Medication safety and administration

1. Medication Safety and
Administration
Update June 2009, K.Klee
Medication administration for nursing
students in clinical at Seattle
Children’s

2. Objectives
• Describe appropriate methods of medication delivery
for different ages.
• Accurately document medications per hospital
policies and procedures.
• Safely administer medications.
• Know standards of practice specific to caring for
children at Seattle Children’s
• Know limitations of student responsibilities at Seattle
Children’s

4. What you need to know….
• Medication errors happen
• Near misses happen (when an error is discovered
before it gets to the patient)
• Injury and even death happens from medication
errors.
You are part of the team and you
can help prevent errors by talking
with your instructor when you are
unsure, overwhelmed, or new to a
task

5. What Can You Do To Decrease Medication Errors?
• Check and double check, if in doubt check it out, again!
• Follow the 5 R’s: right patient, right drug, right dose,
right time, right route
• Never assume, “pharmacy put the medication in the
drawer so this must be right”, pharmacy makes errors
too.
• Never assume, “the resident ordered this large dose so
it must be right”, Residents make errors too.
• Know the correct mg/kg dose of medications you are
administering.
• Know why you are giving the medication, the expected
action, and any potential side effects.

6. Time for a story

7. Story: Admission of a patient…
•3 month old
admitted with
respiratory
distress most
likely due to
bronchiolitis
Admitting Nurse: “I did his
admission assessment and then
it was time for change of shift so
I gave report to the next nurse”
Oncoming Nurse: “I received
report at 7 p.m. and was
reviewing the orders and saw
that he had some medications
due”

8. “I saw that he had some medications due…”
Infants Nurse:
“The infant had
reglan and digoxin
ordered BID. They
were due at 8pm. I
went to the
medication room
and the meds were
in the drawer so I
took them into the
infants room”.
•What are the next steps to take?
•5 R’s
•What questions do you have?
•What are the clinical
indications for these two meds
in this infant
•You go into the room to give the
medications…what steps do you
take?
•Patient ID check, tell patient
and family what meds you are
administering and what they are
for

9. “I took the medication into the room…”
•“I looked at the online formulary
for reglan and digoxin and saw
that they were ordered in the
correct dose and route. I checked
the labels on the syringe and
double checked the dose against
the order on the medication
administration record. I took the
medications into the infants room,
checked his ID band, and told
mom I was giving digoxin and
reglan”.
• Looked meds up on the
online formulary
•Checked the dose
•Checked the med
•Took labeled syringes to pts
room
•Checked the ID band against
the name on the med and
asked mom to verify date of
birth
•Told mom what meds were
about to be administered
EXCELLENT
PRACTICE,
Never short cut this!

10. “I told mom I was giving Digoxin and Reglan..”
•“She said, at home I
give the reglan, the
other medication must
be a new one.”
•“I told her it was
ordered by the doctor
for the baby’s heart”.
•“Mom said, is there
something wrong with
his heart?”
•What do you do?

11. “Mom said is there something wrong with his heart?”
•“I said let me double check
his chart”.
•I left the room and looked
at the chart, he was here for
respiratory distress. I did not
see anything about a heart
problem.
•I called the resident and he
said “he did not know of any
heart problems in this
patient”.
•I called my charge nurse.
•The charge nurse called
the senior resident who
said the child had no
cardiac issues and
should not have an order
for Digoxin.
•Turns out the order was
electronically placed in
the wrong chart.

12. “What if mom had not been there?”
•Always! Ask yourself…
what were the
indications for digoxin in
this infant?
•Know why you are
giving a medication and
the indication in your
patient!

14. What Else Can You Do To Decrease Medication Errors?
• Stop the line, if you have concerns or questions do not give the
medication until you feel the concerns/questions have been
answered.
• If a patient or caregiver says, “hmm, that pill does not look familiar”,
or “the doctor said not to take that today”, or “I already took that pill
today”, or anything that might indicate an error is about to
occur….stop, pick up the medication and leave the room. Double
check the medication and if necessary call the MD to clarify the
orders.
• If you have to pull 2 vials of a medication out of omnicell or need a
large quantity of a medication stop and recalculate with a peer. This
is pediatrics! Medications doses are smaller then adults and are
given in mg/kg!
• Harried? Tired? Distracted? Triple check yourself!

15. 1.Documentation of medication dose, time,
date, route must occur every time a
medication is administered, at the time of
administration.
2.Documentation occurs on the medication
administration record (eMAR) in CIS
3.If you give a scheduled med late you must
document the actual time given.
4.If a scheduled med is not given you must
document not given and document the
reason why..
5.You must have medications cosigned by an
instructor or the RN caring for the child
Medication administration documentation

16. Nursing Student Responsibility and Patient Safety
Follow all Children’s Hospital policies and
procedures especially those related to
Patient Safety.

17. Nursing Student Responsibility
• Nursing students do not take verbal/telephone
orders from physicians
• Nursing students do not receive critical lab
values from the Laboratory
• Nursing student do not alter alarm
settings(change alarm parameters,turn off
alarms…)
• Nursing students do not administer any
chemotherapy agents (oral or IV)

18. Nursing Student Responsibility and
Patient Safety
• Nursing students do not give IV push
medications EVER! (exception: normal saline
(NS) and heparin flush in a PIV only)
• Nursing students do not administer blood or blood
components
• Nursing students do not do Ventriculostomy care
or maintenance
• Nursing students do not administer narcotics,
paralytics, or vasopressors via pump or drip
• Nursing students may not independently program
any infusion pumps

19. 1.You must give medication under the direct
supervision of a nursing instructor unless
supervision has been prearranged with the
instructor and the RN caring for your patient.
2. If you give a scheduled med late you must
document the actual time given.
3.If a scheduled med is not given you must
document not given and document the reason
why..
4.You must have medications cosigned by an
instructor or the RN caring for the child
Medication administration documentation

20. Faculty Responsibility…
• Directly supervise the administration of medications. When the
student has demonstrated adequate knowledge and good technique,
s/he may give medications (except IV meds) with staff nurse
availability. This must be pre-arranged between the faculty and staff
RN.
• All student medication administration is to be directly supervised by
clinical faculty or staff nurse. The supervising RN (faculty or staff RN)
will co-sign the MAR.
• From P&P: RN reviews and co-signs documentation and
medication administration. Writes “I agree/concur with above
documentation” and/or add any additional documentation. (Note:
LPNs may not co-sign RN student nurse medication administration
documentation).

21. Wow, that is a
lot of to do’s
and not to
do’s…but
ultimately
keeping kids
safe is our goal!

22. Documentation
If you do not chart it, it
didn’t happen.
What if you gave
tylenol at 0630 and forgot
to chart it. The next nurse
comes on and the child
has a fever so the child
gets tylenol again at
0730…

23. Some hints from the wise
 Always check name band prior to giving
any medications.
 Always check to see that ordered dose is
appropriate based on weight.
 Always look up medications unfamiliar to
you before leaving the medication room.

24. Pt Safety
• Never leave medications unattended at the
bedside or at the nursing station.
• Never leave medications unattended!
• We are protecting the patients, siblings, friends,
and young visitors that may be curious and
ingest a medication left unattended.
Think Safety!

25. Pt Safety
• Never leave the medication room with a syringe
unless it has a label on it that includes the patients
name, dose, and name of medication.
JJ Amoxicillin 250 mg

26. On line order entry is great…but
• It is not fool proof
• Errors still occur
• Always know when the last dose was
given and frequency of dosing
• Note start and stop dates especially
on weaning schedules
• Watch for duplicate orders

27. Patient Safety
• Check and double check
• 2 patient identifiers (name/DOB or name/MRN)
before any medication or intervention
• Know why you are giving the medication and
that the reasoning matches the pts clinical
state/diagnosis
• Listen to your instinct
• Listen to the family

28. Thanks!

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