Medication Safety Chapter 9

Medication Safety Involves correct dispensing of the drug, correct storage & correct disposal To prevent drug errors & give drugs safely, you must follow the 6 Rights of Drug Administration Right Drug Right Time Right Dose Right Person Right Route

Drug Distribution Systems Pharmacy process & fill drug orders, they are then distributed to the nursing unit. Drug Distribution Systems: Floor or Ward Stock System Individual Prescription Order System Unit Dose System

Floor or Ward Stock Systems Frequently used drugs are kept in the nursing unit Dangerous & rarely used drugs are kept in the pharmacy Ordered drugs are readily available There is no waiting or lag time for the pharmacy to process, fill and send the drug order for the nursing unit Safety Issues: Many drugs stocked = increase in drug errors Monitoring drug expiration dates is difficult Nursing unit may not have space to stock all drugs safely Agency personnel have access to many drugs = drug diversion

Individual Prescription Order System Pharmacy sends 3-5 day supply of an order drug to the nursing unit Drugs are stored in small bins in a cabinet on the nursing unit, each bin containing a patient’s name Bins are arranged alphabetically by name or by room & bed numbers Safer system than the floor/ward system

Unit Dose System (Hospital) Single-unit dose packages of a drug is dispensed for each dose ordered. Daily doses of a drug is individually packaged A 24-hour supply is provided & the pharmacy will refill the med cart drawers every 24 hours Individual drawers within the med cart are labeled with the person’s name and room/bed number Very common system. Safe Cost efficient Time efficient

Medication Cart

Unit Dose System (SNF) Set Up: Each drawer in the drug cart is larger enough to hold drug containers for 1 week or 1 month supply. Each drawer is labeled with patient’s name, room number, bed number, pharmacy name & phone number Pharmacist fills a container with the prescribed drug. Each container has sections for each day of the week Each section contains the number of doses for that day

Narcotic Control Systems Federal law regulates the use of controlled substances In hospitals and SNF, controlled substances are issued in single-unit packages Packages are kept in locked cabinet or locked drawer Nurse manager or charge nurse is responsible for the key Inventory control sheet list each type of controlled substance and the number of doses issued Used to account for each drug and dose administered

Controlled Substance Inventory Sheet

Disposal of Controlled Substances Sometimes the prescribed dose is smaller than that supplied…. When a nurse gives the medication, another nurse must check: Dose How the drug is prepared Disposal of the unused portion Both nurses must sign the inventory control sheet.

Disposing of Drugs Reasons why drugs may need to be disposed: Patient refusal to take Drug is dropped in floor or bed Only portion of drug dispensed Expiration date has passed Contamination Patient deceased Doctor discontinued drug Do not return unused dose or an unused portion of a drug back to stock. Follow agency policy

The Six Rights When giving medications, always protect the patient’s safety Six Rights of Medication Administration Right Drug Right Time Right Dose Right Person Right Route Right Documentation

Right Drug Many drugs have similar names and spelling. Many drugs have similar packaging DO NOT ASSUME THE PHARMACIST PROVIDED THE CORRECT MEDICATION Always read the drug label: Before removing the drug from the unity dose cart or from the shelf Before preparing or measuring the prescribed dose Before returning the drug to the shelf

Right Time Many factors are involved in giving a drug at the right time Drug order Standard administration times Blood levels Drug absorption Diagnostic tests

Right Time (PRN) Before giving a drug ordered PRN (as needed), make sure no one else has giving the drug You must prevent an overdose Check chart and the MAR Make sure that the time between doses has passed Remember to record PRN drugs at once on both the MAR and the progress notes.

Right Dose Dose is the amount of drug to be administered To give the right dose: Compare the dose on Rx label against the MAR Use the correct measuring device for drugs in liquid form Report nausea and vomiting MA-C will never calculate drug dosages

Right Person Make sure you have the right person by comparing information on the MAR against the person’s ID bracelet Do not check only the person’s name Some people have the same name or similar names The Joint Commission requires using at least 2 identifiers Identifiers cannot be the person’s room or bed number Some agencies require that the person state his/her name & birth date or ID number.

Right Route Route means how and where the drug enters the body Not every drug can be given by every route Never change the route of administration & never change the dosage form

Right Route (continued) Absorption rate varies with the route used: Intravenous (IV): Administered directly into the blood stream Most rapid onset to action Greatest risk for adverse effects Intramuscular (IM): Administer into a muscle Second fastest onset of action Subcutaneous (SQ): Administered in the fat layer below the skin After IV and IM, SQ provides the next fast route of action Intradermal Administered into the dermal layer of the skin Absorption rate is slow

Administration As an MA-C, you can only administer drugs by certain routes In Washington MA-C cannot administer injectable drugs, with the exception of insulin Remember: Always administer the drug by the route stated on the order Never change the route Never give a drug by a route not allowed by your state or agency.

Right Documentation You must record giving the drug as soon as possible No documentation assumes that the drug was no administered, resulting in potential overdose

Self Administration Self-directed medication management: Allowing a patient or resident to take own medications Your role may involve: Reminding the person it is time to take a drug Reading the drug label to the person Opening containers Checking dosage against drug label Providing water, juice, milk, crackers, applesauce, etc. as needed Making sure the person takes the right drug, the right amount, at the right time by the right route Charting that the person refused to take the drug Storing drugs

Reporting Drug Errors Report drug errors immediately & complete an incident report Provide facts, not opinions Report Date and time Time the drug was ordered Drug name, dosage and route How you discovered the error Person’s response Signs and symptoms of adverse reactions Date and time you reported the error

Preventing Infection Asepsis: Medical Asepsis (clean technique): Free of disease-producing microbes Medical Asepsis (clean technique): Remove or destroy pathogens Prevent pathogens from spreading from one person or place to another Surgical Asepsis (sterile technique): Practice that keeps items free of all microbes Sterile is the absence of all microbes Sterilization: Process of destroying all microbes Contamination: Process of becoming unclean

Common Aseptic Practices Aseptic practices prevent the spread of microbes: Remember to practice good hand hygiene Wear PPE Do not self-contaminated Remove & discard PPE before leaving the person’s room or care setting