CHAPTER 3 MEDICATION SAFETY THE FIVE-PLUS-FIVE RIGHTS OF DRUG ADMINISTRATION The nurses six rights are: o Right to a complete

e and clear order o Right to have the correct drug route and dose dispensed o Right to access to information o Right to administer medications safely and identify system problems o Right to stop, think and be vigilant when administering medication Clients rights: o Right client o Right drug o Right dose o Right time o Right route Also rights: o Right assessment o Right documentation o Right to education o Right evaluation o Clients right to refuse Right client essential o Verification of client identification is crucial and is done through Checking ID bracelet Distinguishing between two clients with the same last name Coded ID bracelets Accurate identification for outpatients Right drug client receives prescribed drug o Order forms must be used or prescription pads o Make sure the components are all correct: Date and time Drug name and if generic is preferred Drug dosage Route of administration Frequency and duration of administration Any special instructions Physician or other health care providers signature o Must know all the components of a drug order in order to be able to question orders that seem incomplete or unclear Drug label shoul be read three times: o At time of contact with the drug o Before measuring o After measuring READ LABELS CAREFULLY Right dose more than just dose prescribed; o Sometimes doses are prescribed within guidelines for drug administration and is related to clients physical status o Right dose is within recommended range for particular drug o Nurse should have general idea of the answer based on knowledge of the basic drug doses Distribution of drug: o Stock drug method = dispensed to all clients from the same containers o Unit dose method = drugs are individually wrapped and labeled for single doses for each client

Automated dispensing cabinets = assist with correct and quick administration of medications; promotes access, locked storage, electronic tracking Saves time and decreases costs associated with administration Allows automatic collection of documented information The right time o Prescribed dose should be administered at specified times: b.i.d. twice a day t.i.d. three times a day q.i.d. four times a day q6h every six hours o use of military time reduces administration errors and decreases documentation right route is necessary for adequate or appropriate absorption: o oral by mouth o sublingual under the tongue o topical applied to skin o inhalation aerosol sprays o instillation in nose, eye or ears o suppository rectal or vaginal o parenteral intradermal, subQ or intramuscular (IM) or intravenous (IV) right assessment requires a collection of appropriate data before administration of the drug right documentation requires nurse to immediately record the appropriate information about drug administered; response to medication is also required right to education requires receive accurate and thorough information about the medication and how it relates to their particular situation o informed consent based on individual having knowledge to make a decision right evaluation effectiveness of medication be determined by clients responsibility to medication right to refuse nurses responsibility to determine why the client refuses and to take reasonable measure to facilitate the clients taking the medicationdocumented immediately and follow-up required

CULTURE OF SAFETY five goals relate to medication safety: o improve accuracy of patient ID o improve effectiveness of communication among caregivers o improve safety of using medications o reduce risk of health-care associated infections o accurately and completely reconcile medications across continuum of care

Disposal of Medications recommended that you remove drug from original container and dispose of it in a sealed bag with an undesirable substance to prevent reuse remove all identifying information

SAFETY RISKS FOR SAFE MEDICINE ADMINISTRATION pill splitting is a problem, especially if patient cannot afford the medication and want to prolong their prescription so that it lasts a little longer buying drugs online consumers do not always get what they order

Counterfeit Drugs

look like desired drug but may not have any active ingredients, the wrong ingredient or the wrong amount of active ingredient do not crush oral dosage forms!

PREVENTION OF MEDICATION ERRORS in order to prevent drug errors: o Pathways for Medication Safety o Current database of all medication errors and their near misses o National Coordinating Council for Medication Error Reporting and Prevention o Drug references like the USP, NF, PDR and American Hospital Formulary

PREGNANCY CATEGORIES PREGNANCY CATEGORY A DESCRIPTION No risk to fetus; studies have not shown evidence of fetal harm. No risk in animal studies and well-controlled studies in pregnant women are not available; assumed there is little to no risk in pregnant women

Animal studies indicate risk to fetus; controlled studies on pregnant women are not available. Risk versus benefit of drug must be determined

Risk to human fetus has been proved; risk versus benefit of drug must be determined; could be used in life threatening conditions Risk to human fetus has been proved; risk outweighs benefit and drug should be avoided during pregnancy

FACTORS THAT MODIFY DRUG RESPONSE Absorption route of administration of the drug; any GI disturbances affect absorption Distribution protein binding is a major modifier of drug distribution; another is the blood-brain barrier which only allows lipid-soluble drugs to enter into brain and cerebrospinal fluid; placental barrier also keeps blood of mother and fetus separate but some drugs can diffuse across the placenta Metabolism (biotransformation) age, weight and liver function o Excretion decrease in functioning of cells of kidney, decreased excretion of drugs o Age infants and older persons are more sensitive to drugs o Body weight drug doses are ordered to body weight; higher weight increased drug doses and vice versa for those of lower weight Toxicity first adverse symptoms that occur at a particular dose; can be affected by the same factors that affect metabolism o More prevalent in those with renal impairment or liver impairment and in very young or very old clients

Pharmacogenetics study of interrelation of heredity on drug response Route of administration drugs administered by IV act more rapidly than those administered by mouth o Time of administration presence or absence of food in stomach can affect the action of drugs o emotional factors suggestive comments about the drug and its side effects may influence its effects on the client o preexisting disease state liver, kidney, heart, circulatory and GI disorders are examples of what can affect the response to a drug o drug history be aware that past use of the same or different drugs may reduce or intensify the current effect of the drug Tolerance ability of a client to respond to a particular dose of a certain drug may diminish after days or week of repeated administration Cumulative effect occurs when the drug is metabolized or excreted more slowly than rate at which it is being administered o Drug-drug interaction effects of combination of drugs may be greater than, equal to, or less than the effects of a single drug; drugs may compete for the same receptor sites o Food-drug interaction effects of selected foods may speed, delay or prevent absorption of specific drugs