chapter 9/Medication Errors and Risk Reduction

Created by LRetterath 

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medication administration record (MAR)

documentation of all pharmacotherapies received by the

medication error

any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient or consumer

medication error index

categorization of medication errors according to the extent of the harm an error can cause

medication reconcilliation

the process of keeping track of a patient's medication as they proceed from one health care provider to another

polpharmacy

the taking of multiple drugs concurrently

risk management

system of reducing medication errors by modifying policies and procedures within the institution

What is the most common cause of morbidity and preventable death in hospitals?

medication error

NCC MERP index---Harm

impairment of the physical, emotional or psychological function of structure of the body and/or pain resulting therefrom

NCC MERP index----Monitoring

to observe or record relevant physiological or psychological signs

NCC MERP index----Intervention

May include change in therapy or active medical/surgical treatment

NCC MERP index----Intervention Necessary to Sustain Life

Includes cardiovascular and respiratory support (e.g., defibrillation, intubation, etc.)

What drugs are involved in most errors at home?

warfarin and next insulin

sentinel events

a particular form of events, unexpected occurances involving death or serious physical or psychological injury or risk thereof, always investigated

What steps in the nursing process can the nurse apply to the clinical setting to avoid medication errors and promote safe administration?

Assessment, Planning and Implementation

Assessment to avoid errors

ask patient about allergies to food or medications, current health concerns, use of OTC medications and herbal supplements,, for medications taken prior to assessment, ensure that patient has been receiving the right dose, at the right time, and by the right routine, assess kidney, liver and other system function to determine if impairments are present that could affect pharmacotherpy, identify needed patient education

Planning to avoid errors

avoid using abbreviations, follow specific facility policies and procedures related to administration, have patient restate dosing directions, including the correct dose of medications and right time to take it, have patient demonstrate understanding of goals of therapy, do not except verbal orders

Implementation to avoid errors

eliminate potential distractions during medication administration, focus on tasks, five rights of medication,

Category A

circumstances or events that have the capacity to cause error

Category B

An error occured but the error did not reach the patient (An error of omission does reach the patient)

Category C

an error occurred that reached the patient but did not cause patient harm

Category D

An error occured that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm

Category E

An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention

Category F

An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization

Category G

An error occured that may have contributed to or resulted in permanent patient harm

Category H

An error occured that required intervention necessary to sustain life

Category I

An error occured that may have contributed to or resulted in patient's death

Harm

impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting therefrom

Monitoring

to observe or record relevant physiological or psychological signs

intervention

may include change in therapy or active medical/surgical treatment

intervention necessary to sustain life

includes cardiovascular and respiratory support (e.g. CPR, defibrillation, intubation)

How can nurses reduce medication errors?

adhering to the four steps of the nursing process-assessment, planning, implementation and evaluation. Keeping up to date on pharmacotherapeutics and knowing common error types are instrumental to safe medication and administration

Each nurse is responsible for becoming familiar with the nurse practice acts of the state in which he or she practices these acts:

define nursing practice and standards of care for the nurse practicing in a specific state

The nurse administers a medication to the wrong patient. The appropriate nursing action is to:

report the error to the physician, document the medication in the patient record, and complete a report of the error for further follow-up and analysis.

The patient with liver dysfunction experiences toxicity to a drug following administration of several doses. this adverse reaction may have been prevented if the nurse had followed which phase of the nursing process

assessment

Nurses have a legal and moral responsibility to report medication errors. The steps of reporting these errors include:

examining interdisciplinary causes of errors and assisting professional in ways to avoid mistakes

The nurse has administered a medication to the wrong patient. Which of the following is a correct action the nurse must take?

notify the physician, document medication on the medication administration record (MAR, complete a facility report of the error

A medication error is any _______event that may cause or lead to inappropriate medication use or cause ______ _______ while the medication is in the control of the health care professional patient or consumer

preventable, patient, harm

Unexpected occurrences involving death or serious physical or psychological injury are called __________.

sentinel events

The process of keeping track of patients medications as they transfer from one healcare provider to another is called ______ _________.

medication reconciliation

Incomplete orders should be ______ with the prescriber before the drug is _______.

clarified or verified, administered

In the home setting, the drug most frequently associated with medication errors is?

warafarin (coumadin)

to observe or record relevant physiological or psychological signs

monitoring

includes cardiovascular and respiratory support (e.g. CPR defibrillation, intubation)

intervention

Impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting therefrom

harm

may include change in therapy or active medical/surgical treatment

intervention

Assessment is the most important step of the nursing process in preventing medication errors by?

obtaining allergy and medication history information

Which best describes the reporting of medication errors?

is responsible and accountable by the nurse

Nurses should know that the most common type of medication error is which of the following?

giving the wrong dose

A nurse has given an incorrect dose of a medication. She follows the agency protocol by completing an incident report and discussing the incident with the risk manager. The purpose of following this procedure for reporting erros is to:

prevent future medication errors

Morphine every 4 hours is ordered for a patient with terminal cancer who is experiencing severe pain. The nurse records that the patient's respirations are 12 per minute and administers the medication as ordered. Twenty minutes later, the patient develops respiratory arrest and dies. What is the nurses' dilemma?

the nurse's intention was to elleviate pain, using a reasonable and prudent manner

What should a nurse document, if a medication error occurs?

document all nursing interventions taken to protect patient safety on the patient's chart

As the nurse hands the medication cimetidine (Tagament) to the patient, the patient states. Thank you. This is the pill that neutralizes the acid in my stomach, so that I don't get hearburn. The nurse will take which step in the nursing process.

assessment

While administering the 10 a.m. medications, the nurse discovers that the 6 a.m. intravenous dose was still hanging and never infused. What should the nurse's first action?

notify the primary health care provider

The physician approaches the nurse while she is preparing a medication. The nurse asks the physician to come back in 10 minutes. This is an example of which step in the nursing process?

intervention

When the nurse hands the patient his morning medications, he says, "there's a yellow tablet in the cup. The doctor must have ordered a new pill. " Which of the following responses is the best reply?

Let me check the doctor's orders and the medication administration record

A nurse, who is doing telephone triage for an outpatient clinic, receives a call from a 76 year old woman who is concerned because she has not had a bowel movement in 3 days and reports that her stomach really hurts. Which of the following responses is correct.

The nurse suggest that she call her primary care provider and have a more complete assessment

A nurse administers a health care provider's order for 150 mg of medication, when the usual dosage is 75mg. When the nurse manager discusses the incident with the nurse, the nurse states that the dosage administered is what the health care provider ordered. What should the nurse manager tell the nurse?

It is your responsibility to know the correct dosage. If the dosage seemed incorrect, it was your responsibility to call the health care provider.

The nurse is preparing to administer a dose of an enteric-coated tablet to a patient. The patient states that he is unable to swallow a pill. What is the correct action by the nurse?

return to the medication room with the medication and notify the health care provider

Tetracycline 500mg bid by mouth has been ordered for a 36 year old forest ranger who has been diagnosed with Lyme disease. He tells the nurse that antibiotics often give him indigestion, so the nurse gives him a glass of milk to take with his medication. How could this medciation error be avoided?

Milk products inhibit the absorption of tetracycline

Which federal agency is responsible for determining the effectiveness of all new drugs proposed each year?

FDA, food and drug administration

All opiods are assigned a schedule of classification by law. In which schedule will the nurse find morphine sulfate?

Schedule I

What does it mean when a drug is classified as being teratogenic?

It is not safe for the fetus and may cause abnormalities if given

What happens to hepatic function with aging?

hepatic function decreases, slowing drug metabolism

Which legal agency deals with the enforcement of substance abuse laws?

DEA-drug enforcement agency

The nurse reports concerns about the treatment prescribed for a client to the supervisor. This is an example of?

ethics

After administering insulin to a client without obtaining the blood glucose level, the client experiences a hypoglycemic reaction. This nurse's action can be described as?

nonmaleficient

The physician informs the client of the benefits and risks of a particular medication. When the client refuses the procedure, the nurse recognizes the client is exercising his right of:

autonomy

The physician orders morphine 15 mg I.V. STAT to a client in severe pain when other medications have been ineffective. The nurse reports the client's respiratory rate of 10 breaths per minute to the physician, and is directed to adminster the medication immediately. The nurse is facing?

an ethical dilemma

Each nurse is responsible for becoming familiar with the nurse practice acts of the state in which he practices because these acts:

define nursing practice and standards of care for the nurse practicing in a specific state

The nurse administers a medication to the wrong client. The appropriate nursing action is to:

report the error to the physician, document the medication in the client record, and complete an incident report

Several nurses review a medication order and agree on an interpretation. When a nurse administers the incorrect medication and dosage, this error was cause by violation of which principle of safe practice?

clarifying the order with the prescriber

The client with liver dysfunction experiences toxicity to a drug following administration of several doses. This adverse reaction might which phase of the nursing process?

assessment

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