NSG 105 Medication Order & Medication Safety

Medication Orders and Safety in Nursing

Introduction to Medication Administration

• The speaker greets students and expresses hope for their well-being during online classes.

• The discussion focuses on medication orders and safety, crucial topics in nursing practice.

Nursing Interventions in Drug Therapy

• Key nursing interventions include drug administration before, during, and after giving medications.

• Providing comfort to patients experiencing side effects or pain is essential; this may involve administering pain relief medications.

• Patient education is vital; nurses must inform patients about medication effects, potential side effects, and proper administration methods (e.g., with or without food).

Understanding Medication Orders

• A medication order consists of written directions from a licensed healthcare provider for specific medications.

• In the U.S., various licensed practitioners can prescribe drugs; however, in the Philippines, only doctors are authorized to do so. Nurses should clarify ambiguous orders professionally.

Importance of Questioning Medication Orders

• Nurses must question any unusual orders, such as abnormally high dosages that could harm patients.

• Knowledge of pharmacology helps nurses assess whether prescribed medications align with patient conditions (e.g., blood pressure considerations).

Types of Medication Orders

• Different types of medication orders include:

• Stat Order: Immediate administration required (e.g., emergency situations).

• Single Order: One-time dose for specific situations like pre-surgery antibiotics (e.g., 1g IV before surgery).

• Standing Order: Ongoing medication regimen until specified duration ends (e.g., antibiotics taken three times daily for seven days).

PRN and Other Orders

• PRN Orders: Medications given as needed based on patient condition (e.g., paracetamol every six hours for fever).

Medication Orders and Safety in Nursing

Understanding Telephone Orders

• A telephone order from a doctor must be written down and read back to ensure accurate understanding. This is crucial for patient safety.

• The policy of the hospital may require two licensed nurses to confirm orders, with one being the charge nurse and the other at the bedside.

Essential Components of Drug Orders

• Key elements of a drug order include:

• Full name of the patient

• Date and time of the order

• Name of the drug, dosage, frequency, route, and doctor's signature.

• In some hospitals abroad, stickers are used for patient information instead of handwritten notes; however, in the Philippines, handwritten details are still common.

Military Time Usage

• Drug orders should specify military time (e.g., 10:30 or 11:30), avoiding AM/PM to reduce confusion.

• An example includes medication dosages like "10 mg PO daily," indicating oral administration.

Protocol-Based Medication Administration

• Some medications like Sepasulin are administered on-call during surgery; specific instructions are provided only when needed.

• Heparin orders may not specify dosage or route if they follow pharmacy protocols; this requires careful adherence by nursing staff.

Prescription Details in the Philippines

• Prescriptions must include comprehensive patient information along with medication details such as strength and quantity (e.g., "30 tablets").

• Unlike some countries that allow refills, prescriptions in the Philippines typically do not permit refills; patients receive full quantities each time.

Important Considerations for Medication Safety

• Nurses must understand medication purposes, effects, side effects, interactions, and special storage instructions before administration.

• It is critical never to administer medication without complete knowledge about it to ensure patient safety.

The Role of Nurses in Medication Administration

• Nurses serve as final checks in the drug regimen process—prescribing, dispensing, and administering medications while educating patients prior to discharge.

Medication Errors in Healthcare

Understanding Medication Errors

• Medication errors are the most frequent malpractice claims against hospitals and nurses, highlighting a critical area of concern in healthcare.

• A medication error is defined as any preventable event that may lead to inappropriate medication use or patient harm while under the control of healthcare professionals, patients, or consumers. This includes various aspects such as prescribing, labeling, and administration.

Factors Contributing to Medication Errors

• Knowledge about medications is crucial; errors can occur not only during administration but also during patient education regarding medication usage.

• Incorrect transcription of medication orders (e.g., from verbal instructions to written formats) can lead to significant errors in treatment.

• Other factors include mix-ups between patients' medications, calculation mistakes, incorrect labeling, and expired medications.

Prevention Strategies for Medication Errors

• To mitigate risks, it is essential to standardize abbreviations and symbols used in medical settings as mandated by the Joint Commission.

• Awareness of high-alert medications—those that pose a heightened risk of causing significant patient harm if misused—is vital for healthcare providers.

High Alert Medications

• High alert medications require extra caution due to their potential consequences on patient safety when administered incorrectly.

• Examples include anti-infectives (antibiotics), insulin, narcotics, sedatives, chemotherapeutic agents, and anticoagulants. These drugs often have specific protocols for administration.

Best Practices for Handling Medications

• In some medical centers like NMMC in CDO's ICU, high alert medications are clearly labeled with stickers to ensure visibility and awareness among staff.

• Witnessing the administration process for high alert medications is recommended; this includes double-checking with another professional before giving the drug to a patient.

Look-Alike and Sound-Alike Medications

Understanding Look-Alike and Sound-Alike Medications

Identifying Similar Drug Names

• The discussion begins with the concept of "makapareha," referring to look-alike and sound-alike medications, highlighting how similar-sounding drug names can lead to confusion.

• An example is provided using "Celebrex" and "Selexa," demonstrating how slight variations in spelling can create potential for medication errors.

• Other examples include "hydroxyzine" vs. "hydrozine" and "Zantac" vs. "Zyrtec," emphasizing the importance of recognizing these similarities to avoid mistakes.

Visual Aids for Differentiation

• The use of mixed case letters, referred to as “call man lettering,” is suggested as a method to draw attention to differences between similar drug names.

• Emphasis on careful observation when administering medications like adenosine versus dopamine, stressing that lack of focus can lead to significant errors.

Medication Safety Practices

Risks of Medication Errors

• Lack of focus increases the risk of medication errors; healthcare professionals must remain vigilant while handling drugs.

• Discussion on dosage forms highlights that some medications should not be crushed due to their therapeutic coatings designed for specific release mechanisms.

Understanding Therapeutic Coatings

• Therapeutic coated tablets are designed for dissolution in alkaline environments, protecting against gastric irritation or degradation in acidic conditions.

Importance of Medication Reconciliation

Definition and Purpose

• Medication reconciliation is defined as ensuring patients receive appropriate medications during transitions within healthcare facilities, crucial for patient safety.

Process Overview

• The process involves creating an accurate list of all medications a patient is taking and comparing it against physician orders at various transition points (admission, transfer, discharge).

Implementing Effective Medication Management

Assessing Patient Needs

• Healthcare providers must assess patients' current medication regimens during admissions or discharges to prevent drug interactions and adverse reactions.

Documentation Practices

• Example forms used during medication reconciliation are discussed, including details such as dosage routes and frequency which need careful documentation by nurses.

Avoiding Abbreviations in Medical Communication

Risks Associated with Abbreviations