PHARMACOLOGY

| Chapter 7
10. Right advice
Topic Outline: FATORS THAT CONTRIBUTE TO
● Medication error and risk reduction
MEDICATION ERRORS BY THE PATIENTS
 Taking drugs prescribed by several
MEDICATION ERRORS AND RISK
practitioners
REDUCTION
 Getting prescriptions filled at more than one
MEDICATION ERROR
pharmacy
 Any error that occurs in medication
 Not filling or refilling prescriptions
administration process, whether or not it
 Taking medications incorrectly
harms the patient. May be applied to
o Misinterpretations  Taking medications that may be leff over
from a previous illness
o miscalculations
 Taking medications prescribed forsomething
o Misadministration
else
o Handwriting misinterpretation
IMPACT OF MEDICATION ERROR
o Misunderstanding of verbal orders
 Impact of Medication Errors
FACTOR THAT CONTRIBUTES TO
 Common cause of morbidity and
MEDICATION ERRORS BY THE HEALTH
preventable death in hospitals
CARE PROVIDER
 Emotionally devastating to nurse and patient
 Omitting one of the rights of drug
 Increased cost to patient and facility, as it
administration
may extend patient's stay
 Failing to perform an agency system check
 Poor reputation for unit or facility, caused
 Failing to take into account for patient
by high incidence of errors
variables such as age, body size, and renal or
 Penalizing of administrative staff because of
hepatic function
errors
 Giving medications based on verbal orders
INVISTIGATING ERRORS
or phone orders
 No acceptable rate of medication errors
 Giving medication based on an incomplete
 Errors should be investigated and subjected
order or an illegible order
to analysis to determine causes
 Practicing under stressful work conditions
 Reporting and Documenting Medication
Errors
 Documentation should occur in factual
10 RIGHTS OF PATIENTS
manner.
1. Right drug
2. Right patient  Documentation in medical record must
3. Right dose include specific nursing interventions that
4. Right route were implemented after the error in order to
5. Right time protect the patient.
6. Right to refuse  Document all individuals who were notified
7. Right knowledge and understanding of error
8. Right question and challenges
9. Right response and outcomes
G.O. | 1
  Medication-administration record (MAR) is  Review recent laboratory
a source detailing what medication was  Review recent physical-assessment findings
given or omitted.  Identify need for education of medication
REPORTING WITH AN INCIDENT REPORT regimen
 Details recorded in factual and objective
mannerAllows nurse to identify factors that PLANNING
contributed to the error  Avoid using abbreviations that can be
 Is not part of patient's hospital record misunderstood
 Used by agency's risk management  Question unclear orders
personnel for quality improvement  Do not accept verbal orders
LEAGALITY REDUCING ERRORS  Avoid using abbreviations that can be
 Accurate documentation verifies patient's misunderstood
safety  Question unclear orders
 Used as tool to improve drug administration  Do not accept verbal orders
processes IMPLEMENTATION
 Be aware of potential distractions during
MEDICATION ERRORS CAN BE REDUCED BY medication administration
USING WRITTEN DATA  Remove distractions, if possible
 Root cause analvsis (RCA) seeks to prevent  Focus on the task of administering
another occurrence by asking what medications
happened and why, and what can be done to
 Practice the rights of medication
prevent it
administration
SENTINEL EVENTS
 Keep in mind the following steps:
 Unexpected occurrences involving death or
o Positively verify patient using name
serious physical or psychological injury, or
and birthdate
risk thereof
o Use correct procedures for all routes
 Always investigated
of administration
 Interventions taken to ensure there is no
o Calculate medication doses correctly
repeat
REPORTING WITH AN INCIDENT REPORT o Open medications prior to
 Details recorded in factual and objective administering
manner o Record on MAR immediately after
 Allows nurse to identify factors that administering
contributed to the error  Keep in mind the following steps:
 Is not part of patient's hospital recordUsed o Confirm patient has swallowed
by agency's risk management personnel for medication
quality improvement o Be alert for long-acting oral dosage
REDUCTION OF MEDICATION ERRORS AND & forms with indicators such as LA,
INCIDENTS XL, and XR
ASSESSMENT
 Assess food or medication allergies EVALUATION
 Assess current health concerns  Assess patient for expected outcomes
 Assess use of OTCs and herbalsupplements
2
  Determine if any adverse effects have  Correctly storing medication
occurred  Reading drug label
 Avoid drug transfer between containers
NURSES AND ERRORS  Avoid overstocking to prevent expiration
 Nurses should know most frequent types of  Monitor compliance with current medication
drug errors and severities of reaction. abbreviations
 Nurse should never administer a medication  Removing outdated reference books
unless familiar with uses and side effects GOVERNMENTAL AND OTHER AGENCIES
PDAs now help with this. THAT TRACT MEDICATION ERRORS
 FDA's MedWatch
FREQUENT TYPES OF DRUG ERRORS o Health care providers are
 Administering improper dose encouraged to report errors.
 Giving wrong drug o Errors may be reported
 Using wrong route of administration anonymously.
SEVERETIES  Institute for Safe Medication Practices
 One-half of fatal medication errors occurred (ISMP)
in patients older than 60 years of age.  MEDMARX - U.S.
 Children are another vulnerable population Pharmacopeia'sanonymous medication error
due to smaller dosages. reporting
MEDICATION RECONCIALATION
* The process of "keeping track" of a patient's
medications as they proceed from one health care
provider to another
* Polypharmacy-patients to receive multiple
prescriptions that may have conflicting
pharmacologic actions
ADDITIONAL PATIENT EDUCATION
 Know names of all medications
 Know what side effects may occur
 Use appropriate administration devices
 Read label before each drug administration
 Carry a list of all medications, including
 OTC and herbals
 Ask questions
METHODS TO REDUCE NUMBERS OF
MEDICATION ERRORS
 Automated, computerized, locked cabinets
for medication storage on patient-care units
 Risk-management departments to examine
risks and minimize the number of
medication errors
EXAMPLES OF BENEFICIAL POLICIES AND
PROCEDURES
3