Question | Answer |
How many deaths may result each year from medical errors in hospitals alone? | between 44,000 and 98,000 |
How many deaths each year are related to medications? | more than 7,000 |
According the the Institute of Medicine, how many medication errors per day are patients subject to? | at least one per day |
How many people in U.S. each year are injured due to medication errors? | 1.3 million |
How much do medications errors cost the U.S. per year? | $4 billion |
What are 4 reported common medication errors? | wrong medication or dose in IV, dangerous interactions, wrong dose dispensed by pharmacy, wrong dose given by nurses |
What are the 5 of the 10 elements needed for medication safety according the the Institute for Safe Medication practices? | patient information, drug information, adequate communication, drug packaging, labeling, and nomenclature, medication storage, stock, standardization, and distribution |
What are the 5 of the 10 elements needed for medication safety according the the Institute for Safe Medication practices? | drug device acquisition, use, and monitoring, environmental factors, staff education and competency, patient education, quality processes and risk management |
What happens if not all 10 key elements of medication safety are not present? | error occurs |
What are 3 Patient safety goals of 2013 | identify patients correctly
improve staff communication
use medications safely |
How do you identify patients correctly? | use 2 patient identifiers |
2 ways to improve staff communication | get important test results to right staff person on time
standardize list of approved abbreviations |
4 ways to use medications safely | label medications
record correct information about patient's meds
compare new meds to old meds
make sure patient knows what meds to take at home and to take up to date list to doctor |
elements identified in medication preparation assessment | drug
dose
route
frequency
time
rationale |
What should you know about the drug in preparation assessment? | generic and trade name |
What should you know about the dose in preparation assessment? | is it within specified parameters
any abnormal labs
accurate calculations |
What should you know about the route in preparation assessment? | how it is administered
PO
sublingual
intradermal
sub-q
IM
topical |
What should you know about the frequency in preparation assessment? | how often |
What should you know about the time in preparation assessment? | standardized
maximum absorption |
What should you know about the rationale in preparation assessment? | why patient is receiving this drug
patient history
current condition
lab values
drug guide under nursing considerations |
What is our job as nurses according to the rationale in preparation assessment? | know when to hold medications |
What are other areas to assess during preparation assessment? | allergies
other medications on MAR
specific orders to hold medication
specific parameters
is it a STAT, PRN, or one time only order |
What are MORE areas to assess during preparation assessment? | stop order
high alert
patient's swallowing ability
fluid availability/restrictions
acceptable "window" of timely medication administration |
What should you do if patient is having difficulty swallowing when administering oral medications? | put medication in thick substance |
What is the "acceptable window" of timely medication administration? | 30 minutes before or after ordered time to give meds |
3 examples of high alert medications | anticoagulants
narcotics
hypoglycemic medications |
Medication dispensing equipment | MAR
automated dispensing system
bar coding and eMAR
medication cups or syringe
pill crusher or splitter |
Can students directly access automated dispensing systems? | No, must be licensed nurse
instructor
RN caring for patient |
What must you have to dispose of controlled substances? | co-signer of a licensed nurse |
What does administration of insulin require? | double checked by 2 licensed nurses |
What are the rights of medication administration? | right drug
right patient
right dose
right route
right time
right documentation |
procedure for medication administration before arriving at bedside | clean hands
prepare meds for one patient
remove meds per MAR
check medicaiton label with MAR 2 times
place unopened package into med cup |
When should you check medications with faculty? | on the 3rd medication label check |
procedure for medication administration at bedside | identify patient
reconfirm allergies
perform patient teaching
open and administer meds
position patient
assess patient swallows meds
wash hands
document med was given |
When should you leave medications at the bedside? | never |
What are appropriate patient identifiers? | name
date of birth
medical record number |
When should you document that medication was given? | after med was given |
procedure for medications held or refused | document medication held or refused and why
notify physician if needed |
3 reasons why medication would be held | at test
NPO for surgery
not needed |
5 forms of oral medicaitons | solids
capsules
enteric coated
liquids
crushed medications |
Can enteric coated meds be crushed? | no
coated to prevent gastric juices from dissolving meds so it can be absorbed in small intestine |
characteristics of sublingual medication | under the tongue
rapid acting
very vascular area |
example of sublingual medication | nitroglycerin for angin |
where are buccal medications given? | between gums and cheek |
procedure for administering eye drops | clean away drainage
give patient a tissue
extend head upwards
retract lower eyelid
place in conjunctival sac
close eye and press on nasal-lacrimal duct for 30 seconds |
Where should eye drops be administered? | in conjunctival sac |
What should you do after administering eye drops? | close eye and press on nasal-lacrimal duct for 30 seconds |
procedure for administering eye ointment | thin line from inner canthus to outer
do not touch eye with tube |
What should you do after administering eye ointment? | rub eyelid |
Should you wear gloves when administering eye drops? | yes |
procedure for administering ear drops in adult | position on side
pull pinna up and out
instill drops holding dropper 1 cm above ear canal
keep patient on side for a few minutes
apply gentle pressure and massage tragus with finger |
procedure for administering ear drops in child | position on side
pull pinna down and back
instill drops holding dropper 1 cm away from canal
keep patient on side for a few minutes
apply gentle pressure and massage tragus with finger |
How should you straighten out ear canal in adults? | pull pinna up and back |
how should you straighten out ear canal in children? | pull pinna down and back |
Where should you massage after giving ear drops | on tragus with finger |
procedure for administering nasal spray | clear patient passage way
occlude opposite nasal passage
shake spray
insert tip to nostril
squeeze bottle to give dose
inhale while squeezing |
when should patients self administer nasal sprays? | when they are able |
How long should you shake inhalers? | 2 to 5 seconds |
procedure for administering inhalers | shake container
place in mouth
have patient exhale
inhale slowly as inhaler is depressed
hold breath for 10 seconds |
How long should you hold breath after administering inhaler? | 10 seconds |
How long should you wait between puffs from same inhaler? | 20 to 30 seconds |
How long should you wait between puffs from different inhalers? | 2 to 5 minutes |
When should patients self administer inhalers/ | when they are able |
procedure for administering topical medications | absorbed through skin
wear gloves
assure clean skin
apply per order |
procedure for administering paste/transdermal patch | remove old patch
check skin for irritation
apply new patch in new site
squeeze out amount ordered
do not massage
date, time, initial patches |
procedure for administering rectal medicaitons | simms position
only expose rectal area
don gloves
lubricate suppository and index finger
patient take deep breath
insert suppository into anus
remain on side |
How far should you insert suppository in anus of adults | 4 inches |
How far should you insert suppository in anus of children | 2 inches |
How long should patient remain on side after insertion of rectal suppository | 5 minutes |
Equipment needed for parenteral medication administration | syringes
needles
vials
ampules
alcohol swabs |
Syringe size ranges for parenteral medication administration | 0.3 ml to 3 mL |
What are the 3 components of a needle | hub
shaft
bevel |
Needle size ranges for parenteral medicaiton adminstration | 1/4 inch to 3 inches |
what should you assess for parenteral medication administration | circulation
adipose tissue
muscle atrophy |
procedure for administering all injections | assessment
prepare medicaiton
wash hands/gloves
select site
patient in comfortable position
cleanse site
remove cap
hold syringe between thumb and forefinger
inject
dispose in sharps |
purpose of intradermal injections | skin testing |
needle gauge needed for intradermal injections | 25 - 27g |
needle length needed for intradermal injections | 3/8 inch to 5/8 inch |
site of intradermal injection | into dermis
inner aspect of arm |
liquid amount of intradermal injection | 0.01 mL to 0.1 mL |
procedure for intradermal injection | needle angel 5 to 15 degrees
pull skin taut, insert bevel up
do not aspirate
inject solution slowly
small bleb |
is intradermal test valid if bleb does not appear? | no |
purpose of subcutaneous injections | slow absorption
sustained effect |
syringe size for subcutaneous injections | 0.5 to 3 mL |
Needle gauge for subcutaneous injections | 25 to 27g |
needle length for subcutaneous injections | 3/8 to 5/8 inch |
sites for subcutaneous injections | abdomen
thigh
back
ventrodorsal gluetal area |
liquid amount of subcutaneous injection | 1mL or less |
procedure for subcutaneous injection | choose site
cleanse site
pinch skin
inster 45 to 90 degrees
release tissue and inject slowly
remove and apply gentle pressure
discard in sharps container |
If you grasp 2 inches of subcutaneous tissue what angel should you insert the needle at? | 90 degrees |
If you grasp 1 inch of subcutaneous tissue what angle should you insert the needle at? | 45 degrees |
Is it necessary to aspirate with subcutaneous injections? | no |
What route is insulin administered? | subcutaneously |
What is sliding scale for insulin based on? | blood glucose level |
What does insulin do? | controls blood glucose levels |
What should you monitor before giving insulin? | blood glucose level
are they going to eat |
Does insulin need to be verified? | Yes with 2 licensed professionals |
With what insulins should you administer withing 15 minutes of eating? | short acting or regular insulin |
What does long acting insulin look like in vial? | cloudy |
What does short acting or regular insulin look like in vial? | clear |
In what order should you draw up insulins | clear into cloudy
short acting into long actin |
What is the onset of rapid acting insulin? | 15 to 30 minutes |
What is the peak effect of rapid acting insulin? | 1.5 to 2.5 hours |
What is the duration of action for rapid acting insulin? | 3 to 6.5 hours |
What is the onset of short acting insulin? | 30 to 60 minutes |
What is the peak effect of short acting insulin? | 1 to 5 hours |
What is the duration of action of short acting insulin? | 6 to 10 hours |
what is the onset of intermediate acting insulin? | 1 to 2 hours |
What is the peak effect of intermediate acting insulin? | 6 to 14 hours |
What is the duration of action of intermediate acting insulin? | 16 to 24 hours |
What is the onset of long acting insulin? | 1 hour |
What is the peak effect of long acting insulin | plateau |
what is the duratiton of action for long acting insulin? | 24 hours |
What should you check when giving coumadin (po)? | INR |
What should you check when giving heparin? | PTT (partial thromboplastin time) |
what should you check when giving lovenox? | clearance is predictable and requires little monitoring
if needed use PTT insensitive |
What sites should you avoid when giving anticoagulant injection/ | ecchymotic
scars
lesions |
Site of anticoagulant injections | lower abdomen fat pad |
do you aspirate when administering anticoagulant injections? | no |
purpose of intramuscular injections | promote rapid absorption
irritating medicaitons |
syringe size for intramuscular injections | 1-5 mL |
needle gauge for deltoid injection | 23-25g |
needle gauge for vastus/ventrogluteal injection | 18-23g |
needle length for deltoid injection | 5/8 inch to 1 inch |
needle length for vastus/ventrogluteal injection | 1 to 1.5 inch |
Sites for intramuscular injections | ventroglueteal
vastus lateralis
deltoid |
liquid amounts for intramuscular injections in adults | up to 3mL |
liquid amounts for intramuscular injections in old adult and thin patients | 2mL |
liquid amounts for intramuscular injections in infants and small children | 1mL |
procedure for administering intramuscular injections | choose site
clean site
pull skin taut in z track fashion
insert needle at 90 degrees
aspirate, if no blood inject slowly
remove needle and apply gentle pressure
discard syringe in sharps contain |
What is the preferred method for all IM injections? | z track |
define z track fashion | laterally 2.5 to 3.5 cm and hold until medication injection |
landmarks for deltoid injections | 1 to 2 inches below acromion process
four fingers across deltoid |
advantages of deltoid intramuscular injection | faster absorption
easily accessible with minimal exposure
less pain
fewer local side effects |
disadvantages of deltoid intramuscular injection | small muscle limits liquid amount
possible radial nerve and axillary nerve damage |
liquid amounts for deltoid intramuscular injection | 0.05 to 1.0 mL |
landmarks for vastus lateralis injection | greater trochanter and lateral femoral condyl
mid 3rd and anterior lateral aspect of thigh |
advantages of vastus lateralis injection | large muscle tolerate large amount of fluid
easily accessible |
disadvantages of vastus lateralis injection | thrombosis of femoral artery from injection of mid thigh
more painful site |
landmarks for ventrogluteal injection | greater trochanter, palm at site
point index finger toward patient's groin
middle finger along posterior iliac crest
form "V" |
advantages of ventrogluteal injection | free of important nerves/vessels
easily identified
accommodates large amount of fluid
less painful |
disadvantages of ventrogluteal injection | nurses are unfamiliar with site |