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PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSESA Pathophysiological ApproachA Pathophysiological Approach
FOURTH EDITIONFOURTH EDITION
Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.All Rights Reserved
CHAPTER
Medication Errors and Risk Reduction
7
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Medication ErrorMedication Error
• Any error that occurs in medication administration process, whether or not it harms the patient. May be applied to– Misinterpretations, miscalculations– Misadministration – Handwriting misinterpretation– Misunderstanding of verbal orders
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Figure 7.1 Index for categorizing medication errors algorithmSource: Reprinted with the permission of the National Coordinating Council for Medication Error Reporting and Prevention, ©2001.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Factors That Contribute to Medication Factors That Contribute to Medication Errors by the Health Care ProviderErrors by the Health Care Provider
• Omitting one of the rights of drug administration
• Failing to perform an agency system check
• Failing to take into account for patient variables such as age, body size, and renal or hepatic function
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Factors That Contribute to Medication Factors That Contribute to Medication Errors by the Health Care ProviderErrors by the Health Care Provider
• Giving medications based on verbal orders or phone orders
• Giving medication based on an incomplete order or an illegible order
• Practicing under stressful work conditions
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Factors That Contribute to Factors That Contribute to Medication Errors by the PatientMedication Errors by the Patient• Taking drugs prescribed by several
practitioners • Getting prescriptions filled at more than
one pharmacy• Not filling or refilling prescriptions
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Factors That Contribute to Factors That Contribute to Medication Errors by the PatientMedication Errors by the Patient• Taking medications incorrectly• Taking medications that may be left
over from a previous illness• Taking medications prescribed for
something else
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Impact of Medication ErrorsImpact of Medication Errors
• Common cause of morbidity and preventable death in hospitals
• Emotionally devastating to nurse and patient
• Increased cost to patient and facility, as it may extend patient's stay
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Impact of Medication ErrorsImpact of Medication Errors
• Poor reputation for unit or facility, caused by high incidence of errors
• Penalizing of administrative staff because of errors
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Investigating ErrorsInvestigating Errors
• No acceptable rate of medication errors• Errors should be investigated and
subjected to analysis to determine causes.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reporting and Documenting Reporting and Documenting Medication ErrorsMedication Errors
• Documentation should occur in a factual manner.
• Documentation in medical record must include specific nursing interventions that were implemented after the error in order to protect the patient.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reporting and Documenting Reporting and Documenting Medication ErrorsMedication Errors
• Document all individuals who were notified of error
• Medication-administration record (MAR) is a source detailing what medication was given or omitted.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reporting with an Incident ReportReporting with an Incident Report
• Details recorded in factual and objective manner
• Allows nurse to identify factors that contributed to the error
• Is not part of patient's hospital record• Used by agency's risk management
personnel for quality improvement
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Legality and Reducing ErrorsLegality and Reducing Errors
• Accurate documentation verifies patient's safety
• Used as tool to improve drug administration processes
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Legality and Reducing ErrorsLegality and Reducing Errors
• Medication errors can be reduced by using written data– Root cause analysis (RCA) seeks to
prevent another occurrence by asking what happened and why, and what can be done to prevent it
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Sentinel EventsSentinel Events
• Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof
• Always investigated• Interventions taken to ensure there is
no repeat
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—AssessmentIncidents—Assessment
• Assess food or medication allergies• Assess current health concerns• Assess use of OTCs and herbal
supplements• Review recent laboratory tests
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—AssessmentIncidents—Assessment
• Review recent physical-assessment findings
• Identify need for education of medication regimen
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—PlanningIncidents—Planning
• Avoid using abbreviations that can be misunderstood
• Question unclear orders • Do not accept verbal orders
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—PlanningIncidents—Planning
• Follow specific facility policies and procedures related to medication administration
• Ask the patient to participate by restating the right time and dose of medication
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—ImplementationIncidents—Implementation
• Be aware of potential distractions during medication administration
• Remove distractions, if possible • Focus on the task of administering
medications • Practice the rights of medication
administration
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—ImplementationIncidents—Implementation
• Keep in mind the following steps:– Positively verify patient using name and
birthdate– Use correct procedures for all routes of
administration– Calculate medication doses correctly– Open medications prior to administering– Record on MAR immediately after
administering
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—ImplementationIncidents—Implementation
• Keep in mind the following steps:– Confirm patient has swallowed
medication– Be alert for long-acting oral dosage
forms with indicators such as LA, XL, and XR
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Reduction of Medication Errors and Reduction of Medication Errors and Incidents—EvaluationIncidents—Evaluation
• Assess patient for expected outcomes• Determine if any adverse effects have
occurred
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Nurses and ErrorsNurses and Errors
• Nurses should know most frequent types of drug errors and severities of reaction.
• Nurse should never administer a medication unless familiar with uses and side effects—PDAs now help with this.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 7.1 Selected Look-Alike and Sound-Alike Drug Names
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 7.1 (continued) Selected Look-Alike and Sound-Alike Drug Names
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 7.1 (continued) Selected Look-Alike and Sound-Alike Drug Names
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 7.1 (continued) Selected Look-Alike and Sound-Alike Drug Names
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Frequent Types of Drug Errors Frequent Types of Drug Errors
• Administering improper dose• Giving wrong drug• Using wrong route of administration
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Severities Severities
• One-half of fatal medication errors occurred in patients older than 60 years of age.
• Children are another vulnerable population due to smaller dosages.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Medication ReconciliationMedication Reconciliation
• 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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Medication ReconciliationMedication Reconciliation
• Many serious medication errors tracked to poor reconciliation
• Reconciliation lists all medications that a patient is taking to reduce errors
• Hospitals encouraged to document a complete list when patient is admitted
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Educate Patient withEducate Patient with
• Written, age-appropriate handouts• Audiovisual teaching aids• Contact information
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Additional Patient Education 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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Methods to Reduce Number of Methods to Reduce Number of Medication ErrorsMedication 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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Methods to Reduce Number of Methods to Reduce Number of Medication ErrorsMedication Errors
• Electronic health records and e-prescriptions
• Barcode-assisted medication administration
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Examples of Beneficial Policies and Examples of Beneficial Policies and ProceduresProcedures
• Correctly storing medication• Reading drug label• Avoid drug transfer between containers• Avoid overstocking to prevent
expiration• Monitor compliance with current
medication abbreviations• Removing outdated reference books
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Governmental and Other Agencies Governmental and Other Agencies that Track Medication Errorsthat Track Medication Errors
• FDA's MedWatch– Health care providers are encouraged to
report errors.– Errors may be reported anonymously.
• Institute for Safe Medication Practices (ISMP)
• MEDMARX - U.S. Pharmacopeia's anonymous medication error reporting program
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