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Medication safety and administration
This document provides guidance for nursing students on safe medication administration at Seattle Children's hospital. It outlines key objectives around appropriate delivery methods, documentation, and safety. It emphasizes the importance of preventing medication errors and describes steps students should take like checking the 5 rights, knowing drug indications, and consulting instructors with any uncertainties. The document also outlines nursing student limitations and responsibilities to ensure supervision and follow hospital policies. It provides a case example of catching a wrong medication order and emphasizes always verifying orders match the patient's condition. Overall, the document stresses meticulous processes, communication, and vigilance to maintain patient safety during medication administration.
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Medication safety and administration
- 1. Medication Safety and Administration UpdateJune 2009, K.Klee Medication administration for nursing students in clinical at Seattle Childrenâs
- 2. Objectives ⢠Describe appropriatemethods of medication delivery for different ages. ⢠Accurately document medications per hospital policies and procedures. ⢠Safely administer medications. ⢠Know standards of practice specific to caring for children at Seattle Childrenâs ⢠Know limitations of student responsibilities at Seattle Childrenâs
- 4. What you needto knowâŚ. ⢠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 talking with your instructor when you are unsure, overwhelmed, or new to a task
- 5. What Can YouDo To Decrease Medication Errors? ⢠Check and double check, if in doubt check it out, again! ⢠Follow the 5 Râs: right patient, right drug, right dose, right time, right route ⢠Never assume, âpharmacy put the medication in the drawer so this must be rightâ, pharmacy makes errors too. ⢠Never assume, âthe resident ordered this large dose so it must be rightâ, Residents make errors too. ⢠Know the correct mg/kg dose of medications you are administering. ⢠Know why you are giving the medication, the expected action, and any potential side effects.
- 6. Time for astory
- 7. Story: Admission ofa patient⌠â˘3 month old admitted with respiratory distress most likely due to bronchiolitis Admitting Nurse: âI did his admission assessment and then it was time for change of shift so I gave report to the next nurseâ Oncoming Nurse: âI received report at 7 p.m. and was reviewing the orders and saw that he had some medications dueâ
- 8. âI saw thathe had some medications dueâŚâ Infants Nurse: âThe infant had reglan and digoxin ordered BID. They were due at 8pm. I went to the medication room and the meds were in the drawer so I took them into the infants roomâ. â˘What are the next steps to take? â˘5 Râs â˘What questions do you have? â˘What are the clinical indications for these two meds in this infant â˘You go into the room to give the medicationsâŚwhat steps do you take? â˘Patient ID check, tell patient and family what meds you are administering and what they are for
- 9. âI took themedication into the roomâŚâ â˘âI looked at the online formulary for reglan and digoxin and saw that they were ordered in the correct dose and route. I checked the labels on the syringe and double checked the dose against the order on the medication administration record. I took the medications into the infants room, checked his ID band, and told mom I was giving digoxin and reglanâ. ⢠Looked meds up on the online formulary â˘Checked the dose â˘Checked the med â˘Took labeled syringes to pts room â˘Checked the ID band against the name on the med and asked mom to verify date of birth â˘Told mom what meds were about to be administered EXCELLENT PRACTICE, Never short cut this!
- 10. âI told momI was giving Digoxin and Reglan..â â˘âShe said, at home I give the reglan, the other medication must be a new one.â â˘âI told her it was ordered by the doctor for the babyâs heartâ. â˘âMom said, is there something wrong with his heart?â â˘What do you do?
- 11. âMom said isthere something wrong with his heart?â â˘âI said let me double check his chartâ. â˘I left the room and looked at the chart, he was here for respiratory distress. I did not see anything about a heart problem. â˘I called the resident and he said âhe did not know of any heart problems in this patientâ. â˘I called my charge nurse. â˘The charge nurse called the senior resident who said the child had no cardiac issues and should not have an order for Digoxin. â˘Turns out the order was electronically placed in the wrong chart.
- 12. âWhat if momhad not been there?â â˘Always! Ask yourself⌠what were the indications for digoxin in this infant? â˘Know why you are giving a medication and the indication in your patient!
- 14. What Else CanYou Do To Decrease Medication Errors? ⢠Stop the line, if you have concerns or questions do not give the medication until you feel the concerns/questions have been answered. ⢠If a patient or caregiver says, âhmm, that pill does not look familiarâ, or âthe doctor said not to take that todayâ, or âI already took that pill todayâ, or anything that might indicate an error is about to occurâŚ.stop, pick up the medication and leave the room. Double check the medication and if necessary call the MD to clarify the orders. ⢠If you have to pull 2 vials of a medication out of omnicell or need a large quantity of a medication stop and recalculate with a peer. This is pediatrics! Medications doses are smaller then adults and are given in mg/kg! ⢠Harried? Tired? Distracted? Triple check yourself!
- 15. 1.Documentation of medicationdose, time, date, route must occur every time a medication is administered, at the time of administration. 2.Documentation occurs on the medication administration record (eMAR) in CIS 3.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 the reason why.. 5.You must have medications cosigned by an instructor or the RN caring for the child Medication administration documentation
- 16. Nursing Student Responsibilityand Patient Safety Follow all Childrenâs Hospital policies and procedures especially those related to Patient Safety.
- 17. Nursing Student Responsibility â˘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 alarmsâŚ) ⢠Nursing students do not administer any chemotherapy agents (oral or IV)
- 18. Nursing Student Responsibilityand Patient Safety ⢠Nursing students do not give IV push medications 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. 1.You must givemedication under the direct supervision of a nursing instructor unless supervision 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 the reason why.. 4.You must have medications cosigned by an instructor or the RN caring for the child Medication administration documentation
- 20. Faculty Responsibility⌠⢠Directlysupervise the administration of medications. When the student has demonstrated adequate knowledge and good technique, s/he may give medications (except IV meds) with staff nurse availability. 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 and medication administration. Writes âI agree/concur with above documentationâ and/or add any additional documentation. (Note: LPNs may not co-sign RN student nurse medication administration documentation).
- 21. Wow, that isa lot of to doâs and not to doâsâŚbut ultimately keeping kids safe is our goal!
- 22. Documentation ďIf you donot chart it, it didnât happen. ďWhat if you gave tylenol at 0630 and forgot to chart it. The next nurse comes on and the child has a fever so the child gets tylenol again at 0730âŚ
- 23. Some hints fromthe wise ďź Always check name band prior to giving any medications. ďź Always check to see that ordered dose is appropriate based on weight. ďź Always look up medications unfamiliar to you before leaving the medication room.
- 24. Pt Safety ⢠Neverleave 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. Pt Safety ⢠Neverleave 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. On line orderentry is greatâŚbut ⢠It is not fool proof ⢠Errors still occur ⢠Always know when the last dose was given and frequency of dosing ⢠Note start and stop dates especially on weaning schedules ⢠Watch for duplicate orders
- 27. Patient Safety ⢠Checkand 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
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