Transcript Ch. 9-Medication Safetyx - NAC / CNA Certification Spokane WA

Medication Safety
Chapter 9
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
1.
2.
3.
4.
5.
Right Drug
Right Time
Right Dose
Right Person
Right Route
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
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:
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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
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
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
Medication Cart
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
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
Controlled Substance Inventory Sheet
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.
Disposing of Drugs
• Reasons why drugs may need to be disposed:
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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
The Six Rights
• When giving medications, always protect the
patient’s safety
– Six Rights of Medication Administration
1.
2.
3.
4.
5.
6.
Right Drug
Right Time
Right Dose
Right Person
Right Route
Right Documentation
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
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
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.
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
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.
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
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
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.
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
Self Administration
• Self-directed medication management:
– Allowing a patient or resident to take own
medications
• Your role may involve:
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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
Reporting Drug Errors
• Report drug errors immediately & complete
an incident report
– Provide facts, not opinions
• Report
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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
Preventing Infection
• Asepsis:
– 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
Common Aseptic Practices
• Aseptic practices
prevent the spread of
microbes:
– Remember to practice
good hand hygiene
– Wear PPE
– Do not selfcontaminated
– Remove & discard PPE
before leaving the
person’s room or care
setting