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40 Cards in this Set
- Front
- Back
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What is the prescriber's role?
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Take Med History
Perform Physical Exam Diagnose Symptoms Prescribe Meds Monitor Response Modify Med orders as needed |
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Who has prescriptive Authority?
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Physicians
Dentists Podiatrists Physician Assistants Advanced practice nurse Nurse Practitioner |
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Types of Orders
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Standing / Routine Orders
Contingency or PRN One-time STAT / Now Prescriptions |
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Order followed until cancelled
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Standing / Routine
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Order based on client need and nurse's judgement and may include a "range"
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Contingency or PRN
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Orders that are Pre-Op, Today, This PM, On call
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One-time
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Orders carried out immediately as in arrest or acute adverse event
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STAT / Now
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What is the right and wrong way to order a contingency order?
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The right way is to choose one drug to give without giving nurses a choice between multiple drugs.
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What is the right way to explain the time on an order with contingency orders
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Every 4 hours instead of "ever 4 - 6 hours"
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What are things to consider with range orders?
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Age
Drug Naivete Weight Sex Condition |
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What must the maximum dose of a range order not exceed
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4 times the minimum dose
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What has to be done with telephone orders within 24 hours?
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The MD / HCP must sign it
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Who shouldn't you take phone orders from?
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Chemotherapy
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What do you do for sound alike meds and numbers?
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Spell the meds back and say each digit in the number back
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Orders with the same criteria as a telephone order and given only under urgent or emergent situations
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Verbal Orders
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Do students take orders?
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No
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Do registered nurses have prescriptive authority?
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No
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What are the elements of a medication order?
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Name of recipient
Date and Time Name of Medication Dosage Route Time and Frequency Signature of person writing it |
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What are the two MR numbers for a patient?
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The U number is their baseline permanent number for the facility
The A number is with admissions and changes |
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How is a med order filled?
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Secretary / Nurse transcribes
Scanned to pharmacy then faxed Pharmacy delivers or enters in profile Meds are on a locked cart Refrigerated for specific meds Narcotics are counted each shift |
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What are the pharmacists responsible for?
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Selecting, obtaining, and storing drugs
interpret and dispense med orders Monitor med usage Educate Public Stock Pharmacy Check for out of date meds / return unused Clarify med orders by dr.s (at COVHS) |
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What is the nurse's role and responsibility
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Up to date knowledge base
Skills that ensure correct admin of all types of meds Assist people to safely use meds safeguard, store, and care for meds Serve as role model by educating others Know when to hold meds / choose appropriate routes Obtain clarification of unclear orders Advocate for individuals by protecting rights/responsib Question incorrect / incomplete med orders |
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What are the skills that ensure admin of all types of meds?
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Assesments (VS ok?)
Planning (meals/ activities) Implementation (accurate calc) Evaluation |
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What are some things nurse's should know?
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Generic and Brand Name
Normal dose/range of doses Admin Route Desire Action Common Side Effects Contraindications Specific consideration for specific meds |
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To avoid legal trouble what should nurse's understand?
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Classification, action, significant side effects, and reason for admin
Take steps to prevent med errors Provide safe admin through careful assessment/teaching/monitoring Document administration and omissions Observe, report, and document (adverse, phys/psych response) |
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When somebody takes a narcotic that belongs to a patient to take themselves
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Diversion
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Ethical issues to consider with giving drugs
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Clients with drug dependence
Safeguard med access Experimental drugs |
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How many healthcare workers were known to diverting drugs?
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15% of healthcare workers
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The DEA's position on diversion
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An employee who has knowledge that a co-worker is stealing drugs has an obligation to report such information to the employer
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Traits of healthcare workers who abuse drugs?
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Overtime, comes early, leaves late
Excessive absence, tardies, lame excuses Frequent BR use, off unit for extended periods Charting errors, omissions, discrepancies Barely adequate work Defensive behavior, crying, acting out Erratic/abuse home life Volunteers to give somebody's meds to keep narco keys Their clients receive more pain meds, without pain relief Frequent reports of lost/wasted meds Meds on unit show tampering Nurse has blood spots on clothes Nurse carries narcotics around for multi clients |
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What are some things to remember to handle narcotics correctly
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Every action is recorded
Swear to protect PW/bio-identity Witness wastage of narcotics Weekly diversion report by pharmacy Pyxis CII safe compare report - daily Override Reports Discrepancy Reports User Modification Reports |
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What are some consequences when caught with narcotics
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Counseling
Drug Screening Termination Report to Peer Review Report to BNE Lose License Texas Peer Assistance Program for Nurses |
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What are the patient's responsibilities?
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Understand the therapy/question what's not understood
Understand their role Adhere to the regimen Report adverse effects of meds or changes in medical condition Avoid misuse or abuse of meds Store meds safely |
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What are the patient's bill of rights?
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Reveive qualified nursing asses.
Be informed about the drug Refuse to take meds Receive labeled meds Be advised of exper. drugs Receive supportive therapy Receive the right drug |
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What are some goals for the different med giving systems
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Promote safety / accuracy
Reduce Errors Reduce prep time Contain costs Involve people in self-care |
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What are the generalized desired effects we want when giving meds?
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Promotion of health
Prevention of disease Alleviation of discomfort/pain Cure/control of disease process |
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Expected or predictable response
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Therapeutic effect
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Type of med admin with a needle stick
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Parenteral Admin
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What do medication error reports include?
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Name of persons involved in error
Narrative of events |
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Who needs to be notified of a medication error
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Healthcare Provider
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