Reduction in medication errors in hospitals,natural methods to cure diabetes mellitus,acupuncture treatment for diabetes type 1 vs,type 2 diabetes and numbness in feet sciatica - Good Point

ABSTRACTNeuromuscular blocking agents (NMBAs) are commonly used to paralyze skeletal muscles during surgery conducted under general anesthesia and for patients requiring intubation for airway management.
The Green Bag scheme aims to improve patient safety by giving healthcare staff accurate information on patients’ medicines, in particular ensuring that medicines prescribed on admission correspond to those that the patient was taking before admission. The Green Medicines bags keep all the patients medicines together in a readily identifiable container.
Helping avoid delays in administration and discharge as the patient’s own medicines stay with the patient throughout.
Provides a bag for keeping medicines related information in, for example a repeat prescription. Reduction in the resupply of medicines (as patients’ will already have their own) so helping to eliminate waste and save money. Neither the service provider nor the domain owner maintain any relationship with the advertisers. These medications are used in emergency departments, intensive care units, interventional radiology areas, and even medical and surgical units. The idea of having one type of green bag used across the whole of South Central will enable cheaper prices to be negotiated.
In case of trademark issues please contact the domain owner directly (contact information can be found in whois). NMBAs render patients unable to move or breathe and are considered high-alert drugs because misuse can lead to catastrophic injuries or death, especially when administered to patients who are not properly ventilated. Patients’ medicines will move through the care system in the Green bag with the patient.
Between June 2004 and March 2009, Pennsylvania healthcare facilities submitted 154 event reports that mentioned medication errors involving the use of NMBAs. Further analysis showed that 47.4% of the intended medications were not NMBAs, including cases in which the patient was harmed.
Strategies to address these problems include limiting access to NMBAs, segregating NMBAs from other medications, sequestering and affixing warning labels to vials of NMBAs stocked in the pharmacy, and requiring independent double checks before dispensing and administering NMBAs.
Neuromuscular blocking agents (NMBAs) are commonly used to relax skeletal muscles during surgery conducted under general anesthesia. These agents are also used in emergency departments (EDs), intensive care units (ICUs), interventional radiology areas, and even medical and surgical units for patients requiring intubation for airway management.1NMBAs produce their effect at the neuromuscular junction by interacting with acetylcholine either by depolarizing the motor end plate or by competing with acetylcholine for binding sites on the motor end plate. It is crucial for healthcare practitioners to remember that NMBAs do not affect a patient’s level of consciousness, pain, or anxiety. These medications simply render the patient unable to move or breathe.2 NMBAs are considered high-alert drugs because misuse can lead to catastrophic injuries or death, especially when they are erroneously given to patients who are not properly ventilated. Reports Involving Neuromuscular Blocking Agents Grouped by   Harm Score (N = 154)  Analysis of the reported ages of the patient involved in medication errors with NMBAs reveals that more than 17% (n = 27) of the reports involved pediatric patients (see Table 2). Patient Age Groups Associated with Reports Involving   Neuromuscular Blocking Agents (N = 154)   Table 3. Predominant Medication Error Event Types Associated with   Neuromuscular Blocking Agents (n = 120)Wrong-Drug Errors Involving NMBAsAnalysis of Authority reports focused on the predominant event type for this class of medication, as well as potentially the most devastating: wrong-drug errors. If an NMBA is given in error to a patient who is not intubated, the respiratory muscles may be paralyzed, potentially leading to serious harm or death.
There were six cases in which the NMBA vecuronium was administered instead of the intended antibiotic cefazolin; all of these cases resulted in harm to the patient. Intended (Prescribed) Medications Involved in Wrong-Drug  Medication Error Reports (n = 57)    Wrong-drug medication errors reported to the Authority include the following:A patient was admitted for a planned surgery. While in holding area of the OR prior to surgery, anesthesia staff started an IV [intravenous] infusion and administered what they thought was midazolam [Versed®] 1.6 mg IV. The patient was taken to the OR to be ventilated and monitored until patient awoke (approximately five minutes).

The ED physician was planning to intubate the patient, and the nurse brought in the requested medications for the intubation [midazolam, fentanyl, and succinylcholine]. The nurse picked up the syringe and administered 1 mL when she realized it was succinylcholine.
Intubation occurred earlier than planned.In the literature, other cases appear in which NMBAs have been inadvertently administered to patients who were not receiving proper ventilatory assistance.
While some of those errors have occurred in the OR, most have taken place in EDs, interventional radiology departments, ICUs, and other medical, surgical, and psychiatric units.4 Contributing Factors to Wrong-Drug ErrorsMany wrong-drug errors can be attributed to one or more common contributing factors.
An example of a storage-related event reported to the Authority is as follows:A patient had a cesarean section and a healthy baby was delivered.
The CRNA [certified nurse anesthetist] obtained [and administered] the medication from the anesthesia kit that he thought was Ancef, but the patient developed respiratory insufficiency and the CRNA noted that he had administered vecuronium not Ancef.
The patient was resuscitated, given neostigmine to reverse the respiratory paralysis, intubated, and administered oxygen. It was later determined that the physician had administered the syringe containing rocuronium instead of the intended midazolam. One example involving similar manufacturer labeling, as well as storage issues, submitted to the Authority is as follows:A patient was scheduled for an open reduction internal fixation for a fracture of the left hand.
The anesthesiologist came into the room at the time that the patient complained of being short of breath. The surgery procedure was completed, and the patient was extubated and taken to the postanesthesia care unit with no sequelae. After the surgery was completed, a review of the trash and needle box led the anesthesiologist and the CRNA to believe that vecuronium (which was located next to Ancef in anesthesia cart) had been administered rather than Ancef (both require reconstituting and are similar shape vials).Other cases have been reported in the literature. For example, a number of nurses mistakenly reconstituted measles and Bacillus Calmette-Guerin vaccines with pancuronium, instead of sodium chloride, and administered the vaccines to healthy infants. The patients experienced dyspnea and respiratory depression but, fortunately, sustained no permanent injuries.7Look-alike drug names. In follow-up to the event, labels were placed on the medication drawers indicting both the generic and brand name.Norcuron 10 mg was ordered verbally.
The first nurse asked another nurse to obtain the medication from the automated dispensing cabinet.
The second nurse repeated back “Narcan 10 mg” and the first nurse stated, “yes.” The second nurse handed 5 x 2 mg syringes to the first nurse. Narcan was given by the first nurse.Similar cases have been reported to ISMP involving mix-ups between the proprietary names Narcan (naloxone) and Norcuron (vecuronium). In one case, a pharmacist misheard a verbal order and dispensed the NMBA Norcuron when the opioid antagonist Narcan 1 mg IV was ordered. In another case, a nurse transcribed a verbal order for Narcan as “1 amp Narcan,” but a pharmacist misread the handwritten transcription as “1 amp Norcuron.” When Norcuron was dispensed, another nurse thought Norcuron was the generic name for Narcan and administered it to the patient, who immediately stopped breathing.
In the third case, a physician wrote “Narcan 1 amp IV.” An ICU nurse tried to obtain the drug from an automated dispensing module where drugs were listed by their generic names. She asked a colleague, “What is the generic name for Norcuron?” When her coworker said vecuronium, she removed the NMBA from the cabinet and gave the patient an unknown quantity from the 10 mg vial. However, the pharmacist misread the faxed copy of the handwritten order and entered vecuronium into the pharmacy computer.
Fortunately, the technician had affixed a vivid alert sticker stating, “Neuromuscular blocker, patient must be intubated” to the bag, which the nurse noticed, thereby averting a serious medication error.6Unlabeled syringes.
NMBAs have been accidentally administered when syringes containing the drug were either unlabeled or mislabeled. Although Pennsylvania facilities have not submitted reports specifically mentioning unlabeled syringes with NMBAs to the Authority, one example of a mislabeled syringe is as follows:The anesthesiologist thought he was administering Versed.
The patient was unable to speak for three to five minutes, and the anesthesiologist recognized that the wrong drug was given to the patient.

This was reversed and the patient responded without any problemOne example of an unlabeled-syringe-related error reported in the literature occurred in an ED. Commercially prefilled saline flush syringes were not available, so nurses prepared a supply of syringes each day from multidose vials. The syringe containing vecuronium was later used to flush the IV line of an alert three-year-old child. Allow floor stock of these agents only in the OR, ED, and critical care units where patients can be properly ventilated and monitored.Segregate storage. When NMBAs must be available as floor stock, have pharmacy assemble the vials in a distinct, sealed box with warnings affixed as noted below.
Include the need for ventilation support during and after administration as well as a protocol that stipulates automatic discontinuation of these agents after extubation and removal from a ventilator. Build alerts in the pharmacy computer to verify the patient’s location when NMBAs are entered. If the patient is not in a critical care unit, ED, OR, or invasive procedure area, question the order and verify ventilatory assistance before dispensing the drug. If possible, establish computerized crosschecking of the patient’s location when entering NMBAs. Consider an independent double check of these medications before dispensing and administering. Ensure the medication is checked against the original order.Supervision during initial administration. Require bedside attendance of a licensed practitioner who has experience with intubation and airway management during initial administration of an NMBA.Prompt removal of discontinued products. Place vials, bags, and syringes of NMBAs in a sequestered bin for immediate pharmacy pickup after the patient has been extubated or the drug has been discontinued.Increase awareness. Orders should not be written “prn for agitation” but more specifically as part of an intubation procedure or to maintain a specific level of paralysis while the patient is on a ventilator only.
Improving the safety of neuromuscular blocking agents: a statement from the USP Safe Medication Use Expert Committee. Self Assessment Questions The following questions about this article may be useful for internal education and assessment. They should only be administered by staff with experience in maintaining an adequate airway and respiratory support. They are often used in emergency departments, intensive care units, and interventional radiology areas. They interact with acetylcholine to prevent motor transmission, which then prevents patient movement.The most commonly reported type of medication error event types associated with NMBAs are ___________. Limit access to NMBAs by only storing them in care areas where patients can be properly ventilated and monitored.
Build alerts in the pharmacy computer to verify the patient’s location when NMBAs are entered.A patient had a cesarean section and a healthy baby was delivered.
The certified registered nurse anesthetist (CRNA) obtained and administered a medication from the anesthesia kit that he thought was Ancef. The patient developed respiratory insufficiency, and the CRNA noted that he had administered vecuronium, a NMBA, not Ancef. Require an independent double check of NMBAs when retrieving and before administering the medication.

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