This document provides information on medication errors, including defining medication errors, common causes, ways to prevent errors, and the importance of reporting errors. It begins by stating the objectives of the course and defining medication errors as mistakes in drug administration that can harm patients. Various causes of errors are discussed, such as transcription mistakes, unfamiliarity with drugs, and unclear orders. Suggestions to prevent errors include using checklists, taking time to prepare drugs correctly, and being aware of look-alike and sound-alike medications. The "five rights" of medication administration are also reviewed.
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
Hello Everyone :)
I hope this presentation will help us to:
Understand the system-based causes of medication errors.
Describe a model for a systems approach to error analysis.
Identify weaknesses or failures in key elements of the medication-use system.
Select effective risk-reduction strategies to prevent medication errors.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Medication error- Etiology and strategic methods to reduce the incidence of M...Dr. Jibin Mathew
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
Hello Everyone :)
I hope this presentation will help us to:
Understand the system-based causes of medication errors.
Describe a model for a systems approach to error analysis.
Identify weaknesses or failures in key elements of the medication-use system.
Select effective risk-reduction strategies to prevent medication errors.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
Medication error- Etiology and strategic methods to reduce the incidence of M...Dr. Jibin Mathew
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
Medication Errors A Serious Topic Left Behind Leslie Richard
Medication Error is the third most common desiese leading to death . A serious topic for nurses and doctor's which was left behind . What to do in case of High Alert .
Clinical errors by nursing / paramedic staffMohit Changani
Nursing staff care is very critical for the management of any patient. Nursing staff need to be specific and punctual in providing care. This presentation deals with common clinical errors that might be occurring on the care provided by nursing or paramedic staff
Medication safety and Prevention of Medication errors.pptxsats81
The topic is related to pharmacology in nursing. The topic concretely described about common medical errors in medication prescription and administration .The topic also include how we can prevent medication errors at different stages of emdication dispensing.
COMMON ERRORS IN DISPENSING by Mrs omorodion 3.pptxAnijuKenechukwu
a presentation on the common dispensing error encountered in a pharmacy and the role of pharmacy technicians in curbing or reducing the rate of these common errors
COMMON ERRORS IN DISPENSING by Mrs omorodion 3.pptx
Safe medication admin
1. Medication Errors
Course #109
2 contact hours
Author: Monica Oram, RN, BSN
This is NOT the Florida Required course.
(The Florida Required Course is #104, preventing medical errors)
Upon completion of this course the reader will be able to achieve the
following objectives:
1. Define what are medication errors
2. Recognize high alert medications
3. Understand importance of reporting errors
4. Factors that contribute to medication errors
5. Understand the five rights of medication administration
What are medication errors?
Medication errors are mistakes in the administration of drugs to patients.
Medication errors can have serious results for our patients. Medication errors
can cause pain and suffering, treatment delays, loss of income, and higher
medical bills.
Healthcare workers are also affected. It is an experience that can cause guilt,
anxiety and self-doubt.
Most medication errors can be easily avoided by double checking and being
very careful as medications are administered.
You can reduce medication errors by making certain:
You can read the doctor’s orders
You check the drug against the medication administration record
Make certain you are giving it to the right patient
Always question any dose that seems too high or too low.
Your efforts will lead to greater patient satisfaction, and greater patient
safety. You will experience greater job satisfaction by knowing you are
practicing safely and efficiently.
2. Medication errors can occur:
1. When orders are not taken off properly, and carried out correctly.
2. Orders are incorrect.
3. Orders are not carried out at all.
4. Orders are unclear.
Lets take a deeper looker…..
When orders are not taken off properly, there can be many problems
associated with medication errors. Many drugs look alike in name, or sound
similar to others with a completely different purpose and effect.
Errors can occur if a ward clerk takes off medication orders. Make certain
that a nurse is double checking all orders against the physician orders to
prevent a transcription error. If you are ever in doubt….check it out !!!
Incorrect orders can include ordering the wrong drug, or the wrong dose.
This can also be a particular problem if the person has a known allergy, and
it is not noticed before the drug is ordered or given.
When an order is not carried out, this is a medication error. Orders that “fall
through the cracks” can be a serious problem to the patient in need of the
medication.
Unclear orders are a big problem that causes a lot of confusion. Confusion
over what the order says often results in giving the wrong drug, or the wrong
dose.
All medication errors should be reported.
All medication errors should be taken seriously!
When orders are not carried out properly, this also creates a medication
error, such as giving the right drug to the right patient, but giving it at the
wrong time.
Suggestions To Prevent Errors
Beware of look alike and sound alike drugs- match the drug’s indications
with the patient’s diagnosis to prevent this common occurrence.
One of the biggest liabilities and challenges for nurses is that we have a
3. license to protect. One of the big problems is that the physician orders the
medication, the pharmacy fills the prescription, and the nurse administers the
drug.
Why is this a problem?
This is a problem because there are several opportunities for an error to
occur. The error can begin with the doctor prescribing the drug, or the
pharmacy can make a mistake in filling the prescription.
But it does not stop there…..
The next liability falls on the nurse. Nurses have a lot of responsibility in
ensuring that medications are given correctly. If a patient has a reaction, the
nurse can be held liable because “they are the one who gave the
medication”. Don’t be mislead that all nurses are held liable for all errors.
This is not really the case. Doctors can and do face liability as well when
wrong medications are ordered. Pharmacies are also to blame at times for
errors. The point is, that nurses must be mindful to what is being
administered. Nurses should know to check out anything that does not seem
right. Nurses should be aware of the complications associated with potential
adverse reactions from drug interactions. So, if the doctor prescribed the
drug correctly, and the pharmacy filled the prescription properly, and the
nurse gives the medication which in turn causes harm to the patient, then the
nurse can be held liable for this error.
Nurses are most likely to be blamed for medication errors because they are
involved at the administration level. Remember that medication errors are
complex and are rarely ever the result of one person’s actions.
Statistical data suggests that when medication errors occur they can be
broken down as follows:
35% of errors occur in the prescribing phase.
45% of errors occur in the nurse administration phase.
20% of errors occur in the pharmacy dispensing phase.
Nurses today are faced with a tremendous amount of added responsibility,
increased patient loads, and lack of sufficient staffing.
With the increased workload and responsibilities, there are increased
opportunity and chances for more medication errors to be made.
Verbal orders a very high source of errors. When a nurse takes a verbal
order, it is increasingly possible to interpret the wrong drug or dosage,
4. making the liability greater on the nurse who “heard wrong” or “wrote it
wrong” as an order. Of the 45% of errors made by nurses, approximately
20% of these are due to verbal orders being taken incorrectly.
Suggestions To Help Avoid Errors
Beware of look alike drugs and sound alike drugs
Match the drugs indication with the patient’s diagnosis
Maintain competency in drug delivery devices. No delivery device is
safe unless the nurse can use it safely and properly.
Use a system of double checks. Check concentration, flow rates, and drug
to be given.
Organize the workflow- working in a cluttered place, poor lighting, noise
and interruptions make the preparation tasks more difficult and error-
prone. (we all know that in the real world, these are a common
occurrence and cannot be avoidable a lot of the time) Therefore, we have
to know how to work in an environment that is conducive to providing
safe patient care despite the environmental factors that are distracting)
Educate the patients- encourage them to ask questions.
Listen to your patient- sometimes they can be the last line of defense to
avoid an error. Many are very aware of what medications they are
receiving. Let’s look a few examples: If a patient says something like, “
I have not taken a pill that looks like this before” or “ I usually get only
two pills in the morning” (and you have more than two in the medication
cup) DO NOT GIVE THEM THE MEDICATION until you go back and
check it out. They may in fact be right, and avoid a potential error before
it occurs.
Healthcare professionals should remain educated and up to date on new
medications. Invest in a good drug book and have it accessible on the job.
Nurses are not doctors, and we are not pharmacists. We can’t be a
“walking PDR”, but we can be educated and knowledgeable to look up
what we don’t know.
Promote error detection and correction to uncover a problem before it
reaches the patient. Honest reporting of errors helps all health care
professionals to devise changes in the system that are a potential
problem.
5. COMMON CAUSES OF MEDICATION ERRORS
Table Provided By Dana, 2001 and Fagan 2001
Cause Description Example
Lack of knowledge of the drug The nurse has insufficient Rapid infusion of vancomyacin
knowledge of the indications causing a hypotensive episode
for use, available forms,
correct dose, appropriate
routes, adverse effects,
toxicity, and compatibilities of
the medication
Lack of information about the The nurse is unaware of a vital Administering insulin without
patient aspect of the patient’s knowing the patient’s blood
condition sugar
Forgetting and memory lapses Errors in which the nurse knew Missed doses of medication or
the rules and is not able to duplicate doses of medications
explain the error
Transcription errors Errors in the ordering or Writing 50 units of insulin vs. 5
verification process units because the “u” looked
like a zero
Faulty interaction with other Problems communicating with Changes in Vancomyacin dose
services others when transferring (related to peak and trough)
between services not reported to a nurse
Faulty drug identity Errors in identifying the drug Confusion with drugs that
that results in patient getting sound alike. Celebrex Vs.
the wrong medication Celexa
Faulty dose verification Failure to ensure that the Hanging the same IV twice in
proper dose was given or a row, when two different IV
dispensed medications were ordered
alternately
Infusion pump and delivery Errors in setting up the Infusion of TPN through a
system failures infusion pump, confusion peripheral line instead of
between central and peripheral central line. Overdose of
lines, accidental tubing medication from pump not set
disconnections correctly
Inadequate monitoring Failure to appropriately adjust Physician not notified of critical
the dose of medication lab values such as prothrombin
because of necessary time for a patient receiving
monitoring. ( lab values, vital coumadin
signs) not done or ignored
Drug stocking and delivery Late or missing deliveries of Medications or IV meds not
problems medication to the patient delivered in a timely manner
Preparation Error Errors in calculating and Incorrectly prepared mixed
mixing drugs that result in insulin dose
incorrect dose
6. Lack of standardization Administration errors resulting Heparin for IV flushes available
from non-standard in 1,000 units/ml and 10,000
concentrations, dosing units/ml
schedules, or infusion rates.
Other Things To Consider
Abbreviations: When using abbreviations, stick to the standard
abbreviations that all are familiar with. Illegible or confusing handwriting
and communication failure often contribute to errors involving
abbreviations.
Examples of some problem abbreviations include:
Handwriting a “u” for units. It can be mistaken for a zero.
Handwriting “ g” instead of mcg. The “ “ can be mistaken for am M,
and could be incorrectly interpreted at mg instead of mcg.
Watch for leading decimals and trailing zeros. The use of trailing zeros
such as 2.0 instead of 2, or the use of a leading decimal point, as in .2
instead of 0.2 are very dangerous practices. It is easy for a nurse to miss
the decimal point and make an error that is TEN TIMES incorrect.
Remember that “covering up” an error is unacceptable. You put your patient,
yourself , your license, and your organization on the line when reporting of
errors are not done.
Adverse event and error reporting is the professional and ethical
responsibility of the nurse. Reporting “near misses”, even though no actual
harm was done, is also very important to report.
In the past, healthcare professionals have used the personal approach of:
“ Aim, Blame, Shame, and Retrain”
That approach is not working. This is why the requirement of medical errors
training has come about. We can learn from mistakes. A whole new approach
is needed to not blame the individual making the error, but to look at
systems that will improve and prevent the error from reoccurring.
The Five Rights
7. We all remember “the five rights” from nursing school. However, they are
always worthwhile to review.
1. The right drug- read and reread the medication order and the drug label.
When your facility changes drug vendors, take time to get familiar with
the new labeling and markings. Be cautious of drugs that look alike and
sound alike. When taking verbal orders, ask the physician to spell out the
name of the drug. Some manufacturers have even changed the names of
drugs to prevent confusion. (Example: Losec to Prilosec, so as to not
confuse it with Lasix)
2. The right patient- Be careful of name alerts, or patients in the same room
with same first name or similar last name. Place name alert stickers on
charts and MAR’s as needed. Identify patient by name band if unfamiliar
with the patient. Confused patients may answer to any name. Example:
Do not ask a patient, “ Is your name ____?” (a confused patient may say
“yes” with no comprehension to who they are.) Pictures are helpful in
LTC facilities. They need to be updated periodically though, because as
they become sicker, gain weight or loose weight, the picture may no
longer resemble the resident. These concepts are a particular concern if
you work for a staffing agency, or if your facility utilizes agency nurses
unfamiliar with the patients.
3. The right dose- The use of decimals and trailing Zeros, (as discussed
earlier.) Take into consideration weight and age when deciding if dose is
appropriate and should be in question. If ever in doubt, call the doctor.
Clarify any order that is unclear. If you have to make a drug calculation,
ALWAYS have a second nurse double check your calculation. Get
familiar with the normal doses of medications and invest in a good drug
book.
4. The right route- If the route is not specified, never assume it is oral.. It
must be clarified. If a patient’s condition warrants a new route (ie: can no
longer swallow pills, and requires liquid form) a new order must be
written to reflect the change. If a liquid is used in place of oral, do not put
in a syringe that could be mistaken for IV route. Spell out “intravenous”
and “international units” so there is no confusion to IV&IU. Make sure
all lines are labeled and dedicated for their purpose.
5. The right time- Medications should be given on time. Medication should
not be given any more than one hour before or one hour after the
8. scheduled time. The right time should be scheduled around
manufacturer’s recommendations of with food or on an empty stomach.
If a medication cannot be given on time, document why.
In addition, the patient has the RIGHT TO BE EDUCATED and the RIGHT
TO REFUSE.
Right to be educated- Inform the patient what the medication is for and
potential side effects to be aware of that may need to be reported.
Right to refuse- This is not a medication error, but does need to be
documented as a refusal on the MAR. It should be documented in the
medical record as well.
Remember that if a patient refuses, it is not an error… but if the nurse leaves
it at the bedside, and the patient throws it away, then it is a medication error.
MEDICATION CHECKLIST
BEFORE
Patient’s name band checked or patient identified before given?
Medication checked against MAR before giving?
Medication is right route?
Drug/drug and drug/food allergies observed?
Medication prepared immediately prior to administration?
Pulse or blood pressure checked if indicated?
Privacy respected (drapes with NGT, g-tube)
Nurse aware of reason for med?
DURING
Medication correctly crushed or not crushed as directed, if needed?
Calibrated measuring devices when needed?
Liquids measured at eye level?
Medication diluted if indicated?
NGT or G-Tube flushed before and after administration?
Liquids shaken? ( unless contraindicated)
Oral inhaler used properly?
Tablets or capsules not touched by hands while preparing?
Medication given within one hour of scheduled time?
9. Medication given with milk, water or antacid if indicated?
Practice the “Three Time Check”
Read the label when you first get the medication
Read the label when preparing the medication
Read the label just before giving the medication
If you make a mistake
ACCEPT RESPONSIBILITY
Report any error to your supervisor. Take steps to correct the situation right
away.
HELP DETERMINE THE CAUSE
This helps improve medication policies and procedures, and helps reduce
future errors.
FORGIVE YOURSELF
No one is perfect. Most healthcare professionals have had at least one
experience with a medication error.
Help educate the larger medical community.
There is an anonymous hotline, where errors can be reported to help health
care professionals, drug manufacturers and others to learn from mistakes.
You can report to the USP Medication Errors Reporting Program, operated
in cooperation with ISMP ( Institute for Safe Medication Practices) Reports
are made and retained in confidence, and used for statistical data and error
research. www.ismp.org
Summary
Medication errors can be prevented if we take the added necessary steps to
be more mindful of what we are doing. Those few extra minutes, that “we
10. don’t have” can save a patient a lot of grief and/or potential harm or even
death. Remember, “If in doubt, check it out.” Practice safe, and practice
Smart. The rewards will go along way in protecting your patients, and
protecting your self from liability. Your efforts help ensure that patients get
the medications they need--- safely!
References:
Mosby Drug Reference, 2003
Philadelphia, Pa.
Springhouse Nursing Manual
2002, Springhouse, Pennsylvania
Institute for Safe Medication Practices
1-800-23-ERROR
www.imsp.org
11. Nurses' Six Rights for Safe Medication Administration
By Michelle Colleran Cook
Below, is testimony provided by MNA Member Michelle Colleran Cook on behalf of the MNA Congress
on Nursing Practice at a hearing before the Joint Committee on Health Care, which concerned the
issue of prevention of medication errors in health care settings.
My name is Michelle Colleran Cook. I am employed per diem in the Recovery Room of a Boston
teaching hospital. I am also an instructor in a LPN School of Nursing and will graduate from Regis
College with a Masters Degree in Nursing Administration in May 1999.
Recently, there have been national and local incidences of nurse errors in medication administration
that have resulted in negative patient outcomes. Nurses, because they administer the drugs directly
to patients, are the last links in the safe medication administration chain. Complicating matters is
the increased acuity of the patients they serve, and the decrease in the resources available to
nurses to ensure safe practice. Because of the climate of health care today, nurses need to become
cognizant of their practice’s vulnerability and vigilant about protecting their practice.
All nurses have been taught the five rights of medication administration. They were drilled into our
conscious in nursing school until they became part of our unconscious behavior as practicing nurses.
The right patient, the right drug, the right dose, the right route and the right time form the
foundation from which nurses practice safely when administrating medications to our patients in all
health care settings.
Just as nurses know the five rights of medication administration, they should also know what rights
they have when administering medications. These "Six Rights for Nurses Administering Medications"
will hopefully guide nurses as they continue to care for patients despite these turbulent times.
1. THE RIGHT TO A COMPLETE AND CLEARLY WRITTEN ORDER
You, as the nurse, have the right to demand that an order be complete and clearly written.
12. You have the right to require that the drug, dose, route and frequency be written by the
physician. All of these components must be present for a physician order to be considered
complete.
It is no longer good practice to accept orders when the dosage is written as "1 tablet." A
complete order includes specific numerical dosages. For example, Acetaminophen 2 tablets
po prn should now be written as Acetaminophen 650 mg. po prn. It is also no longer safe
practice to administer vague orders such as "Laxative of choice." Drugs ordered need to be
specific and the dose explicit.
Verbal orders should never be taken and telephone orders should only be taken if the
physician is not physically present. Nurses cognitively know this but often in the interest of
saving time may be tempted not to practice it. Nurses who write orders for physicians are
placing their license and their patients at risk.
Orders should be legibly written. The Massachusetts Hospital Coalition recommends
physicians use computers to directly order medications. However, such costly systems may
take years to implement. Until that occurs, nurses need to remember that it is their duty
and right to question physician orders that are illegible. Cefoxitan and Cefotetan may look
alike when hand written but confusing one drug for the other results in the patient receiving
the wrong medication.
2. THE RIGHT TO HAVE THE CORRECT DRUG ROUTE AND DOSE DISPENSED
Nurses administer medications but it is the pharmacy’s duty to dispense medications
correctly. Pharmacies process and distribute an incredible volume of medications daily.
Pharmacists, like nurses, are susceptible to the pressures of time and patient needs and
can dispense the incorrect drug or dose. The nurse who discovers the error then notifies the
pharmacy of this oversight. If all goes well, pharmacy will deliver the medication promptly
to the nursing unit. In this case the system works well.
Sometimes, the nurse is told there is no one from pharmacy available to deliver the
medication. The nurse is given the option of either waiting for her patient’s medication,
coming to the pharmacy herself to get the medication, or finding someone else to do so.
Such errors of dispensing eat away at nursing time and energy. They pull nurses away from
caring for their patients. They place patients in jeopardy of not receiving the drug on time.
Additionally, unnecessary stress is placed on the nurse who is struggling just trying to
gather the drugs necessary to care for her patient. This hurried atmosphere places the
nurse in a position that she may make a medication error in her haste.
Another recommendation from the Massachusetts Hospital Coalition states that a unit dose
system of medication can decrease the number of medication errors. Many hospitals have
adopted this system of medication administration. However, scenarios such as the one
above coupled with the available technology of automated medication administration
13. systems such as the Pixis has placed nurses in a potentially unsafe situation. First
developed to dispense narcotics, these automated systems can be programmed to allow
nurses access to many other types of medications. Now, in an attempt to address missing
or incorrectly dispensed medications, and decrease the turnaround time of getting the
correct drug to the patient, they are being used widely in acute care hospitals as quasi
satellite pharmacies.
At first, they may be seen by the nurse as a welcome relief from the frustration of not
having medications readily available to administer. But they must be used with caution. The
nurse enters patient data into the automated medication dispenser; the machine opens the
correct drawer and directs the nurse to the correct drug compartment where the medication
can be found. But in some systems, when the Pixis drawer opens, the nurse has access to
many drugs. In this situation, the unit dose safeguard is eliminated and therefore increases
the chances of the nurse selecting the incorrect drug or dose and administering it to their
patient.
3. THE RIGHT TO HAVE ACCESS TO INFORMATION
Nurses have the right to expect updated and easily accessible drug information. This means
that the hospital formulary, a Physicians Desk Reference and a current nursing drug
reference book need to be available to nurses who administer medications.
Nurses have the right to ask questions about the drugs that they are to administer to their
patients. Pharmacists are the drug experts and nurses should have access to a pharmacist
no matter what time of day. Hospitals need to have a pharmacist available on a 24-hour
basis. More dialogue between nurses and pharmacists can only improves patient outcomes
and decreases the chances of medication errors occurring.
As pharmacology and technology advances, patients should be able to expect a nurse who
is continually updated on new medications and the ways they are delivered. Good nursing
practice dictates that nurses are never to administer a drug they are unfamiliar with. If a
patient is to receive a drug that is too new to be in the usual reference books, nurses
should insist that information be provided to them. And they should not administer that
drug until they have enough information to be comfortable doing so.
4. THE RIGHT TO HAVE POLICIES ON MEDICATION ADMINISTRATION
It is the responsibility of health care administration to provide the structure necessary for
nurses to administer medications safely. Nursing practice is governed by the Board of
Regulation in Nursing but nursing policies are what guide nursing practice at that health
care entity. Policies often protect the nurse from litigation should an error occur. Conversely,
not following policy or administrating medication without a policy will put the nurse at risk
not only for litigation but can result in license suspension or forfeit.
New medications enter the market daily. Research discovers new uses and ways to
14. administer old medications. Administrators are not practitioners; they need to be updated
by staff on new trends in medication administration. Subsequently, nursing administrators
need to initiate and develop systems that promote safe medication administration. Nursing
administrators have to insist that nurses of their organization be allowed to deliver patient
care in the safest environment possible.
5. THE RIGHT TO ADMINSTER MEDICATIONS SAFELY AND TO IDENTIFY PROBLEMS
IN THE SYSTEM
Nurses are the experts on what impacts safe medication administration. Shaping systems
and creating solution for safe medication administration should include those who actually
do the work of administering medications.
Nurses have the right to speak up when they see situations that can potentially result in
medication errors. System glitches that place the patient at risk need to be addressed and
corrected. Repeated breaks in the system can only be fixed if at first it is identified. Just as
you would advocate for a patient, you should advocate for your ability to practice in a safe
setting. Your input is of tremendous value to all.
6. THE RIGHT TO STOP, THINK, AND BE VIGILANT WHEN ADMINISTERING
MEDICATIONS
Nurses know medication administration is serious business. Often nurses are caught up in
the hustle and hassle of a busy work place. With decreases in licensed staff and
organizational support and increasing patient acuity, nurses still manage to do it all. But we
are human, we are all fallible. There is only so much sensory input a person can handle,
only so many questions one can process at a time.
When we find our minds so overloaded we are unable to think. We have the right to stop
and do so. When we see orders that somehow do not make sense even if we can not
identify why this order seems odd, we have the right to stop and find out why. When we are
about to administer a drug we are unfamiliar with, we have the right to stop and find out
about this new drug. If we need to ask other nurses or professionals about this drug or
check the policy for giving this drug, we need to stop and do so. Will this take additional
time? Yes. Will others think we are stupid? Maybe. Will some people become irritated with
us? Probably.
But, if stopping to think before administering medications to your patient seems like an
inconvenience, ask yourself this question: Would I rather be known as the nurse who is
slow giving her meds, or the nurse who did her patient harm?
Unsafe medication administration situations will be lessened as long as nurses continue to
recognize problems and steadfastly protect their patients and their practice. Nurses need to
take the time to identify and address sloppiness in their work place and in other
professionals. Confrontation is not easy for nurses. Nurses would rather fix it themselves.
15. This system only perpetuates others’ poor practice and allows the nurse to assume
responsibility for all. This is not our job. Our allegiance is to our patients.
Course Description
Practical application of knowledge and skills required for nursing care of adult patients with
commonly occurring acute/critical medical-surgical problems is demonstrated in both Lab and
clinical settings. Concurrent enrollment in NSG 320 is required unless approved by the
Department Chair. Clinical Lab is graded on a Satisfactory/Unsatisfactory basis based on
successful completion of the course requirements.
Learning Outcomes
• Provide standardized nursing care to a group of adult, acutely/critically ill patients in a
structured setting. Perform nursing skills safely and effectively. Administer nursing care
based on the patient's present bio-psycho-social-cultural-spiritual situation. Determine the
patient's priority of needs and plan care accordingly. Complete nursing care for at least three
adult patients on time using an organized and efficient approach.
• Utilize the nursing process to administer care to the adult patient with commonly
occurring health care needs and problems. Collect data on the patient's health status in a
systematic and objective manner using the system's review. Assess the data considering
the normal physiologic and psychologic parameters of the adult, acutely/critically ill patient's
experience and identify the assets and deficits of that experience. Formulate a nursing
diagnosis for each actual or potential problem which has been identified from the patient's
health assessment. Devise a nursing care plan which provides nursing interventions to the
patient as needed and reflects awareness of the priority problems in the care of the patient.
Implement the plan of care and state the rationale for the nursing interventions. Evaluate the
effectiveness of the care based on the stated expected outcomes or goals of care.
• Provide appropriate health information to the patient and family using standardized
teaching plans. Assess the patient as to their learning needs and knowledge deficits.
Implement a standard teaching plan to meet the patient's learning needs. Evaluate the
effectiveness of that experience. Identify hospital as well as community resources available
to patients and make referrals following consultation with team leader or instructor.
• Utilize therapeutic communication skills, guidance and support in interacting with the
adult patient and family and record observations in proper sequence and format. Recognize
own values and behavioral responses which may be conditioned by own culture and
experiential background. Provide therapeutic and supportive communication to the adult,
acutely/critically ill patient and family. Communicate and report pertinent observations and
inferences to appropriate personnel (i. e. instructor, team leader, etc.) promptly. Record
medications, treatments and subjective/objective observations properly in the patient's
record.
• Assume responsibility for personal and professional growth in the medical-surgical
setting. Accept responsibility for his own actions/behaviors as a student member of the
16. health care team. Is prepared with pre-care level patient data prior to each clinical lab day.
Report promptly to clinical laboratory and pre/post conferences. Constructively use
instructor's feedback by initiating appropriate actions in subsequent written work or clinical
behavior. Identify specific experiences in clinical practice which are needed to accomplish
learning objectives. Appropriately seeks assistance where needed. Contribute to the growth
of self and classmates by sharing learning experiences on the clinical units during pre and
post conferences. Evaluate own clinical and academic performance based on these course
objectives
• Utilize teaching-learning principles by implementing a standard teaching plan in a
structured setting. Identify the patient and family/significant others' responses to impact of
illness, hospitalization and treatments.