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the nurse is legally responsible for safe and accurate medication administration, including what? 5 rights. right drug right dose right patient right route right time what is the 6th right lilley adds? right documentation what are some additional rights? 2 right approach right technique the nurse must have sufficient knowledge to: * * *recognize and question wrong orders *Evaluate results and recognize adverse side effects what does ADE stand for? Adverse Drug Events ______________: undesirable occurance related to administration of medication or failure to administer an intended medication. it may or may not result in harm to patient. *medical error *adverse drug reaction -allergic reaction -idiosyncratic reaction Adverse drug event _______________:any unexpected, unintended, undesired RESPONSE to a medication at a normal dose.it may or may not be preventable and it may or may not cause pt. harm. adverse drug reaction ____________: a preventable ADE. it may or may not cause harm in a patient. medication error medication errors may be considered a_____________that has to be reported to the joint commissions on healthcare agencies (JACHO) "sentinel event' _______________ are a major problem in healthcare, resulting in many deaths,additional hospital days, and lots of expense. medication errors medication errors account for about _____ of the sentinel events reported to jacho. 12% most medication errors are "systems " problems-workload; errors in______________________,_____________,_____________,___ communication between md, nurse, pharmacy,...ect. approx. 50% of medication errors in administration are due to _________________. *about 30 % of errors due to inadquate knowledge of? *about 20% due to inadequate knowledge of? insufficient knowledge. medication patient who is resposible for most medication errors? nurses what are the five steps of the nursing process? assessment analysis/nursing diagnoses planning/ goals and outcomes implementation evaluation NURSING PROCESS--ASSESSMENT what are the following questions obtaining? *what is patients primary health problem and significant past medical history? *are there any health problems that would alter pharmacokinetics? *are there any problems that would atler ability of patient to safely self medicate? health history/ status NURSING PROCESS--ASSESSMENT what are the following questions obtaining? *meds currently taking, including rx,otc, herbals *any meds that should be taking. *any drug allergies, drug-drug or drug-food interactions * any illegal drug use or alcohol intake drug history, (note) includes patients understanding & compliance NURSING PROCESS--ASSESSMENT what are the following questions obtaining? *patients ethnic/cultural background; any religous or cultural factors that would influence treatment plan and patients compliance. *patients education- can pt. read write and understand instructions. *overall economic status-ability to afford meds; does patient have insurance that will pay for meds? * socioeconomic/cultural factors NURSING PROCESS--ASSESSMENT what are the following questions obtaining? * your knowledge of med. any special precautions for giving,ect (LEGALLY REQUIRED TO KNOW) *are there any special skills you need to safely administer med and what is your skill level? self-assessment nursing process-- ____________part * disease related diagnoses:review pt's health history for factors that may affect meds. examples include: -altered tissue perfussion in pt with poor circulation. -pc:decreased cardiac output in pt with heart failure or other heart disease. -altered bowl elimination in pt. with diarrhea or constipation. analysis & nursing diagnosis nursing process-- ____________part *adverse effects related diagnoses: review meds for side effects and potential problems. examples include; -at rish for injury with meds that result in dizziness. -alerations in nutrition with med that result in diarrhea, drug-food interactions,ect... analysis & nursing diagnosis nursing process-- ____________part *patient education & self-care related diagnoses; review data relative to patient's knowledge of treatment plan and meds. example diagnoses include: -knowledge deficit of... -altered health maintenance -noncompliance^ ^ noncompliance related to lack of knowledge is NOT an appropriate diagnosis. one cannot comply with what one does not know. to be noncompliant, pt must have knowledge but not be complying for some other reason- perhaps insufficient financial resources, cultural conflict, ect. ^determine causative factor, then determine if there is an appropriate intervention. analysis & nursing diagnosis nursing process-_____________ * remember that ________implies advanced preparation. do not wait until med are due. * medication order- review orders ^ compare MAR to physician's orders. is MAR correct? is order complete? any doubts, clarify with prescribing physician. ^ is drug available in correct form and dosage? if not how do you go about getting what you need? ^time & frequency: how can you maximize your efforts? are there meds that cannot be given concurrently? for PRN orders, when was last dose. planning plan nursing process-_____________ *patient- specific factors ^consider pt's age and health status to identify factors that might affect med administartion-for example, injection to give to patient is 2 years old. ^is pt NPO? scheduled for any tests or special procedure? *drug-specific factors ^are there any preparations requirements, such as a powder that must be mixed, special IV tubing needed? ect. ^ are there safety percautions to be considered, such as a medication that causes drowsiness & assisting pt to BR before giving meds, ect. ^if two or more drugs are they compatable? ^are there drugs that require you to check blood levels or other labs before administering? planning nursing process-_____________ also includes eastablishing goals and intended outcomes, *goals and outcomes should be stated in terms of patient behavior not nurse's ^example; in giving a pain medication, the anticipated outcome is that PATIENT will express relief from pain and discomfort: not that the nurse will make the patient comfortable. * expected outcome must be determined before effective evaluation can occur. if you do not know what a medication is for, you will not be able to know whether or not it is accomplished its intended effect or if adverse effects developed. * planning nursing process-_____________ * medication order ^type of order- written,verbal,pre-printed. what are institutional policies relative to each. ^components- verify again that order is complete and correct ^verify that order as transcribed to MAR is correct; check MAR against chart. ^beware of abbreviations!!! as general rule, most things are written out. implementation nursing process-_____________ *preparation ^ supply-where is med kept, such as med room, natcotic cabinet, refrigerator? ^compare label and MAR- do you have right med for right patient?do you have to calculate dose? Be Very Careful Of Sound- Alike names and look-Alike Drugs. ^using aseptic technique, prepare meds. follow a system, such as starting at top of mar. read every line,compare again to label. After all meds ready. read MAR again. implementation nursing process-_____________ *CHECK AND RECHECK 5 RIGHTS *PERFORM ANY ASSESSMENT NEEDED BEFORE GIVING. *GIVE MED; USUALLY ORAL MEDS PRIOR TO INJECTION. *INSTITUTE NECESSARY POST-ADMINISTRATION ASSESSMENT AND SAFETY MEASURES. IMPLEMENTATION *DOCUMENTATION ^following policy, document on MAR meds given & in nurses notes any reasons why not given. ^note on order sheet "given" or "done" for one-time only or stat orders *complete as necessary any narcotic records. implementation. nursing process-_______________? *effect of medication ^what was the intended effect of medication and was effect achieved? if not, try to identify causative factors. ^ assess patient for any side effects or other adverse effects. communicate with physician and institute any measures indicated * patient compliance ^ assess patient's compliance with treatment plan. if not compliant, try to determine causative factors and determine if there are measures which can be instituted that might promote compliance. evaluation assessment of the individual patient is imperative! what you start with and what you expect may be entirely different from what you get. assessment of the individual patient is imperative! what you start with and what you expect may be entirely different from what you get. ... the patient already knows. readiness ability