Question

Provide your answers to the following questions in a 2-page paper. Use APA Editorial Format for all citations and references used.

1. What should the "culture and environment of safety" look like when preparing and administering medications?

2. Discuss a common breach of medication administration.

3. Identify three (3) factors that lead to errors in documentation related to medication administration.

4. What can I do to prevent medication errors?

Answer 1

Culture and environmental safety when preparing and administering medication:-

Under the Nurses (Registered) and Nurse Practitioners Regulation, nurses have the authority to compound, dispense and administer medications. This document provides nurses with the information they need to safely administer medications. It should be read in conjunction with Scope of Practice documents for registered nurses or nurse practitioners and the Dispensing Medications practice standard.

Employers are responsible for providing the organizational supports and systems necessary for safe medication administration by nurses, including medication reconciliation and supporting voluntary reporting of medication incidents and near misses.

Principles of medication administration safety:-

1. Nurses are responsible for administering medications within their scope of practice.

2.Nurses are knowledgeable about the effects, side effects and interactions of medications and take action as necessary.

3.Nurses adhere to "seven rights" of medication administration: right medication, right client, right dose, right time, right route, right reason and right documentation.

4.Nurses determine all orders for an individual are clear, complete, current, legible and appropriate for the client before administering any medication.

5.If there is no alternative, nurses can administer a medication using the pharmacy dispensing label as an order after confirming it is still appropriate.

6.Nurses act upon pre-printed orders when the authorized health professional has made those orders client-specific by reviewing them, adding the client's name, customizing them signing, and dating them.

7.Nurses act upon verbal and telephone orders only when circumstances require doing so and if there are no other reasonable options.

8.Nurses administer only medications they themselves or a pharmacist have prepared, except in an emergency.

9.Nurses educate clients about all the client's medications.

10.Nurses understand the human and system factors that increase medication errors and near misses and take steps to prevent them.

11.Nurses verify that medication orders, pharmacy labels and/or medication administration records are complete and include the name of the client, the name of the medication, the medication strength and the dosage, route and frequency with which the medication is to be administered.

12.When a medication error or near miss occurs at any point in the process of prescribing, compounding, dispensing or administering a medication, nurses take appropriate steps to resolve and report it in a timely manner.

(2.)Answer:- medication error are common breach of medication adminstration:-

"A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use."

TYPES OF MEDICATION ERRORS:-

Medication errors can occur anywhere along the route, from the clinician who prescribes the medication to the healthcare professional who administers the medication.

The different types of medication errors include (but are not necessarily limited to):

(a.)Prescribing errors , wherein the selection of a drug is incorrect based on the patient's allergies or other indications. Additionally, the wrong dose, form, quantity, route (oral vs intravenous), concentration, or rate of admission could be used.

(b.)Omission errors , in which there is a failure to give a medication dose before the next one is scheduled.

(c) Wrong time errors , wherein a medication is given outside the predetermined interval from its scheduled time.

(d) Improper dosing errors , wherein a greater or lesser amount of a medication is delivered than is required to manage the patient's condition.

(e.) Wrong dose errors , wherein the correct dosage was prescribed, but the wrong dose was administered.

(f.) Improper administration technique errors , such as administering a medication intravenously instead of orally.

(g.)Wrong drug preparation errors , wherein a medication is incorrectly formulated (i.e., too much or too little diluting solution added when a medication is reconstituted).

(h.) Fragmented care errors , wherein a lack of communication exists between the prescribing physician and other healthcare professionals.

CAUSES OF MEDICATION ERRORS:-

(i ) Distraction : A nurse who is distracted may read "diazepam" as "diltiazem." The outcome is not insignificant-if diazepam is accidentally administered, it could sedate the patient, or worse (e.g., if the patient has an allergy to the drug).

(ii) Environment : A nurse who is chronically overworked can make medication errors out of exhaustion. Additionally, lack of proper lighting, heat/cold, and other environmental factors can cause distractions that lead to errors.

(iii)Lack of knowledge/understanding : Nurses who lack complete knowledge about how a drug works, its various names (generic and brand), its side effects, its contraindications, etc. can make errors.

(iV) Incomplete patient information : Lacking information about which medications a patient is allergic to, other medications the patient is taking, previous diagnoses, or current lab results can all lead to errors. Nurses who aren't sure should always ask the physician or cross-check with another nurse.

(v)Memory lapses : A nurse may know that a patient is allergic, but forget. This is often caused by distractions. Forgetting to specify a maximum daily dose for an "as required" drug is another example of a memory-based error.

(Vi)Systemic problems : Medications that aren't properly labeled, medications with similar names placed in close proximity to one another, lack of bar code scanning system, and other issues can lead to medical errors.

(3.) Three factors that lead to errors in documentation related to medication adminstration:- Professional Standards require nurses to document timely and appropriate reports of assessments, decisions about client status, plans, interventions and client outcomes.

Documentation is any written or electronically generated information about a client that describes the care or service provided to that client. It is an essential part of nursing practice.

Documentation serves three purposes:

1) it facilitates communication;

2) it promotes safe and appropriate nursing care; and

3) it meets professional and legal standards.

(1.)Communication: Through documentation, nurses communicate to other health care providers their nursing assessment and diagnosis3 of a client's condition,4 the plan of care, interventions that are carried out by nurses, and the outcomes of the interventions.

(2.) Safe and appropriate nursing care: When nurses document the care they provide, other members of the health care team are able to review the documentation and plan their own contributions to safe and appropriate care. Documentation also provides data for research and workload management, both of which have the potential to improve health outcomes.

(3.) Professional and legal standards: Documentation is a comprehensive record of care provided to a client. It demonstrates how a nurse has applied nursing knowledge, skills and judgment according to BCCNP Standards of Practice. Documentation is generally accepted as evidence in legal proceedings. It establishes the facts and circumstances related to the care given and assists nurses to recall details about a specific situation.

COMMON DOCUMENTATION ERRORS:-

#1: Not dating, timing, and signing entries:-

Every single entry should have the date, time, and the name of the person who entered it. Unless you're working with an EHR/PMS that enters this information automatically, you must enter it every time. On paper charts, indicate the date and time, along with your first initial, full last name, and your title (RN, LPN, etc.). When your documentation continues from one page to the next, write your name on each page, along with the date and time, and indicate "continued from previous page" on all subsequent pages.

#2: Writing sloppily or illegibly:-

This requires little explanation. Sloppy writing can result in confusion and communication problems that, at best, can lead to inefficiencies and, at worst, could cost patients their lives. Sloppy writing can also interfere with a nurse's defense in a malpractice suit.

#3: Not documenting omitted medications or treatments:-

Medication and treatment omissions happen, especially when your facility is short staffed or when you're pressed for time because you're working a double shift. Regardless of the circumstances, you are still accountable for these oversights. Always document omitted medications or treatments along with the reason for the omission and your signature.

#4: Leaving blanks on forms:-

This leaves the reader wondering if care was delivered and not recorded, or not delivered at all, as in the legal case we looked at earlier. Nurses need to draw a line through blanks that are not applicable on documentation forms, and initial them.

#5: Adding late entries:-

Anyone who has ever tried to briefly memorize a phone number before dialing it knows that the information can slip away within seconds. Failing to record actions taken and other information immediately or very soon after the event can lead to lost detail-especially when it comes to numbers-and ultimately errors down the line that could negatively impact the patient. Clearly state the date and time of the late entry, indicate the actual time the care or observation occurred, and mark it as "late entry."

(4.) Answer:- PREVENTING MEDICATION ERRORS:-

Nurses may not have the authority to make infrastructural changes, but they do have the power to suggest needed changes and take precautions to prevent medication errors, including the following:

#1.) KNOW THE PATIENT:-

This includes the patient's name, age, date of birth, weight, vital signs, allergies, diagnosis, and current lab results. If patients have a barcode armband-use it. The added administration times of using arm band systems have led some nurses to create potentially dangerous "workarounds" to avoid scanning barcodes. Don't make this potentially dangerous mistake- use all of the information at your disposal to ensure patient safety, and avoid shortcuts.

#2.) KNOW THE DRUG:-

Nurses need access to accurate, current, readily available drug information, whether the information comes from computerized drug information systems, order sets, text references, or patient profiles. If you have any questions or concerns about a drug, don't ignore your instincts-ask. Remember that you are still culpable, even if the physician prescribed the wrong medication, the wrong dose, the wrong frequency, etc.

#3.) KEEP LINES OF COMMUNICATION OPEN:-

Breakdowns in communication among physicians, nurses, pharmacists, and others in the healthcare system can lead to medication errors. The "SBAR" method can help alleviate miscommunications. SBAR (Situation, Background, Assessment, Recommendation) works like this:

(a) Situation : "The situation is that Mr. Smith is complaining of chest pain."

(b) Background : "He had hip surgery yesterday. About two hours ago he began complaining of chest discomfort. His pulse is 115, and he is short of breath and agitated."

(c) Assessment : "My assessment is that Mr. Smith may be having a cardiac event."

(d) Recommendation : "My recommendation is that you see him immediately, and that we start him on O2 and administer an analgesic immediately. Do you agree?"

Communication is vitally important, as it is the root cause of many sentinel events.

#4.)DOUBLE CHECK HIGH ALERT MEDICINES:-

High-alert medicines such as heparin can have devastating consequences if not administered properly. A tragic case involving the death of three infant patients after receiving massive heparin overdoses happened as a result of misleading packaging. Since this incident, the drug manufacturer now uses larger font sizes, tear-off cautionary labels, and different colors to distinguish drug doses.6 Medications often look alike and sound alike-this can be a source of errors. Double check high alert medications with another nurse to prevent accidental overdoses and other medication errors.

#5.) DOCUMENT EACH DRUG ADMINISTERED:-

Accurate documentation is essential and should include accurate recording of the drug information, the name of the drug, the dose, route, time, patient response, and any refusal of the drug by the patient.

#6.) TAKE AN ACTIVE ROLE IN CORRECTING ISSUES YOU IDENTIFY:-

If you see that look-alike or sound-alike medications are stored next to each other, ask your supervisor to correct the problem, emphasizing the increased risk of medication errors. Request that medications be reconciled (i.e., that the names, dosages, and administration routes of all medications are compared to identify conflicts). Request that a bar coding system be implemented that allows for the verification of the six medication rights (right individual, right medication, right dose, right time, right route, right documentation).