ATI Safe Medication Administration with complete solution graded A+

Nurse responsibilities: Ans- Preparing, administering medications, Evaluating client responses, Maintaining up-to-date knowledge base What nurses need to know about a medication. Ans- adverse effects What nurses need to know about a medication. Ans- toxic responses What nurses need to know about a medication. Ans- side effects What nurses need to know about a medication. Ans- safe dosage range What nurses need to know about a medication. Ans- purpose What nurses need to know about a medication. Ans- route of administration What nurses need to know about a medication. Ans- mechanism of action What nurses need to know about a medication. Ans- precautions and contraindications What nurses need to know about a medication. Ans- Maintaining skills What nurses need to know about a medication. Ans- Proper ways to prepare meds, proper administration skills, etc. Practice may change over time due to Ans- new information learned from nursing research The scope of RN practice how? Ans- varies from state to state since each state board regulates these It is your responsibility as an RN to determine what 2 things? Ans- medication accuracy and report any errors that occur with medications You are also responsible to make sure that all medications are ________________ properly when you leave them unattended Ans- stored and safeguarded Right client Ans- Need two identifiers acceptable identifier include: client's name, an assigned identification number, a telephone number, a birth date, or another person-specific identifier s/a a photo; some facilities also use barcodes to scan client identifiers into the system True/False: In long term care facilities, two identifiers are only required for the first dose of a new medication administered; after that, just one identifier s/a facial recognition is sufficient for administering a medication Ans- TRUE Check prescription! Does this med make sense for patient? The nurse knows that this is associated with which Right of Medication Administration? Ans- Right medication Verify medication w/ what is ordered in the _________________. Ans- medication administration record (MAR) Prescription s/b compared w/ the MAR three times: Ans- 1) before you take the medication from its drawer or shelf, 2) as you remove it from the container and 3) at the bedside right before you administer it It is also important to look at the _______________ on the package before administering the medication. Ans- expiration date If unfamiliar w/ the medication, what 2 things can a nurse do? Ans- check in a medication guide or talk with a pharmacist to learn more about it True/False; it's safe to always assume a prescription is correct; but if you are in doubt or it doesn't make sense, check w/ the prescriber Ans- FALSE; NEVER assume it is correct True/False: It is acceptable to administer a medication that another nurse prepared if there is an emergency that calls the primary nurse away. Ans- FALSE: NEVER acceptable to administer a medication that another nurse has prepared. Many meds can be administered via more than one route; therefore the nurse knows that this is part of which Right of Administration? Ans- Right route Be sure to compare the label w/ the prescription and verify the route; then compare it w/ the label on ______________. Ans- the medication container If prescription doesn't include a route that is appropriate for the pt or if it doesn't specific a route at all, what should the nurse do? Ans- clarify w/ the provider Be especially careful w/what kinds of meds? Ans- liquid What route involves enteral? Ans- oral or via enteral tubes What route involves parenteral? Ans- injection or infusion Follow facility guideline for medication administration timing refers to which Right of Administration? Ans- Right time If interruption occurs and are unable to administer med right at specified time, how soon should you aim to administer the dose? Ans- try to administer dose w/in 30 minutes of scheduled time STAT Ans- right away PC Ans- w/in 30 minutes after a meal PRN Ans- use your nursing judgment The nurse compares the dose he prepares with the dose that prescriber provided. He is practicing which Right of Administration? Ans- Right dose Verify that dose is __________________. Ans- appropriate for the client What kinds of client specifics may influence the correct dose for that client, and may even cause the nurse to question the dose with the provider? Ans- The client has a renal or hepatic disorder, or the dose is outside of the appropriate range for that medication When performing conversions and calculations as needed to prepare meds, what can you do if you are not sure or if you have any doubts? Ans- have a second nurse verify your calculations The nurse knows that documentation timing for medication should occur immediately after administration and never before and never later on. She is acknowledging which Right of Administration? Ans- Right documentation If medications are not documented promptly after administration, what can happen to adversely affect the patient? Ans- another nurse may assume the medication has not been given and administer another dose to the patient What are some reasons that a medication may not be given at the right time? What is important to do in these instances? Ans- pt at radiology; will administer med upon return. Also important to follow facility protocol for documentation whenever a medication is not given at the scheduled time be sure to note the reason for the time difference Types of Prescriptions Ans- In effect until provider changes or discontinues it; or until pt is discharged Ans- Routine True/False: Some routine orders do have a set end date Ans- TRUE The provider must re-prescribe certain types of meds w/in a specific time frame, s/a which? Ans- opioids and antibiotics Med is administered only one time either at time provider indicates or ASAP Ans- Single (one time) prescription Examples: med is ordered prior to surgery or prior to diagnostic procedure Ans- Single (one time) prescription Ensure that exact time of medication administration is documented in the MAR for which type of prescription? Ans- STAT prescription (true for all, but especially for STAT) Administered ASAP; usually in emergency situations Ans- STAT prescription Med, dose, route, frequency and circumstances indicating its implementation are all included in this order (i.e. give if pain or temperature is above a certain set point) Ans- PRN prescription How does the nurse determine when to give a PRN prescription? Ans- Use clinical judgment and client's subjective report to determine if it is appropriate for administration Follow facility guidelines to document ________________________ the PRN medication, as well as the time it was administered and other required data Ans- the reason for administering Protocol-based and contain a list of directives to implement in specific situations Ans- Standing Prescriptions True/False: Standing prescriptions can include regular, single and PRN prescriptions, as well as other actions besides medication administration s/a diet, ambulation parameters, and treatments Ans- TRUE True/False: Standing prescriptions always a fixed end date and require renewal; they never are in place until the provider changes them or discharges the client Ans- FALSE! They can have a fixed end date requiring renewal but are also sometimes in place until the provider changes them. Patient s/b ____________________ to determine whether or not standing prescriptions are appropriate Ans- assessed frequently Similar to single order or stat prescription but not as urgent Ans- Now prescriptions (should NOT be considered STAT; you have time to give them) Expectation is to administer medication w/in ________minutes of order Ans- 90 components of a medication prescription Ans- Date and time prescription was written Client's full name components of a medication prescription Ans- Name of medication (typically generic) components of a medication prescription Ans- dose includes amount, frequency or set times of administration, sometimes strength or potency components of a medication prescription Ans- Provider also indicates the route of administration and the times or frequency of dosing, s/a 3x per day, Q6 hours, or at bedtime components of a medication prescription Ans- Provider also signs the prescription Prescriptions filled at a pharmacy by the patient include what additional items? Ans- dispensing instructions related to quantity, directions for the patient, refilling parameters, and any special cautions s/a "do not take w/ food" "need to refrigerate after opening" Common Medication Errors Ans- What is a medication error? Ans- a variation of what the provider intended for the client and may cause the client serious harm What can be done to protect patients from med errors? Ans- follow the Rights of medication administration common med errors: Ans- Wrong medication or wrong strength common med errors: Ans- Infusing wrong IV fluid or diluting the medication w/ the wrong solution common med errors: Ans- Calculating dose or infusion rate incorrectly common med errors: Ans- Giving med to wrong client common med errors: Ans- Giving med at wrong time or wrong route common med errors: Ans- Giving med that pt has noted allergy to common med errors: Ans- Inappropriately omitting a dose common med errors: Ans- Giving a medication that is past its expiration date common med errors: Ans- Erroneously discontinuing a medication or an IV fluid infusion common med errors: Ans- Nursing Process and Med Administration: Ans- nursing process is another important safeguard in medication administration During assessment/data collection phase of nursing process, gather all info from the client pertaining to medication administration Ans- 1. Assessment/Data Collection This includes current status and hx Ans- 1. Assessment/Data Collection Prior to administering certain meds, the patient's heart rate or BP may need to be checked Ans- 1. Assessment/Data Collection Medication should not be given if pt vital sign are outside appropriate range Ans- 1. Assessment/Data Collection Patient's allergy record and med record should be consulted for possible interactions or contraindication Ans- 1. Assessment/Data Collection Medication prescription should contain all of the necessary elements as discussed above Ans- 1. Assessment/Data Collection Check w/ provider if you have any concerns about the prescription s/a if it is missing elements or if it does not seem appropriate for the particular client Ans- 1. Assessment/Data Collection -distractions and rushing s/b avoided when preparing medications Ans- 2. Planning -calculations s/b performed carefully and you should verify that you are using the strength of medication that the provider prescribed Ans- 2. Planning -calculations for high-alert medications s/b verified w/ another nurse when necessary Ans- 2. Planning -prioritize medication administration depending on client needs (e.g. if client reports severe pain, administering their medication s/b your top priority) Ans- 2. Planning -carefully use the Right of medication administration Ans- 3. Implementation -explain to client what you are doing and provide instructions/information about the medication being administered according the client's needs Ans- 3. Implementation -never administer medication that another nurse has prepared Ans- 3. Implementation -follow facility policy for routes of administration and adhere to laws/regulations for controlled substances Ans- 3. Implementation -if client has any questions about the medication, wait to administer until their question can be appropriately addressed Ans- 3. Implementation Verify w/ prescriber and then revisit client's concerns Ans- 3. Implementation -evaluate client response to medication, document and report Ans- 4. Evaluation Is intended therapeutic effect being accomplished? Ans- 4. Evaluation Any side or adverse effects? Ans- 4. Evaluation Were there any errors in medication administration? Ans- 4. Evaluation if yes, assess and collect data from client and perform any necessary reporting and corrective measures Ans- 4. Evaluation In the case of a medication error, focus on what first? Ans- client is priority when you discover a medication error What should be done first when an error is discovered? Ans- assess/collect data to identify any adverse reactions and provide any relevant interventions What should be done not first, but soon after a medication error is discovered? Ans- notify clients provider and your manager How should documentation of error occur? Ans- follow facility protocol for documenting med error and any actions according to protocol to ensure client safety What should be included in the error documentation? Ans- reflect what led to error to determine if error could have been prevented and share any relevant insight w/ manager to prevent recurrence of same error When filing an incident report, (depending on facility policy), you will usually will have___________how long?_____ after an error has occurred/been discovered to complete the incident report Ans- 24 hours incident report will usually include: Ans- required demographic info objective, factual account of what transpired details about medication what you did about the error True/ False, if possible, try to cast blame and draw any conclusions you can about the root cause of the error. Ans- False; this is only a report so keep it factual.