1. Principles of Medication Administration and Medication Safety Chapter 7 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 7 Lesson 7.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Identify the limitations relating to medication administration placed on licensed practical nurses, vocational nurses, registered nurses, and nurse clinicians by the nurse practice act in the state where you will be practicing Study the policies and procedures of the practice setting to identify specific regulations concerning medication administration by licensed practical nurses, vocational nurses, registered nurses, and nurse clinicians Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Slide 4 Objectives (cont’d) Identify the basic categories of information available in a patient’s chart Study patient charts at different practice settings to identify the various formats used to chart patient data Cite the information contained in a Kardex, and describe the purpose of this file Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Legal and Ethical Considerations Standards of care: developed by each state’s nurse practice act, state and federal law, The Joint Commission, professional organizations Before administering medication, the nurse must have:  Current license to practice  Clear policy statement authorizing the act  Signed medication order  Understanding of rationale for drug use  Understanding of drug action, dosing, dilution, route and rate of administration, common and serious adverse effects, and contraindications Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Contents of Patient Charts Summary sheet Consent forms Physician’s order form History and physical examination form Progress notes Critical pathways Core measures Nurses’ notes Laboratory tests record Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Contents of Patient Charts (cont’d) Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or medication profile PRN or unscheduled medication record Case management Patient education record Kardex Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Chapter 7 Lesson 7.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Slide 9 Objectives Cite the advantages and disadvantages of the ward stock system, computer-controlled ordering and dispensing system, individual prescription order system, and unit dose system Study the narcotic control system used at your assigned clinical practice setting and compare it with the requirements of the Controlled Substances Act of 1970 Define the four categories of medication orders used Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Slide 10 Objectives (cont’d) Describe the procedure used in the assigned clinical setting for taking, recording, transcribing, and verifying verbal medication orders Identify common types of drug errors and actions for their prevention Memorize and recite standard abbreviations associated with the scheduling of medications Identify data found in the patient’s chart used to determine if the patient has abnormal renal or hepatic function Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 Drug Distribution Systems Floor or ward stock system Individual prescription order system Computer-controlled dispensing system Unit dose drug distribution systems Long-term-care unit dose system Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Narcotic Control Systems Controlled substances must be kept in a locked cabinet Records are kept to document the dispensing of each type of medication issued Two nurses are needed when accounting for any discarded narcotics Discrepancies are carefully checked; if the inaccuracy is not resolved by checking the patient’s chart, the pharmacy and nursing service is notified Slide 12 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Drug Disposal Environmental concerns regarding drugs contaminating water prompted guidelines for disposal of medications in 2007 Do not flush prescription drugs in toilet (unless instructed by manufacturer) If no instructions are given, throw in trash Utilize drug take-back programs, which allow public to dispose of unused drugs Slide 13 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Slide 14 The Drug Order Stat order – emergency use Single order – one time use Standing order – given for specific number of doses PRN order – administer as needed Verbal orders – avoid whenever possible Electronic transmission of patient orders Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Slide 15 Medication Errors Prescribing errors Transcription errors Dispensing errors Administration errors Monitoring errors Adverse Drug Events (ADE) – costly errors  Using CPOE, bar coding, smart pumps, and other technologies helps to prevent errors Medication reconciliation – five-step process Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Slide 16 Nurse Responsibilities Verification  Nurse makes professional judgment regarding medication orders Includes type of drug, usual dose, therapeutic intent, potential allergic reactions, contraindications Transcription  Nurse is responsible for verification of orders transcribed by others Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

17. Slide 17 Chapter 7 Lesson 7.3 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Slide 18 Objectives Identify specific precautions needed to ensure that the right drug is prepared for the patient Describe specific safety precautions that the nurse should follow to ensure that correct drug calculations are made Review the policies and procedures of the practice setting to identify drugs for which doses must be checked by two qualified people Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

19. Slide 19 Objectives (cont’d) Describe the methods used to ensure that the correct patient receives the correct medication, by the correct route, in the correct amount, at the correct time Identify appropriate nursing actions to document the administration and therapeutic effectiveness of each medication administered Compare each safety measure described to ensure safe preparation and administration of medications with those procedures used in the clinical practice setting Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Slide 20 The Six Rights Right drug  Compare exact spelling and concentration of drug with medication card and drug container; drug label should be read three times Right time  Standard abbreviations for specific times  Standardized administration times to maximize drug absorption  Maintenance of consistent blood levels; generally laboratory tests used  PRN medications determine the last time given Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

21. Slide 21 The Six Rights (cont’d) Right dose  Abnormal hepatic or renal function  Any nausea and vomiting  Accurate dose forms  Accurate calculations  Correct measuring devices Right patient  ID bracelet checking  Considerations for pediatric and older adult patients Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

22. Slide 22 The Six Rights (cont’d) Right route  Oral route  Subcutaneous route  Intramuscular (IM) route  Intravenous (IV) route Right documentation  Safety/ethical considerations  Legal considerations  Always include date/time, drug name, dose, route, site of administration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.