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Medication administration

Medication administration






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    Medication administration Medication administration Presentation Transcript

    • Medication AdministrationIt is important medication is administered in a timely, efficient, andaccurate method Medication is administered by licensed nurse associates to the right patient, in the right dose, by the right route, at the right time, and is documented appropriately in the chart. The patient must also be educated on the medications when applicable The pharmacist must have the allergies, height, and weight listed in order to enter the medicines into the system There is a pharmacist here 24 hours a day. At night if unable to reach the pharmacist by phone use the Vocera. Say “call pharmacist”
    • Medication Administration (cont) When beginning a shift, licensed nurses utilize the MAR to check and verify the accuracy of all medications and allergies against physician orders prior to administration The nurse verifies the patient’s identity by having the patient state his or her name and date of birth or by verifying with any family members present If the patient cannot state his name/date of birth and no family is present, the account number is verified in addition to the name/date of birth on the patient’s armband
    • Medication Administration (cont)Medication SchedulingEstablished medication times are adhered to as closely as possibleThe following are noted exceptions:• Insulin is given at 0730 for a.m. and 1730 for p.m. unless otherwise ordered by the physician• Daily Lanoxin is given at 1400 unless otherwise ordered by the physician• Daily Coumadin is given at 2100 unless otherwise ordered by the physician• Lasix BID is given at 0800 and 1400
    • Administration TimesDaily 0900 Q4H 0200 0600 1000 1400 1800Bedtime 2100 2200BID 0900 2100 Q6H 0600 1200 1800 2400TID 0600 1400 2100 Q8H 0600 1400 2200QID 0600 1200 1800 2100 Q12H 0900 2100QH 0600 0700 0800 etc. AC 0700 1100 1700Q2H 0200 0400 0600 0800 etc. PC 0800 1300 1800 with meals 0730 1200 1730IV Heparin ordered every six hours shouldbe given at 0200, 0800, 1400, 2000. Thesehours fit the lab hours and drawing of PTT’s
    • Administration Times (cont)IV Piggyback Dosing Schedule:Every 6 hours 0600 1200 1800 2400Every 8 hours 0600 1400 2200Every 12 hours Start ASAP and time to followEvery 24 hours Start ASAP and time to followOn initial order the piggyback should be hung as soon as possibleafter the medication reaches the nursing unitPharmacy does not need to reschedule the antibiotic time from thestart time of the first dose
    • Medication Administration (cont) For 6 hour piggybacks, if there are more than 2 hours before the next dosing time (0600, 1200, 1800, 2400) the second piggyback should be hung at the next scheduled time If there are less than 2 hours before the next scheduled dosing time, the next one should be skipped For 8 hour piggybacks, if there are more than 3 hours before the next dosing time (0600, 1400, 2000), the second piggyback should be hung at the next scheduled time If there is less than 3 hours before the next scheduled dosing time, the next one should be skipped All second and third piggybacks of a different antibiotic on a given patient, that are to be hung at the same scheduled time, should be hung in succession
    • Medication Administration (cont)Documentation All medications must be addressed at the scheduled time If a medication is given, it needs to be documented as “given” If a medication is omitted, it needs to be documented as “omitted” If a medication is given at a different time, this needs to be included in the comments section The times medications are given (especially antibiotics) must be documented accurately *Antibiotics have to also have an end time documented*
    • Medication Administration (cont)The medication room should Stop: Pause for one secondbe considered a quiet or Red Think: Attention on taskZoneNo interruptions or Act: Take the actiondistractions should take place Review: Check for resultwhile the nurse is removingmedicationsThe STAR technique is a selfchecking technique which canbe used at any time and maybehelpful in reducing medicationerrors
    • Medication ErrorsA medication error is defined as administration of a medication which varies from any of the “6 R’s” of medication administration 1. Right drug to the… 2. Right patient in the… 3. Right dose by the… 4. Right route at the… 5. Right time 6. Right documentationOmission of a medication is an errorAdministration more than thirty minutes before or thirty minutes after a scheduled time is an error
    • Medication Errors (continued)The unit charge nurse is notified immediately of any medicationerrorsAs soon as possible after the discovery that a medication error hasoccurred, the nurse notifies the attending physician of the • Type of error • Time at which it occurred • Pertinent patient signs and symptomsErrors are reported to the Administrative Supervisor on duty as thedesignee of the Vice President of Patient Services – the supervisormay opt to notify Administration immediately if severity warrants
    • Medication Errors (continued) The unit Nurse Manager, Director of Quality Management, Director of Pharmacy, and Vice President of Patient Services are notified during normal working hours Trends and patterns in the occurrence of medication errors are monitored on an ongoing basis for each unit and for individual nursing associates All trends or patterns are addressed through remedial education for the unit or nurse(s) involved Recurrent problems related to inaccurate and unsafe medication administration practices are addressed through appropriate associate counseling procedures
    • Medication Errors (continued)Documentation Date, time, drug administered, dose, route, & pertinent patient observations are recorded in the medical record The entry is not flagged with comments such as “in error”, “by mistake”, variance filed”, etc. The date and time of physician notification and any new orders or pertinent observations are documented in the medical record A QA Communication Tool is completed in its entirety, including as much objective detail as possible to help trend causes No accusatory or blaming statements are made