If the drugs are administered sublingually (under the tongue) or orally (between the cheek and gums), the mouth should be moist. Offering the patient a sip of water before administering the medication can help with absorption. Ask the patient to allow the medication to dissolve completely and emphasize the importance of not swallowing or chewing the medication. It is difficult to ensure that prescriptions and prescription transcription for investigational and study drugs are done in a manner that maximizes patient safety and meets JCAHO standards for medication management for several reasons. In addition to the common prescription writing errors mentioned above, factors specific to the experimental study may also contribute to medication ordering and transcription errors. This includes failure to provide a study protocol number, an appropriate subject identifier (subject number or randomization number) or a study visit number. These factors may be particularly important when a drug is blinded, patient-specific, or at a specific visit in an experimental study, as they contribute to a violation of the study protocol and can potentially expose the study participant to unforeseen risk. It is also not uncommon for several different protocols in the same facility to involve the same drug at the same time. In these cases, omissions or errors in the ordering of medicines may result in the waiver of incorrect supply of medicines at the time of execution of the order.
Finally, in the experimental study, the minimization of errors in ordering and transcribing prescriptions is complicated by the lack of familiarity with the study drug, as these active ingredients are usually not yet available on the market and can only be identified by a sponsor code number (instead of a name). This can be particularly problematic because the investigator (or other staff involved in the prescription) may not be aware of the dosage form, strength and packaging of the investigational medicinal product, whether it is supplied by a sponsor in its final form or assembled by the pharmacy. The handwritten or computer-generated signature makes this prescription a legal part of the patient`s file. The guidelines of the health facility or pharmacy department determine the frequency and hours of routine medications. Abbreviation of the Latin word statim, which means immediate; Often used on medication orders to immediately indicate the need for the drug. Recent literature shows that up to ten rights should be completed as part of a safe medication administration process. These additional rights include good history and assessment, good drug interactions, the right to refuse, and appropriate education and information. Information about each of these rights is described in more detail below.
[6], [7] The University of Michigan Health System`s Investigational Drug Service (UMHS) currently manages drugs for approximately 270 clinical research trials conducted at the 850-bed tertiary care academic teaching clinic, as well as various academic and outpatient health centers. The tasks of the IDS include the development of detailed procedures for the production, delivery and administration of investigation and study preparations. In addition, CIU is responsible for receiving and properly storing investigational and study drugs, as well as managing drug inventories and maintaining accurate records of drug accountability. While most orders for investigational or study drugs are processed by the IDS pharmacy, investigational or study drugs can also be dispensed by decentralized pharmacies. Second, there are PRN drug orders. These drugs are only given when the patient needs them. Medications to relieve pain, sleep, and nausea can be written in the form of PRN prescriptions. Sometimes you can find medications for blood sugar and high blood pressure as an order for PRN medications. Remember: nursing students cannot receive verbal or telephone orders, only licensed practitioners. It is important to remember that if a medication error occurs and causes harm to a patient, a nurse can be held liable, even if she is “just following orders.” It is absolutely essential that nurses use critical thinking and clinical judgment to ensure that each medication is safe for each patient prior to administration. The consequences of liability for medication error can range from charges of negligence in court to loss of employment or loss of nursing licensure. Once the dose is administered, the control is no longer active.
If the patient needs another dose of the same drug, another prescription should be written. In addition to examining the fundamental rights of medication administration and documenting administration, it is also important for caregivers to review the following information to avoid medication errors. The dosage of a drug is prescribed using the metric system or the home system. The metric system is the most widely accepted system internationally. Examples of standard dosages are 5 ml (milliliters) or 1 teaspoon. In terms of dosage, standard metric measurement abbreviations are often used, such as mg (milligrams), kg (kilograms), ml (milliliters), mcg (micrograms) or L (liters). However, it is considered safe practice to avoid further abbreviations and to include full words in regulations to avoid errors. In fact, several abbreviations were deemed dangerous by the Joint Commission and placed on a “do not use” list. The following links provide a list of abbreviations to avoid from the Joint Commission and Institute for Safe Medication Practices (ISMP) “Excluded Persons List”. If a dosage is written unclear or confusing in a prescription, it is always best to clarify the order with the prescriber before administering the drug.
When planning for the timing of a new medication, pharmacists should also consider what other medications the patient is taking. For example, if a patient is taking both ciprofloxacin and calcium carbonate, there must be sufficient time between doses of each agent. If these drugs are taken too close together, calcium carbonate can reduce the amount of ciprofloxacin absorbed by the patient. The resulting decrease in ciprofloxacin absorption may render treatment ineffective. If the ordering part does not provide a specific designation on the urgency of a drug, technicians can use critical thinking skills to prioritize orders. Most prioritization decisions require basic knowledge of drugs and common sense. It is also helpful for technicians to familiarize themselves with their hospital`s specific policies regarding task prioritization. For example, some hospitals treat all orders from a particular unit – such as an intensive care unit – as urgent. Many hospitals have set administration times for certain medications, such as warfarin, which can change the prioritization of the order based on receipt of the order.
Policies vary from pharmacy to pharmacy, and technicians should familiarize themselves with the prioritization system used in their facility. Order entry steps. The following section describes the steps for entering a medication order into the pharmacy`s computer system. The signature of the prescribing supplier is required on the order and can be electronic or handwritten. Verbal instructions from a prescribing physician are not recommended, but may be permitted in some organizations in an emergency. Verbal instructions require the nurse to “repeat” the instruction to the prescribing physician for confirmation. Figure 13–2. Example image of task scanning technology. Entering patient orders directly into a computer system. A good rule of thumb for determining whether a dose might be too high or too low is that if the dose requires less than half of one or more dosage units (capsules, tablets, vials, etc.), consult the pharmacist before proceeding.
Often, dosage units developed by manufacturers are designed as a single unit of use or very close to a typical dose. Tablet A solid dosage form containing one or more medications. Most tablets also contain other pharmaceutical ingredients such as thinners, disintegrants, dyes, binders, solubilizers and coatings. The name of the drug can be ordered after the generic name or brand name.