Safety and Quality Assurance - Webcourses@UCF

Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 11

Safety and Quality Assurance

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Learning Objectives Explaining the importance of safety when using

over-the-counter (OTC) medications. Describing legal, ethical, and other measures to

protect health care personnel during medication administration.

Describing quality assurance in medication administration.

Explaining the relationship of the medical office and Occupational Safety and Health Administration (OSHA) regulations related to pharmacology.


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Learning Objectives (cont’d.)

Discussing three “befores” and seven “rights” of administering medications.

Explaining procedures necessary to prevent medication errors and the documentation required in the event an error occurs.

Describing routes by which medications are delivered to the body.


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Safety with Medications Taken by Patients

Document excessive use of drugs/alcohol Document tobacco products Document OTC and herbal products Instruct patient in dangers of self-medication

when used with prescription medications Inform patients that OTC medications may

contain low doses of medication and may not supply the adequate medications

Discuss how OTC medications may contain more than one active ingredient


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Medication Administration

Medication Administration: giving a dose of medication to a patient

Requires proper knowledge of: medications techniques safety precautions

Quality assurance standards of excellence are at the core of safety.


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Occupational Safety and Health Administration Standards in Medication

Administration

Wear barrier equipment if there is a possibility of splashing or spraying body fluids.

Wear gloves when performing injections. Place all equipment coming into contact with

body fluids into infectious waste containers.


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Administration

Place sharp materials in puncture-proof containers located close to area of use.

Figure 11-1 Disposable syringes and sharps should be disposed of in a puncture-proof container. (From Young AP, Proctor DB: Kinn’s the medical assistant, ed 11, St Louis, 2011, Elsevier.)


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Administration

Use safety needles to protect against accidental needlesticks.

Figure 11-2 The Occupational Safety and Health Administration suggests using syringes with retractable needle covers. (From Young AP, Proctor DB: Kinn’s the medical assistant, ed 11, St Louis, 2011, Elsevier.)


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Administration Do NOT recap, bend, or

break used needles, remove from disposable syringes, or otherwise manipulate by hand.

If you must recap the needle, use one-handed scooping method.

Figure 11-3 To recap needles, use one hand and a scooping technique. (From Young AP, Proctor DB: Kinn’s the medical assistant, ed 10, St Louis, 2007, Elsevier.)


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Administration Dispose of contaminated waste properly. Evaluate any exposure with a postexposure

plan. Failure to comply may result in fines—$7000

(first offense) to $70,000 (repeated violations).


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Quality Assurance Verify medication maintained at appropriate

temperature during transport. Avoid reordering stock medications close to

weekends and holidays because delivery may be delayed.

Medications with special considerations should be stored in accordance to relevant controls.

Strength, size of container, and drug should be checked against inventory and packing slip.


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Quality Assurance

Always store with label facing forward. Organize medications by predetermined

groupings (for example, route, specific use). Check expiration dates—stock oldest in front Store away from heat, light, moisture, and air. Keep external- and internal-use medications

separate. Keep poisons and chemicals away from

drugs.


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Quality Assurance

Always keep labels intact. Always keep medication in original container. Destroy any container without a label.


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Medication Administration for Patient Safety

Notify physician of any changes occurring since medication was ordered.

Assess size and age of patient. Note changes in vital signs. Check for contraindications to drug. Check for food or animal allergies. Note any change in medical condition that

might hinder administration route.


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Question prescriber if any doubts as to proper dosage of medication.

Ensure presence of appropriate person in the event allergic reaction occurs.

Maintain safe surroundings, especially after administering pain medications.

Assess presence of family members. Maintain quiet environment.


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Give only ordered medication. Know the drug being given. Calculate dose in quiet area; have someone

recheck calculation. Always wash hands. Do not handle medication. Identify the patient. Ask about possible allergies.


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Never return unused medications to original containers—dispose of properly.

Do not document administration of a medication before actually giving it.

Observe patient for adverse reactions. Document any reactions. Report any errors to physician immediately. Consult handbooks when calculating doses.


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Three Befores

Always read label three times: before removing drug from shelf before preparing medication for administration before returning drug to shelf

Never give medications not personally prepared by YOU.


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Seven Rights

Right patient Right drug Right strength Right time Right route Right technique Right documentation


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Seven Rights

Right Patient Verify person’s name with medication order.

If there is any confusion, ask patient to state his or her name.

Ask parents to identify young children.

Figure 11-4 The seven rights of medication administration.


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Seven Rights Right Drug Use the three “befores.” Check for exact concentration, spelling of ordered drug. Never give expired drugs. Learn to palm the label when pouring medication.



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Seven Rights

Right Dose Ensure that the dose is within the acceptable dose range for patient. Have working knowledge of medication being given. Double-check calculations. Use proper device to obtain most accurate measurement.



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Seven Rights

Right Time Important in maintaining consistent blood levels. May affect how patient reacts to drug.



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Seven Rights

Right Route Match route with medication order. Evaluate whether patient has injury that might prevent use of desired site.



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Seven Rights

Right Technique Use aseptic technique. Select appropriate site, use appropriate delivery technique.



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Seven Rights

Right Documentation: any patient assessment date and time medication

given name of medication, dose

administered lot numbers,

manufacturer, expiration date of immunizations

patient reactions, patient education, patient refusal of medication

Figure 11-4 The seven rights of medication administration. Document after drug

administration


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Seven Rights

Figure 11-5 Documentation of the seven rights of medication administration.


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Sources of Medication Errors

Every medication error is potentially tragic or costly for patients and professionals alike.

Follow three “befores,” seven “rights.” Clarify any confusing medication orders. Be aware of possible drug interactions.


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Sources of Medication Errors

If an error is made: assess patient, notify physician, proceed with any needed therapy, document occurrence.

Assess situation; make needed changes in policy and/or procedure to prevent occurrence of same errors.


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Delivery of Medications

Enterally—absorbed through GI tract; safe, convenient, economical, slow absorption

Parenterally—by injection; systemic effects, rapid absorption, greater cost of supplies, increased chance of adverse reactions

Percutaneously—absorbed through skin, tissue, mucous membranes; local effects, slow absorption, evaluate condition of patient’s skin and mucous membranes


Delivery of Medications

Five factors to choose route of medication administration Chemical properties of the drug Physical properties of the drug Desired site of action How rapidly the drug response is wanted Physical and mental health of the person receiving

the drug

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How would you document the following situation? Sara Medici, age 2, has come in for an MMR vaccine. The doctor orders Sara receive the vaccine in the vastus lateralis muscle. The lot number is 12356; manufacturer is Sohol Drugs. The dose for MMR is 1 vial (or 1 mL) after reconstitution. You have informed the patient’s mother of the side effects to expect and possible reactions, including the possibility of rash and low-grade fever in 2 to 3 days.

Review Exercise #1


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x/x/20xx (Time) MMR vaccine 1 mL (Sohol Drugs), Lot # 12356, exp. date 10/04/09 given in ® vastus lateralis with no apparent side effects. Mother instructed of possible side effects and adverse reactions. Signed permission from mother attached.----------------------------------SMA

Review Exercise #1 – Answer


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How would you document the following situation? Mary Allero has come to the office to receive her allergy injection. She has a standing order from the doctor to receive the next dose unless a reaction occurred to the previous dose. She says she had no problems with the last dose. Today’s dose comes from Allergy Extract Bottle no. 4, 0.2 mL of extract. You give the injection subcutaneously in the right deltoid area. Ms. Allero always waits 20 minutes after the injection to ensure no reaction occurs. When you check her, there is no redness or swelling at the injection site, and she shows no signs of allergic reaction.

Review Exercise #2


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x/x/20xx (Time) Reports no adverse reactions from last inj of allergy extract. Allergy Extract #4 0.2 mL SC ® deltoid area with no apparent adverse reactions p 20 min.------------------SMA



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How would you document the following situation? Mr. Johanson has a history of kidney stones. The doctor examines him and finds him to be in severe pain with nausea. The doctor orders Demerol 50 mg and Phenergan 25 mg to be given intramuscularly in the deltoid area. You ask Mr. Johanson if there is anyone to drive him home, because it is dangerous for him to drive after taking these medications. You also tell him he should go home and lie down to allow the medication to have full effect.

Review Exercise #3


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x/x/20xx (Time) Demerol 50 mg and Phenergan 25 mg IM ® deltoid area. Instructed not to drive, to relax at home to allow medication to have effect. No apparent adverse reaction on leaving the office.-------------------------------SMA



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How would you document the following situation? Malia comes to the office with a high fever and earache. Dr. Merry asks you to give Malia aspirin gr x for fever before she leaves the office. You discuss with Malia ways in which she can lower her fever at home.

Review Exercise #4


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x/x/20xx (Time) Aspirin gr x administered as ordered/Dr. Merry. Patient education for lowering fever at home. ------------------SMA



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How would you document the following situation? Ms. Robbins is seen by Dr. Merry for congestive heart failure. Her pulse is 84. Dr. Merry orders Lanoxin 0.5 mg po as directed. Ms. Robbins asks you if there are any instructions she needs to know to take Lanoxin at home. You tell her to take her pulse every day just before taking Lanoxin, and to call the office if her pulse is below 60 beats per minute.

Review Exercise #5


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x/x/20xx (Time) P-84, Lanoxin 0.5 mg po administered as ordered/Dr. Merry. Instructed to take pulse daily prior to taking Lanoxin; report pulse ↓60 before taking medication. ------------------------------SMA


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