1. Chapter 6 Reading Oral medication labels
Dimensinal Analysis
Chapter 6
Reading Oral medication labels

2. Nurse Charged With Felony In Medication Error Death
Medication error could send nurse to prison for up to 6 years in death of OB patient.
A former Madison, WI nurse was charged with criminal neglect in the death of 16-year-old Jasmine Gant, who died in July of a medication error while giving birth. Julie Thao, 41, of Belleville, faces a count of neglect of a patient causing great bodily harm, which carries a maximum prison sentence of six years in prison.
Nurse Charged With Felony In Medication Error Death
Medication error could send nurse to prison for up to 6 years in death of OB patient.
By Stephen A. Frew JD
Published Nov 8, 2006
A former Madison, WI nurse was charged with criminal neglect in the death of 16-year-old Jasmine Gant, who died in July of a medication error while giving birth. Julie Thao, 41, of Belleville, faces a count of neglect of a patient causing great bodily harm, which carries a maximum prison sentence of six years in prison.
Gant allegedly died after an epidural anesthetic was allegedly mistaken for a prescribed dose of penicillin. Thao is alleged to have taken the drug from a locker and administered it to the patient intravenously even though the container carried a warning that it was not for IV use.
The patient died within an hour, but the infant survived when doctors performed an emergency ceasarian delivery.
A criminal complaint alleges that Thao ignored every safeguard put in place to prevent medication errors at Madison's St. Mary's Hospital and Medical Center. The prosecutor alleges Thao ignored the hospital's "Bridge System," used to scan medication labels before drugs are administered, took a potentially lethal drug from a storage locker without authorization and didn't read the label of a drug she injected into Gant.

3. Nurse Charged With Felony In Medication Error Death
Gant allegedly died after an epidural anesthetic was allegedly mistaken for a prescribed dose of penicillin. Thao is alleged to have taken the drug from a locker and administered it to the patient intravenously even though the container carried a warning that it was not for IV use.
The patient died within an hour, but the infant survived when doctors performed an emergency ceasarian delivery.

4. Nurse Charged With Felony In Medication Error Death
A criminal complaint alleges that Thao ignored every safeguard put in place to prevent medication errors at Madison's St. Mary's Hospital and Medical Center. The prosecutor alleges Thao ignored the hospital's "Bridge System," used to scan medication labels before drugs are administered, took a potentially lethal drug from a storage locker without authorization and didn't read the label of a drug she injected into Gant.

5. Nurse's suicide highlights twin tragedies of medical errors
For registered nurse Kimberly Hiatt, the horror began last Sept. 14, the moment she realized she’d overdosed a fragile baby with 10 times too much medication.
Stunned, she told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had happened. “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse, Michelle Asplin, in a statement to state investigators.

6. Nurse's suicide highlights twin tragedies of medical errors
In Hiatt’s 24-year career, all of it at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the only serious medical mistake she’d ever made, public investigation records show.

7. Nurse's suicide highlights twin tragedies of medical errors
“She was devastated, just devastated,” said Lyn Hiatt…
That mistake turned out to be the beginning of an unraveled life, contributing not only to
the death of the child, 8-month-old Kaia,
but also to Hiatt’s firing,
a state nursing commission investigation
and Hiatt's suicide on April 3 at age 50.

8. Safe Drugs
U.S. Food and Drug Administration (FDA)

9. 1938: The Federal Food, Drug & Cosmetic Act
Federal regulation
Drugs must be labeled with directions
Manufactures had to prove meds were safe
Government inspections

10. Thalidomide Morning Sickness pill Severe birth defects -limbs
1950’s / Europe
Severe birth defects -limbs
Manufactured by a German company in the 1950’s.
Sleeping pill / antiemetic during pregnancy
Infants born with severe birth defects of the limbs

11. Medication Orders: components
1. Patient identify information
Name
DOB
Medical Record #
Dr.

12. Medication Orders: components
2. Date and time of order

13. 24-hour clock / military time
Standard clock
24 hour clock
1:00 AM
0100
2:00 AM
0200
4:00 AM
0400
6:00 AM
0600
8:00 AM
0800
10:00 AM
1000
10:30 AM
1030
11:00 AM
1100
11:15 AM
1115
11:30 AM
1130

14. 24-hour clock / military time
Standard clock
24 hour clock
12:00 PM
1200
12:45 PM
1245
1:00 PM
1300
2:00 PM
1400
3:00 PM
1500
4:00 PM
1600
5:00 PM
1700
8:00 PM
2000
10:00 PM
2200

15. On a 24-hour clock what time would 6:30 PM be?
0630
1430
1630
1830
None of the above?

16. On a 24-hour clock what time would 10:15 PM be?
1015
1215
0815
2015
None of the above

17. On a 24-hour clock what time would 8:00 PM be?
0800
1000
2000
2200
None of the above

18. On a 24-hour clock what time would 12:45 PM be?
1245
0045
1445
1045
None of the above

19. On a 24-hour clock what time would 6:30 AM be?
0630
0830
1830
1630
None of the above

20. On a 24-hour clock what time would 12:30 AM be?
1230
0230
0030
1430
None of the above

21. On a 24-hour clock what time would 7:30 PM be?
1930
1730
1530
0730
None of the above

22. On a 24-hour clock what time would 1:30 AM be?
1330
0030
0330
0130
None of the above

23. Medication Orders: components
3. Name of medication
Generic or trade name – but generic is best to prevent confusion

24. Medication Orders: components
4. Medication dosage
500 mg
20 mEq
100 units
30 mL

25. Medication Orders: components
5. Route of administration

26. Route: enteral
Oral (by mouth) PO
Tablets
Capsules
Caplets

27. Route: enteral
Rectal (per rectal) PR
suppositories

28. Route: enteral
Via tubes (GT or NGT)

29. Route: Parenteral
Intravenous IV

30. Route: Parenteral
Intramuscular IM

31. Route: Parenteral
Subcutaneous
Subcut

32. Route: Parenteral
Intradermal ID

33. Route: Other
Sublingual SL

34. Route: other
Transdermal

35. Medication Orders: components
6. Frequency &/or time
Daily
daily
Twice a day
bid
Three times a day
tid
At bedtime
Every 2,4 or 6 hours
q2hr
q4hr
q6hr

36. Before meals ac
After meals pc

37. Medication Orders: components
7. Prescriber’s name & credentials
Mary Jones, MD
John Gonadal, DO

38. Medication Orders: components
8. Name of person transcribing the order
Noted: E. Keele, RN

39. The 6 rights & 3 checks
Rights
Checks
Patient

40. The 6 rights & 3 checks Patient Drug Dose Route Time Documentation
Check medication
While pulling
After pulling
Before giving
Patient
Drug
Dose
Route
Time
Documentation

41. Oral Mediations Tablets Scored tablets Enteric coated tablets Capsules
Controlled release capsules
Gelatin capsules

42. Tablets
Tablets
Scored tablets
Enteric coated tablets

43. Capsules Capsules Control release capsules
In the manufacture of pharmaceuticals, encapsulation refers to a range of techniques used to enclose medicines in a relatively stable shell known as a capsule, allowing them to, for example, be taken orally or be used as suppositories. The two main types of capsules are:
Hard-shelled capsules, which are normally used for dry, powdered ingredients or miniature pellets (also called beads that are made by the process of Extrusion and Spheronization) - or mini tablets;
Soft-shelled capsules, primarily used for oils and for active ingredients that are dissolved or suspended in oil.
Both of these classes of capsules are made from aqueous solutions of gelling agents like:
Animal protein mainly gelatin;
Plant polysaccharides or their derivatives like carrageenans and modified forms of starch and cellulose.
Other ingredients can be added to the gelling agent solution like plasticizers such as glycerin and/or sorbitol to decrease the capsule's hardness, coloring agents, preservatives, disintegrants, lubricants and surface treatment.

44. Gelatin capsules

45. What are these capsules made of?
Gelatin
Plant starch and cellulose
In the manufacture of pharmaceuticals, encapsulation refers to a range of techniques used to enclose medicines in a relatively stable shell known as a capsule, allowing them to, for example, be taken orally or be used as suppositories. The two main types of capsules are:
Hard-shelled capsules, which are normally used for dry, powdered ingredients or miniature pellets (also called beads that are made by the process of Extrusion and Spheronization) - or mini tablets;
Soft-shelled capsules, primarily used for oils and for active ingredients that are dissolved or suspended in oil.
Both of these classes of capsules are made from aqueous solutions of gelling agents like:
Animal protein mainly gelatin;
Plant polysaccharides or their derivatives like carrageenans and modified forms of starch and cellulose.
Other ingredients can be added to the gelling agent solution like plasticizers such as glycerin and/or sorbitol to decrease the capsule's hardness, coloring agents, preservatives, disintegrants, lubricants and surface treatment.

46. Can a scored tablet be divided in half
Can a scored tablet be divided in half? Giving only half of a tablet to a patient?
Yes No

47. Can a gelatin filled capsule be divided in half - giving only half of a capsule to a patient?
Yes No
I don’t know – I’ll wait until Mrs. Keele shows me the right answer!

48. Can a capsule be divided in half
Can a capsule be divided in half? Giving only half of a capsule to a patient?
Yes No

49. Can you open a capsule and give a patient the medication without the capsule casing?
Yes No

50. May you open a time release capsule and give a patient the medication without the capsule?
Yes No

51. Unit Dosage label Each tablet or capsule is packages separately
Halcion / Triazolam(trye ay' zoe lam)
Last Revision: February 1, 2011.
Why is this medication prescribed?
Triazolam is used on a short-term basis to treat insomnia (difficulty falling asleep or staying asleep). Triazolam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow sleep.

52. Unit Dosage label

53. Example Trade name Generic/official name Dosage strength
Unit of measure
Manufacturer
Exp date:

54. Multiple dose label More than one tablet / capsule in a package
What is the difference?
Klonopin
AHFS Consumer Medication Information.
Clonazepam(kloe na' ze pam)
Last Revision: July 1, 2010.
Why is this medication prescribed?
Clonazepam is used alone or in combination with other medications to control certain types of seizures. It is also used to relieve panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Clonazepam is in a class of medications called benzodiazepines. It works by decreasing abnormal electrical activity in the brain.

55. Example Trade name? Generic name? Dosage strength? Unit of measure?
How many tablets in this bottle?

56. U.S.P & N.F.
U.S.P
United States Pharmacopeia
N.F.
National Formulary

57. Exp. Exp. Make a habit of checking the expiration date on labels!

58. 2 medications in one pill
Contains 2 medications
Carbidopa
Levodopa
Ordered by the trade name & # of tablets to be given.
2 dose amounts
25-100
Parkinson medication

59. You Turn! What is the generic name? What is the trade name?
What is the dosage strength
How many capsules in this bottle?

60. Tablet/capsule dosage calculation
Medication records will tell you the name and amount of drug to be given, it will not tell you how many tablets or capsules to give!

61. Tablet/capsule dosage calculation
Learn to question orders for more than three tablets or capsules.
An unusual number of tablets or capsules could be a warning of an error in prescribing, transcribing or your calculations.

62. Tablet/capsule dosage calculation
Regardless of the source of the error, if you give a wrong drug or dosage you are legally responsible for it.

63. Trade name?
Generic name?
Dosage strength?
Number of tablets in the bottle?

64. How much medication to give?
Give Aricept 12.5 mg
Formula:
Desire = what to give
Have

65. How much medication to give?
Give Aricept 12.5 mg
What do we desire to give / What did the doctor order?
12.5 mg
What do we have / what is the unit dose?
5 mg

66. How much medication to give?
Give Aricept 12.5 mg
Formula:
Desire mg = _____ tablets
Have mg
** THE DOSAGE METRIC UNIT MUST MATCH!

67. Give Halcion 0.625 mg Trade name? Generic name? Dosage strength?
Number of tablets in the bottle?

68. Give Halcion 0.625 mg Formula Desire Desire = __#__ tablets Have

69. Give Halcion 0.625 mg Formula Desire: 0.625 mg = ? tablets
Desire = __#__ tablets
Have
Desire: mg = ? tablets
Have: mg
0.625 mg / 0.25 mg = 2.5 tablets
Give 2 ½ tablets

70. Your turn! What is the dosage strength? If 10 mg is ordered give…?
If 7.5 mg if ordered give…?

71. Answers! What is the dosage strength? If 10 mg is ordered give…?
D: 10 mg = ?
H: 5 mg
10 mg / 5 mg =
2 Tablets

72. Answers! What is the dosage strength? If 2.5 mg is ordered give…?
D: 2.5 mg = ?
H: 5 mg
2.5 mg / 5 mg =
0.5 mg
½ tablet

73. Answers! What is the dosage strength? If 7.5 mg if ordered give…?
D: 7.5 mg = ?
H: 5 mg
7.5 mg / 5 mg =
1.5 tablets
1 ½ tablets

74. Your turn! What is the dosage strength?
If the doctor orders you to give 240 mg how many capsules would you give?

75. Answer! What is the dosage strength?
If the doctor orders you to give 240 mg of Verelan how many capsules would you give?
D: 240 mg = ? Capsules
H: 120 mg
2 capsules

76. Another question What is the dosage strength?
The doctor orders Terbutaline Sulfate 3.75 mg. How much will you give?
D: 3.75 mg = _?_ tablets
H: 2.5 mg
1.5 tablets
1 ½ tablets

77. One more example What is the dosage strength?
The doctor orders 250mg of Azulfidine. How many tablets should you give?
D: 250 mg = _?_ tablets
H: 500 mg
0.5 tablets
½ tablets

78. Should an enteric coated tablet be cut in half or crushed – before giving to a patient?
Yes No