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Pharmacology Chapter 5: Medication Errors

Terms in this set (29)

adverse drug event
a general term that encompasses all types of clinical problems related to medication use is a(n)
adverse drug
reaction is defined as unexpected, unintended, or excessive response to medications given at therapeutic dosages (as opposed to overdose), which is one type of adverse drug event.
allergic
reaction is an immunologic reaction resulting from an unusual sensitivity of a patient to a particular medication.
idiosyncratic
reaction is any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.
(true or false) High-alert medications are involved in more errors than other drugs
False: High alert medications are not necessarily involved in more errors than other drugs. However, the potential for patient harm is higher with these medications
(true or false) Allergic reactions are often predictable
True: many medications carry expected side effects or allergic responses because they occur frequently and may be identifiable based on the patient. I.e.: penicillin and cephalosporin carry similar properties, and an allergic reaction to one may indicate a similar response to the other.
4 categories of medication errors
1) no error, although circumstances or events occurred that could have led to error
2) medication error that causes no harm
3) medication error that causes harm
4) medication error that results in death
Steps of the medication errors
procuring, prescribing, transcribing, dispensing, administering, and monitoring
Issues contributing to Errors
organizational issues, educational system issues, sociology factors, and use of abbreviations
6 rights of medication administration
right drug, dosage, time, route, patient, and documentation
What are high alert medications? Examples?
Potential for patient harm is higher with these medications: insulin, opiates, anticoagulants, potassium chloride for injection
During the medication administration process, it is important that the nurse remembers which guideline?
If a patient expresses a concern about a drug, stop, listen and investigate the concerns
Which measures is used to reduce the risk of medication errors?
Always double check the many drugs with sound alike and look alike names b/c of the high risk of error
When receiving a patient transferred from another unit, which action is most useful to prevent medication errors?
Completing a medication reconciliation between units
When admitting an elderly patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?
Ask the patient and/or family to bring in all medications the patient was taking at home.
The nurse administers a medication to the wrong client. Which is the appropriate nursing action following this error?
Notify the provider and document the error on a incident report.
What organization announced new regulations requiring bar codes for all prescription and over-the-counter medications?
U.S. Food and Drug Adminisration (FDA)
Medication Reconciliation
-Continuous assessment and updating of patient medication information (verification, clarification, reconciliation)
-Should be done at each stage of health care delivery (admission, status change, patient transfer within or between facilities/provider teams, discharge)
The nurse knows that the medication reconciliation process involves which three steps?
Reconciliation
Verification
Clarification
errors in procuring
getting wrong medication from pharmacy
error in presribing
perhaps the prescription is wrong
errors in transcribing
spell/sound a like prescriptions (ex: Celexa, Cerebrex, Cerebyx)
error in dispensing
there is an issue in pharmacy dispensing (only an error for pharmacists)
error in administering
medicine is expired, discontinued, or taking a medication with the different trade name also
errors in monitoring
not watching for adverse effects
Reporting a Medication error
-Report to prescriber and nursing management
-Document error per policy and procedure
-Factual documentation only
-External reporting of errors
External reporting of errors examples
DONE BY THE HOSPITAL OR FACILITY
-USP MERP (united States Pharmacopeia Medication Errors Reporting Program)
-MedWatch, sponsored by the FDA
-Institute for Safe Medication Practices (ISMP)
-The Joint Commission
The nurse is administering a drug that has been ordered as follows: "Give 10 mg on odd-numbered days and 5 mg on even-numbered days." When the date changes from May 31 to June 1, what should the nurse do?

a) Give 10 mg because June 1 is an odd-numbered day
b) Hold the dose until the next odd-numbered day
c) Change the order to read "Give 10 mg on even-numbered days and 5 mg on odd-numbered days"
d) Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd- or even-numbered
Correct answer: D
Rationale: While option C seems reasonable, the nurse does not have prescriptive authority to change the order. Therefore, the prescriber should be consulted to verify the order, which can be written in clearer terms. The other options would result in a change in the alternating dose schedule.
The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient's blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first?

a)Notify the patient's physician
b)Notify the clinical faculty
c)Take the patient's blood pressure
d)Continue to monitor the patient
Correct answer: B
Rationale: The patient's blood pressure will need to be monitored, but it was just taken and the medication dose will not have an immediate effect. The student should notify the clinical instructor immediately.
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