MEDICATION SAFETY Administration of Medications

Report
MEDICATION SAFETY
Administration of Medications
Meeting HFAP Accreditation
Standards for Pharmacy Services and
Medication Use
Part Three
MEDICATION SAFETY
Administration of Medications
• HFAP Chapter 25 keeps you in compliance
with the Medicare Conditions of Participation
Medication Safety Series
1.
2.
3.
4.
5.
Using CPOE: Challenges and Solutions to
Address HFAP Standards
Procurement, Preparation and Dispensing
Administration of medications – timing,
unit dose, bedside medication verification
Monitoring of therapy, Medication Use
Evaluations
TBD
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The 6 rights
Collaborative Process (nurses, RT, pharmacists, physicians)
Routes of administration
BMV
 Advantages
 Disadvantages
 What to do if you see medication errors (wrong patient, wrong
drug, wrong time)
 Patient process
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Hand hygiene
Identification
Education of the patient
Verification of the medication (double verification)
Medications at the bedside and self-administration
Observe for reactions
 Oral: sublingual, buccal
 Parenteral: intradermal, subcutaneous,
intramuscular, intravenous
 Topical
 Inhalation
 Intraocular
 Metric
 Apothecary (grains)
 Household
 Grams (g), milligrams (mg), kilograms (kg)
 Liters (L), milliliters (ml)
 Tablespoons
 Teaspoons
 Ounces
 Cups
 Pints
 Quarts
 Conversions within systems
 Conversions between systems
 Six rights
 Triple-check before administration
 Patient assessment
 Right medication
 Right dose
 Right patient
 Right route
 Right time
 Right documentation
 Information
 Refusal
 Careful assessment
 Informed consent
 Safe administration
 Supportive therapy
 No unnecessary medications
 Collaborative process
 Nurses
 Pharmacists
 Respiratory Therapists
 Psychiatric Technicians
 Physicians
 Infants and children
 Older adults
 Polypharmacy
 Self-prescribing
 Over-the-counter medications
 Misuse
 Noncompliance
 Patient response to medications
 Patient and family ability to administer
medications
 Presence of GI alterations
 Ability to swallow
 Use of gastric suction
 Positioning
 Skin applications
 Use of gloves or applicators
 Preparation of skin
 Thickness of application
 Assessment of nares
 Patient instruction and self-administration
 Positioning
 Drops, ointments, disks
 Assessment of eyes
 Asepsis
 Positioning
 Assessment of ear canal
 Warming of solution
 Straightening of canal for children and adults
 Positioning
 Metered-dose inhalers (MDIs) and dry powder
inhalers (DPIs)
 Patient assessment and instruction
 Use of spacer
 Determination of doses in canister
 Medications used to wash out a body cavity
delivered with a stream of solution (sterile
water, saline, or antiseptic)
 Asepsis
 Equipment
 Syringes: sizes (volume), types
 Needles: length, gauge
 Disposable units: Tubex, Carpuject
 Ampules
 Vials
 Mixing medications
 Determine compatibility of the medications
 Do not contaminate one medication with
another
 Ensure the final dose is accurate
 Maintain aseptic technique
 Insulin
 Syringes and needle sizes
 Types of insulin
 Mixing of insulins
 Rotation of vials before withdrawal of solution
 Minimize discomfort
 Use smallest suitable needle
 Position client comfortably
 Select proper site
 Divert client’s attention
 Insert the needle quickly and smoothly
 Hold the syringe steady
 Inject the medication slowly and steadily
 Subcutaneous injections
 Sites: condition of area, rotation of use
 Amount of solution
 Length and gauge of needle
 Pinch or spread skin
 Angle of insertion
 Intramuscular injections
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Sites: landmarks, condition of area
Amount of solution
Length and gauge of needle
Angle of insertion
Aspiration
Air-lock method
Z-track technique
 Sites
 Ventrogluteal
 Vastus lateralis
 Deltoid
 Intradermal injections
 Skin testing
 Sites
 Length and gauge of needle
 Angle of insertion
 Formation of small bleb
 Needleless devices
 Sharps disposal
 One-handed recapping technique
 Large volume infusions
 Bolus injection
 Volume-controlled infusions Piggyback
 Tandem
 Volume-control set
 Mini-infusor pump
 Hand hygiene
 Identification
 Education of the patient
 Verification of the medication (double verification)
 Medications at the bedside and self-administration
 Observe for reactions
 Wash hands with soap and water or with waterless
hand sanitizer before and after patient contact
 Gloves
 Must use at least two patient identifiers whenever
administering medications.
 Acceptable identifiers may be the person’s name, an
assigned identification number, a telephone number, a
photograph, or another personal identifier.
 If bar code scanning is available, scan the patient’s
armband
 Scan barcode
 Verify that this is the correct medication
 Verify dose
 Double verify
 High risk medications (heparin, insulin)
 Controlled substances
More people die in a given year as a result of medical
errors than from motor vehicle accidents (43,458),
breast cancer (42,297), or AIDS (16,516).
Kohn, Corrigan & Donaldson, “To Err is Human”, Institute of Medicine, 1999
Ordering
56%
Administration
34%
Transcription
6%
Dispensing
4%
Bates, Cullen, Laird, et al. “Incidence of Adverse Drug Events and Potential Adverse Drug Events.” JAMA, 1995, 274, 29-34.
Why barcode medications?
Nationally 2 of every 100 admissions experienced a
preventable adverse drug event, resulting in
increased hospital costs of $4,700 per admission.
This is $2.8 million annually for a 700-bed teaching
hospital.
Kohn, Corrigan & Donaldson, “To Err is Human”, Institute of Medicine, 1999
*Barcode Medication Administration (BCMA) in VA Medical Centers*:
 Right drug
 Right dose
 Right patient
 Right time
 Missed meds
75% improvement
62% improvement
93% improvement
87% improvement
70% improvement
*Johnson, Carlson, Tucker, & Willette Using BCMA in VA Medical Centers
Journal of Healthcare Information Management-Vol 16, No.1
*Eastern Kansas Health Care System (VA) 1994-2001*:
 8,000,000 doses dispensed
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549,000 errors prevented
0 documented errors
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Physician order received
Order faxed to Pharmacy
Pharmacists edit and verify electronic orders
into patient profile
Pharmacy dispenses ordered medications in BarCoded packages
Nurse accesses BMCA software on computer
via log on
Nurse scans unique patient bar-coded ID band
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Nurse utilizes two unique patient identifiers to
verify armband
Nurse verifies patient profile medications as per
order
Nurse scans bar-code on medications
Nurse administers medications
•Reduction in medication errors
•The FDA estimated that over a 20 year period the number of medication
errors would be reduced by 50% and up to 500,000 adverse events would be
avoided by utilizing BCMA
(Food and Drug Administration, 2004).
•Ease of checking the five rights of medication
administration
•Automatic MAR creation
•Lab results can be displayed at the point of care
•Alerts for missed medications
 Estimated to cost $1,799 per bed to implement BCMA,
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with an additional $1,000 yearly for maintenance
No universally accepted bar codes
Bar codes that are unable to be scanned
Equipment malfunction
Over reliance on BCMA to catch errors
Stat medication turnaround time
(ZIH, 2006)
 Over 15 types have been identified that could potentially lead
to errors
 For example:
 Nurses override alerts for 4.2 % of patients cared for and for 10.3% of
meds charted
(Karsh, Koppel, Telles, & Wetterneck, 2008)
 Require special order from physician
 Must be stored in a secure manner
 Avoid using home medications unless they are
unavailable from the hospital pharmacy
 If using home medications, they must be stored in and
dispensed from the hospital pharmacy only upon
positive identification
 Patient education on self-administration
 Example: inhalers
 Assessment
 Vital signs
 Blood glucose
 Pain level
 Education
 What drug is for
 Side effects
 Reassessment
 Types of errors:
 Omissions
 Drug administration without a physician’s order
 Wrong drug
 Wrong dose
 Wrong time
 Failure to follow manufacturer specifications
 Do not crush
 Shake well
 Inadequate fluids
 Administration without adequate fluids
 Administration through enteral feeding tube:
 Example: phenytoin
 Administration of eye drops
 Contact time with eye
 Inhalers
 Administration with regard to meal times
 Monitoring of Therapy
 Medication Use Evaluations
 Trending of medication errors

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