Medication safety: transcend the fundamentals

For every nurse working in a direct care setting, preparing medications and administering them to patients is a component of the each day routine. Errors can occur at any stage of the method. Administrative errors are a few of the most serious and customary errors made by nurses. The result may extend the hospital stay, increase costs, or have life-or-death consequences for the patient. So what are you able to do to manage medications safely?

• Check your medication order and be sure it’s complete. The order should include the name of the drug, dosage, frequency and route of administration. If any item is missing, seek the advice of a specialist.
• Check the patient’s medical records for allergies or contraindications to the prescribed medication. If there may be an allergy or contraindication, don’t administer the drug and notify your doctor.
• Prepare medications for one patient at a time.
• Educate patients about their medications. Encourage them to talk up if something seems incorrect.
• Follow the eight laws of medication administration

• Know that interruptions and distractions have a definite impact in your performance, causing inattention, forgetfulness and errors.
• Before you start preparations or administrative activities, be sure you’ve gotten all required materials and documents available.
• Follow your facility’s policy regarding using a “no-go zone” (NIZ), a practice really helpful by the Institute for Safe Medication Practices (ISMP) to boost patient safety. Your NIZ must be a discreet area where treatment-related tasks are performed. This may very well be a dedicated medical room or a quiet space marked off with visual markers.
• If your facility requires it, wear a special vest, apron, sash, lighted lanyard, or other item to point that you simply are administering medications and shouldn’t interrupt them.
• If your facility uses mobile devices, temporarily transfer calls and other notifications to a different worker or pause the device through the most complex steps of preparing and administering medications.

• Be especially vigilant in high-risk situations, resembling if you end up stressed, drained or indignant, or when supervising inexperienced staff. Monitor and modify work schedules to reduce work- or fatigue-related medication errors.
• Be aware of all relevant antidotes, reversals and rescue measures. Find out where they’re stored in your device and how one can manage them in an emergency.
• Learn about medications that require special care (resembling anticoagulants, antidiabetics, sedatives, and chemotherapy drugs). Have one other nurse perform an independent double check and proper any discrepancies BEFORE administering the medication.
• Be aware of the ISMP and your facility’s drug name confusion list, which incorporates pairs of similar-sounding names (resembling Zocor and Cozaar) and similar names (resembling vinblastine and vincristine). Particular caution must be exercised when administering medications from these lists. Your facility may additionally have additional safeguards, resembling requiring that each brand and generic names for the drug be recorded on all orders, or organising computerized selection screens to forestall an identical names from appearing side by side.
• Notice the Tall Man, a visible safety feature that highlights a part of the drug name in capital letters to assist distinguish similar-looking pairs of names, resembling BuPROPion (an antidepressant) from BusPIRone (an anti-anxiety drug) or glipiZIDE from glyBURIDE (two different antidiabetic drugs).
• Measure and document patient weight in metric units (grams and kilograms) ONLY to enable accurate dose calculation. The patient also needs to be weighed as soon as possible upon admission and shouldn’t depend on reported, estimated or historical weights.
• For patients receiving intravenous opioid medications, respiratory rate, sedation level, and oxygen saturation or exhaled carbon dioxide levels must be regularly monitored to scale back the chance of adversarial effects related to intravenous opioid use. If unwanted side effects occur, it’s best to respond immediately to forestall delays in treatment.
• Administer intravenous infusions of high-alert medications using a programmable infusion device that uses software to scale back dosing errors.
• Reconcile a patient’s medications every time there may be a change in care and when a brand new medication is ordered to scale back the chance of medication errors, including omissions, duplications, dosage errors and drug interactions.
• Educate and supply written instructions to the patient and family (or caregiver) regarding prescribed home medications and check for understanding prior to discharge.

Knowing the medications you’re administering and following protected practices may also help protect patients from medication errors.

More details about drug safety could be found at:
CDC: Drug Safety Program
Institute for Safe Medication Practices
AHRQ Patient Safety Net: Medication Errors
US FDA: Drug-Related Medication Errors

Bibliography:
Institute for Safe Medication Practices. (2016). “Target best practices for drug safety in hospitals for 2016-2017” [Online]. Accessed April 2016 via the Internet at http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf

Principles of protected drug administration, general. (2015). In Lippincott procedures. Downloaded from http://procedures.lww.com.

Medication Manual for Nurses 2016. (2016). Wolters Kluwer: Philadelphia, Pennsylvania.