Transcript Dimensional Analysis #6

Dimensinal Analysis
Chapter 6
Reading Oral medication labels
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
• 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.
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.
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.
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.
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.
Safe Drugs
• U.S. Food and Drug Administration (FDA)
1938: The Federal Food, Drug &
Cosmetic Act
• Federal regulation
• Drugs must be labeled with
directions
• Manufactures had to prove meds
were safe
• Government inspections
Thalidomide
• Morning Sickness pill
– 1950’s / Europe
• Severe birth defects limbs
Medication Orders: components
1. Patient identify
information
–
–
–
–
Name
DOB
Medical Record #
Dr.
Medication Orders: components
2. Date and time
of order
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
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
On a 24-hour clock what time would
6:30 PM be?
A. 0630
B. 1430
C. 1630
D. 1830
E. None of the above?
On a 24-hour clock what time would
10:15 PM be?
A. 1015
B. 1215
C. 0815
D. 2015
E. None of the above
On a 24-hour clock what time would
8:00 PM be?
A. 0800
B. 1000
C. 2000
D. 2200
E. None of the above
On a 24-hour clock what time would
12:45 PM be?
A. 1245
B. 0045
C. 1445
D. 1045
E. None of the above
On a 24-hour clock what time would
6:30 AM be?
A. 0630
B. 0830
C. 1830
D. 1630
E. None of the above
On a 24-hour clock what time would
12:30 AM be?
A. 1230
B. 0230
C. 0030
D. 1430
E. None of the above
On a 24-hour clock what time would
7:30 PM be?
A. 1930
B. 1730
C. 1530
D. 0730
E. None of the above
On a 24-hour clock what time would
1:30 AM be?
A. 1330
B. 0030
C. 0330
D. 0130
E. None of the above
Medication Orders: components
3. Name of
medication
Medication Orders: components
4. Medication
dosage
–
–
–
–
500 mg
20 mEq
100 units
30 mL
Medication Orders: components
5. Route of
administration
Route: enteral
• Oral (by mouth)
–PO
• Tablets
• Capsules
• Caplets
Route: enteral
• Rectal (per rectal)
–PR
• suppositories
Route: enteral
• Via tubes (GT or NGT)
Route: Parenteral
• Intravenous
–IV
Route: Parenteral
• Intramuscular
–IM
Route: Parenteral
• Subcutaneous
–Subcut
Route: Parenteral
• Intradermal
–ID
Route: Other
• Sublingual
–SL
Route: other
• Transdermal
Medication Orders: components
6. Frequency &/or • At bedtime
• At bedtime
time
• Daily
• daily
• Twice a day
• bid
• Three times a day
• tid
• Every 2,4 or 6 hours
• q2hr
• q4hr
• q6hr
• Before meals
–ac
• After meals
–pc
Medication Orders: components
7. Prescriber’s name
& credentials
• Mary Jones, MD
• John Gonadal, DO
Medication Orders: components
8. Name of person
transcribing the
order
• Noted: E. Keele, RN
The 6 rights & 3 checks
Rights
1. Patient
Checks
The 6 rights & 3 checks
Rights
1.
2.
3.
4.
5.
6.
Patient
Drug
Dose
Route
Time
Documentation
Checks
• Check medication
– While pulling
– After pulling
– Before giving
Oral Mediations
•
•
•
•
•
Tablets
Scored tablets
Enteric coated tablets
Capsules
Controlled release
capsules
• Gelatin capsules
Tablets
• Tablets
• Scored tablets
• Enteric coated tablets
Capsules
• Capsules
• Control release capsules
Gelatin capsules
What are these capsules made of?
• Gelatin
• Plant starch and cellulose
Can a scored tablet be divided in half?
Giving only half of a tablet to a
patient?
A. Yes
B. No
Can a gelatin filled capsule be divided
in half - giving only half of a capsule to
a patient?
A. Yes
B. No
C. I don’t know – I’ll wait until Mrs.
Keele shows me the right answer!
Can a capsule be divided in half?
Giving only half of a capsule to a
patient?
A. Yes
B. No
Can you open a capsule and give a
patient the medication without the
capsule casing?
A. Yes
B. No
May you open a time release capsule
and give a patient the medication
without the capsule?
A. Yes
B. No
Unit Dosage label
• Each tablet or capsule is
packages separately
Unit Dosage label
Example
•
•
•
•
•
•
Trade name
Generic/official name
Dosage strength
Unit of measure
Manufacturer
Exp date:
Multiple dose label
• More than one
tablet / capsule in a
package
• What is the
difference?
Example
•
•
•
•
•
Trade name?
Generic name?
Dosage strength?
Unit of measure?
How many tablets in
this bottle?
U.S.P & N.F.
• U.S.P
– United States
Pharmacopeia
• N.F.
– National Formulary
Exp.
• Exp.
– Expiration date
• Make a habit of
checking the expiration
date on labels!
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
You Turn!
• What is the generic
name?
• What is the trade
name?
• What is the dosage
strength
• How many capsules in
this bottle?
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!
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.
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.
•
•
•
•
Trade name?
Generic name?
Dosage strength?
Number of tablets in
the bottle?
How much medication to give?
• Give Aricept 12.5 mg
• Formula:
Desire
Have
= what to give
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
How much medication to give?
• Give Aricept 12.5 mg
• Formula:
Desire
Have
12.5 mg = _____ tablets
5 mg
** THE DOSAGE METRIC UNIT
MUST MATCH!
Give Halcion 0.625 mg
•
•
•
•
Trade name?
Generic name?
Dosage strength?
Number of tablets in
the bottle?
Give Halcion 0.625 mg
• Formula
– Desire = __#__ tablets
Have
• Desire
– 0.625 mg
• Have
– 0.25 mg
Give Halcion 0.625 mg
• Formula
– Desire = __#__ tablets
Have
Desire: 0.625 mg = ? tablets
Have: 0.25 mg
0.625 mg / 0.25 mg = 2.5 tablets
Give 2 ½ tablets
Your turn!
• What is the dosage
strength?
• If 10 mg is ordered
give…?
• If 2.5 mg is ordered
give…?
• If 7.5 mg if ordered
give…?
Answers!
• What is the dosage
strength?
• If 10 mg is ordered
give…?
– D: 10 mg = ?
– H: 5 mg
– 10 mg / 5 mg =
• 2 Tablets
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
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
Your turn!
• What is the dosage
strength?
• If the doctor orders you
to give 240 mg how
many capsules would
you give?
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
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
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
Should an enteric coated tablet be cut
in half or crushed – before giving to a
patient?
A. Yes
B. No