Chapter 7: Parenteral Medication Administration Show
Critical Thinking Exercises: Questions, Answers, and Sources / References
a. Implement changes to medication practices with staff involvement and staff champions b. medication preparation areas and include signage that identifies distraction free zones c. Staff to wear signage to educate patients, facilities / visitors in an effort to educate and involve them in safe medication practices d. Encourage a culture where staff, patients and families / visitors recognize the importance of not interrupting the nurse during medication preparation. Source: Connor, J., et al. (2016). Implementing a distraction free practice with the red zone medication safety initiative. Dimensions of Critical Care Nursing Vol. 35 / No. 3 Wolters Kluwer Health, Inc. DOI: 10.1097/DCC.0000000000000179 2. Identify three strategies the nurse should do to prevent infection associated with parenteral medication administration.
Copied from Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 7. 2 Preparing Medications from Ampules and Vials. https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/ Sources: Centers for Disease Control (CDC). (2015). Injection safety. http://www.cdc.gov/injectionsafety/. Children’s Hospitals and Clinics of Minnesota. (2018). Infiltration and extravasation care. https://www.childrensmn.org/educationmaterials/childrensmn/article/16565/infiltration-and-extravasation-care/. Hutin, Y., Hauri, A., Chiarello, L., Caitlin, M., Stillwell, B., Ghebrehiwet, T., Garner, J., & Members of the Safe Injection Practices Development Group (2003). Best infection control practices for intradermal, subcutaneous, and intramuscular injections. http://www.who.int/bulletin/volumes/81/7/Hutin0703.pdf. Perry, A., Potter, P., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby. Provincial Infectious Disease Advisory Committee. (2014). Best practices for hand hygiene in all health care settings (4th ed.). http://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf. Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Healthcare Infection Control Practices Advisory Committee. (2007). Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. 3. Identify five principles of safe medication administration.
Copied from: Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 6.2 Safe Medication Administration. https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/ Sources: Agency for Healthcare Research and Quality. (2014). Checklists. http://psnet.ahrq.gov/primer.aspx?primerID=14. Canadian Patient Safety Institute. (2012). Canadian analysis incident framework. http://www.patientsafetyinstitute.ca/english/toolsresources/incidentanalysis/documents/canadian%20incident%20analysis%20framework.pdf. Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses’ workarounds in acute healthcare settings: A scoping review. BMC Health Services Research, 13(175). doi: 10.1186/1472-6963-13-175. Institute for Healthcare Improvement. (2015). High-alert medication safety. http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx. Institute for Safe Medication Practices (ISMP). (2018). High-alert medications in acute care settings. https://www.ismp.org/recommendations/high-alert-medications-acute-list. National Patient Safety Agency. (2009). Safety in doses. Improving the use of medication in NHS. http://www.nrls.npsa.nhs.uk/resources/?entryid45=61625. National Priority Partnership. (2010). Preventing medical errors: A $21 billion opportunity. http://psnet.ahrq.gov/resource.aspx?resourceID=20529. Prakash, V., Koczmara, C., Savage, P., Trip, K., Stewart, J., McCurdie, T., . . . Trbovich, P. (2014). Mitigating errors caused by interruptions during medication verification and administration: Interventions in a simulated ambulatory chemotherapy setting. BMJ Quality and Safety, 23(11). https://doi.org/10.1136/bmjqs-2013-002484. Shah, K., Lo, C., Babich, M., Tsao, N., & Bansback, N. (2016). Bar code medication administration technology: A systematic review of impact on patient safety when used with computerized prescriber order entry and automated dispensing devices [PMID: 27826157]. Canadian Journal of Hospital Pharmacy, 69(5), 394-402. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5085324/. 4. Describe two strategies to prevent needle-stick injuries.
Copied from: Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 7.2 Preparing medications from ampules and vials. https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/safe-injection-administration-and-preparing-medication-from-ampules-and-vials/ Data sources: American Nurses Association. (2002). Needlestick prevention guide. http://www.who.int/occupational_health/activities/2needguid.pdf. Centers for Disease Control (CDC). (2012). NOISH fast facts (home healthcare workers). How to prevent needlestick and sharps injuries. http://www.cdc.gov/niosh/docs/2012-123/pdfs/2012-123.pdf. National Patient Safety Agency. (2009). Safety in doses. Improving the use of medication in NHS. http://www.nrls.npsa.nhs.uk/resources/?entryid45=61625. Perry, A., Potter, P., & Ostendorf, W. (2018). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby. Pratt, J. R., Pellowe, C. M., Wilson, J. A., Loveday, H. P., Harper, P. J., Jones, S. R., … Wilcox, M. J. (2007). Epic2: National evidence based guidelines for preventing health care associated infections in NHS hospitals in England. Journal of Hospital Infection, 65(1), S1-64. https://doi.org/10.1016/S0195-6701(07)60002-4. Wilburn, S. Q. (2004). Needlestick and sharps injury prevention. The Online Journal of Issues in Nursing, 9(3). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html. Wilburn, S. Q., & Eijkemans, G. (2004). Preventing needlestick injuries among healthcare workers: A WHO-ICN collaboration. International Journal of Occupational and Environmental Health, 10(4), 451-456. https://doi.org/10.1179/oeh.2004.10.4.451. Sample Quiz Questions
Answer: minimize use of needles when preparing medications by using blunt fill and blunt fill filters; scoop cap if necessary; prepare medications away from distractions Sources: noted above in question #4. 2. Identify 5 guidelines for safe medication practices. Answer:
Source: noted above in question #3. 3. Name two strategies to reduce the risk of harm from high-alert medications. Answer: independent double check where another nurse performs a check of the medication separate from the person administering it; be vigilant when preparing meds, have another nurse verify calculations; be alert to high alert meds and high risk situations (multiple IV meds / frequent insulin administration) Sources: Institute for Healthcare Improvement. (2015). High-alert medication safety. http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx. Institute for Safe Medication Practices (ISMP). (2018). High-alert medications in acute care settings. https://www.ismp.org/recommendations/high-alert-medications-acute-list. What procedure is needed when drawing up a medication from an ampule?Hold the ampule upright and tap the top of the chamber quickly and lightly until all fluid flows to the bottom of the chamber. 6. Using a clean piece of gauze, or a new alcohol wipe, grasp the neck of the ampule and quickly snap the top off directing away from you.
What is the greatest safety concern when withdrawing medication from an ampule group of answer choices?What is the greatest safety concern when withdrawing medication from an ampule? Rationale: Measures must be taken to prevent glass particles from being drawn into the syringe when aspirating medication from an ampule. It is not necessary to wear clean gloves when preparing medication.
What items can be used to prevent accidental cuts when breaking an ampule?- Protect your hands from injury by wearing gloves and using a swab or towel on the neck of the ampule before breaking it.
When withdrawing medication from an ampule you should use a needle with a?Ampules are glass containers in 1 ml to 10 ml sizes that hold a single dose of medication in liquid form. They are made of glass and have a scored neck to indicate where to break the ampule (see Figure 7.2). Medication is withdrawn using a syringe and a filter needle.
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