Patient rights for medication safety
- 1. right client (use 2 identifiers)
2. right medication (name and form)
3. right dose
4. right route
5. right time
6. right documentation
-additional rights:
1. right to refuse
2. right assessment
-is medication appropriate for the patient's condition
3. right education
-what medication, expected benefits, side effects
4. right response/evaluation
-observe response to med and follow up
Prevention of medication errors
-perform medication checks in addition to 6 rights: check med against MAR, check drug upon
preparation, check drug prior to admin
-medication reconciliation
-determine accuracy of prescriptions (push back on provider if necessary)
-report errors
-properly handle and store
-delegate properly
-limit distractions
-check with pharmacy or provider if incomplete/illegible
-check math
-6 rights + 3 checks
-assess for high risk variables (age, allergies, disease, lab data)
Routes of medication administration
- 1. oral/enteral
-assess patient ability to swallow (switch to oral suspension if needed)
-do not crush or split extended/sustained release meds
-multidose bottles should be labeled with expiration date (facility dependent)
,-shake liquids gently
-avoid chewing/swallowing buccal or sublingual (make sure to tell client)
-enteral tube feeds: flush, don't mix with infusion feeds ( if meds interact with feeds, stop
feeds for 30 minutes)
2. topical/trasndermal
-remove old patches before applying new!
-rotate sites
-clean, dry skin with minimal hair
-ointments: only prescribed dose (use dosing cards)
-upper tors, arms, chest
-eyedrops instilled in lower eyelid using aseptic technique
-ear positioning
-inhalers: clean, shake, use spacer if necessary, and always rinse mouth after
3. parenteral
-proper needle size and angle
-clean skin
-know when to aspirate with IM injections
-sites and appropriate volume that can go there
-needlestick prevention
-no recapping
-safety devices and know how to use
-sharps container shouldn't be filled past 3/4 full
-rotate sites
Error reporting with medications
-facility dependent for steps and how to report error
-you must always report errors
-document
Safe med administration techniques
-go through 6 rights and 3 checks
-follow scope of practice
-delegate appropriately
-assess prior to administration
-dont take orders over the phone unless absolutely necessary
-report errors
-check black box warning
-prepare, administer, and evaluate client response
, -determine accuracy of prescriptions
-proper storage and handling
-have another nurse watch meds if you have to step away
-have another nurse "witness" for opioids/etc
-medication reconciliation
-know allergies of client
-orders should have:
name
date/time of order
drug name (generic)
dosage
route
frequency
indication of usage
provider's signature
-second nurse to check med math
-use resources for unfamiliar meds
-label
-administer meds to one patient at a time
-avoid administering meds you didn't prepare
-prioritize scheduled meds
Individual client considerations for safe administration
-age
-body weight
-genetics
-gender
-tolerance
-accumulation/metabolism
-psychological factors (placebo)
-medical conditions (changes to absorption/excretion/metabolism)
Physical techniques and tools for physical assessment
-inspect and palpate
-maintain privacy and prepare environment: uncover one body part at a time and maintain
dignity
-clinical photography may be used to compare findings
-good lighting
-measuring tool
-gloves for contact with body fluids and open wounds
- 1. right client (use 2 identifiers)
2. right medication (name and form)
3. right dose
4. right route
5. right time
6. right documentation
-additional rights:
1. right to refuse
2. right assessment
-is medication appropriate for the patient's condition
3. right education
-what medication, expected benefits, side effects
4. right response/evaluation
-observe response to med and follow up
Prevention of medication errors
-perform medication checks in addition to 6 rights: check med against MAR, check drug upon
preparation, check drug prior to admin
-medication reconciliation
-determine accuracy of prescriptions (push back on provider if necessary)
-report errors
-properly handle and store
-delegate properly
-limit distractions
-check with pharmacy or provider if incomplete/illegible
-check math
-6 rights + 3 checks
-assess for high risk variables (age, allergies, disease, lab data)
Routes of medication administration
- 1. oral/enteral
-assess patient ability to swallow (switch to oral suspension if needed)
-do not crush or split extended/sustained release meds
-multidose bottles should be labeled with expiration date (facility dependent)
,-shake liquids gently
-avoid chewing/swallowing buccal or sublingual (make sure to tell client)
-enteral tube feeds: flush, don't mix with infusion feeds ( if meds interact with feeds, stop
feeds for 30 minutes)
2. topical/trasndermal
-remove old patches before applying new!
-rotate sites
-clean, dry skin with minimal hair
-ointments: only prescribed dose (use dosing cards)
-upper tors, arms, chest
-eyedrops instilled in lower eyelid using aseptic technique
-ear positioning
-inhalers: clean, shake, use spacer if necessary, and always rinse mouth after
3. parenteral
-proper needle size and angle
-clean skin
-know when to aspirate with IM injections
-sites and appropriate volume that can go there
-needlestick prevention
-no recapping
-safety devices and know how to use
-sharps container shouldn't be filled past 3/4 full
-rotate sites
Error reporting with medications
-facility dependent for steps and how to report error
-you must always report errors
-document
Safe med administration techniques
-go through 6 rights and 3 checks
-follow scope of practice
-delegate appropriately
-assess prior to administration
-dont take orders over the phone unless absolutely necessary
-report errors
-check black box warning
-prepare, administer, and evaluate client response
, -determine accuracy of prescriptions
-proper storage and handling
-have another nurse watch meds if you have to step away
-have another nurse "witness" for opioids/etc
-medication reconciliation
-know allergies of client
-orders should have:
name
date/time of order
drug name (generic)
dosage
route
frequency
indication of usage
provider's signature
-second nurse to check med math
-use resources for unfamiliar meds
-label
-administer meds to one patient at a time
-avoid administering meds you didn't prepare
-prioritize scheduled meds
Individual client considerations for safe administration
-age
-body weight
-genetics
-gender
-tolerance
-accumulation/metabolism
-psychological factors (placebo)
-medical conditions (changes to absorption/excretion/metabolism)
Physical techniques and tools for physical assessment
-inspect and palpate
-maintain privacy and prepare environment: uncover one body part at a time and maintain
dignity
-clinical photography may be used to compare findings
-good lighting
-measuring tool
-gloves for contact with body fluids and open wounds
