Patient Safety and Quality Improvement

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Presentation transcript:

Patient Safety and Quality Improvement Copyright © 2006, 2001 by Mosby, Inc.

Copyright © 2006, 2001 by Mosby, Inc. Standards of Care Institute of Safe Medicine Practices Joint Commission on Accreditation of Health Care Organizations National Patient Safety Goals Copyright © 2006, 2001 by Mosby, Inc.

Nursing responsibilities Know purpose, actions, effects, and major side effects and toxic effects of drug Teaching required to enable client or caregiver to safely and accurately self-administer drug Monitor for SEs and report them Correctly calculate drug dosages Not pre-pour, pre-chart, give others meds, or falsify Question prescriber if necessary Follow policies regarding verbal and phone orders Keep up with continuing ed R/T meds, skills Copyright © 2006, 2001 by Mosby, Inc.

Prevention: Managing Drug Errors Use drug reference Follow 10 rights (including assessment, education, evaluation, and refusal) 3 checks Unit dosing Computerized prescriber order entry system Bar coding at the point-of-care Question illegible orders Do not use unacceptable abbreviations or zeros Private area for preparing Copyright © 2006, 2001 by Mosby, Inc.

Types of Errors Ones related to ordering (39%), administering (38%), transcribing (12%), or dispensing (11%) Wrong med or infusions Wrong dose or rate Wrong patient Wrong route Wrong time Giving known allergic drugs or infusions Omission of dose Discontinuation of drug not meant to be D/C’d Copyright © 2006, 2001 by Mosby, Inc.

Factors Involved In Errors More drugs on market Violation of 10 rights Lack of drug knowledge Memory lapses Transcription, dispensing, or delivery probs Inadequate monitoring Distractions Copyright © 2006, 2001 by Mosby, Inc.

Lack of standardization Confusing packaging Equipment failures Factors cont’d Overwork Lack of standardization Confusing packaging Equipment failures Inadequate client hx taking Poor interdepartmental communication Copyright © 2006, 2001 by Mosby, Inc.

I’ve Made a Mistake-NOW WHAT?? Don’t hide it—remember advocacy Check patient Report it—to supervisor, MD Follow agency protocol for paperwork F/U and monitoring Do you tell the patient? Copyright © 2006, 2001 by Mosby, Inc.

Monkey See, Monkey Do: Critical Thinking ?s If giving an antihypertensive? Antihypertensive and 90/60? Antihypertensive + narcotic? Med refusal? Insulin injection? NPO for surgery or tests? D/C at lunchtime, going home on same morning meds? Medical patient in for surgery? Pt c/o pain and has 3 different pain meds? Copyright © 2006, 2001 by Mosby, Inc.