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Dimensinal Analysis. Chapter 6 Reading Oral medication labels. Nurse Charged With Felony In Medication Error  Death. Medication error could send nurse to prison for up to 6 years in death of OB patient.

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dimensinal analysis

Dimensinal Analysis

Chapter 6

Reading Oral medication labels

nurse charged with felony in medication error death
Nurse Charged With Felony In Medication Error Death
  • Medication error could send nurse to prison for up to 6 years in death of OB patient.
  • A former Madison, WI nurse was charged with criminal neglect in the death of 16-year-old Jasmine Gant, who died in July of a medication error while giving birth. Julie Thao, 41, of Belleville, faces a count of neglect of a patient causing great bodily harm, which carries a maximum prison sentence of six years in prison.
nurse charged with felony in medication error death1
Nurse Charged With Felony In Medication Error Death
  • Gant allegedly died after an epidural anesthetic was allegedly mistaken for a prescribed dose of penicillin. Thao is alleged to have taken the drug from a locker and administered it to the patient intravenously even though the container carried a warning that it was not for IV use.
  • The patient died within an hour, but the infant survived when doctors performed an emergency ceasarian delivery.
nurse charged with felony in medication error death2
Nurse Charged With Felony In Medication Error Death
  • A criminal complaint alleges that Thao ignored every safeguard put in place to prevent medication errors at Madison's St. Mary's Hospital and Medical Center. The prosecutor alleges Thao ignored the hospital's "Bridge System," used to scan medication labels before drugs are administered, took a potentially lethal drug from a storage locker without authorization and didn't read the label of a drug she injected into Gant.
nurse s suicide highlights twin tragedies of medical errors
Nurse's suicide highlights twin tragedies of medical errors
  • For registered nurse Kimberly Hiatt, the horror began last Sept. 14, the moment she realized she’d overdosed a fragile baby with 10 times too much medication.
  • Stunned, she told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had happened. “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse, Michelle Asplin, in a statement to state investigators.
nurse s suicide highlights twin tragedies of medical errors1
Nurse's suicide highlights twin tragedies of medical errors
  • In Hiatt’s 24-year career, all of it at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the only serious medical mistake she’d ever made, public investigation records show.
nurse s suicide highlights twin tragedies of medical errors2
Nurse's suicide highlights twin tragedies of medical errors
  • “She was devastated, just devastated,” said Lyn Hiatt…
  • That mistake turned out to be the beginning of an unraveled life, contributing not only to
  • the death of the child, 8-month-old Kaia,
  • but also to Hiatt’s firing,
  • a state nursing commission investigation
  • and Hiatt's suicide on April 3 at age 50.
safe drugs
Safe Drugs
  • U.S. Food and Drug Administration (FDA)
1938 the federal food drug cosmetic act
1938: The Federal Food, Drug & Cosmetic Act
  • Federal regulation
  • Drugs must be labeled with directions
  • Manufactures had to prove meds were safe
  • Government inspections
thalidomide
Thalidomide
  • Morning Sickness pill
    • 1950’s / Europe
  • Severe birth defects -limbs
medication orders components
Medication Orders: components

1. Patient identify information

  • Name
  • DOB
  • Medical Record #
  • Dr.
medication orders components1
Medication Orders: components

2. Date and time of order

on a 24 hour clock what time would 6 30 pm be
On a 24-hour clock what time would 6:30 PM be?
  • 0630
  • 1430
  • 1630
  • 1830
  • None of the above?
on a 24 hour clock what time would 10 15 pm be
On a 24-hour clock what time would 10:15 PM be?
  • 1015
  • 1215
  • 0815
  • 2015
  • None of the above
on a 24 hour clock what time would 8 00 pm be
On a 24-hour clock what time would 8:00 PM be?
  • 0800
  • 1000
  • 2000
  • 2200
  • None of the above
on a 24 hour clock what time would 12 45 pm be
On a 24-hour clock what time would 12:45 PM be?
  • 1245
  • 0045
  • 1445
  • 1045
  • None of the above
on a 24 hour clock what time would 6 30 am be
On a 24-hour clock what time would 6:30 AM be?
  • 0630
  • 0830
  • 1830
  • 1630
  • None of the above
on a 24 hour clock what time would 12 30 am be
On a 24-hour clock what time would 12:30 AM be?
  • 1230
  • 0230
  • 0030
  • 1430
  • None of the above
on a 24 hour clock what time would 7 30 pm be
On a 24-hour clock what time would 7:30 PM be?
  • 1930
  • 1730
  • 1530
  • 0730
  • None of the above
on a 24 hour clock what time would 1 30 am be
On a 24-hour clock what time would 1:30 AM be?
  • 1330
  • 0030
  • 0330
  • 0130
  • None of the above
medication orders components2
Medication Orders: components

3. Name of medication

medication orders components3
Medication Orders: components

4. Medication dosage

  • 500 mg
  • 20 mEq
  • 100 units
  • 30 mL
medication orders components4
Medication Orders: components

5. Route of administration

route enteral
Route: enteral
  • Oral (by mouth)
    • PO
      • Tablets
      • Capsules
      • Caplets
route enteral1
Route: enteral
  • Rectal (per rectal)
    • PR
      • suppositories
route enteral2
Route: enteral
  • Via tubes (GT or NGT)
route parenteral
Route: Parenteral
  • Intravenous
    • IV
route parenteral1
Route: Parenteral
  • Intramuscular
    • IM
route parenteral2
Route: Parenteral
  • Subcutaneous
    • Subcut
route parenteral3
Route: Parenteral
  • Intradermal
    • ID
route other
Route: Other
  • Sublingual
    • SL
route other1
Route: other
  • Transdermal
medication orders components5
Medication Orders: components

6. Frequency &/or time

  • Daily
    • daily
  • Twice a day
    • bid
  • Three times a day
    • tid
  • At bedtime
    • At bedtime
  • Every 2,4 or 6 hours
    • q2hr
    • q4hr
    • q6hr
slide36

Before meals

    • ac
  • After meals
    • pc
medication orders components6
Medication Orders: components

7. Prescriber’s name & credentials

  • Mary Jones, MD
  • John Gonadal, DO
medication orders components7
Medication Orders: components

8. Name of person transcribing the order

  • Noted: E. Keele, RN
the 6 rights 3 checks
The 6 rights & 3 checks

Rights

Checks

  • Patient
the 6 rights 3 checks1
The 6 rights & 3 checks

Rights

Checks

Check medication

While pulling

After pulling

Before giving

  • Patient
  • Drug
  • Dose
  • Route
  • Time
  • Documentation
oral mediations
Oral Mediations
  • Tablets
  • Scored tablets
  • Enteric coated tablets
  • Capsules
  • Controlled release capsules
  • Gelatin capsules
tablets
Tablets
  • Tablets
  • Scored tablets
  • Enteric coated tablets
capsules
Capsules
  • Capsules
  • Control release capsules
what are these capsules made of
What are these capsules made of?
  • Gelatin
  • Plant starch and cellulose
can a gelatin filled capsule be divided in half giving only half of a capsule to a patient
Can a gelatin filled capsule be divided in half - giving only half of a capsule to a patient?
  • Yes
  • No
  • I don’t know – I’ll wait until Mrs. Keele shows me the right answer!
unit dosage label
Unit Dosage label
  • Each tablet or capsule is packages separately
example
Example
  • Trade name
  • Generic/official name
  • Dosage strength
  • Unit of measure
  • Manufacturer
  • Exp date:
multiple dose label
Multiple dose label
  • More than one tablet / capsule in a package
  • What is the difference?
example1
Example
  • Trade name?
  • Generic name?
  • Dosage strength?
  • Unit of measure?
  • How many tablets in this bottle?
u s p n f
U.S.P & N.F.
  • U.S.P
    • United States Pharmacopeia
  • N.F.
    • National Formulary
slide57
Exp.
  • Exp.
    • Expiration date
  • Make a habit of checking the expiration date on labels!
2 medications in one pill
2 medications in one pill
  • Contains 2 medications
    • Carbidopa
    • Levodopa
  • Ordered by the trade name & # of tablets to be given.
  • 2 dose amounts
    • 25-100
you turn
You Turn!
  • What is the generic name?
  • What is the trade name?
  • What is the dosage strength
  • How many capsules in this bottle?
tablet capsule dosage calculation
Tablet/capsule dosage calculation
  • Medication records will tell you the name and amount of drug to be given, it will not tell you how many tablets or capsules to give!
tablet capsule dosage calculation1
Tablet/capsule dosage calculation
  • Learn to question orders for more than three tablets or capsules.
  • An unusual number of tablets or capsules could be a warning of an error in prescribing, transcribing or your calculations.
tablet capsule dosage calculation2
Tablet/capsule dosage calculation
  • Regardless of the source of the error, if you give a wrong drug or dosage you are legally responsible for it.
slide63

Trade name?

  • Generic name?
  • Dosage strength?
  • Number of tablets in the bottle?
how much medication to give
How much medication to give?
  • Give Aricept 12.5 mg
  • Formula:

Desire = what to give

Have

how much medication to give1
How much medication to give?
  • Give Aricept 12.5 mg
    • What do we desire to give / What did the doctor order?
      • 12.5 mg
    • What do we have / what is the unit dose?
      • 5 mg
how much medication to give2
How much medication to give?
  • Give Aricept 12.5 mg
  • Formula:

Desire 12.5 mg = _____ tablets

Have 5 mg

** THE DOSAGE METRIC UNIT MUST MATCH!

give halcion 0 625 mg
Give Halcion 0.625 mg
  • Trade name?
  • Generic name?
  • Dosage strength?
  • Number of tablets in the bottle?
give halcion 0 625 mg1
Give Halcion 0.625 mg
  • Formula
    • Desire = __#__ tablets

Have

  • Desire
    • 0.625 mg
  • Have
    • 0.25 mg
give halcion 0 625 mg2
Give Halcion 0.625 mg
  • Formula
    • Desire = __#__ tablets

Have

Desire: 0.625 mg = ? tablets

Have: 0.25 mg

0.625 mg / 0.25 mg = 2.5 tablets

Give 2 ½ tablets

your turn
Your turn!
  • What is the dosage strength?
  • If 10 mg is ordered give…?
  • If 2.5 mg is ordered give…?
  • If 7.5 mg if ordered give…?
answers
Answers!
  • What is the dosage strength?
  • If 10 mg is ordered give…?
    • D: 10 mg = ?
    • H: 5 mg
    • 10 mg / 5 mg =
      • 2 Tablets
answers1
Answers!
  • What is the dosage strength?
  • If 2.5 mg is ordered give…?
    • D: 2.5 mg = ?
    • H: 5 mg
    • 2.5 mg / 5 mg =
      • 0.5 mg
      • ½ tablet
answers2
Answers!
  • What is the dosage strength?
  • If 7.5 mg if ordered give…?
    • D: 7.5 mg = ?
    • H: 5 mg
    • 7.5 mg / 5 mg =
      • 1.5 tablets
      • 1 ½ tablets
your turn1
Your turn!
  • What is the dosage strength?
  • If the doctor orders you to give 240 mg how many capsules would you give?
answer
Answer!
  • What is the dosage strength?
  • If the doctor orders you to give 240 mg of Verelan how many capsules would you give?
    • D: 240 mg = ? Capsules
    • H: 120 mg
    • 2 capsules
another question
Another question
  • What is the dosage strength?
  • The doctor orders Terbutaline Sulfate 3.75 mg. How much will you give?
    • D: 3.75 mg = _?_ tablets
    • H: 2.5 mg
      • 1.5 tablets
      • 1 ½ tablets
one more example
One more example
  • What is the dosage strength?
  • The doctor orders 250mg of Azulfidine. How many tablets should you give?
    • D: 250 mg = _?_ tablets
    • H: 500 mg
      • 0.5 tablets
      • ½ tablets