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MEDICATION SAFETY Administration of Medications Meeting HFAP Accreditation Standards for Pharmacy Services and Medication Use Part Three.

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Presentation on theme: "MEDICATION SAFETY Administration of Medications Meeting HFAP Accreditation Standards for Pharmacy Services and Medication Use Part Three."— Presentation transcript:

1 MEDICATION SAFETY Administration of Medications Meeting HFAP Accreditation Standards for Pharmacy Services and Medication Use Part Three

2 MEDICATION SAFETY Administration of Medications HFAP Chapter 25 keeps you in compliance with the Medicare Conditions of Participation

3 Medication Safety Series 1. Using CPOE: Challenges and Solutions to Address HFAP Standards 2. Procurement, Preparation and Dispensing 3. Administration of medications – timing, unit dose, bedside medication verification 4. Monitoring of therapy, Medication Use Evaluations 5. TBD

4 The 6 rights Collaborative Process (nurses, RT, pharmacists, physicians) Routes of administration BMV Advantages Disadvantages What to do if you see medication errors (wrong patient, wrong drug, wrong time) Patient process Hand hygiene Identification Education of the patient Verification of the medication (double verification) Medications at the bedside and self-administration Observe for reactions

5 Oral: sublingual, buccal Parenteral: intradermal, subcutaneous, intramuscular, intravenous Topical Inhalation Intraocular

6 Metric Apothecary (grains) Household

7 Grams (g), milligrams (mg), kilograms (kg) Liters (L), milliliters (ml)

8 Tablespoons Teaspoons Ounces Cups Pints Quarts

9 Conversions within systems Conversions between systems

10 Six rights Triple-check before administration Patient assessment

11 Right medication Right dose Right patient Right route Right time Right documentation

12 Information Refusal Careful assessment Informed consent Safe administration Supportive therapy No unnecessary medications

13 Collaborative process Nurses Pharmacists Respiratory Therapists Psychiatric Technicians Physicians

14 Infants and children Older adults Polypharmacy Self-prescribing Over-the-counter medications Misuse Noncompliance

15 Patient response to medications Patient and family ability to administer medications

16 Presence of GI alterations Ability to swallow Use of gastric suction Positioning

17 Skin applications Use of gloves or applicators Preparation of skin Thickness of application

18 Assessment of nares Patient instruction and self-administration Positioning

19 Drops, ointments, disks Assessment of eyes Asepsis Positioning

20 Assessment of ear canal Warming of solution Straightening of canal for children and adults Positioning

21 Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) Patient assessment and instruction Use of spacer Determination of doses in canister

22 Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic) Asepsis

23 Equipment Syringes: sizes (volume), types Needles: length, gauge Disposable units: Tubex, Carpuject Ampules Vials

24 Mixing medications Determine compatibility of the medications Do not contaminate one medication with another Ensure the final dose is accurate Maintain aseptic technique

25 Insulin Syringes and needle sizes Types of insulin Mixing of insulins Rotation of vials before withdrawal of solution

26 Minimize discomfort Use smallest suitable needle Position client comfortably Select proper site Divert client’s attention Insert the needle quickly and smoothly Hold the syringe steady Inject the medication slowly and steadily

27 Subcutaneous injections Sites: condition of area, rotation of use Amount of solution Length and gauge of needle Pinch or spread skin Angle of insertion

28 Intramuscular injections Sites: landmarks, condition of area Amount of solution Length and gauge of needle Angle of insertion Aspiration Air-lock method Z-track technique

29 Sites Ventrogluteal Vastus lateralis Deltoid

30 Intradermal injections Skin testing Sites Length and gauge of needle Angle of insertion Formation of small bleb

31 Needleless devices Sharps disposal One-handed recapping technique

32 Large volume infusions Bolus injection Volume-controlled infusionsPiggyback Tandem Volume-control set Mini-infusor pump

33 Hand hygiene Identification Education of the patient Verification of the medication (double verification) Medications at the bedside and self-administration Observe for reactions

34 Wash hands with soap and water or with waterless hand sanitizer before and after patient contact Gloves

35 Must use at least two patient identifiers whenever administering medications. Acceptable identifiers may be the person’s name, an assigned identification number, a telephone number, a photograph, or another personal identifier. If bar code scanning is available, scan the patient’s armband

36 Scan barcode Verify that this is the correct medication Verify dose Double verify High risk medications (heparin, insulin) Controlled substances

37 More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516). Kohn, Corrigan & Donaldson, “To Err is Human”, Institute of Medicine, 1999

38 Transcription 6% Dispensing 4% Administration 34% Ordering 56% Bates, Cullen, Laird, et al. “Incidence of Adverse Drug Events and Potential Adverse Drug Events.” JAMA, 1995, 274, 29-34.

39 Nationally 2 of every 100 admissions experienced a preventable adverse drug event, resulting in increased hospital costs of $4,700 per admission. This is $2.8 million annually for a 700-bed teaching hospital. Kohn, Corrigan & Donaldson, “To Err is Human”, Institute of Medicine, 1999 Why barcode medications?

40 Right drug75% improvement Right dose62% improvement Right patient93% improvement Right time87% improvement Missed meds70% improvement *Johnson, Carlson, Tucker, & Willette Using BCMA in VA Medical Centers Journal of Healthcare Information Management-Vol 16, No.1 *Barcode Medication Administration (BCMA) in VA Medical Centers*:

41 8,000,000doses dispensed 549,000errors prevented 0documented errors *Eastern Kansas Health Care System (VA) 1994-2001*:

42 Physician order received Order faxed to Pharmacy Pharmacists edit and verify electronic orders into patient profile Pharmacy dispenses ordered medications in Bar- Coded packages Nurse accesses BMCA software on computer via log on Nurse scans unique patient bar-coded ID band

43 Nurse utilizes two unique patient identifiers to verify armband Nurse verifies patient profile medications as per order Nurse scans bar-code on medications Nurse administers medications

44 Reduction in medication errors The FDA estimated that over a 20 year period the number of medication errors would be reduced by 50% and up to 500,000 adverse events would be avoided by utilizing BCMA (Food and Drug Administration, 2004). Ease of checking the five rights of medication administration Automatic MAR creation Lab results can be displayed at the point of care Alerts for missed medications

45 Estimated to cost $1,799 per bed to implement BCMA, with an additional $1,000 yearly for maintenance No universally accepted bar codes Bar codes that are unable to be scanned Equipment malfunction Over reliance on BCMA to catch errors Stat medication turnaround time (ZIH, 2006)

46 Over 15 types have been identified that could potentially lead to errors For example: Nurses override alerts for 4.2 % of patients cared for and for 10.3% of meds charted (Karsh, Koppel, Telles, & Wetterneck, 2008)

47 Require special order from physician Must be stored in a secure manner Avoid using home medications unless they are unavailable from the hospital pharmacy If using home medications, they must be stored in and dispensed from the hospital pharmacy only upon positive identification Patient education on self-administration Example: inhalers

48 Assessment Vital signs Blood glucose Pain level Education What drug is for Side effects

49 Reassessment

50 Types of errors: Omissions Drug administration without a physician’s order Wrong drug Wrong dose Wrong time Failure to follow manufacturer specifications Do not crush Shake well Inadequate fluids

51 Administration without adequate fluids Administration through enteral feeding tube: Example: phenytoin Administration of eye drops Contact time with eye Inhalers Administration with regard to meal times

52 Monitoring of Therapy Medication Use Evaluations Trending of medication errors


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