Intro Dosage Calculations Sn

8/4/2019 Intro Dosage Calculations Sn

1/32

Introduction

Marcia Brown1


2/32

Tools for Success in Dosagea cu at ons

Practice! Practice!! Practice!!!

Use the on-line math review and web resources See internet resources under Course Documentweek 1

Attend class regularly and bring your textbook

Make an appointment to review your DC quiz results with theprofessor

One-on-one math tutoring is available 5 days/wk. Contact thelearning centre in the library to book an appointment.

Marcia Brown2


3/32

Permissible Calculators Basic, non-programmable, 8-digit calculators must be used.

Calculators must not have metric conversions.

Calculators must not have the capacity to store information (i.e.formulas).

Calculator must be removed from case and/or cover.

Ensure the calculator is not set to automatically round your

calculations.

touched.

Each student must have his or her own calculator. Calculators

. Substitutes for calculators are unacceptable (i.e. cell phones,

pocket organizers).

Marcia Brown

Calculators with large digit displays are unacceptable.

3


4/32

Medication Administration and Criticaln ng

Calculate doses in an or anized s stematic manner

Estimate what is reasonable amountof drug to be administered

understand.never assume!

Marcia Brown4


5/32

Medication errors can be classified into three main

types: Commissions

Omissions

Near-miss events

All medication errors result in potentially negative

outcomes for the patient, including near or actualdeath

Marcia BrownCollege of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors 5


6/32

Medication errors are reventable events associated

with four phases:

Prescribing

Administerin

Marcia Brown6


7/32

What causes medication errors?Errors often reflect a problem with the medication system

nvo v ng one or more o e me ca on p ases.

departments (i.e. a medication error may involve the

nurse, physician/prescriber, and pharmacist)

Medication errors can result from:

Human Factors

Marcia Brown

College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors

7


8/32

Human Factors Reduce the probability of medication errors caused by human

factors:

Follow the rights of medication adminstration Document during or after medication

a m n s ra on

Be knowledgeable about the medication

Provide clear directions for use of the medication

Perform an inde endent double check of our

calculations

Keep your patient informed of their medications

Marcia Brown

n orme pa en s re uce e r s o me errors

8


9/32

Systems IssuesMedication errors resulting from system issues

may involve:

Workload and staffing issues

. . ,pumps)

Confusing drug names (sound alike or similarspe e rug names

Drug Manufacturer (similar labels for differentdrugs, medications that look the same)

Using Trade names versus Generic drug names


Marcia Brown

ana a

9


10/32

Medication ReconciliationMedicationreconciliationisaprocessintendedtopreventmedicationerrors. Allmembersofthehealthcareteammaybeinvolved.1. Createanaccuratelistofallcurrentmedicationsandthetimeoflast

dose

2. Physician/designateshouldusethelistwhenwritingadmissionorders3. Comparethelistwiththeadmissionmedicationorders4. Identifyanydiscrepanciesandnotifytheprescribertomakethe

appropriatechanges5. Communicatethecurrentlistofmedicationstotheclientandcaregivers

.

ensure

theclientsmedicationsarereconciledattransfer/discharge

Marcia Brown

CollegeCollegeofNursesofOntario.(2008).MedicationPracticeStandardofNursesofOntario.(2008).MedicationPracticeStandard10


11/32

ISMP CanadaThe Institute for Safe Medication Practices

An independent, non-profit CanadianAgency established for the collection &analysis of medication error reports and

the development of recommendations forenhancement of patient safety.

Encoura in a Culture of Safet

Marcia Brown11


12/32

When a Medication Error Occurs

w a s your nurs ng respons y

ssess your pat ent

Notify the physician/prescriber and pharmacy

Monitor and treat your patient as required

Talk to your patient, explain what happened andw at ntervent ons are necessary

Document the medication error and actions

a en


Marcia Brown12


13/32

To understand the root cause of medication errors, nurses

need to report all errors.

,

Reflect on the incident:

What happened? Why did it happen? How can it beprevented from recurring?

Seek out assistance, learning resources/courses

safety

Marcia Brown

o ege o urses o n ar o. . e ca on rac ce an ar : e ca on errors

13


14/32

Abbreviations, Symbols, and Dose

es gna onsThe use of some abbreviations, symbols, and dose

of serious and even fatal medication errors.

Can anyone read the written order below?

Marcia BrownISMP Canada, (2006). Safety Bulletin. 6 (4). 14


15/32

A list of commonl used abbreviations is osted on Bb

under course document. See also Pickar p. 106

Do Not Use: Dangerous Abbreviations, Symbols and DoseDesignationsPlease see p. 77of Lilley 2ed as well as.

Abbreviations can vary among institutions and users.

check your hospital policy for acceptable abbreviations

Marcia Brown15


16/32

Can you interpret these orders?

a) morphine 10-15mg IM q4h prn

b) aluminum hydroxide 30.0 mL po pc tid

c) Tylenol supp 650 mg PR stat

d) penicillin G 500 000 iu IV qid

According to ISMP Canada,Why is it problematic to use a trailing zero?

Marcia Brown

y s t pro emat c to use t e a rev at on u

16


17/32

Can vary greatly in terms of content and

It is important to develop the habit of readinglabels thoroughly

Marcia Brown17


18/32

D = Desired dose Ordered in unit of measure

, ,

H = Strength available

Have on hand in unit of measure

available mg, g, units Q = Quantity

Unit of measure that carries whatis on hand cited in

H - tabs mL ca s

x= Unknown

Number of Qs needed to givethe prescribed dose

Marcia Brown18


19/32

.

2. Place info in formula and label terms.

4. Apply logic test for reasonable answer

.

6. Label answer with correct unit of measure

equivalents when possible metric is the principalsystem used for medications

Marcia Brown19


20/32

Mr. Pete was ordered amoxicillin 0.5 g q8h. How many capsules will the

nurse administer to Mr. Pete for his afternoon (1400) dose?

Show all calculations

Marcia Brown20


21/32

relationship

two equal ratios

quantities

an equation =

E.g. 5:10

10:20

. .

10 20

Marcia Brown21


22/32

Ratio and Pro ortionIn a proportion, the product of the means

equals the product of the extremes.

Marcia Brown22


23/32

-,

products are equal -

Example:

Marcia Brown23


24/32

med calculations ,

ordered dose is 25 mgone unknown: xmL

,

Sequence mustmatch

Example: mg : mL = mg : mL (left sequencematches right sequence)

Marcia Brown24


25/32

50 mg 25 mg

1 mL mL

x

50 = 25x

=

50 25

x

50 50= 0.5 mLx

Marcia BrownMarcia Brown25


26/32

Ratio and Proportion: Key

Points

measure beforestarting calculations

the medication is available

onver n e rec on a e m na esdecimals whenever possibledecimals

are sources or error

Marcia Brown26


27/32

Ratio and Proportion: Key

Points

State unknown or desired second

eep e t an r g t s es n matc ng

sequence mg : mL = mg : mL

Label all terms, including x

Make mental estimate of logical answerfirst

Marcia Brown27


28/32

Practice Ratio and Proportion

MethodMr. Pete was ordered amoxicillin 0.5 g q8h. How many capsules will the

nurse administer to Mr. Pete for his afternoon (1400) dose?

Show all calculations

Marcia Brown28


29/32

Calculating Doses Involving

Tablets & Capsules Choose the dose stren th that allows the least number

of tablets/capsules to be given.

When possible, choose a dose strength that does notinvolve breaking tablets.

Alwa s consult a dru reference or harmacist before

piercing/opening a capsule or crushing a tablet

Marcia Brown29


30/32

What dose strength would you

choose?.

Marcia Brown30


31/32

When are oral liquid

medications preferred?

. .gastric tubes)

Young children, infants, elderly clients

When medications are ordered that cannot be

Marcia Brown31


32/32

Measurin Oral Li uids Pour liquid medications at eye level on a flat surface

.

different medications

When would a syringe be used to draw up an oralliquid?

Should tablespoons or teaspoons be used to

Marcia Brown

measure ora qu s

32

Documents

Intro Dosage Calculations Sn