar labeling and packaging of products, medications with very similar names and storage of these similar products together. In addition, poor communication is a common cause of administering the wrong drug. When transcribing verbal orders or verifying transcription of orders, a few simple precautions can help avoid errors: o Always repeat verbal orders o Avoid using dosage and product abbreviations o Never assume ROUTE of administration o Never use trailing zeros (write 25 not 25.0) o Never try to decipher illegible orders o When in doubt, always check with the prescriber, pharmacist or literature o Always check the drug label and dose against the doctor's order three times prior to administration o Do not administer any drug if you are unsure of its intended use for your patient o DO NOT ASSUME ANYTHING //__ Right Dose __// If dosage must be calculated, always recheck your math and have someone else verify your final dosage. It is important to consider the patient's age, size and vital signs when deciding if a dose is appropriate. Newborns, pediatric and elderly patients are particularly susceptible to slight changes in medication dose.

//__ Right Time __// In general, medications must be given one-half hour before or after the actual time specified in the orders. Many hospitals have specific policies regarding the "before/after" rule; always check your facility guidelines. When scheduling administration times, it is important to consider drug-drug and drug-food interactions. Many drugs interfere with absorption of other drugs when given simultaneously. Appropriate spacing of doses also needs to be considered. Bioavailability, the need for consistent dosing around the clock, should also be considered to ensure efficacy of the medication. If diagnostic studies are scheduled, a medication dose may need to be skipped or delayed until testing is complete. //__ Right Route __// Many medications can be administered by a variety of routes, such as oral, rectal, intravenous, subcutaneous, intramuscular, or sublingual. The route selected by the prescriber depends on the patient's condition and the speed with which the therapeutic effect will need to occur. The prescribed dosage is based on the route by which the drug is given. In general, oral dosages are greater than injected dosages for the same drug. Errors can occur when a dose intended for oral administration is given by injection. For example, 30 mg dose of Morphine Sulfate mistakenly given IV rather than orally could potentially result in respiratory arrest and death. Special caution must be taken with medication given by the intravenous route. Many drugs will cause severe soft tissue injury if the IV becomes infiltrated. It is important to check for blood return prior to administration of any intravenous medication given by direct IV injection (push), intermittent (piggyback) or continuous infusion. Medications given intravenously have a rapid onset of action. It is necessary to stay with the patient during the first few minutes of any intravenous infusion to assess for signs and symptoms of adverse reaction. //__ Right Patient __// In today's hectic health care environment, it is especially important to confirm a patient's identity prior to conducting any procedure. Many nurses float between units, work part-time or work in ambulatory settings where large numbers o patients are in and out during the day. These situations increase the probability of giving medication to the wrong patient. It is imperative to check every patient's ID bracelet prior to giving a medication. Always confirm the patient's name, age and allergies, and ask the patient to state his name. While it is important to utilize the five rights when administering medications, nursing responsibilities related to drug therapy require an extensive knowledge of pharmacology and how the nursing process assists the practitioner in ensuring that each patient achieves the best possible outcome from his drug regimen. The nurse is often the first health care provider to identify signs and symptoms that may require drug therapy or may signal an adverse outcome from ongoing therapy. 
 * Nursing Responsibility **