role of nurses in drug administration and preventing medication errors

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    THE ROLE OF THETHE ROLE OF THE

    NURSE INNURSE IN

    DRUG ADMINISTRATIONDRUG ADMINISTRATION

    &&PREVENTINGPREVENTING

    MEDICATION ERRORSMEDICATION ERRORS

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    PATIENTS RIGHTSPATIENTS RIGHTS

    There are risks involved in the drugThere are risks involved in the drug

    administration, therefore,administration, therefore,

    patients have the right to:patients have the right to:

    be informed of the name, purpose, actionbe informed of the name, purpose, action&& potential side eects of drugspotential side eects of drugs

    refuse a medication regardless of therefuse a medication regardless of theconsequencesconsequences

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    receive labelled medications safely inreceive labelled medications safely inaccordance with the ve !" rights of drugaccordance with the ve !" rights of drugadministrationadministration

    be adequately informed of thebe adequately informed of thee#perimental nature of any drug and signe#perimental nature of any drug and sign

    a written consenta written consent

    not receive unnecessary medicationsnot receive unnecessary medications

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    WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL

    MEDICATION ORDERMEDICATION ORDER

    $edication charts$edication charts are legalare legal

    documents and must be completeddocuments and must be completedaccurately and unambiguously inaccurately and unambiguously in

    order to ensure that patients receiveorder to ensure that patients receive

    safe and optimal drug therapy%safe and optimal drug therapy%

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    $edication harts$edication harts should be writtenshould be written

    legibly in the prescriber's ownlegibly in the prescriber's own

    handwriting and include:handwriting and include:

    (atient's surname, rst name, medical(atient's surname, rst name, medicalrecord number $)*", ward+clinicrecord number $)*", ward+clinic

    if a patient -. label is used, it must be if a patient -. label is used, it must be

    a/#ed to every medication chart anda/#ed to every medication chart andsigned for verication by the prescribersigned for verication by the prescriber

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    .rug name generic", dosage form,.rug name generic", dosage form,strength and dose requiredstrength and dose required

    omplete, clear and unambiguousomplete, clear and unambiguous

    directions for each itemdirections for each item00 directions should be written in plaindirections should be written in plain

    1nglish only approved abbreviations1nglish only approved abbreviations

    may be used"may be used"

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    (rescriber's printed name, signature(rescriber's printed name, signature

    and date of order the prescriber'sand date of order the prescriber'sfull signature and date of order mustfull signature and date of order must

    be written for 123 .)45 orderedbe written for 123 .)45 ordered

    6eight should be provided for any6eight should be provided for anydrug dosed by weight%drug dosed by weight%

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    Each medication order must beEach medication order must belegible, complete and unambiguouslegible, complete and unambiguous

    so that the correct patient isso that the correct patient is

    administered with the correct drugadministered with the correct drugat the appropriate dose. A nurseat the appropriate dose. A nurse

    cannot administer the drug and acannot administer the drug and a

    pharmacist cannot dispense a drugpharmacist cannot dispense a drug

    to a patient unless all details areto a patient unless all details are

    correct and complete.correct and complete.

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    THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG

    ADMINISTRATIONADMINISTRATION

    1very registered nurse is legally responsible1very registered nurse is legally responsiblefor the correct administration of drugs% Thisfor the correct administration of drugs% Thisincludes theincludes the 7ive 8)ights9 of 2dministration7ive 8)ights9 of 2dministration::

    )ight (atient)ight (atient )ight .rug)ight .rug

    )ight .ose)ight .ose )ight )oute)ight )oute )ight Time)ight Time

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    RIGHT PATIENTRIGHT PATIENT

    0 check the patient's name & hospitalcheck the patient's name & hospital

    number against the chart & -%.% band%number against the chart & -%.% band%

    0 ask the patient to state his+her name, &ask the patient to state his+her name, &their date of birth .%%;"their date of birth .%%;"

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    -mportant-mportant

    heck if your patient:heck if your patient:

    % has been assessed for her pregnancy

    statusstatus

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    RIGHT DRUGRIGHT DRUG

    -dentify the drug from the $%%'s order%-dentify the drug from the $%%'s order%larify with the $%% if in doubt%larify with the $%% if in doubt%

    heck the drug three >" times:heck the drug three >" times:

    before removing it from the trolley or shelf before removing it from the trolley or shelf when the drug is removed from the when the drug is removed from the

    containercontainer

    before the container is returned to storage before the container is returned to storage

    heck the e#piry date of the drug+sheck the e#piry date of the drug+s

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    -mportant-mportantheck for .rug -nteractionsheck for .rug -nteractions

    AntagonisticAntagonistic lessening the eectiveness lessening the eectivenessofof another druganother drug

    SynergisticSynergistic enhancing or improving the enhancing or improving theeectiveness of another drugeectiveness of another drug

    heck for 7ood -nteractionsheck for 7ood -nteractionsThere are medications that requires dietaryThere are medications that requires dietary

    restrictions%restrictions%

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    The generic and brand name shouldThe generic and brand name should

    match those on the prescription%match those on the prescription%

    5eneric name5eneric name the name assigned by the the name assigned by themanufacturer who rst develops the drug%manufacturer who rst develops the drug% ftenften

    the generic name is derived from thethe generic name is derived from the chemicalchemical

    name%name%

    Trade+ ;rand+ (roprietary nameTrade+ ;rand+ (roprietary name

    is the name selected by the drug company is the name selected by the drug company

    selling the drug and is copyrightedselling the drug and is copyrighted

    a drug can have several trade names when a drug can have several trade names whenproduced by dierent manufacturersproduced by dierent manufacturers

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    1#ample:1#ample:

    Generic name = AspirinGeneric name = Aspirin

    Trade names available = Jusprin, DisprinTrade names available = Jusprin, Disprin

    ;e aware that in dierent countries;e aware that in dierent countries

    generic and trade names will also dier,generic and trade names will also dier,e%g% in 2ustralia & the 4nited ?tates onee%g% in 2ustralia & the 4nited ?tates one

    drug has the generic names ofdrug has the generic names of

    paracetamol & acetaminophen, i%e%paracetamol & acetaminophen, i%e%

    (anadol+Tylenol(anadol+Tylenol

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    atch out !or "oo#$ali#e and Sound$Ali#eatch out !or "oo#$ali#e and Sound$Ali#e

    Drug %ames&Drug %ames&

    ?ome ommon .rugs that are @ookalike and?ome ommon .rugs that are @ookalike and

    ?ound2like:?ound2like:

    2ccupril 0 2ccutane2ccupril 0 2ccutane

    alfentanil 0 fentanylalfentanil 0 fentanyl

    2llegra 0 Aiagra2llegra 0 Aiagra

    aBithromycin 0 erythromycinaBithromycin 0 erythromycin;etagan 0 ;etagen;etagan 0 ;etagen

    apitrol aptoprilapitrol aptopril

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    ciproCo#acin 0 oCo#acinciproCo#acin 0 oCo#acin

    clonidine 0 quinidineclonidine 0 quinidine

    clotrimaBole 0 cotrimaBoleclotrimaBole 0 cotrimaBole.eso#yn 0 digo#in.eso#yn 0 digo#in

    .iatab 0 .iatabs.iatab 0 .iatabs

    dobutamine 0 dopaminedobutamine 0 dopamine1ura# 0 4re#1ura# 0 4re#

    folic acid 0 folinic acidfolic acid 0 folinic acid

    fosphenytoin 0 phenytoinfosphenytoin 0 phenytoin

    guiafenesin 0 guanfacineguiafenesin 0 guanfacine

    @amasil 0 @omotil@amasil 0 @omotil

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    losartan 0 valsartanlosartan 0 valsartan

    mebendaBole 0 methimaBolemebendaBole 0 methimaBole

    metoprolol 0 misoprostolmetoprolol 0 misoprostol

    nalo#one 0 naltre#onenalo#one 0 naltre#one

    (anadol 0 pindolol 0 (lendil(anadol 0 pindolol 0 (lendil

    ranitidine 0 rimantadineranitidine 0 rimantadine

    salbutamol 0 salmeterolsalbutamol 0 salmeterol

    Tobrade# 0 Tobre#Tobrade# 0 Tobre#

    tretinoin 0 trentinetretinoin 0 trentineAerelan AirilonAerelan Airilon

    Dantac DyrtecDantac Dyrtec

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    RIGHT DOSERIGHT DOSE

    check the dose, read the container label, check the dose, read the container label,calculate the dose & check with anothercalculate the dose & check with another)* if necessary)* if necessary

    use proper measuring devices for liquids, use proper measuring devices for liquids,do not crush tablets or open capsulesdo not crush tablets or open capsulesunless directed by the pharmacistunless directed by the pharmacist

    if a drug is required in another dosage if a drug is required in another dosageform, you may get it from the pharmacy%form, you may get it from the pharmacy%

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    -mportant-mportant

    Enowledge of the dierent dosage forms isEnowledge of the dierent dosage forms is

    essential in giving the right dose to theessential in giving the right dose to thepatient so that the intended therapeuticpatient so that the intended therapeutic

    eect of the drug will be achieved%eect of the drug will be achieved%

    1#ample:1#ample:Tablets maybe eervescent, sublingual,Tablets maybe eervescent, sublingual,

    buccal, chewable, enteric coated, etcFbuccal, chewable, enteric coated, etcF

    ther liquid dosage forms should bether liquid dosage forms should beshaken well before administration like oralshaken well before administration like oral

    suspensions and oral emulsionsFsuspensions and oral emulsionsF

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    RIGHT ROUTERIGHT ROUTE

    make sure the $%%'s order is clear & only make sure the $%%'s order is clear & onlygive the medications by the routegive the medications by the route

    designated%designated%

    'nowledge o! the di(erent dosage'nowledge o! the di(erent dosage

    !orms is also important in giving the!orms is also important in giving the

    medication in the right routemedication in the right route%%

    know the common abbreviations used for know the common abbreviations used for

    the dierent routes%the dierent routes%

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    $$* 2;;)1A-2T-*? 4?1. -*$$* 2;;)1A-2T-*? 4?1. -*$1.-2T-* ).1)? 7) .-77% )4T1?$1.-2T-* ).1)? 7) .-77% )4T1?

    ;4;40 buccal+ inside cheek0 buccal+ inside cheek

    ((0 per orem+ by mounth0 per orem+ by mounth

    ?@?@0 sublingually+ under the tongue0 sublingually+ under the tongue

    -*+*2?-*+*2? intranasal intranasal-.-. intradermal intradermal

    -$-$0 intramuscular0 intramuscular

    ?+?G+?ubq?+?G+?ubq0 subcutaneous0 subcutaneous

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    $$* 2;;)1A-2T-*? 4?1. -*$$* 2;;)1A-2T-*? 4?1. -*$1.-2T-* ).1)? 7) .-77 )4T$1.-2T-* ).1)? 7) .-77 )4T1?1?

    -(-(0 intraperitoneal0 intraperitoneal

    -A-A0 intravenous0 intravenous

    -A(-A(0 intravenous push0 intravenous push-A(;-A(;0 intravenous piggy back0 intravenous piggy back

    ()()0 per rectum + rectally0 per rectum + rectally

    T(T(

    topical topical

    A25A25 vaginal vaginal

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    RIGHT TIMERIGHT TIME

    check the appropriate time of the day, check the appropriate time of the day,time interval, and frequency, ordered bytime interval, and frequency, ordered by

    the $%% &the $%% &

    give the medication at the prescribedgive the medication at the prescribedtime%time%

    drugs should be given within =H minutes drugs should be given within =H minutes

    of the prescribed time%of the prescribed time%

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    $$* 2;;)1A-2T-*? 4?1. -*$$* 2;;)1A-2T-*? 4?1. -*$1.-2T-* ).1)?$1.-2T-* ).1)?

    a%c%a%c% ante cibumante cibum before meals before meals;.?, b%d%s%;.?, b%d%s% bis die sumendumbis die sumendum twice daily twice daily

    b%i%d%, b%d%b%i%d%, b%d% bis in diebis in die twice daily twice daily

    1.1. every other day every other dayh%s%h%s%00 hora somnihora somni 0 at bedtime0 at bedtime

    manemane00 manemane0 in the morning0 in the morning

    noctnoct00 noctenocte0 at night0 at nightp%c%p%c% 00post cibumpost cibum 0 after meals0 after meals

    p%r%n%, ()*p%r%n%, ()* pro re natapro re nata as needed, when as needed, when

    necessarynecessary

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    qq00 )ua)ue)ua)ue every, per every, per

    q%< h, q% times a day > times a day

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    Error-Prone Abbreviaion!"Error-Prone Abbreviaion!"

    S#$bo%!" an Do!e De!i'naion!S#$bo%!" an Do!e De!i'naion!

    OgOg0 microgram mistaken as 8mg9 4se0 microgram mistaken as 8mg9 4se 8mcg98mcg9

    2., 2?, 242., 2?, 24 right ear, left ear, each ear right ear, left ear, each ear

    $istaken as ., ?, 4$istaken as ., ?, 4

    right eye, left eye, each eye"right eye, left eye, each eye"

    4se4se 8right ear,9 8left ear,9 or 8each ear98right ear,9 8left ear,9 or 8each ear9

    ., ?, 4., ?, 4 right eye, left eye, each eye right eye, left eye, each eye

    $istaken as 2., 2?, 24$istaken as 2., 2?, 24right ear, left ear, each ear"right ear, left ear, each ear"

    4se4se 8right eye,9 8left eye,9 or 8each eye98right eye,9 8left eye,9 or 8each eye9

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    ;-., ;.;-., ;. 0 twice a day 0 mistaken as ;T bedtime"0 twice a day 0 mistaken as ;T bedtime"

    4se4se 8twice a day98twice a day9

    3?3?0 half strength 0 mistaken as bedtime0 half strength 0 mistaken as bedtime

    hshs0 at bedtime 0 mistaken as half strength0 at bedtime 0 mistaken as half strength

    4se4se 8halfstrength98halfstrength9oror 8bedtime98bedtime9

    -4-4 -nternational unit mistaken as -A -nternational unit mistaken as -A

    4se 4se 8units98units9

    o%d% or .o%d% or . once daily mistaken as 8right eye9 once daily mistaken as 8right eye9 .oculus.oculusde#ter"de#ter"

    4se 4se 8daily98daily9

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    Trailing Bero after decimal point e%g%,

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    2bbreviations such as mg%2bbreviations such as mg% or m@% with aor m@% with aperiodperiod following the abbreviationfollowing the abbreviation

    The period %" is unnecessary and couldThe period %" is unnecessary and couldbe mistaken as the number < ifbe mistaken as the number < if writtenwritten

    poorlypoorly

    4se4se

    mgmg

    ,,

    m@m@

    , etc% without a terminal, etc% without a terminal

    periodperiod

    Q at mistaken as 8=9 4seQ at mistaken as 8=9 4se 8at98at9

    J hour mistaken as a BeroJ hour mistaken as a Bero

    e%g%, q=J seen as q =H"e%g%, q=J seen as q =H"

    4se 4se 8hr,9 8h,9 or 8hour98hr,9 8h,9 or 8hour9

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    (lace adequate space between the drug(lace adequate space between the drug

    name, dose, and unit of measurename, dose, and unit of measure

    -nderalLHmg 0 mistaken as -nderal

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    2DT 0Didovudine )etrovir" 0 mistaken as2DT 0Didovudine )etrovir" 0 mistaken as

    2Btreonam2Btreonam

    (2 0 (rocainamide 0 mistaken as (atient(2 0 (rocainamide 0 mistaken as (atient

    ontrolledontrolled

    2nalgesia2nalgesia

    88*itro9 drip nitroglycerin infusion*itro9 drip nitroglycerin infusion

    mistaken as sodium nitroprussidemistaken as sodium nitroprusside

    infusioninfusion

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