Before administering any medication, check the Medication Administration Record, or MAR, against the provider's orders. The best way to prevent medication errors is to ensure the six rights of medication administration, as shown in that video skill. Begin by reviewing the medication order, which should include the patient's full name, the name of the drug, the dosage, the route of administration. The frequency or timing of administration, the indication for use, if it's a PRN order, and the date on which the order expires. The order must be signed by the prescriber.
Hi, Dr. Jenkins. This is Jessica. I'm calling about Veronica Adams in room 404. To avoid errors, consult the prescriber about any illegible handwriting, an unusually large or small dose. or an order that seems incomplete, incorrect, or inappropriate for the patient.
Once you begin medication administration, don't let anything interrupt the process, and use these error prevention tips for each of the six rights. Begin with the right medication, comparing the drug label with the MAR three times, once before removing the drug from the drawer or shelf. Once, before placing the drug in a medicine cup or taking it to the patient's room. And once again, before administering the drug at the bedside. If the patient questions the medication you've prepared, withhold it until you can recheck the preparation against the order.
And if a drug ever seems inappropriate for the patient's condition, check with the prescriber. I have your thyroid medicine for you. I usually take this once a day. Okay, let me check on that for you.
Next, make sure you have the right dose. If you need to calculate a dose or conversion, double-check your calculations. Hi, Cindy. Can you verify this with me? Sure.
Then verify them with another nurse. That's what I got. Okay. Thank you.
If you have to administer part of a tablet to ensure the right dose, use a cutting device and split only tablets that have been scored by the manufacturer. If possible, determine if the pharmacy can split the pill or encourage the healthcare provider to order medications that do not require splitting. To crush a tablet, pulverize it and mix it with a small amount of food or a little liquid. If mixing with food, ensure there is no incompatibility. Of course, sublingual, enteric-coated and time-release medications must never be crushed.
The medication crusher should be thoroughly cleaned after each use. To ensure that medication is always given to the right patient, use at least two identifiers. For example, check the patient's ID band and then ask the patient to state his or her full name and birth date. If the patient's ID band is illegible or missing, obtain a new one for him.
Mrs. Krasinski. If your patient is confused or unresponsive, compare the information in the MAR with that printed on the patient's ID band. Make sure you know the right route of administration for each medication you administer.
Use oral syringes for oral and enteral medications. And use parenteral syringes for injectable medications. Label all syringes at the point of preparation with the drug. Dose. and root.
Consult the prescriber immediately if the root is missing, the specified root is not the recommended one, or the specified root is contraindicated for your patient's condition. For example, if the prescriber has ordered a Tylenol capsule for pain in a patient who has become nauseated, ask the prescriber about switching from oral Tylenol to the same drug delivered by suppository. Keeping in mind the right time to give a medication and making adjustments as necessary will also help prevent errors. For example, if a drug is to be given one hour after a morning meal, ask a team member when he had breakfast and how much solid food he ate. Then administer the drug accordingly.
Or suppose a patient is to receive one drug, Q8H, or every eight hours, and another drug, TID, or three times a day. Since both drugs are to be given three times within 24 hours, it makes sense to determine if they can be given together. Remember that a Q8H drug must be given around the clock to maintain a therapeutic blood level.
A TID drug, however, is given during waking hours and can be scheduled around the patient's activities. To make sure you prepare the right documentation, Be sure to record all medications as soon as they're given. Timely, thorough, accurate documentation can prevent errors, as explained in the video skill, Documenting Medication Administration.
If a medication error does occur despite your best efforts, follow up by reporting it according to agency policy and by intervening for the patient, such as administering an antidote, withholding the next dose, and monitoring the patient as appropriate.