CH MedAdmin

8/12/2019 CH MedAdmin

1/28

Medication Safety and

Administration

Update June 2009, K.Klee

Medication administration for nursing

students in clinical at Seattle Childrens


2/28

Objectives

Describe appropriate methods of medication deliveryfor different ages.

Accurately document medications per hospital

policies and procedures. Safely administer medications.

Know standards of practice specific to caring forchildren at Seattle Childrens

Know limitations of student responsibilities at SeattleChildrens


3/28


4/28

What you need to know.

Medication errors happen

Near misses happen (when an error is discovered

before it gets to the patient)

Injury and even death happens from medication

errors.

You are part of the team and you

can help prevent errors by talkingwith your instructor when you areunsure, overwhelmed, or new to atask


5/28

What Can You Do To Decrease Medication Errors?

Check and double check, if in doubt check it out, again!

Follow the 5 Rs: right patient, right drug, right dose,right time, right route

Never assume, pharmacy put the medication in thedrawer so this must be right, pharmacy makes errorstoo.

Never assume, the resident ordered this large dose soit must be right, Residents make errors too.

Know the correct mg/kg dose of medications you areadministering.

Know why you are giving the medication, the expectedaction, and any potential side effects.


6/28

Time for a story


7/28

Story: Admission of a patient

3 month old

admitted with

respiratorydistress most

likely due to

bronchiolitis

Admitting Nurse: I did his

admission assessment and then

it was time for change of shift so

I gave report to the next nurse

Oncoming Nurse:I received

report at 7 p.m. and was

reviewing the orders and sawthat he had some medications

due


8/28

I saw that he had some medications due

Infants Nurse:The infant hadreglan and digoxin

ordered BID. Theywere due at 8pm. Iwent to themedication room

and the meds werein the drawer so Itook them into theinfants room.

What are the next steps to take?

5 Rs

What questions do you have?

What are the clinical

indications for these two medsin this infant

You go into the room to give themedicationswhat steps do youtake?

Patient ID check, tell patientand family what meds you areadministering and what they arefor


9/28

I took the medication into the room

I looked at the online formularyfor reglan and digoxin and sawthat they were ordered in thecorrect dose and route. I checked

the labels on the syringe anddouble checked the dose againstthe order on the medicationadministration record. I took themedications into the infants room,checked his ID band, and told

mom I was giving digoxin andreglan.

Looked meds up on theonline formulary

Checked the dose

Checked the medTook labeled syringes to ptsroom

Checked the ID band againstthe name on the med andasked mom to verify date of

birthTold mom what meds wereabout to be administered


10/28

I told mom I was giving Digoxin and Reglan..

She said, at home Igive the reglan, theother medication must

be a new one.I told her it wasordered by the doctorfor the babys heart.

Mom said, is theresomething wrong withhis heart?

What do you do?


11/28

Mom said is there something wrong with his heart?

I said let me double checkhis chart.

I left the room and looked

at the chart, he was here forrespiratory distress. I did notsee anything about a heartproblem.

I called the resident and he

said he did not know of anyheart problems in thispatient.

I called my charge nurse.

The charge nurse called

the senior resident who

said the child had no

cardiac issues andshould not have an order

for Digoxin.

Turns out the order was

electronically placed inthe wrong chart.


12/28

What if mom had not been there?

Always! Ask

yourselfwhat were the

indications for digoxin inthis infant?

Know why you are

giving a medication andthe indication in your

patient!


13/28


14/28

What Else Can You Do To Decrease Medication Errors?

Stop the line, if you have concerns or questions do not give themedication until you feel the concerns/questions have beenanswered.

If a patient or caregiver says, hmm, that pill does not look familiar,

or the doctor said not to take that today, or I already took that pilltoday, or anything that might indicate an error is about tooccur.stop, pick up the medication and leave the room. Doublecheck the medication and if necessary call the MD to clarify theorders.

If you have to pull 2 vials of a medication out of omnicell or need alarge quantity of a medication stop and recalculate with a peer. Thisis pediatrics! Medications doses are smallerthen adults and aregiven in mg/kg!

Harried? Tired? Distracted? Triple check yourself!


15/28

1.Documentation of medication dose, time,date, route must occur every time amedication is administered, at the time ofadministration.

2.Documentation occurs on the medicationadministration record (eMAR) in CIS3.If you give a scheduled med late you must

document the actual time given.4.If a scheduled med is not given you must

document not given and document thereason why..

5.You must have medications cosigned by aninstructor or the RN caring for the child

Medication administration documentation


16/28


17/28

Nursing Student Responsibility

Nursing students do not take verbal/telephone

orders from physicians

Nursing students do not receive critical lab

values from the Laboratory

Nursing student do not alter alarm

settings(change alarm parameters,turn off

alarms) Nursing students do not administer any

chemotherapy agents (oral or IV)


18/28

Nursing Student Responsibility and

Patient Safety

Nursing students do not give IV pushmedications EVER! (exception: normal saline(NS) and heparin flush in a PIV only)

Nursing students do not administer blood or blood

components Nursing students do not do Ventriculostomy care

or maintenance

Nursing students do not administer narcotics,

paralytics, or vasopressors via pump or drip Nursing students may not independently program

any infusion pumps


19/28

1.You must give medication under the directsupervision of a nursing instructor unlesssupervision has been prearranged with the

instructor and the RN caring for your patient.2. If you give a scheduled med late you must

document the actual time given.3.If a scheduled med is not given you must

document not given and document thereason why..

4.You must have medications cosigned by aninstructor or the RN caring for the child

Medication administration documentation


20/28

Faculty Responsibility

Directly supervise the administration of medications. When thestudent has demonstrated adequate knowledge and good technique,s/he may give medications (except IV meds) with staff nurseavailability. This must be pre-arranged between the faculty and staff

RN. All student medication administration is to be directly supervised by

clinical faculty or staff nurse. The supervising RN (faculty or staff RN)will co-sign the MAR.

From P&P: RN reviews and co-signs documentation andmedication administration. Writes I agree/concur with abovedocumentation and/or add any additional documentation. (Note:LPNs may not co-sign RN student nurse medication administrationdocumentation).


21/28

Wow, that is alot of to dos

and not todosbutultimatelykeeping kids

safe is our goal!


22/28

Documentation

If you do not chart it, itdidnt happen.

What if you gavetylenol at 0630 and forgotto chart it. The next nursecomes on and the child

has a fever so the childgets tylenol again at0730


23/28

Some hints from the wise

Always check name band prior to giving

any medications.

Always check to see that ordered dose isappropriate based on weight.

Always look up medications unfamiliar to

you before leaving the medication room.


24/28

Pt Safety

Never leave medications unattended at the

bedside or at the nursing station.

Never leave medications unattended!

We are protecting the patients, siblings, friends,

and young visitors that may be curious and

ingest a medication left unattended.

Think Safety!


25/28

Pt Safety

Never leave the medication room with a syringe

unless it has a label on it that includes the patients

name, dose, and name of medication.

JJ Amoxicillin 250 mg


26/28

On line order entry is greatbut

It is not fool proof

Errors still occur

Always know when the last dose wasgiven and frequency of dosing

Note start and stop dates especially

on weaning schedules Watch for duplicate orders


27/28

Patient Safety

Check and double check

2 patient identifiers (name/DOB or name/MRN)

before any medication or intervention Know why you are giving the medication and

that the reasoning matches the pts clinical

state/diagnosis

Listen to your instinct

Listen to the family


28/28

Thanks!

Documents

CH MedAdmin