Module 1 - Advanced Nursing Skills

How many Americans die each year due to medication errors? 7,000 to 9,000 people (NCBI, 2021) Each year, how many Americans require hospitalization after emergency visit due to adverse drug event? 350,000 people (CDC) Each year, how many emergency department visits are caused by adverse drug events in the United States? 1.3 million Globally each year, how much is the cost associated with medication errors? $42 billion (WHO, 2017) What does nurse check regarding medication orders? -Appropriate for client -Drug -Dose -Timing -Active and complete Importance of medication metabolism Where does the body breakdown medications? JCo official "Do Not Use" List of abbreviations U (unit) IU (international unit) QD (daily) QOD (every other day) Trailing zero MS Safety guidelines for medication administration -Don't rush -Avoid distractions -6 Medication Administration rights --right drug --right dose --right route --right time --right patient --right documentation How does nurse verify the correct client? 2 methods of ID (name and DOB) -visual (e.g. ID band, pictures) -verbal (e.g. ask for full name and DOB) How does nurse verify the correct drug? Compare MAR with medication label: 1. while removing from medication bin/cart 2. while preparing 3. before actual medication administration Never give a medication that someone else has prepared Repeat: never give a medication that someone else has prepared Checklist for 3rd accuracy check for medication administration -6 rights -2 identifiers -allergies -scan armband then medication -sign med given AFTER client takes it -use mg/g/units Medication error prevention strategies -empower patient -teach importance of proper patient identification -familiarize patient with color, shape, and purpose of each medication -obtain complex drug history from patient -if patient questions particular drug, STOP and investigate If patient questions a particular drug, STOP and investigate REPREAT: If a patient questions a particular drug, STOP and investigate Drug responses to medication primary effect (desirable); secondary effect (desirable or undesirable side effects and/or adverse effects) What should the nurse do when administering a first dose of a new medication to a patient (e.g. penicillin, sulfa, ibuprofen, naproxen)? Monitor for side and adverse effects What should nurse do if medication error occurs? Report immediately; med errors can result in adverse drug reaction (4th leading cause of death in United States) Considerations for pediatric medication administration -dosage based on: age, size, weight -not given as standardized amount -involve parents (can give if meds are oral) -do not equate medication to candy Considerations for older adult medication administration -chronic conditions and polypharmacy (drug interactions) -slowed metabolism of drugs (may require lower doses especially if kidney or liver problems) -long-term anti-inflammatory drugs for arthritis (GI bleeding or anemia) -pill organizer -blood pressure fluctuations and fall risk -risk for dehydration or electrolyte imbalances (diuretics) -limited finances for medications -limited vision creates concern for adhering to regimen (taking correct medications) -weakened muscles causing swallow issues or inability to open childproof bottles due to arthritis -stroke -nonadherent d/t autonomy, fear of addiction or undesired side effects -detailed medication regimen education before discharge to benefit patient, family, and home health personnel Factors in nonadherence -lacks understanding of drug action -unaware how long to take medication -fear/refusal to experience undesired side effects -males often stop meds d/t urinary retention or sexual dysfunction -medication too expensive -condition improves after first round -forget -refusal to depend on medications to maintain health Why do males often stop taking a medication? Side effects include urinary retention and/or sexual dysfunction Which laboratory levels are affected by diurectics? Potassium Why conduct a swallow test? Check gag reflex How to administer oral medication for stroke patient? Place on strong side Comprehensive Drug Abuse Prevention and Control Act of 1970