Safe Medication Administration – Patient/Family Education
CNO uses a Medication practice tool for standardized decision making. There are 3 sections:
authority, safety, competence.
Authority Safety
There are various things you need Have I considered the risk, contraindications and adverse
to ask yourself… reactions?
Does this medication practice What evidence informs my practice?
require an order? What are the strategies to minimize the risk of harm?
Is a controlled act involved? Are there supports to minimize harm if an adverse event
Does other legislation impact occurs?
performing this in my workplace Do I need to collaborate or consult with others? For example,
setting? the health care team or the client.
Is the order clear, complete and Have I provided the client with education?
appropriate? See CNO Standard Is the client informed?
for Medication decision tree to Has the client or substitute decision-maker been involved in the
decide care planning?
Are there any workplace policies Are there system approaches that support safe medication
about the medication practice that practices available? For example, safe storage, reporting errors
I need to consider? and strategies to reduce drug diversion.
Competence
Am I the appropriate care provider? Do I have the knowledge, skill and judgment?
If you're not sure, consider what resources you need to answer this question. For example, look up
drug references or best practices and guidelines.
What evidence informs my practice?
What organizational policies might influence my practice?
Is the medication practice appropriate for my client?
Is the medication practice appropriate for my workplace setting?
Do I have the appropriate environmental supports, such as organizational guidelines, equipment and
protocols, to administer and manage outcomes safely?
Do I need to develop a Learning Plan related to this medication practice?
Guidelines for Timely Medication Administration
Time Critical Scheduled medications Non-Critical Scheduled Medications
- Administer at exact time when - Daily, weekly, monthly medications:
necessary (ex. Paid acting insulin) administer within 2 hours before or after
- Otherwise, 30 min before or after scheduled time
scheduled time - Medications prescribed more frequently
than daily but no greater than q4h:
Administer within 1 hour before or after
scheduled time.
Medication Errors
“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 provider, patient, or consumer”
- About 9000-24 000 patients die each year due to errors or adverse events; 68% are
preventable
- The culture generally recognizes that the system is at fault when an error occurs. When this
, happens, professionals much have remedial education and must be held accountable
- In general, medication errors are preventable and are a common causse of adverse
healthcare outcomes (usually are CNS, anticoagulants and chemotherapeutic drugs)
Types of Medication Errors
- Near miss error; events that could’ve occurred to lead to an error
- No harm error; medication error that causes no harm
- Harm error; medication that causes harm
- Critical incident; mediation error that results in serious harm
Most Common Medical Errors: SALAD
- Misdiagnosis Sound-alike
- Patient misidentification Look alike drugs
- Lack of patient monitoring LASA
- Wrong site surgery Look alike
- Medication errors Sound alike
Adverse Drug Event Issues that Contribute to Errors
- Medication errors This can occur during any step of the medication
- Adverse drug reactions (ADRs) can be process
allergic reactions or idiosyncratic - Procuring
reactions - Prescribing
- Transcribing
- Dispensing
- Administering
- Monitoring
Preventing Medication Errors
- Multiple systems of checks and balances should be implemented to prevent medication
errors.
- Prescribers must write legible orders that contain correct information, or orders should be
entered electronically.
- Authoritative resources such as pharmacists or current (within the past 3 to 5 years) drug
references or literature must be consulted.
Nurses need to always check the medication Assessment
order 3 times before giving the drug Two patient identifiers
Faculty members should not be the student’s Do not administer if you did not
research source regarding medication draw up or prepare yourself.
The right of medication administration should be Minimize verbal or telephone
used consistently orders.
Avoid abbreviations. o Repeat order to
Never assume anything about items not specified prescriber.
in a drug order (e.g., route). o Spell drug name aloud.
Do not hesitate to question a medication order o Speak slowly and clearly.
for any reason when in doubt. List indication next to each order.
Do not try to decipher illegibly written orders;
contact the prescriber for clarification.
Never use a “trailing zero” with medication orders.
Do not use 1.0 mg; use 1 mg.
1.0 mg could be misread as 10 mg, resulting in a 10-fold dose increase.
CNO uses a Medication practice tool for standardized decision making. There are 3 sections:
authority, safety, competence.
Authority Safety
There are various things you need Have I considered the risk, contraindications and adverse
to ask yourself… reactions?
Does this medication practice What evidence informs my practice?
require an order? What are the strategies to minimize the risk of harm?
Is a controlled act involved? Are there supports to minimize harm if an adverse event
Does other legislation impact occurs?
performing this in my workplace Do I need to collaborate or consult with others? For example,
setting? the health care team or the client.
Is the order clear, complete and Have I provided the client with education?
appropriate? See CNO Standard Is the client informed?
for Medication decision tree to Has the client or substitute decision-maker been involved in the
decide care planning?
Are there any workplace policies Are there system approaches that support safe medication
about the medication practice that practices available? For example, safe storage, reporting errors
I need to consider? and strategies to reduce drug diversion.
Competence
Am I the appropriate care provider? Do I have the knowledge, skill and judgment?
If you're not sure, consider what resources you need to answer this question. For example, look up
drug references or best practices and guidelines.
What evidence informs my practice?
What organizational policies might influence my practice?
Is the medication practice appropriate for my client?
Is the medication practice appropriate for my workplace setting?
Do I have the appropriate environmental supports, such as organizational guidelines, equipment and
protocols, to administer and manage outcomes safely?
Do I need to develop a Learning Plan related to this medication practice?
Guidelines for Timely Medication Administration
Time Critical Scheduled medications Non-Critical Scheduled Medications
- Administer at exact time when - Daily, weekly, monthly medications:
necessary (ex. Paid acting insulin) administer within 2 hours before or after
- Otherwise, 30 min before or after scheduled time
scheduled time - Medications prescribed more frequently
than daily but no greater than q4h:
Administer within 1 hour before or after
scheduled time.
Medication Errors
“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 provider, patient, or consumer”
- About 9000-24 000 patients die each year due to errors or adverse events; 68% are
preventable
- The culture generally recognizes that the system is at fault when an error occurs. When this
, happens, professionals much have remedial education and must be held accountable
- In general, medication errors are preventable and are a common causse of adverse
healthcare outcomes (usually are CNS, anticoagulants and chemotherapeutic drugs)
Types of Medication Errors
- Near miss error; events that could’ve occurred to lead to an error
- No harm error; medication error that causes no harm
- Harm error; medication that causes harm
- Critical incident; mediation error that results in serious harm
Most Common Medical Errors: SALAD
- Misdiagnosis Sound-alike
- Patient misidentification Look alike drugs
- Lack of patient monitoring LASA
- Wrong site surgery Look alike
- Medication errors Sound alike
Adverse Drug Event Issues that Contribute to Errors
- Medication errors This can occur during any step of the medication
- Adverse drug reactions (ADRs) can be process
allergic reactions or idiosyncratic - Procuring
reactions - Prescribing
- Transcribing
- Dispensing
- Administering
- Monitoring
Preventing Medication Errors
- Multiple systems of checks and balances should be implemented to prevent medication
errors.
- Prescribers must write legible orders that contain correct information, or orders should be
entered electronically.
- Authoritative resources such as pharmacists or current (within the past 3 to 5 years) drug
references or literature must be consulted.
Nurses need to always check the medication Assessment
order 3 times before giving the drug Two patient identifiers
Faculty members should not be the student’s Do not administer if you did not
research source regarding medication draw up or prepare yourself.
The right of medication administration should be Minimize verbal or telephone
used consistently orders.
Avoid abbreviations. o Repeat order to
Never assume anything about items not specified prescriber.
in a drug order (e.g., route). o Spell drug name aloud.
Do not hesitate to question a medication order o Speak slowly and clearly.
for any reason when in doubt. List indication next to each order.
Do not try to decipher illegibly written orders;
contact the prescriber for clarification.
Never use a “trailing zero” with medication orders.
Do not use 1.0 mg; use 1 mg.
1.0 mg could be misread as 10 mg, resulting in a 10-fold dose increase.
