CH. 18 medication administration

1. CH. 18 medication administration This power point is an “interactive review” of Ch. 18 material

2. Joint Commission’s 2008 National patient Safety Goals • Reduce the likelihood of patient harm from administration of anticoagulants • Improved recognition and response to changes in patients’ conditions

3. Joint Commission’s 2008 National patient Safety Goals • Two pt identifiers for patients when providing tx • “read back” verbal or telephone orders

4. Joint Commission’s 2008 National patient Safety Goals • implementing standardized “hand off” communication approaches when care transitions from one person to another or from one area of care to another

5. Joint Commission’s 2008 National patient Safety Goals • Standardized lists of abbreviations and dose designations that are not to be used in the organization • Improving the timeliness of reporting

6. Joint commission’s specific medication goals-2008 • Identify, at least annually, a list of look-alike/sound-alike drugs and take action to prevent errors involving interchange of these drugs • Label all medications and medication containers EVEN on sterile fields

7. Joint commission’s specific medication goals-2008 • Accurately and completely reconcile all mediations across the continuum of care • Have a process to compare the pt’s current medications (when admitted) with those ordered for the pt while receiving care in the organization

8. Joint commission’s specific medication goals-2008 • A complete list of medications must be communicated to the next provider of service when the pt is transferred • A complete list must be given to the pt upon discharge

9. a. 15-25% b. 25-35% c.40-60% d. 60-75% It is estimated that nurses spend about _____ % of their work time engaged in administering medications to patients.

10. a. Advanced procedures b. Basic rules c. Package insert guidelines d. IOM report Statistics show that many medication errors result from failure to follow the _________ of safe administration.

11. a. 98,000 b. 28,000 c.68,000 d. 128,000 The Institute of Medicine’s 2000 report identified up to __________ deaths per year in hospitals as a result of medical errors.

12. a. secrecy b. confidence c. safety d. dignity The U.S. Dept. of Health & Human Services and the Agency for Healthcare Research and Quality have partnered to help establish a culture of _________ in health care settings.

13. a. To reduce pt. harm from anticoagulants b. To eradicate all medication-related errors c. Improve recognition and response to changes in pt condition Which answer choice is NOT included in the Joint Commission’s 2008 National Patient Safety Goals for hospital programs:

14. a. MedWatch b. Medicaid c. National Patient Safety d. Institute for Safe Medication Practices ___________is the name of the FDA’s adverse event reporting program.

15. a. 35 b. 20 c.5 d. 50 According to the nonprofit research group-The institute for Safe Medication Practices, as few as ____ drugs have been identified in 80% of deaths due to medication errors.

16. a. trouble-spot b. fail-safe c. error-prone d. potential-error In 2002, the Joint Commission adopted the ISMP’s list of ________-________ abbreviations, symbols, and dose designations.

17. a. 12.5 b. 11.5 c.10.5 d. 16 Another area identified by the Joint Commission and the ANA as a possible contributing factor to medical errors is when nurses work shifts lasting ____ hours or longer.

18. a. malpractice b. malfeasance c. error d. injury Legally speaking, in order to prove negligence, a plaintiff must show there was: (1) a duty, (2) a breach of duty, (3) proximate causation between the duty and breach of duty, and (4) :

19. a. right b. responsibility c. duty d. breach of duty Legally speaking, a nurse has a ______ to follow correctly written physician’s orders for medication administration.

20. a. Right time b. Right dosage c. Right method d. Right doctor Which choice is not one of the 6 “rights” of medication administration?

21. TRUE. TRUE or FALSE? Many medication errors do not result in injury to the patient and would not support a civil action for negligence.

22. TRUE. TRUE or FALSE? Some cases of negligence in which the patient’s injury was very serious (even leading to death) have been the subject of criminal litigation.

23. a. A b. I c. U d. R One potential medication error can arise because someone can read the letter ____ as an extra zero.

24. Nurse Thao’s error • Take a couple of minutes to review Nurse Thao’s case on Pg. 99 and be prepared to answer the following questions

25. a. stress b. Under-paid c. fatigue d. incompetence What fact was cited as a contributing factor to Nurse Thao’s error?

26. a. misdemeanor b. felony c. Minor infraction d. Plea bargain What was Nurse Thao originally charged with?

27. Let’s review the caseChavez v. Parkview Episcopal Hospital, pg. 101

28. a. 1 b. 2 c. 3 d. 4 In Chavez v. Parkview Episcopal Hospital, how many parties were found negligent on appeal?

29. a. A nurse b. A doctor c. PCA pump manufacturer d. PCA pump distributor In Chavez v. Parkview Episcopal Hospital, Who was “Baxter”?

30. Let’s review the caseEllis v. Bard, pg. 101

31. Patient’s self- Administered over-dose Unauthorized 3rd party Administration of medication Misapplication of rules regarding who can administer drug thru PCA 4. All of the above Prior to the requirement that PCA pumps must use tubing that prevents the free-flow of medication, what kind of potential errors/accidents existed? See Ellis v. Bard on pg. 101

32. Not guilty. In Ellis v. Bard, Inc. and Baxter Healthcare Corporation, was the Defendant -manufacturer found guilty or not guilty of negligence?

33. Let’s review the caseMcAllen v. Muniz, pg. 102

34. Failure to record/document Failure to monitor patient’s response to narcotic In McAllen Hospitals v. Carmen Muniz et al., what were the two standards that the nurse failed to uphold that were found to have led to the patient’s death?

35. Let’s review the case kapadiav.alief general hospitalpg.102-103

36. In Kapadia, why did both the original trial jury and the Court of Appeals find that the hospital (and the nurse) was not negligent in this case? Even though there was conflicting evidence as to whether the standard of care was upheld, the jury had found substantial evidence to believe that it was upheld.

37. Let’s review the case Gassen v. east jefferson general hospital pg.103

38. In Gassen, although the evidence supports that the Doctor made the original error in writing an order with the incorrect route of administration, the nurse should have: . . .questioned the Doctor’s order at the point of preparing the medication.

39. Take home messages Nurses remain individually accountable for their own errors/actions even if someone else started the chain of events. It is the responsibility of the nurse to clarify orders because s/he is the last checkpoint for the pt’s safety.

40. Take home messages High Alert medications include: Insulin, potassium chloride, heparin, digoxin and other potent cardiac drugs, chemotherapeutic agents, narcotics, and anesthetics.

41. Take home messages Extra checkpoints include: Two nurses check dosage/dosage calculation, and administration methods