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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.