Chapter 3 Medication Safety: preventing med errors Answer Key

Chapter 3 Clinical Reasoning and Decision-Making Activities

You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.

3.3 Safe Medication Administration

Learning Activity 1

The nurse should provide verbal education regarding when to take medication, side effects to watch for, and potential adverse effects.  The patient should also be educated on any restrictions related to diet, over-the-counter medications, and herbal supplements.

Learning activity 2

1. The 7 rights the nurse checks before administering any medication include right patient, right medication, right dose, right route, right time, right reason, and right documentation. Checking allergies and the expiration date of the medication are also included when checking the 7 rights.
2. Nurses confirm patient identification prior to administering medication by asking the patient their name and date of birth, checking the patient’s identification band, and by scanning bar codes on the medication and patient’s armband.  In long-term care settings where patients don’t wear armbands and may not be able to recall their name and date of birth, the nurse may use alternative methods of identification, such as using a patient’s picture in the medication record or asking another staff member to confirm the patient’s identity.
3. Prior to the administration of morphine, an opioid medication, the nurse should assess the patient’s pain level, level of consciousness, respiratory rate, and oxygenation status.  If the patient exhibits a decreased respiratory rate, decreased oxygenation level, or an increased sedation, the medication should be withheld and appropriate interventions implemented.
4. After administering an opioid medication, the nurse should evaluate the effectiveness of the medication in treating the pain,  as well as continuing to monitor respiratory rate, oxygenation level, and sedation status.
5. The nurse should teach the patient about common side effects, such as constipation and drowsiness.
6. The shift handoff report should include the location of the patient’s pain, the reported pain level, pain medications administered during the shift, the time of medication administration, and the patient’s response to the medication.

 3.4 Health Literacy

The nurse should suggest the mother obtain an oral syringe from the pharmacist to ensure accurate measurement of the medication.  Errors can occur when families use spoons in their homes to administer medication. Ensure the caregiver understands the instructions and explore if there are any barriers for the caregiver to go to the pharmacy.

3.8 Factors Affecting Medication Safety — Healthcare Provider, Systems, and Client Factors

In addition to verifying the 7 rights of medication administration, the nurse should confirm the blood glucose level, insulin type, concentration, and the date the insulin vial was opened. The nurse should draw up the dose and confirm correct dosing with another RN prior to administration.  The nurse should be aware of onset, peak, and duration of action and monitor for potential side effects such as hypoglycemia.

3.9 Medication Safety Across the Lifespans — Pediatrics

1. A. Always draw up the med with the syringe closest to the amount required to ensure accuracy.
2. 2.4 mL.

Desire 60 mg = 1 mL

Have 125 mg    5 mL

125x=300

X = 300/125 = 2.4 mL

3. The wasting of controlled substances should be done by two licensed staff. This can be done by RNs, LPNs or NPs. A care aid cannot perform this function.

3.11 Medication Safety in Transitions of Care

The nurse can use alternative sources of medication information when the patient cannot recall their home medication and it is not available in the electronic medical health records. In BC, prescribers have access to the client’s Pharmanet, which supplies information about current medications the client is on.  The Pharmanet profile should be printed and included in the client’s chart. Another common intervention is to ask the patient to bring all of their medications to their appointment, including prescribed medications, over-the-counter medications, vitamins, and herbal supplements.  Family members, such as a spouse or adult children, can also provide valid information with the patient’s permission.  After determining the patient’s current medications, the nurse should print a copy of the list of medications and instruct the patient to bring it with them to all of the health care providers and update it as needed.

3.13 Clinical Reasoning and Decision-Making Learning Activities

1.a The social determinants of health (SDOH) are the conditions that can influence their overall health and well-being. These factors play a significant role in medication safety, especially in vulnerable populations like older adults, people from low-income backgrounds, and those with limited access to healthcare.

Economic stability: 

Access to Medications: Limited financial resources can lead to difficulties in affording prescriptions, leading to underuse or non-adherence to prescribed medications.

Medication Choices: Patients may opt for cheaper, potentially less effective or inappropriate medications due to financial constraints, increasing the risk of adverse effects or drug interactions.

Health Literacy: Lower levels of education are often associated with lower health literacy, which can lead to difficulties in understanding prescription instructions, including dosages, frequency, and potential side effects.

Support Systems: A lack of social support, such as from family or caregivers, may affect a person’s ability to manage complex medication regimens or attend medical appointments.

Cultural Factors: Medications prescribed without considering cultural beliefs or preferences can lead to non-adherence or discontinuation. For example, some patients may not take medications if they perceive them to be incompatible with their cultural practices or values.

Disparities in Healthcare: Racial and ethnic minorities may face implicit biases or unequal access to healthcare, resulting in delayed diagnoses, inappropriate treatment options, and potential medication-related harm

1.b. The client takes over 10 medications and this is considered polypharmacy with a high risk of drug interactions and potential error with administering them correctly. As part of the deprescribing cascade, the nurse should review the meds, and find out more information on when the meds were prescribed and for what purpose (primary issue or prescribed to manage a side effect from another med?). After speaking with the client and/or caregiver, a call to the pharmacist or prescriber may be needed. The nurse’s assessment should also include discussing any symptoms or issues the client is experiencing. Some meds can pose a fall risk due to the effects of dizziness, confusion or fatigue. Consider the Beer’s Criteria and any meds that the client is on that puts them at risk.