Tutorial 15 2023.pptx in the materal science

Editor's Notes

• #4 2 many medications – 4.5 or more medications associated with falls and mortality Lot of different providers More medications and can have a negative effect. Could show video from pre tutorial work
• #5 P 154 of text Signing the drug chart Tall man lettering
• #6 Look at ICN code of ethics and Codes for Nursing Practice and Standards The different types of medication errors include (but are not necessarily limited to): Prescribing errors , wherein the selection of a drug is incorrect based on the patient’s allergies or other indications. Additionally, the wrong dose, form, quantity, route (oral vs intravenous), concentration, or rate of admission could be used. Omission errors , in which there is a failure to give a medication dose before the next one is scheduled. Wrong time errors , wherein a medication is given outside the predetermined interval from its scheduled time. Improper dosing errors , wherein a greater or lesser amount of a medication is delivered than is required to manage the patient’s condition. Wrong dose errors , wherein the correct dosage was prescribed, but the wrong dose was administered. Improper administration technique errors , such as administering a medication intravenously instead of orally. Wrong drug preparation errors , wherein a medication is incorrectly formulated (i.e., too much or too little diluting solution added when a medication is reconstituted). Fragmented care errors , wherein a lack of communication exists between the prescribing physician and other healthcare professionals. These are just some of the many possible medication errors that can occur. CAUSES OF MEDICATION ERRORS Distraction : A nurse who is distracted may read “diazepam” as “diltiazem.” The outcome is not insignificant-if diazepam is accidentally administered, it could sedate the patient, or worse (e.g., if the patient has an allergy to the drug). Environment : A nurse who is chronically overworked can make medication errors out of exhaustion. Additionally, lack of proper lighting, heat/cold, and other environmental factors can cause distractions that lead to errors. Lack of knowledge/understanding : Nurses who lack complete knowledge about how a drug works, its various names (generic and brand), its side effects, its contraindications, etc. can make errors. Incomplete patient information : Lacking information about which medications a patient is allergic to, other medications the patient is taking, previous diagnoses, or current lab results can all lead to errors. Nurses who aren’t sure should always ask the physician or cross-check with another nurse. Memory lapses : A nurse may know that a patient is allergic, but forget. This is often caused by distractions. Forgetting to specify a maximum daily dose for an “as required” drug is another example of a memory-based error. Systemic problems : Medications that aren’t properly labeled, medications with similar names placed in close proximity to one another, lack of bar code scanning system, and other issues can lead to medical errors. PREVENTING MEDICATION ERRORS Nurses may not have the authority to make infrastructural changes, but they do have the power to suggest needed changes and take precautions to prevent medication errors, including the following: KNOW THE PATIENT This includes the patient’s name, age, date of birth, weight, vital signs, allergies, diagnosis, and current lab results. If patients have a barcode armband-use it. The added administration times of using arm band systems have led some nurses to create potentially dangerous “workarounds” to avoid scanning barcodes. Don’t make this potentially dangerous mistake- use all of the information at your disposal to ensure patient safety, and avoid shortcuts. KNOW THE DRUG Nurses need access to accurate, current, readily available drug information, whether the information comes from computerized drug information systems, order sets, text references, or patient profiles. If you have any questions or concerns about a drug, don’t ignore your instincts-ask. Remember that you are still culpable, even if the physician prescribed the wrong medication, the wrong dose, the wrong frequency, etc. KEEP LINES OF COMMUNICATION OPEN Breakdowns in communication among physicians, nurses, pharmacists, and others in the healthcare system can lead to medication errors. The “SBAR” method can help alleviate miscommunications. SBAR (Situation, Background, Assessment, Recommendation) works like this: Situation : “The situation is that Mr. Smith is complaining of chest pain.” Background : “He had hip surgery yesterday. About two hours ago he began complaining of chest discomfort. His pulse is 115, and he is short of breath and agitated.” Assessment : “My assessment is that Mr. Smith may be having a cardiac event.” Recommendation : “My recommendation is that you see him immediately, and that we start him on O2 and administer an analgesic immediately. Do you agree?” Communication is vitally important, as it is the root cause of many sentinel events, according to the Joint Commission (TJC).5 DOUBLE CHECK HIGH ALERT MEDICINES High-alert medicines such as heparin can have devastating consequences if not administered properly. A tragic case involving the death of three infant patients after receiving massive heparin overdoses happened as a result of misleading packaging. Since this incident, the drug manufacturer now uses larger font sizes, tear-off cautionary labels, and different colors to distinguish drug doses.6 Medications often look alike and sound alike-this can be a source of errors. Double check high alert medications with another nurse to prevent accidental overdoses and other medication errors. DOCUMENT EACH DRUG ADMINISTERED Accurate documentation is essential and should include accurate recording of the drug information, the name of the drug, the dose, route, time, patient response, and any refusal of the drug by the patient. TAKE AN ACTIVE ROLE IN CORRECTING ISSUES YOU IDENTIFY If you see that look-alike or sound-alike medications are stored next to each other, ask your supervisor to correct the problem, emphasizing the increased risk of medication errors. Request that medications be reconciled (i.e., that the names, dosages, and administration routes of all medications are compared to identify conflicts). Request that a bar coding system be implemented that allows for the verification of the six medication rights (right individual, right medication, right dose, right time, right route, right documentation). INFORM THE PATIENT OF THE DRUGS THEY ARE RECEIVING Make sure your patients know the names of the medications they are taking, what they look like, what they are for, how to take them or how they will be administered, the dosage, and the potential side effects and interactions. ASK FOR CONTINUING EDUCATION Ask for mandatory training sessions about medications that are introduced to your facility. Training should include medication-related policies, procedures, and protocols. Updates like these, along with comprehensive nurse CE programs that include healthcare videos, empower nurses and can help prevent medication errors. Nurse educators and continuing education providers should include all of these prevention tips, and more, in nurse education programs to help nurses avoid medication errors that could have detrimental or even deadly consequences for patients, and significant consequences for nurses, including disciplinary action, job dismissal, criminal charges, and mental anguish.
• #8 Medication safety can be improved by
• #12 Optional