Chapter 6. Non-Parenteral Medication Administration Show
In the Institute of Medicine’s often-cited book To Err Is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000), it is estimated that approximately 1.5-million preventable adverse drug events (ADEs) occur annually. The Joint Commission (TJC) defines medication errors as any preventable event that may cause inappropriate medication use or jeopardize patient safety (TJC, 2012). Medication errors are the number-one error in health care (Centers for Disease Control [CDC], 2013). Safe and accurate medication administration is an important and potentially challenging nursing responsibility. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety. Medication errors have a substantial impact on health care in Canada (Butt, 2010). When preparing and administering medication, and assessing patients after receiving medication, always follow agency policy to ensure safe practice. Review Table 6.1 for guidelines for safe medication administration. Table 6.1 Guidelines for Safe Medication Administration
Technological Advances That Help Mitigate Medication ErrorsComputerized physician order entry (CPOE) is a system that allows prescribers to electronically enter orders for medications, thus eliminating the need for written orders. CPOE increases the accuracy and legibility of medication orders; the potential for the integration of clinical decision support; and the optimization of prescriber, nurse, and pharmacist time (Agrawal, 2009). Decision support software integrated into a CPOE system can allow for the automatic checking of drug allergies, dosage indications, baseline laboratory results, and potential drug interactions. When a prescriber enters an order through CPOE, the information about the order will then transmit to the pharmacy and ultimately to the MAR. The use of electronic bar codes on medication labels and packaging has the potential to improve patient safety in a number of ways. A patient’s MAR is entered into the hospital’s information system and encoded into the patient’s wristband, which is accessible to the nurse through a handheld device. When administering a medication, the nurse scans the patient’s medical record number on the wristband, and the bar code on the drug. The computer processes the scanned information, charts it, and updates the patient’s MAR record appropriately (Poon et al., 2010). Automated medication dispensing systems (AMDS) provide electronic automated control of all medications, including narcotics. Each nurse accessing the system has a unique access code. The nurse will enter the patient’s name, the medication, the dosage, and the route of administration. The system will then open either the patient’s individual drawer or the narcotic drawer to dispense the specific medication. If the patient’s electronic health record is linked to the AMDS, the medication and the nurse who accessed the system will be linked to the patient’s electronic record. Read the Top Ten Tips PDF to review the importance of medication reconciliation. Checklist 43 outlines the steps for safe medication administration.
What is the priority assessment when administering a topical medication?Assess the child's skin integrity before administration of topical medication. Observe for cleanliness and clean off dirt and excess lotions as needed. Assess the condition of the child's skin, noting areas of healing, excoriation, edema, rashes, or increased redness.
How should a nurse apply a topical medication?Before application always wash and dry your hands thoroughly. Topicals should be applied directly to the skin. Apply a thin layer of the cream, spreading evenly over the affected area. They should be spread gently on the skin, not smoothed or rubbed.
Which priority action would the nurse take before administering a new drug quizlet?Which priority action would the nurse take before administering a new drug? Confer with a colleague before giving the medication. Consult with a pharmacist to obtain knowledge about the medication.
What nursing action is most appropriate when applying a new transdermal patch?When applying a new patch, the nurse should remove the clear plastic backing and take care to not touch the medication surface of the patch while placing it on the patient's skin. Patches should be placed on an appropriate skin area per manufacturer guidelines, such as the upper arms or on the chest.
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