Medication Safety and Administration by dffhrtcv3


									Medication Safety and

  Medication administration for nursing
  students in clinical at Seattle Children’s

            Update June 2009,   K.Klee

   • Describe appropriate methods of medication delivery
     for different ages.
   • Accurately document medications per hospital
     policies and procedures.
   • Safely administer medications.
   • Know standards of practice specific to caring for
     children at Seattle Children’s
   • Know limitations of student responsibilities at Seattle
What you need to know….

   • Medication errors happen
   • Near misses happen (when an error is discovered
     before it gets to the patient)
   • Injury and even death happens from medication
  You are part of the team and you
  can help prevent errors by talking
  with your instructor when you are
  unsure, overwhelmed, or new to a
What Can You Do To Decrease Medication Errors?

 • Check and double check, if in doubt check it out, again!
 • Follow the 5 R’s: right patient, right drug, right dose,
   right time, right route
 • Never assume, “pharmacy put the medication in the
   drawer so this must be right”, pharmacy makes errors
 • Never assume, “the resident ordered this large dose so
   it must be right”, Residents make errors too.
 • Know the correct mg/kg dose of medications you are
 • Know why you are giving the medication, the expected
   action, and any potential side effects.
Time for a story
Story: Admission of a patient…

•3 month old       Admitting Nurse: “I did his
admitted with      admission assessment and then
                   it was time for change of shift so
respiratory        I gave report to the next nurse”
distress most
likely due to      Oncoming Nurse: “I received
bronchiolitis      report at 7 p.m. and was
                   reviewing the orders and saw
                   that he had some medications
“I saw that he had some medications due…”

  Infants Nurse:           •What are the next steps to take?
  “The infant had          •5 R’s
  reglan and digoxin       •What questions do you have?
                           •What are the clinical
  ordered BID. They        indications for these two meds
  were due at 8pm. I       in this infant
  went to the              •You go into the room to give the
                           medications…what steps do you
  medication room          take?
  and the meds were        •Patient ID check, tell patient
  in the drawer so I       and family what meds you are
                           administering and what they are
  took them into the       for
  infants room”.
“I took the medication into the room…”

  •“I looked at the online formulary   • Looked meds up on the
  for reglan and digoxin and saw       online formulary
  that they were ordered in the
                                       •Checked the dose
  correct dose and route. I checked
  the labels on the syringe and        •Checked the med
  double checked the dose against      •Took labeled syringes to pts
  the order on the medication          room
  administration record. I took the    •Checked the ID band against
  medications into the infants room,   the name on the med and
  checked his ID band, and told        asked mom to verify date of
  mom I was giving digoxin and         birth
  reglan”.                             •Told mom what meds were
                                       about to be administered
“I told mom I was giving Digoxin and Reglan..”

   •“She  said, at home I          •What do you do?
   give the reglan, the
   other medication must
   be a new one.”
   •“I told her it was
   ordered by the doctor
   for the baby’s heart”.
   •“Mom said, is there
   something wrong with
   his heart?”
“Mom said is there something wrong with his heart?”

   •“I said let me double check      •The charge nurse called
   his chart”.                       the senior resident who
   •I left the room and looked       said the child had no
   at the chart, he was here for     cardiac issues and
   respiratory distress. I did not   should not have an order
   see anything about a heart        for Digoxin.
   •I called the resident and he     •Turns out the order was
   said “he did not know of any      electronically placed in
   heart problems in this            the wrong chart.
   •I called my charge nurse.
“What if mom had not been there?”

                  •Always! Ask
                  yourself…what were the
                  indications for digoxin in
                  this infant?
                  •Know why you are
                  giving a medication and
                  the indication in your
What Else Can You Do To Decrease Medication Errors?

• Stop the line, if you have concerns or questions do not give the
  medication until you feel the concerns/questions have been
• If a patient or caregiver says, “hmm, that pill does not look familiar”,
  or “the doctor said not to take that today”, or “I already took that pill
  today”, or anything that might indicate an error is about to
  occur….stop, pick up the medication and leave the room. Double
  check the medication and if necessary call the MD to clarify the
• If you have to pull 2 vials of a medication out of omnicell or need a
  large quantity of a medication stop and recalculate with a peer. This
  is pediatrics! Medications doses are smaller then adults and are
  given in mg/kg!
• Harried? Tired? Distracted? Triple check yourself!
Medication administration documentation

  1. Documentation of medication dose, time,
     date, route must occur every time a
     medication is administered, at the time of
  2. Documentation occurs on the medication
     administration record (eMAR) in CIS
  3. If you give a scheduled med late you must
     document the actual time given.
  4. If a scheduled med is not given you must
     document not given and document the
     reason why..
  5. You must have medications cosigned by an
     instructor or the RN caring for the child
Nursing Student Responsibility and Patient Safety

   Follow all Children’s Hospital policies and
     procedures especially those related to
     Patient Safety.
    Nursing Student Responsibility

• Nursing students do not take verbal/telephone
  orders from physicians
• Nursing students do not receive critical lab
  values from the Laboratory
• Nursing student do not alter alarm
  settings(change alarm parameters,turn off
• Nursing students do not administer any
  chemotherapy agents (oral or IV)
     Nursing Student Responsibility and
               Patient Safety

• Nursing students do not give IV push
  medications EVER! (exception: normal saline
  (NS) and heparin flush in a PIV only)
• Nursing students do not administer blood or blood
• Nursing students do not do Ventriculostomy care
  or maintenance
• Nursing students do not administer narcotics,
  paralytics, or vasopressors via pump or drip
• Nursing students may not independently program
  any infusion pumps
Medication administration documentation

1. You must give medication under the direct
   supervision of a nursing instructor unless
   supervision has been prearranged with the
   instructor and the RN caring for your patient.
2. If you give a scheduled med late you must
   document the actual time given.
3. If a scheduled med is not given you must
   document not given and document the
   reason why..
4. You must have medications cosigned by an
   instructor or the RN caring for the child
               Faculty Responsibility…

• Directly supervise the administration of medications. When the
  student has demonstrated adequate knowledge and good technique,
  s/he may give medications (except IV meds) with staff nurse
  availability. This must be pre-arranged between the faculty and staff
• All student medication administration is to be directly supervised by
  clinical faculty or staff nurse. The supervising RN (faculty or staff RN)
  will co-sign the MAR.

• From P&P: RN reviews and co-signs documentation and
  medication administration. Writes “I agree/concur with above
  documentation” and/or add any additional documentation. (Note:
  LPNs may not co-sign RN student nurse medication administration
Wow, that is a
lot of to do’s
and not to
keeping kids
safe is our goal!

If you do not chart it, it
didn’t happen.
What if you gave
tylenol at 0630 and forgot
to chart it. The next nurse
comes on and the child
has a fever so the child
gets tylenol again at
        Some hints from the wise

 Always check name band prior to giving
  any medications.
 Always check to see that ordered dose is
  appropriate based on weight.
 Always look up medications unfamiliar to
  you before leaving the medication room.
                     Pt Safety

•   Never leave medications unattended at the
    bedside or at the nursing station.
•   Never leave medications unattended!
•   We are protecting the patients, siblings, friends,
    and young visitors that may be curious and
    ingest a medication left unattended.
                   Think Safety!
                    Pt Safety

•   Never leave the medication room with a syringe
    unless it has a label on it that includes the patients
    name, dose, and name of medication.

                             JJ Amoxicillin 250 mg
   On line order entry is great…but

• It is not fool proof
• Errors still occur
• Always know when the last dose was
  given and frequency of dosing
• Note start and stop dates especially
  on weaning schedules
• Watch for duplicate orders
               Patient Safety

• Check and double check
• 2 patient identifiers (name/DOB or name/MRN)
  before any medication or intervention
• Know why you are giving the medication and
  that the reasoning matches the pts clinical
• Listen to your instinct
• Listen to the family

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