Question

Carol Petros (C. P.) is a 77-year-old female admitted to the hospital 4 hours earlier after a fall at home caused by dizziness and weakness. She was initially brought to the emergency department by her daughter, who checked on her after not reaching her by phone. Her medical history includes hypertension, osteoarthritis, and a hysterectomy at age 50. She states that she has an allergy to penicillin, and she is full-code status. The patient has lived alone since the death of her spouse 3 months ago. She brought a small plastic bag with multiple medications in it because, as she said, “I can't open my medication bottles easily because of my arthritis.” C. P.'s vital signs are: T 36.5° C (97.7° F), P 92 and regular, R 20 and unlabored, BP 172/92, with a pulse oximetry reading of 98% on room air. She reports a pain level of 8 of 10 in her left hip. She also reports a pain level of 5 of 10 in her hands from her arthritis. As the nurse completed the admission assessment, C. P. stated, “I forgot to take my furosemide in the morning, so I took both tablets before bed. I was up and down to the bathroom a lot, and fell because I was dizzy and my legs gave out early this morning. My daughter came to get me. Right now my hip and leg hurt when I move.” She further reported, “I always have some pain in my hands and have to take medicine for that sometimes, but I don't like to because then I get constipated. I take a tablet of the over-the-counter herb, feverfew, every day to help with my arthritis pain.” The nurse notes a 4 × 5 cm bruise on the left hip. The patient's Braden score is 20, and her Morse Fall score is 40. Her left hip x-ray on admission showed no acute fracture. Serum potassium level is 3.3 mEq/L. Treatment orders are as follows: • Vital signs every 4 hours • No-added-salt diet • Activity as tolerated with assistance • Intake and output • Electrolyte panel in a.m. Medication orders are as follows: • Continue home medications of: • Furosemide 40 mg PO bid • Hydrocodone 5 mg PO every 4 hours PRN for pain • K-Lor 8 mEq daily • Start docusate sodium 50 mg PO daily • Start intravenous (IV) infusion of 5% dextrose in half normal saline (D5 imageNS) with 20 mEq of KCl to run at 75 mL/hr

1. C. P. has requested medication for pain in her bruised hip. When the nurse accesses the locked narcotic cabinet, she finds a discrepancy between the expected amount and actual amount of the prescribed pain medication. What action should the nurse take?

2. The primary care provider electronically transmits an order for C. P. for “docusate sodium daily, PRN.” What additional actions are needed before the nurse can safely administer this medication?

3. The nurse accidentally administers C. P.'s prescribed diuretic, potassium, and stool softener to Charlotte Peters (C. P.), the patient in the next room. Identify at least four safety measures that can prevent medication errors when properly followed, and list the actions the nurse needs to take now.

4. C. P. verbalizes the concern that she will not take her medications correctly when she returns home. What plan can the nurse implement to help the patient safely take her medications?

Answer 1

1.The nurse should clarify the order with the C.P,who prescribed the medication regarding the dosage of medication to be given to the patient, as there is a variation in the prescribed amount and actual amount of medication, in order to avoid medication error.

2. Docusate sodium is a laxative which can cause electrolyte imbalances as a side effect.Thus,the nurse must obtain recent electrolyte profile before administering the medication because the patient is already using a potassium sparing diuretic (Furosemide) and has low potassium level of  3.3 mEq/L. she has prescribed with k-lor and intravenous potassium supplement.Hence, it is important to monitor serum potassium level for safe administration.

3.

Four safety measures that can prevent medication errors

1.Identify the right patient before administering the medication.

• Use two identifiers such as ask the patient to verbalize his /her name if possible or check identification band of the patient. cross check with the medical chart

2.Identify the right medication which is prescribed

• Check the medication order prior to the administration of medication in the medication chart. Clarify any doubts with the prescriber .See for look alike sound alike medications carefully.
• Check medication label ,expiry date and patient history for alleries.

3.Identify the right dosage of medication

• check the medication chart for dosage of medication and calculate the amount if needed. ask another registered nurse to recheck the calculated dosage for confirmation if required.

4. Identify the right route of administration

• check the medication chart for the route of administration and check the label of medication for confirmation.
• Assess the patient whether the patient can receive the particular medicine through the prescribed route.

Action need to take following administration of medication to a wrong patient

1.Assess the patient and determine the effect of administered medication on the patient.

2.Initiate actions which can prevent any adverse effects of medications on the patient.

• Immediate and continuous monitoring of patient
• Notify the treating physician for initiation of counter treatment to prevent or decrease adverse effects.

3. Document the event

4.Report the error as soon as the patient is stabilized according to the facility guidelines.

5. plan to help the patient for safe medication compliance

1.Educate the patient regarding the importance of proper medication regimen and how it helps to improve her health.

2.Effective communication with the patient regarding her treatment and importance to avoid over dosage once the dosage is missed.

3.Patient reminders can be kept in order to remind her to take her medicine .There are different kinds of reminders such as reminder phone calls, text messages, pagers, interactive voice response (IVR) systems, video telephone calls, medication boxes and personalized blisters.

4.Provide access to local community nurse or facility to monitor her medication adherence.

5. Frequent routine follow up can be done by home visit,scheduled clinic visit to ensure safe medication compliance.