all right so today we're going to do chapters one to six and seven role of the nurse in pharmacotherapy so um just a quick little overview this looks like a lot of chapters but it's really not they're pretty short okay so don't get overwhelmed with the reading um so I'm Dr Nettles I'm going to teach you pharmacology this is just pharmacology okay so we're not looking at so much the you know the pathophysiology behind pneumonia we're going to say okay these are the medications that could treat pneumonia and these are how they work and this is how you use them and things you need to look out for okay all right so this is an SLO an SLO you'll get SLO for every lecture we do um you'll get one for every every class every semester not just pharmacology but the nursing special pops all those things so what this says is my topic okay what I will learn my chapters okay so hopefully by the end of this you'll be able to outline the drug approval process utilize nursing process um in providing patient centered pharmacal therapy incorporate Joint commiss Commission standards and medication administration Implement nursing knowledge and responsibilities in medication administration and analyzes the nurs nurses role throughout medication admin medication Administration okay so as we know there's like a thousand million gajillion drugs we're not going to have to learn all of them because new ones come in and old ones go out all the time so it's a constant learning you're never done I hate to say it sorry okay um most importantly is that we know that just because I take a tal for my blood pressure doesn't mean my neighbor takes T law for his blood pressure he may take it for anxiety okay even though they both work on the you know beta receptor and they block the beta receptors they work differently for both of us okay so many drugs are prescribed for more than one disease and drugs um just because a drug works for me as many it's going to work for you okay and just because we both have high blood pressure doesn't mean we're both on the same medication okay we always to figure out the why why is this patient taking it why does it look like they need this one over some something else okay um so drugs elicit different responses for individuals we know that that's why side effects happen right I don't get nauseous but you do when you take a specific medication okay um obviously medications are supposed to improve quality of life all right so what's our role our nurses roles are to educate manage and monitor we are giving medications all the time okay we don't give medications without telling our patients what they are what side of X they are what it does what it should look like all those things okay we don't manage prescription so we see which ones they need which ones they don't prns things like that okay which we'll learn about later all right so these are things that we manage we manage how you take your meds when you take your meds okay and then we monitor the effects after um so Therapeutics so Therapeutics focus on the disease prevention as well as treatment and pain the phac therapy is the application of drugs treating the disease so therapy therapeutic focuses on therapy the pharmacotherapy F focuses on the drug for the therapy okay makes a little more sense on this next page so there's different types how do we classify drugs from each other we use a therapeutic class and we use a pharmacology pharmacological class the therapeutic class is um based on its usefulness the phology pharmacologic classification is how it works in the body okay so for example neuroen neuroin or Gabapentin is an anti-seizure drug that is the therapeutic class because it treats seizures the pharmacology classification is a Gaba five inhibitor I'm pretty sure okay so that's how it works it inhibits the Gaba receptor in the body that's the pharmacology class okay so that's what they mean when you see medication you'll learn a therapeutic and a pharmacological class okay both classifications are well used depends on the medications um the Prototype drugs those are um that's an example of your book in your book it'll give you a prototype so it'll pull one medication from the class and tell you a little bit more about it okay that's just a way to read the book so how do we name drugs we have chemicals we have generic and have trade okay so for our most common we use generic for all of Charity School of Nursing and all of an inlex we they use generic only so we will test you only on generic names okay that's the only thing you need to know for an example this is a medication the generics name is metformin the brand name is glucophage for this one the brand name is Advil and the generic is ibuprofen okay your chemical name we very rarely use chemical names because no one is going to be able to tell you what the heck this is but it's very common sometimes it is we we use parts of it okay but this is how it actually works in the body so like this has seven seven chlorine three um dihydrogen ions one methyl whatever ever that is okay we don't even know that as for the pharmacists it's for people who make the drugs it's not for us right now okay so sometimes we do use it the chemical names like calcium gluconate sodium chloride because that's what it's called that's what it is and technically that is the chemical name okay but it's very very rare sometimes the chemical names can actually be their um classification as well like quinolones and sephos sporin are technically chemical structures of antibiotics but that's also how they're classified all right so generic is supposed to be less complicated supposed to be easy to remember but the important thing about generics is that they group them together okay A lot of times they have either the same prefix or the same suffix like Ben benzo diazines or benzos sometimes we shorten it to that which is like your Xanax all the generics for benzos and in Lamb or PR Pam so Al praisal Lam um laraza Pam lenaz aam diazapam they end in Lamar pram so we know that all of those are benzoin that's the point of generics so that we can classify them and Clump them together and learn them okay there's only one generic name versus there may be multiple Trad names okay um or there's one trade name and there might be multiple generics with different names under that one trade but they all have something different okay so trade names are short they're made by the company they get to pick out what the name is so whoever made by Agra got to pick the word the name Viagra okay whoever pick seis got to pick the name seis now the generics of those both end in defil so that's how we know they're phoso diast Inhibitors five Inhibitors they the generics sound alike because they work the same okay so that's why it's easy to remember generics And Trades because they're more similar in names um the trade names are also uh capitalized and generics are always lowercase always okay uh the other thing is is sometimes people can only take trade or they can only take the generic when the reason that we use generic medications is because they're cheaper usually and then they don't they don't always use all the same ingredients as the trade okay oh we can we can short them on this one oxygen molecule and add this sugar molecule and it makes it cheaper okay a sometimes people are allergic to generics because of that so so we have to pay attention to what we're giving the patient and if it's a trade or if it's a generic okay um to over counter versus prescription I mean it's pretty straightforward right prescription you need a prescription a written prescription electronic prescription from a doctor you can get prescriptions for over-the-counter medications absolutely but it's not necessary overthe counter is just over the counter if you ever see OTC that just means over the counter okay um they don't require health care provider they have still have very serious side effects so we still learn about them and because we're going to be recommending people to to take these medications so we have to know what the side effects are going to be um and sometimes that doesn't work right if I go in and take my ibuprofen every day twice a day for my back pain and it never helps it could be because I don't need apren I need surgery or I need narcotics it's not something that I overthe counter can fix okay um so this is what I was just saying um the trade in generic sometimes the filler they have filler ingredients in generic so um they work the same but they don't always have the same ingredients okay all right so uh drug regulations and the standards so long time ago no one regulated anything right you ever watched Tombstone they say about l Lum the the the woman that was she was addicted to Lum because Lum is straight opium from an opiate from a poppy plant okay so no one regulated how much opium was going into that little bottle they used to give cocaine to people meth to people I mean straight opiates no one needs all that okay so that's why they decided we have to regulate this we have to find some kind of standard you don't know who's making how they're making so now we have a safe way of getting medications properly okay so they started doing this around the the 1800s um back then they didn't have a lot of meds now that we have a lot more we definitely have a lot more um standards and things like that um formulary your formulary is set by your insurance it's set by the hospital so it can mean different things but it's what they have on hand so if you have a formulary at a hospital um and I take this one specific trade or this compound drug they may not have it and you may have to bring it from home so because it's not on my formulary it's not something that I can get from my manufacturer your insurance formulary like your your um prescription Insurance your insurance formulary tells you what you can buy so you ever had a prescription for a medication and they say we'd rather you take this one over that one even though they're they're the same drug it's just a different generic or whatever it is that's what the insurance formulary is it just means it's cheaper and we would rather we'd rather pay for this one instead that one that mean you can't override it um the Pharm farma copia I think I said that right I swear there's a d missing in that because it's it's the pharmacology like encyclopedia okay it's basically like a a reference a very large reference that they keep it in the pharmacy we use smaller ones like our um Green books okay our fais like drug guide that's definitely one that we use all the time we have ones online all and then we use and they're much easier to use cuz it's online you just search it instead of having to look it up okay so these are just like everything we're talking about the classification the routes the mechanism of action all that stuff all in there okay so the FDA decided they were going to they're who controls medications okay that's part of what what the FDA was created for Food and Drug Administration okay they created um the blackbox warnings which are big black boxes on the backs of medications that says hey don't use this it causes fetal um demise which is fetal death okay oh don't use this when it causes cancer these are the big special big big problems okay not necessarily that you don't want to take it but you need to be an um knowledgeable of it and your patient needs to know what the blackbox warnings are okay um these are just different types of how FTA regulates things they they regulate the vaccines that's why the CDC tells you which vaccines to get they regulate blood products they're the ones who like filter all the blood and that's why you don't get HIV when you get a blood product because the FDA regulates it okay all right so the review process so these are the four um steps of the review this the NDA new drug application not nondisclosure um is a review of the pre and the clinical investigation because we're not going to go into it so preclinical this is your lab research I mean like a ridiculous amount of lab research okay you don't test it on humans but you do test it on human cell so they may take some blood work from you they may take some cells like from your skin whatever it is and they chest the cell against the medication and this is where they try to find um how it works how it's going to work on the body things like that okay results are always inconclusive because animals and cells are not humans okay so when we get to our clinical phase this is when we start testing it on people okay so when we test it on people we're trying to see um how it's working when it's working we're getting at good sample size and all those things um it's the longest part because we have to check for all the side effects and sometimes it has to take for a long time this is when they test it on humans this is when they figure out the side effects they get that good accurate sample size hopefully and they try to see what the side effects are going to be okay don't forget that NDA is next though we don't talk about it in post marketing this is when we have medications I'm sure you've heard of hey there's this new drug it's new in the market but it's not FDA approved yet that's what this is okay that means it's gone through some of the approvals but it's not finally approved by the FDA and they're in their postmarketing surveillance they're wide they can distribute it widely they can um give it to like the world so that they can see the um evidence because sometimes they don't know that the harmful effects are actually that harmful or like okay when our sample size 10% of people got nausea or 20% of people got nausea when I did the post marketing surveillance only 5% got so that that's better right because it's a larger sample size more people are taking it more diverse um like backgrounds and things like that so that's why we do Post marketing surveillance okay now there are fast tracks Okay so we've all been through Co so we remember the fast track of the covid vaccine so the fast track is when you um have no the current therapy for this whatever it is and we have to figure out some way to um meet that demand so that's why they made the covid vaccine it doesn't mean they skipped any of the processes just means it was faster okay so the Breakthrough therapy is when you have a breakthrough when youd say hey there's clinical evidence that this is going to improve or cure a life threatening condition and then these are just other you know faster approval processes the priority review is like 6 months review The Accelerated approval is a um an accelerated one okay don't get po down on those all right controlled substance so controlled substances are another way that Med um the FDA controls drugs okay we decided that may everyone should not have access to meth or those kinds of things right so that's why they created Controlled Substances that's why they say hey this is a controlled substance we don't sell it or we don't you know widely distribute this to everybody okay um but these are drugs that have a high potential for abuse obviously meth is very addictive okay dependence is the physiological or psychological need for a substance so if I need this substance to live to make my life better whether it's mentally or physically that is dependence okay physical dependence can be an altered um physical condition and um caused by adaptation of the nervous system to repeated drug use so what that means is the more I take this drug the more it Alters my physical condition could be good could be bad okay when I withdraw or take away the medication I start having some kind of physical discomfort even if my it's a psychological dependence and I withdraw the drug I can have physiological discomfort we've all met the alcoholic right that has stopped taking the who said they're going to put drinking and they get the shakes right they were dependent on the Alcohol now they're now they're getting trimmers they're vomiting they're not Lucid those are side effects of withdrawal they'll get that all later okay but withdrawal is when you stop taking the substance and your body reacts to it okay there are five categories schedule one is your um Highest Potential for abuse they're the worst that's the ones we want to avoid all right so these are our scheduled ones when we have have this is our heroin or LSD I think they actually changed marijuana to level two but we'll go by the book okay schedule four is the lowest potential for abuse okay not all drugs are on here like we were just talking about alcohol and alcohol draw that's not on here nicotine caffeine those aren't regulated by the FDA controlled substance okay so when we talk about this is from your book this is table 2.1 okay these are the examples level one um schedule one or controlled sub controlled substance schedule one control one all the same thing this is your heroin your LSD okay those kinds of things limited without current therapeutic use we don't give this we don't give these drugs now marijuana like I said it's level two now not level one but we do give marijuana but we don't give this to everyone else right okay level two is our usually our um our narcotics okay are Hydromorphone which is diloted madin which is Stadol okay morphine oxycodone um barbituates okay schedule three is our combo drugs so like the medications anabolic steroids combo medications that have codings they may have less coating than the straight coating and they have a combo that's going to help lower it okay so like antibiotic steroids we give those to people who have um a low testosterone um ketamine uh we talked about that why is it only here twice okay schedule four is usually our anti-anxiety medicine so that Al praise a lamb like we're just talking about all the benzos Glazer Pam diazapam luras pan mam all those are Tim asan all benzos okay um and then ambian which is our or zadin which is our um medications that help you sleep but they are still controlled because they they do have the potential for abuse schedule four is are usually our cough syrups because there's this much coating with this much cough syrup so it's a very low dose but there's still potential because there's still coding in it okay all right so um another way that they control control substances is through the DEA which is the drug enforcement agency okay healthc care providers have to register with a DEA to be able to write prescriptions for Controlled Substances okay so that we can look up the remember that um documentary the pharmacist on Netflix about the the lady who was um writing all those oxycotton prescriptions so the DEA can look up her DEA number and see every time she's she's written a prescription for oxycotton and it's been filled okay so this is how we control Healthcare Providers but also how we we control patients because now that it's been written and filled I can go to that patient and find everywhere every doctor every controlled substance they got when where and how much everywhere okay so this is how we control it and monitor it okay and then tolerance so tolerance is different from the dependence does not mean you're addicted okay it does mean that you have a tolerance there are people who have a high tolerance or a low tolerance I've never I'm a very low tolerance I take a Tylenol and I can go to sleep okay some people take 8 milligrams of morphine and they're perfectly fine and don't doesn't affect them at all the tolerance just means when your body adapts to the substance either from repe Administration or just how you were born okay so you may need higher dose does not mean addiction just means you're tolerant okay all right so the nursing process the nursing process is this right here we call it adpie that is how we problem solve okay that's how we form a foundation for nursing process uh practice and we deliver patient- centered and holistic care the clinical judgment model is how we build on that process to um shift to critical thinking and judgment okay so when this is also how you like take test questions okay is ADD Pi assessment I know that's not a d but it's identification because we don't do diagnosis okay planning implementing evaluating or ad pie so a assessment this is when we are getting information okay we're getting the most information we can we're talking to these people because a head to toe is not going to tell me what medications you're on I have to talk to someone I have to figure I have to read their chart I have to do something okay um so when I do this this is how I get what medications and supplements they're taking and I need all of them supplements included okay we need to know what allergies they have and not just what they're allergic to but what happens when they take the penicillin that they're allergic to okay oh you have anaphylaxis let's not give you with Penicillin right or oh you have nausea when you take it it's not really an a a side that's a side effect not really an allergic reaction but we'll take it into consideration when we give you medications okay we when we're talking about our meds we're also asking if they're having the desired response how is your blood pressure managed I see you take a blood pressure medicine right okay how do you're having any side effects from these things have you had any allergic reactions to any of these things um and are they responsible okay so if you're talking to a p you've talked to people that are not bright right or you're like something it and click can he you're telling me you're taking your blood pressure medicine every day but I'm looking at your blood pressure and it's not going down something's not clicking either you're not taking it right you're taking it with um something that's contraindicated or something that makes it inactive right or maybe they're just not taking it right okay maybe it is that they think they're taking it right but they're not okay maybe it's just not working too which is why we want to make sure it's the desired response okay um yeah so then we have herbales herbs and supplements we're going to talk about those a lot okay they're at the Devil herbs and supplements are great things to take okay but we have to know what they are during the assessment because they have the potential to counteract all medications the worst one being St John's wor wart that counteracts and interacts with everything okay if you've ever seen deep you have it pretty good she's on anti-depressants but she's the vice president so no one can know that she's on an anti-depressant because if they knew she was on an anti-depressant you know the common world would freak out well she has some kind of something happened the doctor's like here just take the St John's wart so she takes the St John's wart with her anti-depressant and she gets so high okay then she starts hallucinating and then she starts peel like scratching her face because because she's hallucinating and she winds up all like looks like she ran through a window okay so herbal supplements though they seem like they are harmless they are not they have serious adverse effects and can cancel the effects of your prescribed medicines or multiply them okay so we have to know supplements when we do um our assessments when we have to figure out what medications they're taking okay identification so this is the second St this is D Okay so we've assessed them we've talked to them we know what medicines they're on are they working or are they not okay now we're trying to identify the problems so now we've seen the problems we're identifying what those problems are it seems like it's they're kind of go together right that's why it's the second step so we're using clinical judgment from the nurse's scope of practice can I diagnose with someone with high blood pressure no can I say you take three high blood pressure medicines and this and know that means you have high blood pressure or some kind of cardiac issue yes okay so I may need to make sure that these are working or are they working too good are they work not working at all okay so we're trying to identify problems okay oh I see you're taking three blood pressure medicines and your blood pressure is really low maybe I should tell someone and stop one of these okay I don't have to give all the medications that were that were prescribed okay if they're going to hurt someone I have a right and I have a duty not to give those medications okay so we're trying to promote therapeutic drug effects so when to take it how to take it take it on empty stomach take it with with food things like that okay we're trying to um we're telling them about the diets that can go along with these medications like let's do a low sodium diet with your high blood pressure okay um minimize drug effects and toxicity that's what I was just talking about I have a I have a duty to my patient to not hurt them okay so if I'm doing my assessment and I see they're on a medication that's going to hurt my kidneys or that is hurting my kidneys and my doctor orders a medication that is also nephrotoxic or will hurt my kidneys I need to bring it up hey they're already on this nephrotoxic drug are you sure you want to give them another do we want to check kidney function first we're trying to to prevent toxicity and adverse effects okay and then maximize the ability to self-care so seeing do they need more knowledge they need more skill giving themselves medications right do we need to call social work to get them um uh money to to pay for their prescriptions and things like that okay but this is identific identification so we're not doing these things yet but we're trying to identify the potential problems okay when you plan it's just that simple we're trying to find um what's going to go when okay we're prioritizing diagnosis and outcomes and interventions what are we going to do when are we going to do what's most important okay so when you do these prescription prescriptions when you do the test questions that say what do you do next what is the most important what is the best that what is the priority this what is the priority that that's this stage okay so we're trying to figure out what's going to kill them or hurt them the most first and then work our way down okay so my patient's choking I'm more worried about Airway than teaching them about how not to choke okay do you see what I'm saying me while you're choking if I gave you a lecture about how not to choke and just chew and swallow your food you would be very upset because you are literally choking right so You' got a PR prioritize our goals and our interventions okay our goals are focused on safe and effective administration of medications um therapeutic outcomes that's a good um goal treatment of side effects another good planning goal okay and they have to be realistic if your patient cannot read we are not teaching them to read before they go home that's not g to happen but I can make sure I have a therapeutic outome or plan to have a safe someone show them a video and about how to safely and effectively administer medications at home okay all right so then implementation which is the i in adpie so this is the interventions this is what we do okay this is the giving the medications this is teaching about the medications this is monitoring the effects of the medication this is documenting the um medications okay that I gave them because if you didn't document it it didn't happen okay so you're going to give your patient a medication we're in the implementation phase okay they you give them their medication and they say you tell them hey I have your medication this is mopol 50 milligrams for your high blood pressure this is going to lower your blood pressure you tell them all the things they get the pill they that's great you scan it you do all your things you're supposed to do you give them the pill and they say I don't want it what are you going to do next are you going to say oh okay cool throw it away no because that's moper law that's an uh we want them their blood pressure to go down we don't want their blood pressure to stay up okay so we're going to say what we're not going to ask why because we've learned in communication it's not a good thing but we're going to say tell me what's stopping you from taking this medication and they're going to say this isn't the same color as the one I take at home what do you do next you got to verify right you got to stop say oh hold up this isn't the same medicine because that can happen very easily you open the wrong pill oh they did want this one but they didn't want this one and you go back and you say okay hey look this mopol is blue in round and the mopol I gave you is blue and round they are the same medication we have to verify okay different manufacturers make like I just said earlier in the lecture make medications with different additives may change the color they may change the shape it doesn't mean it's a wrong medicine just means it looks different and that's okay and if they say well I only want that one then we can chart hey patient refused because of this okay I explained to them that it's still like same medication and we explain the importance and bl you did all your du diligence it's okay if they refuse but we got to figure out why okay all right evaluation last step so this is when I've done all my things I've assessed identified Pro potential problems I've planned my outcomes I've administered medications and now I'm evaluating the effects okay so I'm mon how do I know if I've evaluated correctly was my goal met I gave them a high blood pressure medicine to lower their blood pressure I've got to recheck that blood pressure to see if that blood pressure went down if it went down right you get a green check if it didn't we need to start back over okay we got to start back over a day and figure it out all right um the overall goal is safe medication administration okay um the other thing is that we want therapeutic outcomes we don't want the adverse effects okay and we want to make sure our teaching is successful how do you know teaching was successful not just them verbalizing it back but the them demonstrating it especially if it's a skill they need to be able to demonstrate it back okay all right so medical errors happen unfortunately all the time if you ask anybody if they've ever met a medical error they're all going to say yes because it happens to all of us all right so we admit ways that we can um easily contribute to Medical errors preventing um omitting one of the rights of Drug Administration which we'll talk about in a couple weeks failing to perform agency system checks okay so scanning armbands um doing certain checks with certain whether I check MRN versus birthday based on your hospital your agency they may have more rules and that's okay more rules are sometimes okay all right so failing to take into account the patients's age body size or renal or hepatic function these are super important because do I give the same dose to an infant that I do a 200 lb 30-year-old man no so we have to take that into into considerations okay so you have to ask questions hey are you sure you want to give this medication this seems like an adult dose and then then you've do you've done your due diligence you documented you did your due diligence and then that the doctor says no I this is the right dose you know the the book says blah blah blah and you say cool I just want to be sure because I felt uncomfortable right um giving medications on verbal or phone orders easy way to make a mistake because people have accents some people don't hear very well okay that's why we don't like to do them very often do they happen yeah but we try to avoid them because I I've been there I've been on the phone with someone and they've been telling me and they're spelling it for me and I have no idea what they're saying just get them to put it in themselves because that way there is no error okay if I can't hear and understand you I don't want to guess okay because then they definitely can have a medical error okay if I can't read their handwriting I can't F I can't do it right so sometimes when down time happens or when computers go out when the power goes out when hurricanes hit you don't have power you're going to be reading orders and if you can't read it you can't follow it don't guess you got a call okay providing unclear directions to patients okay big one you don't tell them how to take their asthma medication they get home they take their medication how they think they're going to take it supposed to take it it's not helping because you didn't give them clear instructions on how to take it and stressful working considerations this is a big one um so a lot of times in medication rooms there's quiet zones okay so they're supposed to be quiet obviously um because when I prepare my medications I and have to do math or do things like that I don't want people talking about their trip to Barbados behind me I don't want them talking to me because I'm trying to focus on what I'm doing um and I don't want to mess up um during a code that's why thing accidents happens because codes are very stressful environments okay that's when we try to give clear roles beforehand so we don't have all that stress okay how can patients prevent um contribute to medication and administ medication errors they can take drugs from several different people okay if you know Dr Nettles wrote a prescription for a tenolol for this patient for their low blood pressure and Dr um Murdoch wrote them a prescription for atin law for their anxiety and they to say hey well these are for two different things this one's for anxiety and this one's for blood pressure even though it's the same drug they may take both and then they've just taken two blood pressure medicines and really mess themselves up they are both for anxiety and for blood pressure so they think they need to take them both but that's not true okay so when be tell go to one doctor um and try to use one that has same charting system so we can all see each other's work right getting prescriptions filled up more than one Pharmacy big big red flag if you're Pharmacy or doctor hopping is what we call it you know we don't like that because we want you to go to one pharmacist that one pharmacist can control all of your meds and see what meds you're on and accurately be able to um give you a recommendation not filling or refilling prescriptions that's a big one what if they can afford it what if they don't know which ones to fill what if they don't know where it's at what if you tell didn't give them the proper education beforehand about which one's more important and they go fill the prescriptions because if you give someone two Med two medications one for pain and one antibiotic and they can only afford one they're picking the pain medicine every time because no one wants to be in pain but they don't know because you didn't give them clear instructions that this antibiotic is going to cure them and that the pain will go away once you're cured okay but if you don't cure it then the Pain's going to last forever or get worse taking medications incorrectly this happens a lot right you didn't give them clear instructions that house um episode where they say she says my inhaler is not working and he says well how are you taking it and she said I'm using it like it's like I'm supposed to he said can you show me how you use it and she shakes up and sprays it on her neck because no one told her how to use it you're supposed to put in your mouth okay they take medicines wrong all the time or they don't follow the instructions or they read the instructions wrong or they can't read it all okay things happen we have to give clear concise instructions okay um taking medications left over from a previous oh my God previous illness that's not supposed to happen if you don't take all of your antibiotics bad things happen and we'll talk about that in affection but you shouldn't have any left over and if you have any left over and then you take it so if my tooth hurts and I have leftover um antibiotics in my FR in my fridge and I I mean in my cabinet and I take them sometimes those uh bacteria that are causing the or the causing the illness learn that that amoxicillin killed me last time and so now when I go to the doctor and you give me another amoxicillin prescription I only took a half a dose last time and now I'm taking a whole dose it said but I still know that drug and you're not going to kill me this time and so that's why we create super infections not good don't take medications lift over from a previous illness don't take medications prescribed by someone else you think this is pretty straightforward but it's not okay so what happens if you go to take give your patient a medication and they say well I took some Tylenol at home you're like oh okay cool cool cool and then that's great you tried at least right and then they tell you that the prescription's expired the pills are expired they don't work either they're going to be toxic or they're not going to work at all so if you ever have a p patient and you take a pill and you see oh this pill expires you know this month or it's you know expired you can't give it you got to throw it away and start over Okay if it's damaged or looks like it's been opened already you can't get it all right so how do these impact people I mean number one you could kill someone you could cause comorbidities you could cause um emotional distress to the patient and yourself because I mean it's not fun making a medical error lengthen hospital stays increase the cost of the patient in the facility because who who pays when you make a medical medical error the hospital okay it also like can penalize people and give you a bad rap so or bad rep so remember that Vanderbilt thing when Vanderbilt was going on with the big um medication error the whole all of Vanderbilt suffered because they all felt like nothing in Vanderbilt was safe okay all right so how do we investigate we investigate errors we say hey this is something's going on we write ourselves up we tell everyone that we wrote that we made a mistake and that's okay that's what you're supposed to do if you hide it we we have problems so we we report all errors even near misses because let's say I go to give my antibiotic and um the pharmacy brings me the antibiotic I have it it's a it's a bag you know for IV they slap the patient label on I did all my checks I did everything right and when I scan the drug it worked but that's where my label is and if I turn it over I see that this medication is Mox ayin and when I turn it over and I read my label my label says bamin those are not the same drugs nowhere close Okay what if Pharmacy puts the wrong label on it but I caught it and I didn't make a medical error I still need to report it because that may someone else may not stop and do that check so we still have to report near misses as well um this way that someone can read it and say hey stop we need to fix our label machine we need to fix this whatever okay so when you when you document um an error you have to document it in the medical record everyone gets to know forever that you made a medical error okay and you have to tell everyone you told so when you make a medical error you have to tell the patient you have to tell the doctor you have to tell your boss you have to write uh incident report all these things okay we have to detail it in the chart who we told when we told what kind of reactions they had from the medications all those things okay because we don't want to miss a problem if if if I am the oncoming nurse and I didn't know that the the morning nurse gave him extra blood pressure medicine I may give him extra blood pressure medicine I may not monitor it I may not you know take that into consideration when I'm looking under his blood pressure being low so that's when we to document it so everyone knows and everyone's up to date and it's unfortunately sucks but you have to do it okay when you report an error you can you also have to do an incident report or like you have to write yourself up for the hospital okay so the hospital has to know hey this is what happened clearly there was a breakdown somewhere and that's what they Ed to identify problems and how to improve upon them okay not a part of the patient record all that or anything like that it's it's for the hospital okay so if you gave if you know you messed up you gave them the wrong drug you gave them the wrong dose something first step is what number one add pie assess my patient okay see if my patient's having any adverse effects usually while I'm seeing at I'm assessing them I'm calling the doctor and saying hey I gave this med I didn't mean to give and blah blah blah blah blah so that they can um they can be aware and like hey I'm monitoring their blood pressure is fine they're you know with it still they're not having any reactions and we're going to watch them closely for 30 minutes to an hour or however long the drug lasts to make sure they don't have these kinds of air problems but number one is I make sure my patient's okay then I can do all this documentation I ain't worried about the documentation I'm worried about my patient so I am assessing reporting the error to the doctor as soon as possible okay Sentinel events are bad bad things that happen Okay this is when someone dies when a physical injury occurs things like that okay so this is when I mean a senal event I've had a patient I didn't have the patient but I know a hospital who had multiple sen like had one like three in one day really bad you're not supposed to have that many um they cut off the wrong P the wrong of the patient which is a big deal okay that's AAL event I I killed someone like that the Vanderbilt nurse who killed the the patient by giving them the wrong meds that's a sensal event okay these are really big events that we have to take into that have to be reported and we do this analysis to make sure that we don't ever do it again okay so the reason nursing has so many errors and problems is because um we are the last step the doctor wrote it the pharmacist filled it checked it I'm the one that's giving it I'm the Reas I'm the reason I save or hurt someone because if I don't do my due diligence I'm going to do something wrong doesn't matter who wrote it who filled it all those things if I gave it it's still my responsibility okay if you don't know the drug and you don't know the side effects you shouldn't give it you need to look it up there are so many ways to look up a medication it's so easy now I hate it when someone when a student comes to me and brings me a med and we're about to go give it and I say okay what is this and they say I don't know or they say I'm like okay what's the biggest side effect they're like I don't know how do you know what to monitor for how do you know what's going to happen to your patient when you go to give this medicine it's so unsafe it it boggles my mind that some people think that's okay like oh I don't know and what is your patient going to ask as soon as you go to give them this medication what is that when you say hey I'm going to give you your mopol they're going to say what is that because that's not how they pronounce it they call it meta prolol and they don't know the difference that that's the same thing oh this is your blood pressure medicine oh this does this they need to know okay because they're gonna ask and if you don't know that's always when they ask all right Med wck so this is your med reconciliation this is what we're talking about when we get the the prescription the the home list okay this is part of the assessment this is how we check and monitor the patient um making sure they're getting their home medications in the hospital so this is how what it looks like okay so like on their hom meds it'll say this is the medication notice on here what information we have we have the name of the medicine the dose the route and the frequency that's it do I have what doctor wrote it when they wrote it when the refill when it expires no well it does have this order expires but that's okay I'm talking about this one right here okay this is what we're talking about that's this is important because if it did expire if you don't take this medication any anymore and someone didn't take it off when you come to the hospital and no one took off this medication that you don't take anymore someone's going to give it to you okay it's a very easy mistake because you didn't do your if you don't do a proper indepth Med wreck you will make an error okay and when they go home they get a med wreck that's the best part okay and I say this is your med reconciliation this is your this is your med list take it with you everywhere okay take it to your doctor next time because every time you go to the doctor you get a new one put on your portal but it also is important to fill this out okay if my patient um gets discharged in the afternoon and I gave them their morning meds of lenil when they get home they're going to say oh I didn't take my meds and they're going to go take their meds again so that's why it's important to fill this out when do you take the next dose well I gave it to you at 10 o'cl this morning so you don't even take it till tomorrow okay that's what this is for you write what day time all that in here okay this just another way of looking at it okay so this order expired so what it means it this means is um in the hospital so don't don't worry about that part what we're talking about is here okay these are just different ways to look at it um effective teaching we've talked about that if your patient doesn't know what they're taking because they never do or why they're taking they're they're out of disservice even if they have to write it down that's okay no one has to know everything but you need to have a written down okay this one's for blood pressure I take it in the morning that's what the whole point of the med wreck is for okay they need to have their herbal supplements their over-the-counter supplements their dietary supplements added in there as well okay um and you need to make it make them feel comfortable to ask questions and tell them the side effects or adverse reactions that could happen so if you don't tell them how are they going to know this is related to the medication and they have to be able to ask questions and that's okay some of them get scared and they don't want to ask because they don't want to seem dumb or they don't want to bother the doctor bother the doctor bother me I don't care I'd rather you be safe than go home and do something crazy okay all right so ways that we reduce errors are Med recks and the ehrs okay ehrs are um electronic health records that I'm telling you they're they're great if you use someone who has the same system they're amazing I had a um I got pregnant in Rhode Island and when I moved back to miss to Louisiana sorry to Mississippi Louisiana they use the same charting system so my doctor in Louisiana could see everything my doctor in Rhode Island did okay so they could just pull pull it all over and then I didn't have to get repeat testing so that's great okay um there's also barcodes barcodes are great when we scan armbands and scan medications it definitely reduces the amount of um errors because we're having a computer check to make sure we have the right patient and the right medication we're still checking on top of them but that's it it really helps okay um so also automated dispens cabinets the root cause analysis we've talked about it just tells you who when where why okay but this is what a Pixis looks like so you have all of your medications in here okay they're locked under a fingerprint you go find so once you sign in you go find your patient you go pick what medication you want and then it pops out what exact cabinet you need or what drawer or what it tells you exactly where it is that reduces errors then me just having a bag full of pills okay all right so that definitely helps this is also the Joint Commission so what we're mainly focusing on is this medication safety okay but still know all of it okay these are how Joint Commission is like the um is an accreditation board and so it's how hospitals can follow the rules and um get funding okay so we make sure we label all medications um if they're not labeled so if you go and pull a medication into a syringe the syringe is not labeled all the time label your syringe okay met label your cup your Basin whatever it is okay take extra care of patients that take blood thinners okay if you if your patients on blood thinners we need to know that's why they need a medical like a a medical alert bracelet if they're on blood thinners because we need to know if they fall they're going to bleed a lot if they hit their head they may die because they're going to bleed in their brain if I give them a medication that there are a lot of interactions with the blood thinning medications food and medication to medication okay so we have to take that into consideration okay record and pass along correct information with patient meds find out what the patient P medicines the patient's taking compare them to the new medications given that's a medre okay it's saying do your med back and do it right okay and make sure they that they have a list to go home and bring to their doctor wherever they're going okay that's why it's important it's literally one of the national patient safety goals okay all right so that finishes our role of the nurse and that is week one down so if you have any questions please put it on the discussion board discussion board is not for you to ask your friends for help it's to ask me for for help or the the instructor for help okay it's a way to get information from me and number one that helps because if you have the same question I've probably already answered it it's not fair if I answer you know Sally and not Betty on these questions Betty didn't know that I answered Sally and clarified this that she was confused on that's not fair so that's why the discussion boards are there so that I can give one good L um EXP explation and then you can learn from it too okay so don't discredit those discussion boards and I would check those before I um while I was studying too to be sure that it wasn't explained differently or better okay um but if you have any questions please ask and that is all