Can a student nurse take an order over the phone?
No, you have to give phone to faculty or nurse so they can have order repeated to them
What are 5 types of orders?
1. Routine- routine basis, will tell you how often to give
2. PRN- as needed, usually symptom related.
3. Stat- immediately, single order. ER=verbal, Floor=written
4. Now (or one time)- 1 hr to do it & chart from time written, single order, less urgent than STAT
5. Standing- routine per agency and what doctors approve, preprinted orders written for specific populations
Parts of a Medication Order (7)
1. Patients name
2. Date and time order is written (when to start & stop, also legal tracking)
3. Name of drug to be administered
4. Dosage of drug (metric)
5. Route by which is will be given = if don't have this, can't give
6. Frequency of drug
7. Signature of physician
3 Checks of Mediation Adminsitration:
1. when the nurse reaches for the container or unit dose package. compare to MAR & check expiration
2. compare label with MAR after retrieval from the drawer or immediately before pouring from a multi-dose container. leave in packaging
3. when replacing the container to the drawer or shelf or before giving the unit dose medication to the pt
What are the types of medication supply systems?
1. computerized automated dispensing cabinets
2. medication charts
3. bar codes
4. combinations of system - causes confusion
5 Rights of Medication Adminsitration
1. Right Medication (have they been given this before? does it make sense?)
2. Right patient (use 2 identifiers - name & birthday), check allergies
3. Right dose = is it correct? look up meds you don't know, any labs or diagnostics, max dose?)
4. Right route = is it appropriate? Ex. Is pill the correct route if patient can't swallow
5. Right time = when was last dose administered, window of time to administer. is it really the right time? Ex. insulin scheduled to be taken long after breakfast, taken on an empty stomach but given at breakfast
10 Rights of Medication Administration:
1. Right Med
2. Right dose
3. Right time
4. Right route
5. Right client
6. Right client education
7. Right Documentation
8. Right to refuse
9. Right assessment
10. Right evaluation
What is the right patient education?
- applies to every drug
- why receiving
- side effects
- directions to take
- effects = desired results
What is the right documentation?
- chart after giving
- edit times as needed
- agency policy if not given
What is the right to refuse
- you must educate your patient about the risks of refusal & the benefits of taking it
- document this per agency policy
what is the right assessment?
- Vital → does it alter. know vitals before
- labs = know most recent results
- Parameters = Ex. HR range
- Physical assessment findings = must know these before giving drugs.
** It is a medication error if you don't know these assessments
Ex. BP at 0800 & you give meds at 1000 → using 0800 BP depends on trends, how they are feeling, etc..
What is the right evaluation?
- is it working
- side/allergic/adverse reactions
- check on if its working, timing depends on the route
what is safety?
freedom from accidental injury
what is an error?
failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim
What are near-misses?
- errors of a commission or omission that could harm a patient but does not
- incident reports are filled out with errors and near-misses
What is the patient's role in errors?
- patients make errors in their own care or during self-management
- patient noncompliance may lead to errors (accidental or unintentional non-adherence to a therapeutic regimen)
- if a patient questions something STOP & go check
- get patient involved with their medications
What are medication errors?
2. common cause of adverse health care outcomes
3. effects can range from no significant effect to directly causing disability or death
What are 12 ways to prevent med errors?
1. Minimize verbal or telephone orders (only RNs)
- repeat order to prescriber
- spell drug name aloud
- speak slowly & clearly
- document "READ Back"
2. list indication next to each order (Ex. For hyper...)
3. avoid medical shorthand, including abbreviations and acronyms
4. NEVER ASSUME anything about items not specified in a drug order
5. Do not hesitate to question a medication order for any reason when in doubt
6. Do not try to decipher illegibly written orders; contact the prescriber for clarification
7. never use trailing zeros
8. ALWAYS use a leading zero
9. Check medication order & what is available while using the 5/10 rights
10. Take time to learn special administration techniques of certain dosage forms
11. Always listen to and honor any concerns expressed by patients regarding medications
12. check patient allergies & identification
THEY ARE PREVENTABLE
When an error occurs:
-stay with pt, assess and report
-possible consequences to nurses
-reporting and responding to MEs
-Notification of pt regarding MEs
Medication administration errors reduction techniques?
1. use standard processes for medication doses, timing & scales
2. standardize prescription writing & prescribing rules
3. limit the # of different kinds of common equip to get the drug
4. implement physician order entry (computer entry)
5. use pharmaceutical software
6. implement unit dosing - not a lot of meds on floor
7. central pharmacy should supply high-risk IV drugs
8. use special procedures & written protocols for high-risk medication
9. do not store concentrated solutions of hazardous medications on patient units
10. never leave meds at bedside
11. ensure availability of pharm decision support
12. include pharmacist during rounds of patient care
13. make relevant patient info avail at point of care
14. adopt a system-oriented approach to med erro reduction (look at errors and how to improve)
15. improve patient's knowledge about their treatment
what is a standing order?
a physician's order that can be exercised by other health care workers when predetermined conditions have been met.
What is a PRN order
usually symptom based
what is a now order?
- you have one hour to do it & chart it from time the order is written.
- single order
- less urgent than stat