Preventing Medication Errors Chapter 9 Preventing Medication Errors READ ARTICLE ABOUT SN’S HAVING A KEY ROLE IN CULTURE OF SAFETY Medication admin. Is one of the primary functions of the nurse in most health care settings. ANY health care practitioner is at risk for making an error. Several studies indicate there is no relationship between years of service and making errors….ask WHY??

Medication Errors Medication administration errors are common Account for 10% to 18% of hospital injuries Account for 44,000 to 98,000 deaths in U.S. hospitals annually Note: The incidence of medication errors and the characteristics of the nurse (years practicing and education) have no relationship. Ask: what do you think some of the effects are of med error

Medication Errors Effects: Increased length of stay Increased cost Patient disability Death Harm to nurse’s personal and professional status, confidence, and practice The Institute of Medicine estimates that hospitalized patients are subjected to one medication error a day.

Medication Errors Medications that have been designated as high-alert drugs have the highest risk of causing injuries due to errors. The Joint Commission identified these drugs as high alert medications

These drugs are: Insulin Opiates Narcotics Injectable potassium Intravenous anticoagulants The term opiates refers to natural or slightly modified components of opium such as codeine, morphine and heroin.\ Narcotics are a subclass of opiates

Steps in Safe Medication Administration Complete prescription Accurate transcription Correct administration The delivery process is complex. It involves many individuals and departments. SAFE ADMINISTRATION BEGINS WITH: read slide

Rule The wise nurse ALWAYS verifies the safety of the drug order by consulting a reputable drug reference!! Examples/resources for reference guides: ask class

Complete Prescription Licensed providers must have authority within their state to write prescriptions Includes verbal orders Repeat and verify all verbal orders for accuracy Write down and read back all telephone orders MD’S, DDS, DO, PODIATRITS, NP’S, PA’S all have authority to write prescriptions

Complete Prescription Nurses play an important role in preventing errors at prescription step Practitioner who administers drug shares liability for injury Even if medical order was incorrect Verify safety of drug order by checking reliable drug reference Ask class to state seven parts of drug order Reliable references include: hospital formulary, MAR, etc

Verbal Orders Seven parts of all drug orders: Patient’s name Date and time of order Name of drug Dosage of drug Route Frequency or administration schedule Prescriber’s name and licensure As with written med orders, it is necessary for the nurse to be sure all 7 parts of the drug order have been included and are accurate. WHAT if there is confusion or an inaccuracy???

Verbal Orders Write or enter verbal or telephone order into patient’s medical record Read order back to prescriber to ensure clarity Receive confirmation that order is correct Use example of playing telephone to illustrate communication errors. The joint commission states for emergencies ie, a code, a “repeat back” is acceptable

Alert Verbal orders can easily lead to medication errors Nurses must understand their responsibility Caution: Verbal orders are a major responsibility and a situation that can easily lead to medication errors. You should be informed about the policies in the health care facilities where you work. Most health care facilities have rules re verbal orders

Accurate Transcription Institute for Safe Medication Practices (ISMP) identifies unsafe: Abbreviations Acronyms Symbols also, the MD’s handwriting can be a source for concern Both the JC and ISMP have published these lists due to common errors associated with above JC 2004 published do Not Use List page 183

ISMP Suggests that health care facilities identify unsafe abbreviations within organization Know own organization’s policies Pages 183-185 Initially the JC issued its DO NOT USE LIST IN 2004. at the same time the ISMP designated a list of potential error causing abbreviations. Now, JC advices hc organizations to look at ISMP list. Nurses need to stay abreast to guidelines and restrictions according to both of these organizations

Do Not Use U (unit) IU (international unit) Q.D., QD, q.d., or qd (daily) Q.O.D., QOD, q.o.d., or qod (every other day)

Do Not Use Trailing zero (X.0 mg) Lack of leading zero (.X mg) MS or MSO4 (morphine sulfate) MgSO4 (magnesium sulfate)

Computerized Order Entry Many health care institutions are utilizing a computerized physician/prescriber order entry (CPOE) system to help eliminate transcription sources of error. Helps to alleviate questionable handwriting from prescribers

Safe and Correct Administration Six Rights Right patient Right drug Right amount Right route Right time Right documentation

Right Patient Correctly identify patient using two identifiers prior to medication administration Compare armband with medication administration record Ask patient to state name and DOB Compare picture to patient Use electronic identification technology coding One of three most common causes of med error…The failure of the nurse to accurately id a a pt is the most common cause for error

Right Patient Tell patient at time of administration what medication and dosage is being administered Patient may question drug or dosage Provides opportunity to do medication teaching May prevent an error if patient questions drug or amount

Right Drug 1st!! Check your medication order from prescriber Check medication label against MAR three times during administration: On first contact with drug Prior to measuring Pouring, counting, or withdrawing After preparing drug, just prior to administration

Right Drug Be aware of distractions Do not multitask during administration Use barcode scanning when available Be knowledgeable about drug’s actions, indications, and contraindications Distractions have been id’d as a key reason for error for obtaining the right drug

Right Amount Carefully read and clarify drug orders Recheck labels Have two nurses double-check potent medications Common sources of errors Insulin Narcotics

Right Amount Consult drug references Conduct accurate dosage calculations

Right Route Consult drug information source to confirm correct route

Right Route May need to change or clarify forms or routes of drug for safe medication administration Nil per os (NPO) status Nasogastric or surgically inserted tubes Time-release or enteric-coated medications Only prescriber can change route A common error relates to the nurse and his/her lack of knowledge of a drug

Right Time Order should include frequency of administration Use safe abbreviations Page 193…read

Right Documentation Document as soon as possible after administration. “REAL TIME CHARTING” is best practice. Omitting documentation can result in over- or under-medication

Reminders Check labels carefully Follow Six Rights of medication administration Be aware of and adhere to facility’s policies on medication administration Refer to reputable drug reference resources to validate the safety of the medication as ordered and transcribed

Reminders Check medication three times before administering Identify if form is appropriate for route If unsure of order, clarify prior to administration Ask class: WHAT ARE THE 3 CHECKS YOU MAKE BEFORE ADMINISTERING MEDICATION??? FIRST CONTACT WITH DRUG PRIOR TO MEASURING THE DRUG AFTER PREPARING THE DRUG, JUST PRIOR TO ADMINISTRATION

Summary: THE NURSE who administers a medication is legally liable for medication errors! Whether the primary cause was an unsafe order, an incorrect transcription, a wrong drug, an inaccurate dosage calculation, an improper preparation, or an administration error! Med admin is a critical nursing skill!

DONE MIDTERM APRIL 9, 2019 Chapters 1-9 Homework due: chapters 8-9 and self evaluation