Chapter 6: Non Parenteral Medication Administration
6.2 Safe Medication Practices
Critical Thinking Exercises: Questions, Answers, and Sources / References
- What does the Canadian Patient Safety Institute mean by Medication Reconciliation ?
Answer: Medication reconciliationis a formal process in which healthcare providers work together with patients, families, and care providers to ensure that accurate, comprehensive medication information is communicated consistently across transitions of care. It requires a systematic and comprehensive review of all the medications a patient is taking to ensure that medications being added, changed, or discontinued are carefully evaluated.
Source: Canadian Patient Safety Institute. (nd). Medication Reconciliation (Med Rec). http://www.patientsafetyinstitute.ca/en/Topic/Pages/medication-reconciliation-(med-rec).aspx
2. Name 4 things within the medication reconciliation process that a nurse can do to reduce the risk of an adverse drug event (ADE)
Answer: You can reduce ADEs by following the medication reconciliation processes including:
- Obtain a complete and accurate list of each patient’s current home medications, including name, dosage, frequency, and route and including over the counter medications (vitamins, herbals & others)
- Use that list when writing admission, transfer, or discharge orders
- Compare the list to the patient’s admission, transfer, or discharge orders, identifying and bringing discrepancies to the attention of the prescriber and, if appropriate, making changes to the orders
- Document resulting changes
Source: Canadian Patient Safety Institute. (nd). Medication Reconciliation (Med Rec). http://www.patientsafetyinstitute.ca/en/Topic/Pages/medication-reconciliation-(med-rec).aspx
3. View the Institute for Safe Medication Practices [ISMP] (2017a). List of Error-Prone Abbreviations. To see what abbreviations if used have the potential to compromise medication safety.
Answer: There are many abbreviations students should be aware. Here is a good resource: https://www.ismp.org/recommendations/error-prone-abbreviations-list
4. As a nurse you must be aware that some medications have the potential to cause great harm to patients. Lists of high alert medications are meant to draw the nurse’s attention and result in heightened awareness. Depending on your interest view one or both of the following sites:
- ISMP (2018a). High-Alert Medications in Acute Care Settings https://www.ismp.org/recommendations/high-alert-medications-acute-list
- ISMP (2017b). High-Alert Medications in Long-Term Care Settings. Have you seen any of these in practice yet? https://www.ismp.org/recommendations/high-alert-medications-long-term-care-list
Sample Learning Activities
- Direct the student to the following website to identify 5 examples of error prone abbreviations associated with medication administration
Source: ISMP (2017). List of error prone abbreviations. https://www.ismp.org/recommendations/error-prone-abbreviations-list
2. Discuss ten principles for safer medication administration.
Source: Perry, A., Potter, P., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
3. Discuss what is meant by timely medication administration.
Source: Institute for Safe Medication Practices (ISMP). (2011). Guidelines for timely administration of scheduled medications (acute). https://www.ismp.org/guidelines/timely-administration-scheduled-medications-acute.
4. List and discuss the seven rights of medication administration
Source: Perry, A., Potter, P., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
5. Advise students to go to the following website to identify 5 classes of high alert medications in acute care settings.
- A patient received Morphine 10 mg rather than the prescribed 5 mg. What kind of error does this represent?
a. Wrong patient (incorrect)
b. Wrong time (incorrect)
c. Wrong dose (correct)
d. Wrong route (incorrect)
Source: Lilley, L. L., Rainforth Collins, S., Snyder, J. S., Collins, S., & Swart, B. (2016). Pharmacology for Canadian health care practice (3rd ed.). Toronto, ON: Elsevier Canada.
2. Which of the following is not a right of medication administration identified by the BCCNP?
a. Drug (Incorrect. Read the question. This is a right identified by the BCCNP)
b. Route (Incorrect. Read the question. This is a right identified by the BCCNP)
c. Dose (Incorrect. Read the question. This is a right identified by the BCCNP)
d. Time (Incorrect. Read the question. This is a right identified by the BCCNP)
e. Reason (Incorrect. Read the question. This is a right identified by the BCCNP)
f. Documentation (Incorrect. Read the question. This is a right identified by the BCCNP)
g. The right to be informed (Correct. This is an important right but is not one identified by the BCCNP)
h. The right to refuse (Correct. This is an important right but is not one identified by the BCCNP)
Source: BCCNP. (2019). Rights of Medication Administration. https://www.bccnp.ca/Standards/RN_NP/PracticeStandards/Pages/medicationadmin.aspx
3. When administering meds, the nurse recalls that 3 checks occur at the following times (select all that apply)
a. When the medication is removed from the medication dispensing system / drawer
b. Before the medication package is opened
c. After the medication is poured
d. After the medication is swallowed
Answer: ABC. D is incorrect as the 3 checks must be done BEFORE the patient swallows the medication. The whole purpose is to recognize errors BEFORE the patient consumes the medication.