DAISY A.

VICENCIO

Backbone of Medication Administration

5 Rights
Right patient Right drug

Right dose
Right time Right route

What is Medication Error

Medication Dos and Donts

DOS 1. Give medication on time 2.Use only labeled bottles 3. Look at label 3 times A. When you take it out B. When you pour it C. When you put it back
DONTS 1. Give earlier than 30 minutes and not later than 30 minutes (one hr. window)

4. Check order for accuracy

5. Use quiet area to prepare meds

2. Use unlabeled or blurred labeled bottles 3. Forget to do 3 checks and check expiration dates 4. Assume anything 5. Talk or be distracted when preparing meds 6. Give med, if no I.D. or allergy band
7. Give wrong information to clients 8. Forget to sign immediately. Signature has to be legible

6. Check I.D. and allergy band

7. Know action of drugs 8. Document immediately in MAR. Initial and sign full name, title

Timely Administration of Scheduled Medications

Scheduled medications include all maintenance

doses administered according to a standard, repeated cycle of frequency (e.g., q4h, QID, TID, BID, daily, weekly, monthly, annually).

Scheduled Medications DO NOT include:

STAT and Now doses First doses and loading doses One-time doses Specifically timed doses (e.g., antibiotic for surgical patient to be given a specified amount of time before incision, drug desensitization protocols) On-call doses (e.g., pre-procedure sedation) Time-sequenced or concomitant medications (e.g., chemotherapy and rescue agents, n-acetylcysteine and iodinated contrast media) Drugs administered at specific times to ensure accurate peak/trough/serum drug levels Investigational drugs in clinical trials PRN medications.

Time critical scheduled Medications

Time-critical scheduled medications are those

where early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm or result in substantial sub-optimal therapy or pharmacological effect.

time-critical scheduled medications

1. Identify a hospital-specific list

Medications with a dosing schedule more frequent

than every 4 hours Scheduled (not prn) opioids used for chronic pain or palliative care (fluctuations in the dosing interval may result in unnecessary break-through pain) Immunosuppressive agents used for the prevention of solid-organ transplant rejection or to treat myasthenia gravis

Cont..
Medications that must be administered apart from

other medications (e.g., antacids and fluoroquinolones). Certain medications that require administration within a specified period of time before, after, or with mealsfor example, rapid-, short-, or ultra-shortacting insulins, certain oral antidiabetic agents (e.g., acarbose, nateglinide, repaglinide, glimepiride), alendronate, and pancrelipase. 2.Establish guidelines for time-critical medications

Non- time- critical scheduled Medications

Non-time-critical scheduled medications are

those where early or delayed administration within a specified range of either 1 or 2 hours should not cause harm or result in substantial sub-optimal therapy or pharmacological effect.

Non-Time-Critical Scheduled Medications

1. Establish guidelines for daily, weekly, or

monthly medications Administer these medications within 2 hours before or after the scheduled time.
Medications administered more frequently than

daily but not more frequently than every 4 hours (e.g., BID, TID, q4h, q6h) Administer these medications within 1 hour before or after the scheduled time.

Others:
Sound Alike Medications: confused drug names
Verbal or telephone orders : should have: date and time, the name of the

physician, the generic and brand name of the drug,

drug dosage, quantity , duration, route, frequency, age and weight of patient if known, known allergies of not yet determine, reason the drug is order for the patient, name and level of licensure of the individual Receiving and documenting the order , and must be signed by the physician within 24 hours.

continuation
Verbal Order any order from the physician to the RN

that is given during: emergency ( code Blue ), surgical procedure, endoscopy, bronchoscopy
Telephone orders: maybe prescribed in the following

instances: the prescribing physician has determined the need of the patient and he is physically unavailable.
V.O and T.O are not accepted for anti-neoplastic drugs

and controlled / narcotic drugs

Any Questions?

THANK YOU Keep learning! You are as young as your last bright idea.