Avoiding medication error
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This document provides guidelines for medication administration and preventing errors. It outlines the 5 rights of medication administration as well as dos and don'ts such as checking the patient's identification and allergy bands, documenting administration immediately, and avoiding distractions. It distinguishes time-critical from non-time-critical scheduled medications and establishes time windows for administering each. The document also addresses look-alike medication names, requirements for verbal and telephone orders, and restrictions on those order types.
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Avoiding medication error
- 2. Backbone of Medication Administration 5 Rights Right patient Right drug Right dose Right time Right route
- 3. What is Medication Error
- 4. Medication Do’s and Don’t’s DO’S 1. Give medication on time 2.Use only labeled bottles 3. Look at label 3 times A. When you take it out B. When you pour it C. When you put it back 4. Check order for accuracy 5. Use quiet area to prepare meds 6. Check I.D. and allergy band 7. Know action of drugs 8. Document immediately in MAR. Initial and sign full name, title DON’T’S 1. Give earlier than 30 minutes and not later than 30 minutes (one hr. window) 2. Use unlabeled or blurred labeled bottles 3. Forget to do 3 checks and check expiration dates 4. Assume anything 5. Talk or be distracted when preparing meds 6. Give med, if no I.D. or allergy band 7. Give wrong information to clients 8. Forget to sign immediately. Signature has to be legible
- 5. Timely Administration of Scheduled Medications Scheduled medications include all maintenance doses administered according to a standard, repeated cycle of frequency (e.g., q4h, QID, TID, BID, daily, weekly, monthly, annually).
- 6. Scheduled Medications DO NOT include: STAT and Now doses First doses and loading doses One-time doses Specifically timed doses (e.g., antibiotic for surgical patient to be given a specified amount of time before incision, drug desensitization protocols) On-call doses (e.g., pre-procedure sedation) Time-sequenced or concomitant medications (e.g., chemotherapy and rescue agents, n-acetylcysteine and iodinated contrast media) Drugs administered at specific times to ensure accurate peak/trough/serum drug levels Investigational drugs in clinical trials PRN medications.
- 7. Time – critical scheduled Medications Time-critical scheduled medications are those where early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm or result in substantial sub-optimal therapy or pharmacological effect.
- 8. time-critical scheduled medications 1. Identify a hospital-specific list Medications with a dosing schedule more frequent than every 4 hours Scheduled (not prn) opioids used for chronic pain or palliative care (fluctuations in the dosing interval may result in unnecessary break-through pain) Immunosuppressive agents used for the prevention of solid-organ transplant rejection or to treat myasthenia gravis
- 9. Cont.. Medications that must be administered apart from other medications (e.g., antacids and fluoroquinolones). Certain medications that require administration within a specified period of time before, after, or with meals—for example, rapid-, short-, or ultra-short- acting insulins, certain oral antidiabetic agents (e.g., acarbose, nateglinide, repaglinide, glimepiride), alendronate, and pancrelipase. 2.Establish guidelines for time-critical medications
- 10. Non- time- critical scheduled Medications Non-time-critical scheduled medications are those where early or delayed administration within a specified range of either 1 or 2 hours should not cause harm or result in substantial sub-optimal therapy or pharmacological effect.
- 11. Non-Time-Critical Scheduled Medications 1. Establish guidelines for daily, weekly, or monthly medications Administer these medications within 2 hours before or after the scheduled time. Medications administered more frequently than daily but not more frequently than every 4 hours (e.g., BID, TID, q4h, q6h) Administer these medications within 1 hour before or after the scheduled time.
- 12. Others: Sound Alike Medications: confused drug names Verbal or telephone orders : should have: date and time, the name of the physician, the generic and brand name of the drug, drug dosage, quantity , duration, route, frequency, age and weight of patient if known, known allergies of not yet determine, reason the drug is order for the patient, name and level of licensure of the individual Receiving and documenting the order , and must be signed by the physician within 24 hours.
- 13. continuation Verbal Order any order from the physician to the RN that is given during: emergency ( code Blue ), surgical procedure, endoscopy, bronchoscopy Telephone orders: maybe prescribed in the following instances: the prescribing physician has determined the need of the patient and he is physically unavailable. V.O and T.O are not accepted for anti-neoplastic drugs and controlled / narcotic drugs
- 14. Any Questions?
- 15. THANK YOU Keep learning! You are as young as your last bright idea.
Editor's Notes
- What are responsibilities of the nurse before preparing meds?. Do hand washing first before preparation of meds. And always remember the do’s and don’t’s of medicine adminstrations.
- Medications administered around mealtimes require nursing judgment regarding the entry.time, actual consumption of the meal, and the patient’s condition actual scheduled time of administration, which may fluctuate based on meal delivery Policies should allow prescribers, pharmacists, or nurses to declare any scheduled medication to be time-critical (i.e., must be given at exact time or within 30 minutes before or after the scheduled time) by including this designation with the medication order and/or medication administration record (MAR) entry.time, actual consumption of the meal, and the patient’s condition.
- Establish guidelines that facilitate administration of the hospital-identified, time-critical scheduled medications at the exact time indicated when necessary or within 30 minutes before or 30 minutes after the scheduled time (or more exact timing when indicated, as with rapid-, short-, and ultra-short-acting insulins). MAR entries for hospital-identified time-critical scheduled medications should be designated to remind staff that these drugs require meticulous attention to timely administration
- Although it is generally safe to administer daily/weekly/monthly medications within a timeframe that exceeds 2 hours, ISMP recommends keeping the timeframe to 2 hours before or after the scheduled time to prevent accidental omission of doses that might be more easily forgotten if delayed more than 2 hours.