1. Medication Safety
Chapter 9

2. 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

3. 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

4. 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

5. 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

6. 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

7. Medication Cart

8. 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

9. 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

10. Controlled Substance Inventory Sheet

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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.

19. 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

20. 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

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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