Question

Based on your knowledge of research-based practices and professional behavior/ethics: Answer the following in two-part's,

• Explain the importance of safety and prevention concerns with the legal and ethical principles. Be sure to include:
  • The legal issues and legislation history
  • HIPAA
  • The seven rights of drug administration
• Explain how geriatric pharmacology differs from non-geriatric pharmacology. Be sure to mention:
  • changes in:
    • physiologic changes
    • drug absorption
    • distribution
    • metabolism
    • elimination
  • concerns for polypharmacy
  • disease and death
  • importance of regular monitoring
  • list the six principles important in treat older adults.

Answer 1

1. Safety :-

being protected from tasks, situations, or environments that are likely to cause danger, risk, or injury

Prevention means to prevent something before it occurs .

#. Importance of safety :-

1) right thing to do, workers are mva

2) can decrease number of accidents which can lead to injuries and loss of property (medical cost are very high in US)

3) compliance with state and federal safety regulations (prevents citations, penalties and fines)

Importance of prevention :-

- to reduce incidence

- to reduce cost

- to reduce the resources wastage

2. Seven rights of drug administration are :-

1. Right Medication - This means that the medication that is given is the right medication. Errors in this right are made when:

pharmacy incorrectly dispenses a medication similar to the ordered medication

the nurse administers a medication that has a similar name

the nurse administers a medication not prepared by them

the nurse incorrectly identifies a medication

Always listen for cues from the patient. If they state that they have never seen this medication before or it doesn't look the same, recheck the medication order.

2. Right Patient

Giving the medication to the the patient for whom it was intended. To avoid errors use two identifiers, ask the patient to state their name and check the name band with the medication administration record (MAR). Computerized charts in the room also allow the nurse to scan the arm band. In long-term care facilities pictures are sometimes used.

3. Right Dosage

This means that the patient is given the dose that was ordered and the dose is appropriate for the patient. The errors for inappropriate dose can be avoided if the pharmacist and nurse are aware of the usual dosage ranges of medications. Double check with the physician whenever there is a questions about the dose. Be sure that drugs that require calculation are done correctly and doubled checked.

4. Right Route

The medication is given only the route that was ordered and that the route s safe and appropriate for the patient. Know the usual routes of administration for drugs to be given. Always double check the route of administration.

5. Right Time

This means that the drug was given at the correct time as ordered or according to agency policy. Most institutions consider a medication to be given on time if given 30 minutes before or after the prescribed time. Watch medications that cannot be given with food so they are given before a meal and medications that must be given with a meal need to be given with meals.

6. Right Reason

This is important to make sure the right medication was ordered.

7. Right Documentation

Nurses need to document the delivery of the medication soon after it is given so medications are not given again. Be sure and follow agency policy on documentation. Remember the W's when documenting medication administration on the patient chart:

When (time)

Why (include assessment, symptoms/complaints, lab values)

What (medication, dose, route)

Where (site)

Was (the medication tolerated and if known, helpful to the patient)

3. HIPAA :

Health Insurance Portability and Accountability Act

Purpose of HIPAA

protect patients and their personal health information

It was passed by Congress and signed by the president in

1996

The four main purposes of regulations involved in HIPAA

-Privacy of Health Information

-Security of Electronic recorder

-Administrative simplification

-insurance portabality

4. Geriatric pharmacology :-

#. Altered pharmacokinetics in elderly

• Absorption

- Less efficient uptake in GI tract

- decreased blood supply to stomach and small intestine

- decreased stomach acid and bile salts

• Distribution

- Higher body fat percentage = increased capacity to store meds in adipose tissue (messes with dosing, will leech out when fat is burned)

• Elimination

- Changes in kidney, colon, respiratory tract function

drug elimination

Metabolism: liver

• decreased mass (less liver tissue to deal with meds)

• decreased blood flow

• decreased enzyme activity

Excretion: kidney

• decreased mass

• decreased blood flow, GFR (glomeruler filtration rate)

• decreased tubular function

5. Polypharmacy :-

• Patient's drug regimen includes one or more unnecessary medications

• PCP may send patient to a specialist unnecessarily due to liability

- lots of different doctors prescribing drugs, PCP is no longer in control and coordinating the meds that the pt is on

#. Features of polypharmacy :-

• No apparent reason for drug

• Duplicate drugs - pt may not write all drugs on intake form, may not feel it is important

• Contraindicated drugs

• Interacting drugs - could have a different effect together than intended

• Inappropriate dose - doesn't take into account aging effects

• Use of drugs to treat ADRs (adverse drug reactions)

• Improvement when drug d/c'd (discontinued)

#. Consequences of polypharmacy : -

• More adverse drug reactions

• More drug interactions

• Financial, compliance issues

• Creates vicious cycle

- elderly take more drugs

- increased risk of side effects

- increased "symptoms"

- more drugs prescribed