Medication

Question 1

What is medicine?

Answer 1

Chemical substance given with intention of preventing, or alleviating disease, or enhancing mental and physical welfare

Question 2

A medication containing a substance in the NSW Poisons List;

Answer 2

• Schedule 2: “Pharmacy Medicine” (pharmacy ‘over the counter’ medication)
• Schedule 3: “Pharmacist Only Medicine” (pharmacist controlled ‘over the counter’ medication)
• Schedule 4: “Prescription Only Medicine” ( ‘restricted substance’) stored away from the patient, locked drawer/cabinet
• Schedule 8: “Controlled Drug” ( ‘drug of addiction’)

Question 3

Storage of Medications

Answer 3

• Schedule 2, 3, 4 and unscheduled medications must be stored out of patient and public areas
• Preferably in a locked room or cabinet securely attached to the wall or floor of the premises, with the following exceptions
• On a medication trolley used for medication rounds, which should be kept in a locked room when not in use
• In a secure cabinet (such as a bedside cabinet) including that used for patient self- administration in an approved program, in situations for which it may be impractical to attach the cabinet to the wall or floor of the premises
• Schedule 4 and Schedule 8 medications must be stored and locked behind 2 areas (locked door and in a secure safe)

Question 4

Types of medications required in the intra operative (pre and post op) stages

Answer 4

Analgesia- simple, Nonsteroidal anti- inflammatory drugs, opiates
Antipyretic
Antiemetics
Anticoagulants
Antithrombotic
Antibiotics
Regular medications- Antihypertensive

Question 5

Variety of routes- depends on patients conditions

Answer 5

Oral/ enteral- PO or enteric coated
Rectal- PR
Intravenous- IV
Epidural- Epidural
Subcutaneous/ Sub
Intramuscular- IM
Sublingual- subling
Nebulised- neb
Topical- topical
Naso gastric- NG

Question 6

Trade Name

Answer 6

• Every medicine has a brand name, which is given by the pharmaceutical company that markets the drug
• (R) - registred trade mark symbol

Question 7

Generic Name

Answer 7

The drugs active ingredients that makes it work

Question 8

The advantage of using MIMs- role of the nurse (Medical Inventory Management System)

Answer 8

Composition
Class
Action
Indication
Contraindication
Precautions
Adverse reactions
Dosage and administration

Question 9

High Risk Medications

The medications include (but are not limited to) the APINCH high-risk medicine groups

Answer 9

Anti-infective agents and 
Potassium and other electrolytes, and 
Insulin and 
Narcotics (opioids) and other sedative agents, and 
Chemotherapeutic agents, and
Heparin and other anticoagulants

Question 10

Consumers at risk- examples of risk factors known to predispose people to adverse event

Answer 10

• Age 65 or older
• Currently taking 5 or more regular medications
• Taking more than 12 doses of medication per day
• Suspected non- compliance or inability to manage medication related therapeutic devices
• Literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties
• Patients attending a number of different doctors, both general practitioners and specialists
• Recent discharge from a facility/hospitals (in the last 4 weeks)

Question 11

Medication errors

Answer 11

• Second frequently reported incident type after falls
• Environmental factors→ Inadequate staffing levels, high workloads, noise, distractions, poor lighting, untidy, cluttered or inadequate workspace, working on call/shift/long hours
• Team Factors→ Accessibility of clinical info, layout of charts and records, availability of resources- guidelines references
• Individual factors→ Physical health, feeling hungry/thirsty, tired, mental health- stressed/distracted/having low morale, insufficient knowledge and skills/training/experience to perform tasks required
• Patient factors→ Familiarity with the patient, condition of the patient, ability of the patient to communicate, acuity of problem

Question 12

Causes of wrong drug errors

Answer 12

• Confusion between drug names, labels and packaging are important sources of medication error
• Drug names often sound similar when spoken and may look similar when written down
• The packaging and labelling of different products may look similar and cause confusion

Question 13

General pathway of medication use

Answer 13

• Those administering medicines also play an important role in identifying, prescribing and dispensing errors before they reach the patients
• Adverse drug reaction (ADR): a harmful, unintended reaction to medicines that occurs at doses normally used for treatment
• Near misses- i.e. labelling issues

Question 14

The National Inpatient Medication Chart (NIMC)

Answer 14

• The NIMC standard published by the Australian Commission on Safety and Quality in Health Care is adopted as policy in all NSW Health Facilities
• The NIMC (acute) is a medication chart designed for patients in acute care. It is used across health service organisations in medical and surgical wards, emergency departments and intensive care units

Question 15

National Inpatient Medication Chart (NIMC)

Answer 15

• A medication order on a medication chart must clearly specify
• The medication’s active ingredients and/or proprietary name (where approved for use at the facility) with the strength, form and route of administration and
• The indication for treatment (if applicable) and
• For a ‘regular’ medication
• The dose to be administered
• The frequency and times for administration to the patient
• The maximum number of doses or the maximum duration of treatment with the medication (except where the prescriber’s intention is for the duration of the medication chart)

Question 16

Prescribing- medication selected and prescribed

Answer 16

• Comprehensive medicines assessment prior to any decision to prescribe a new medicine
• Patient’s GP
• Patient’s community pharmacy
• Patients own medications
• The patients family members or carers
• Info from previous admissions
• The patient’s medication list
• The history is used as the basis for therapeutic decision making, for ensuring continuity of regular medicines while a patient is in hospital and to identify adverse medicines events

Question 17

Dispense

Answer 17

• Review prescription by pharmacist
• Prepare and dispense medication
• Deliver medication
• Pharmacy review in green

Question 18

Administering

Answer 18

Review prescription- clear, legible and not open to misinterpretation
Prepare medication
Administer medication to patient

Question 19

Administering: Always remember the following safety checking list

Answer 19

• Right patient that matches the patient ID on the NIMC, the label on the dispensed medicine and is confirmed by the patient using three identifiers
• Right drug (that matches the order and the patient’s condition)
• Right route (that matches the order and is appropriate for the medicine and the patient
• Right dose (that matches the order and is safe for the patient)
• Right time (that matches the order and its frequency and administration time directions
• Right documentations- Ensuring it is correctly dated/time and initials

Question 20

First check of administration (speak to the patient and check the chart and ID band)

Answer 20

• Checks patient’s identity against medication chart
• Ask patient to state name and DOB
• Checks patient name, Medical Record Number and DOB on arm-band against details on the medication chart
• Ask patient for allergies
• Checks medication order for legality- Right drug, route, dose, time (confirm it hasn’t been given to patient)
• If concerned, stop and clarify

Question 21

Second check - Against medication chart and medication

Answer 21

• Correct medication is selected to dispense
• Performs 5 rights by checking the medication against the medication order- Right patient + allergy status, drugs, route, dose and time and expiry date of the drug
• Calculates the required dose and ensures correct dosage is dispensed using proper hygiene
• After dispensing the medication, check the medication against the order a final time- right drug, route, dose, time and expiry date

Question 22

Avoiding product selection errors

Answer 22

• A final double- check is essential
• After you have selected and prepared the product, the very last thing you should do is a re-check thoroughly against the prescription
• Always check your own work, regardless of whether a second person is checking
• Individual bedside medication lockers have been shown to dramatically reduce medication errors caused by incorrect selection

Question 23

Third check

Answer 23

• Checks patient’s identity: ask patient to state name and DOB
• Checks patient name, medical record number (MRN) and DOB on arm-band against details on the medication chart
• Ask patient for allergies/ previous adverse drug reaction and verifies this info with medication chart
• If medication has allergic consequences student to withhold

Question 24

Post administration- nurses responsibility

Answer 24

• Documenting the administration
• Monitoring the effect of the medication
• Proper and complete entries on the medication chart

Question 25

Safety checklist

Answer 25

- Doses must be prepared for only one patient as a time and immediately before the intended use - Due to risks of contamination, potential instability, potential mix up with other medications - Maintain security of the medication - Oral liquid medications must be administered in a medication cup or the use of the ‘orange syringe’

Question 26

What are the 2 most common types of medication incidents that occur in hospitals?

Answer 26

``` Omission of a required drug Under dose Overdose Medication given to wrong patient Medication given by the wrong route ``` A: Omission and overdose are the most common types of medication incident

Question 27

Omissions

Answer 27

``` Might not be administered Oversight The nurse is unaware of the order The medication cannot be physically administered No stock is available ```

Question 28

What do you think is the most common cause of medication errors

Answer 28

- Failing to read or mislead the medication chart - Failing to consider the patient's renal function - Similar sounding drug names - Similar looking packaging of different medications A: Failing to read or mislead the medication chart. Prescription or order errors and unclear or incomplete order are the next 2 categories

Question 29

Wrong dose

Answer 29

- Doses must be written using metric and Arabic e.g. 1,2,3 etc systems - Never use Roman numerals eg. i, ii, iii etc - Always use zero before a decimal point. Eg. 0.5g otherwise the decimal point may be missed - However if possible, it is preferable to state the dose in whole numbers, not decimals e.g. write 500mg instead of 0.5g or write 125 microgram instead of 0.125mg - Never use a trailing zero (.0) as it may be misread if the decimal point is missed (e.g. 1.0 misread as 10) - Don’t use U or IU for units because it may be misread as zero. Always write units in full.

Question 30

Error prone Abbreviations

Answer 30

- Ug, mcg mistaken for ‘mg’ → you should write “microg”, “microgram” instead - O.d or OD- once daily- mistaken for BD → you should write “daily” instead

Question 31

Consequences of medication errors

Answer 31

- 20% result in some degree of harm, 3% significant harm, including death - It can be difficult to deal with errors without apportioning blame to one individual. When an incident or near miss occurs it is easy to put it down to “human error” - But this is too simple, this approach does not address the reasons why the person made the error - Usually failures or shortcomings within the organisation (system failure) can be identified as factors that contributed to the error. By acknowledging and acting on system failures we can prevent future errors from occurring

Question 32

Open Disclosure

Answer 32

- When any clinical incident has an adverse outcome, the patient and family should be informed. The process of open disclosure uses a structured format to assist senior staff member to discuss incidents with patients - Open discussion of an incident that has resulted in harm to a patient receiving care. You should always speak with your supervisor before discussing a clinical incident with a patient.

Question 33

Points to remember

Answer 33

- The same person should select, prepare, administer and record the administration - On 3 occasions confirm the 5 rights and ensure you have a legal order- check your patient, chart and ID band and medication - Preparing the medication including checking the medication's name, strength, route of administration and expiry date against the order - Re-checking the point of administration to the patient with the patient's identification, known allergies and other appropriate patient parameters - Documenting the administration - Monitoring the effect of the medication - Proper and complete entries on the medication chart

Question 34

Administration Times: Morning

Answer 34

Mane

Question 35

Administration Times: Night

Answer 35

Nocte

Question 36

Administration Times: Twice a Day

Answer 36

BD

Question 37

Administration Times: 3 Times a Day

Answer 37

TDS

Question 38

Administration Times: 4 Times a Day

Answer 38

QID