Beyond the "5 Rights" of medication administration... - page 2
What are some helpful hints that you can share about giving medication that has helped you prevent medication errors in your job? I'm talking beyond right dose, right med, right time, right route &... Read More
Feb 16, '07Specialty: 2 year(s) of experience in Medicine ; From: CA ; Joined: Feb '07; Posts: 64; Likes: 8All our oral meds are prepackaged in the PYXIS individually and labelled. Some nurses take them out of the packages before they head to the rooms, but I open them at the bedside, in front of the patient, as I expain (every time) what the med is for while I sign it off in my MAR.
Feb 16, '07Occupation: RN Specialty: Spinal Rehab (2yr), neuro,currently ICU ; Joined: Jan '07; Posts: 52; Likes: 8i work in a 9 bed unit, i get three patients a day.. but when it come to med, there is the 5R, concentration, put a little dot before i sign, check for allergies, cary the MIMS just in case i dont know the particluar medication, and i also check the recomended daily dose, just in case someone is on 200mg of something daily yet they can only have say 80, if am still not sure check with a collegue/consult the physician(we have one at the ward 16 hrs a day, and one on call on night shift).
i also try and explain/watch for any adverse reactions..
Feb 16, '07Specialty: 6 year(s) of experience in PEDS ; Joined: Dec '01; Posts: 15; Likes: 2We use computerized med administration (MedAdmin) so I scan each med as I am putting it in the cup, pulling it up in the syringe, etc. By using the bar code system, I can be certain I have the right patient, drug, and time just by scanning. The system will let you know if you don't. Of course, that doesn't replace nursing judgement, but it helps to have a back up. As far as what is safe for the patients weight, allergies, etc, the computer also alerts you to double check if the computer detects anything. Again, though, the computer is not fool-proof, but for the most part, I think it is much safer.
Feb 16, '07Joined: Jul '06; Posts: 192; Likes: 22When I pull a med from the pt.'s med tin (outside the pt. room) I set it next to the med I.D. on the Mar and check for right pt., right med, right dose, right route, and right time. If all is correct I place a little "tic" mark next to it on the MAR and place it unopened in a med cup.
When I've gathered all the scheduled meds I take the Mar and the meds to the bedside, check the pt.'s identification and allergies against pt.'s bands, pt.'s verbal acknowledgement, and pt.'s number. I review pt.'s allergies with the pt. and against the MAR.
If there are perameter drugs....digoxins, B/P's or etc I get a fresh set of numbers before administration.
I then ask the pt. if he prefers to take his meds all in one gulp or if he wants one at a time. Following pt. direction I then open each, tell him the name, explain what it is for, ask if there are questions, and then administer the drug....if appropriate. I then sign the MAR incorporating the "tic" mark into my initials with any drug refused being circled. I do all this at the bedside.
In case of I.V. or injection I usually draw-up the med at the med tin (outside the pt. room in my facility) and then take the syringe and the vial in with me to the bedside to do my checks that way. I know my facility would like EVERYTHING done at the bedside, yet, there are many pt.s that become quite anxious when they watch you draw-up an injectable no matter the route...IV, IM, SQ, ID....
The only problems I've encountered taking everything to the bedside is not having enough hands to get everything there...especially when dealing with large and multiple bottles of elixers. Also, when handling an empty ampule (I draw the med up outside the pt. room at the med tin) I hate having to handle that jagged thing to do the bedside check). I've thought of looking for a container that I could place that ampule in and carry it safely to the bedside for the check before disposing of it into the sharps container in the pt.'s room.
Mar 20, '08Joined: Mar '08; Posts: 9; Likes: 5When I began nursing in the 80's, it was sacraligous to interrupt a nurse during her med pass. I like the nurse who recommended to treat each patient's med pass as an event in itself. Times have changed, since we can't go back to the days when the hour med pass time was protected, we must assert our focus to our med pass one patient event at a time. I wonder if other nurses out there get disturbed about interruptions during their med pass to the point that the pass takes longer than State Regulations recommend?
Mar 20, '08Joined: Aug '04; Posts: 9,279; Likes: 4,304Quote from nurse nettieI just had this discussion in a meeting with our manager about delegation of duties. And the answer was ----When I began nursing in the 80's, it was sacraligous to interrupt a nurse during her med pass. I like the nurse who recommended to treat each patient's med pass as an event in itself. Times have changed, since we can't go back to the days when the hour med pass time was protected, we must assert our focus to our med pass one patient event at a time. I wonder if other nurses out there get disturbed about interruptions during their med pass to the point that the pass takes longer than State Regulations recommend?
I'm too slow. I should be able to empty that urinal and give those pills and finish my med pass in time.
Mar 20, '08Occupation: Psych nursing Specialty: 9 year(s) of experience in LTC, MDS Cordnator, Mental Health ; From: MN, US ; Joined: Jul '06; Posts: 525; Likes: 355"I do my 5 rights (actually there are anywhere from 6-8 dependant on your school of training), and I get my meds and SIGN the MAR as I put them into the cup! I do this so I know what is in that cup incase something distracts me or something comes up...as it always does during med pass...LOL! If someone doesn't take it, or it is dropped, I "still have to circle the initial and explain so signing at this point is the way to go (I had someone argue with me on that...I won!). Go through each pill carefully and once it is signed for focus on the next till you are done! Concentrating on each pill for each individual pass is the best way to go...time consuming at first...but I do it quickly now..."
I did it that way to (when I was on the cart)... I was told I better not do it that way during survey... well I told the surveyer what i was doing and why. (this Resident had 19 Meds) after wards she told my DON that I had excellent technique.
Jun 2, '08Joined: Apr '06; Posts: 100; Likes: 56I work in a hospice unit. Spend 12 hour shifts with these pts (hospice ward). Have a pt who is on antidepressants and seemed to improve his mood. Recently, his condition is deteriorating. He has hopes of attending a family reunionin July. Lately, he again is staying in bed all day, lights off. I had apporx 30 min discussion with him (did I mention he has throat cancer, and communications with written communication?). I mentioned to him that his mood seems to have declined.
I asked him about the depression. He seems more anxious than anything. Admits he stys awake and thoughts are just dragging him down. Hopeless. Fatigued from all the thoughts intruding. I mentioned to him that perhaps an antianxiety mediation would benefit him. Antidepressants are wonderful, but increasing the dose or changing the med takes time to notice changes and it is a try/succeed/fail situation. This mans life expectancy is getting shorter. I havae had personal experience with depression/anxiety and I told him so.
He is concerned with being "zoned" out. This man wants to be alert. He mainly wants to get to that reunion and be calm about it without the pressure of "time". I told him that antianxiety meds do not change who you are, but relax the barrage of thoughts so that he can rest and not be intruded on by the multitude of issues he is facing at this time. I asked if he would like for me to ask the physician to discuss tis with him further and he was very agreeable to this.
I work "off shifts....irregular 12 hour nights". I documented our conversation and to be assured the physician would see this note ( I bet my job these documented notes are not read on a regular basis). Anyway, I documented and sent the note to the physician for her to co-sign (which basically alerts her and she signs off to acknowledge receipt). Man, the next night I came in and recieved a message via the charge nurse second hand from the ward supervisor that I should never send a note for this physician to co-sign/acknowledge.
I checked my e-mail and a had recieved a note from the physican. Harsh note stating that #1. I shall never inform her of pt condition and that the issue should have went thru the morning report (which it did), and the Charge Nurse would speak to her about it, #2. She told me I need to review my scope of practice (I am an RN...I did not prescribe and only educated the pt on effects of meds and as well requested the physician to discuss further with pt - at HIS request). #3. She states she will report me to the lead physician of the hospital if this happens again.
Oh...she also said her work hours are from 8am-4pm and any issues taking place after those hours go to the triage physician on call. ???? This was not an emergency so I did not inform triage ( who knows nothing of out hospice residents daily issues). What do you guys think of this?
I was confused and then a little irritated by the fact that I was in my scope of practice to be an advocate for this pt.
Dec 16, '08Occupation: Staff Nurse Specialty: Medical-Surgical ; From: PH ; Joined: Dec '08; Posts: 13; Likes: 5Interesting topic to prevent medication errors..simply fantastic...but could anyone explain to me what "pixis" are?...thanks
Dec 16, '08Specialty: 3 year(s) of experience in LTAC, OR ; From: US ; Joined: Nov '07; Posts: 83; Likes: 60The Pyxis is a certain kind of machine that dispenses meds on some floors. Pharmacy programs in all the meds and what time they're given...you have to fingerprint into the machine and then you can take your patients' meds out. It keeps really close track of who pulled what, etc...you have to count stuff like narcotics and ambien every time you take it out.
Dec 19, '08Joined: Dec '08; Posts: 1; Likes: 2I would really like to hear more from subscribers. Are you finding it difficult to pass meds without interuptions?
When I began nursing in the 80's, it was sacraligous to interrupt a nurse during her med pass. I like the nurse who recommended to treat each patient's med pass as an event in itself. Times have changed, since we can't go back to the days when the hour med pass time was protected, we must assert our focus to our med pass one patient event at a time. I wonder if other nurses out there get disturbed about interruptions during their med pass to the point that the pass takes longer than State Regulations recommend?