Medication administration errors nursing 5th,le diab?te type 2 pdf gratuit,glee 8 album - Reviews


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With your full attention and presence of mind, you can reduce the likelihood of making mistakes. Never stop asking for the patient’s name for each medication you will give even if you do it several times in a shift.
For patients with problems stating their names, you can just look at their name band to check if you are dealing with the right patient. To ensure that you are dealing with the right drug, it will be best to use both the generic and brand name of the medication ordered. Whenever you are not sure with the drug you will administer, don’t hesitate to double check with your drug handbook. If you have time, develop the habit of looking up a drug’s information before giving it to the patient.
Sometimes, ordered medications are lost in communication among doctors, nurses and pharmacists. When receiving orders through phone, write down the instructions and repeat everything before hanging up. High alert medication are so potent that a slight variation in dosage given will directly affect the patient’s vital signs. High alert drugs include heparin, dopamine, dobutamine, nicardipine, digoxin and many more. To avoid unnecessary adverse drug reactions, always ask the patient about any known drug allergies before giving new medications. Sometimes, healthcare workers also forget to record the known drug allergies of the patient in their chart. Sometimes, nurses are more sensitive in overseeing drug incompatibilities in the patient’s treatment regimen.
It is not advisable to put drugs into another container but if you must do it, label the new container properly. If you must give the drug through a nasogastric tube, clarify with the doctor first as you should not crush an extended-release tablet. This is practical whenever you can’t read a poorly written medication order or if you think there has been a typographical error in the new order. For example, a nurse is having trouble reading the newly ordered medication for a 14 year old boy with seizures.
If one of your patients receives eardrops and eye drops simultaneously, you can create a simple marker so you don’t confuse using them interchangeably. To avoid medication errors, always keep the patient’s safety in mind while giving their medications.
Lack of Reported Medication Errors Spurs Medcare Hospital to Improve Data Focus, Patient Safetyby Janet JacobsenDespite an established incident reporting system, Medcare Hospital employees were simply not recording medication errors in 2013.In fact, only two medication errors were documented between January and September of that year.
ASQ is a global community of people passionate about quality, who use the tools, their ideas and expertise to make our world work better. Despite advanced technology such as computerized physician order entry (CPOE), barcode medication administration (BCMA) and smart infusion pumps, the risk of manual programming errors still exists on the infusion pump. A simple flaw in the administration of medication can put a patient’s life in danger. You can do this by simply asking the patient’s full name and date of birth to make sure the information given matches your medication card. Some hospitals even use a barcode scanning system where you can just scan the patient’s arm band with a small device to verify their names. There are lots of drugs with similar brand names like clonidine and klonopin, celebrex and cerebryx and many more.
Be careful as well with drug packaging as some medicines come in deceptively similar packaging or canisters. A drug handbook is a wealth of important information about different drugs like adverse reactions, drug incompatibilities, precautions and many more.
Over time, you will memorize important information for different drugs before administration. To avoid miscommunication, there are simple things you can do in carrying out doctor’s orders for new medications. For this reason, it is important to have someone double check your high alert medications before you administer them to your patient. There are some occasions where patients forget to state their drug allergies upon initial history taking.
For these reasons, it is essential to verify and ask your patients about their known drug allergies when starting a new medication.
If you have a smart phone, try to install a drug index app as it will be handy whenever you want to look up for a drug quickly.
If you think a newly ordered medication will do more harm to the patient than its intended therapeutic effect, clarify it with the doctor.


Relating the patient’s case in carrying out new medication orders is helpful in making clarifications. The written order reads like “prednisone” but considering the case of the patient, the nurse decided to clarify with the doctor if the patient really needs prednisone as part of his maintenance drugs at home. Considering the patient’s case in carrying out new medication orders saved him from unnecessary adverse drug reactions.
Applying a small colored sticker on one side of the container is helpful especially if you have lots of medications to administer in other patients. If you are just new in practicing the nursing profession, asking guidance from your senior nurses is also helpful in preventing medication errors.
She is working as a staff nurse in the pediatric ward of a private city hospital for more than two years.
With an additional scan of the pump, Alaris EMR Interoperability extends medication safety to the point of infusion administration by ensuring that the initial programming matches the physician’s order.
Analysts reviewed medication errors and adverse drug reactions (ADRs) involving intravenous (IV) fentaNYL that were reported to the Pennsylvania Patient Safety Authority. Fortunately, you only need one trait to reduce the risk of medication errors at work – attentiveness. It is also more convenient if you will peel the old label from the previous canister and stick it to the new canister.
Be careful in crushing or cutting them up as these drugs will produce quick potent effects when taken without the extended-release coating. This is an easy technique in simplifying safety measures in giving medications to your patients. Seasoned nurses know more techniques in reducing the risks of such mistakes so ask for their guidance and advice as you start working in your unit. Furthermore, infusion data flows back to the patient’s EMR to ensure that every member of the care team can access accurate and timely infusion administration information. Unless otherwise noted, BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company. Opened in 2006, Medcare employs 577 full-time staff, the hospital has an emergency department, 25 outpatient consultation rooms, an intensive care unit, a neonatal intensive care unit, delivery suites, an endoscopy room, and a day-surgery unit. This rapid onset of action explains why fentaNYL has been used with increasing frequency in postanesthesia care units (PACUs) and emergency departments (EDs).3,5 Within three to five minutes of administration, the drug reaches its peak effect, yet it has a relatively short duration of action of 30 to 60 minutes. If a hospital employee dispenses the wrong medication due to an illegibly written order, or if a nurse gives a medication to the wrong patient, the ramifications can be deadly. The short duration of action makes fentaNYL an ideal agent when the goal is to have a short recovery time, such as in outpatient procedures.
The program is based on data collection and statistical analysis to evaluate performance, measure outcomes, identify improvement opportunities, and determine priorities.
In this case, hospital leaders understood unreported errors could compromise patient safety and inhibit efforts to improve safety results.
Additional members from management were also chosen so they’d be informed of, and involved with, the effort, Surani said. More than 85% (n = 1,972) of reports involving IV fentaNYL were reported as medication errors, 10.4% (n = 241) were reported as ADRs, and the remaining events were submitted as other types of reportable events.
Given these sources, the project team concluded physicians, pharmacists, and nurses can all be involved in medication errors.The team then used brainstorming sessions to identify possible reasons for inconsistent error reporting. The causes were divided into four categories: policy, people, process, and plant (work environment). Of the events originating in the administration process, almost 68% (n = 138) mention breakdowns during the pump-programming process. The patient’s level of sensation and ability to move extremities were normal for the first two hours.
The descriptions of events that occurred during the administration node and did not involve the programming of an infusion pump (n = 78) did not provide enough detail to determine specifically what went wrong.
Most reports (56.4%, n =44) simply stated that the patient received a higher or wrong dose than what was intended.
During a trauma care, the physician gave a verbal order for fentaNYL 25 mcg IV push for one dose. She handed the syringe to the second nurse and instructed him to push 25 mcg without telling him how much was in the syringe. The second nurse pushed the entire syringe, which was 250 mcg, a [tenfold] overdose from what was prescribed. The error was immediately noticed by the first nurse when the second nurse returned with an empty syringe. Physician [was made] aware, and patient was closely monitored for any adverse effects.A six-month-old infant was admitted to the hospital for head trauma. In preparation for a head CAT [computerized axial tomography] scan to evaluate the status of his injury, the baby was to be given fentaNYL 5 mcg. The pharmacy saw this order in PACU and halted the order immediately.An order was received for a fentaNYL infusion for a patient who was already on a morphine infusion.


The ED physician was going to intubate the patient, and nursing brought the requested medications for the intubation, including midazolam, fentaNYL, and succinylcholine. Patient [was] not arousing in the recovery area as anticipated, and doctor [was] informed of this. The fentaNYL and the ketamine counts were incorrect.The patient was agitated and attempting to self-extubate. The nurse asked the respiratory therapist at the bedside to place the patient back on the vent.
The nurse looked at the syringe in which they pulled the dose and saw it to be pancuronium. Roughly 8.2% (n = 20) of wrong-drug events with IV fentaNYL involved retrieving the incorrect drug from the automated dispensing cabinet (ADC) or stocking the wrong drug in the drawers of those cabinets. Went to the ADC to get a HYDROmorphone PCA [patient-controlled analgesia] syringe, pulled the medication, went to patient’s room with syringe, and before loading it into the PCA pump, I checked the medication, and it was fentaNYL. I informed the charge nurse, who checked the ADC and found that the HYDROmorphone drawer had fentaNYL and that the fentaNYL drawer had HYDROmorphone.
Nearly 12% (n = 29) of wrong-drug events with IV fentaNYL involved epidural PCA therapy.Patient was connected to an epidural infusion in the OR by anesthesia.
In the PACU, the physician went to restart the infusion and it was determined that the medication in the bag was morphine sulfate for PCA use only and the medication was not restarted.
Analysts searched for “fentanyl” in the “suspected medication,” “additional suspected drug medication,” and event description fields to find ADR reports that may have involved IV fentaNYL alone or in combination with other medications.There were 318 ADR reports submitted to the Authority between June 2004 and March 2012 related to the use of IV fentaNYL. Analysts excluded reports that would not have resulted from dosing-related problems that were categorized as skin reactions (24.2%, n = 77) from the analysis, resulting in 241 reports. Roughly 22% (n = 52) of the reports did not give enough information to discern the types of reaction. Patient received initial medications consisting of midazolam 3 mg, fentaNYL 80 mcg, and diphenhydrAMINE 40 mg. The patient was still awake, so additional doses of midazolam 2 mg and fentaNYL 40 mcg were given. Within 10 minutes, the patient became somnolent and the oxygen saturation fell into the 70s. Narcan was given.Patient was admitted for a colonoscopy and was given sedation for the procedure.
Shortly after the colonoscopy began, the patient became dusky, respirations decreased, and she became unresponsive, with a pulse oximetry [reading] of 65%. The procedure was able to be completed, and the patient was monitored in the recovery area for two hours prior to discharge.A 71-year-old patient received a total of fentaNYL 120 mcg and midazolam 4 mg for ERCP procedure. The patient became less responsive, the respiratory rate was 8 and pulse oximetry [reading] was 72% despite repositioning of head and increased oxygen. Since nurses routinely obtain narcotics from floor stock, the typical pharmacist-nurse double check is not in place (as it is with specific patient doses dispensed from the pharmacy). Some ADCs can be programmed to require a witness when selected narcotics are removed or when the override feature is used to access selected narcotics. More than two-thirds of reported overdosage events mention breakdowns during the pump-programming process, and high-alert medications were involved in almost 7 out of 10 wrong-drug events with fentaNYL. ISMP 2007 survey on high-alert medications: differences between nursing and pharmacy perspectives still prevalent.
Select appropriate strategies to promote the safe prescribing, dispensing, and administering of IV fentaNYL. QuestionsThe following questions about this article may be useful for internal education and assessment.
You may use the following examples or come up with your own questions.A physician writes an order for 500 mcg of IV fentaNYL for a 39-year-old who complains of pain after a laparoscopic procedure. After receiving this dose, the patient was found unresponsive with low oxygen saturation and respiratory rate. 10 mg 20 mg 50 mg 75 mgWhich of the following statements best describes why IV fentaNYL has been considered to be an ideal analgesic agent in outpatient procedures, where the goal is to have a short recovery time? Which of the following is the type of medication error involving the use of IV fentaNYL most commonly reported to the Pennsylvania Patient Safety Authority?
Intensive care unit Postanesthesia care unit Emergency department Medical-surgical unit Which of the following is the adverse drug reaction related to IV fentaNYL most commonly reported to the Authority? Bradycardia Hypotension Central nervous system depression Respiratory depression A facility’s pain team evaluated a patient at 10 a.m. Based on this scenario, which of the following is the least effective strategy to mitigate the risk of harm with IV fentaNYL? Provide staff with safety information on the use of IV fentaNYL via newsletters and in-services.



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Comments

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    01.10.2014

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    01.10.2014