NursingCenter’s In the Round

A dialog by nurses, for nurses

3 days left!

clock February 25, 2014 05:03 by author Lisa Bonsall, MSN, RN, CRNP

Two of our most popular CE collections will be expiring on Friday, February 28, 2014. If you haven’t already taken advantage of these specially-priced collections, you should check them out ASAP!

Anticoagulant Medications
7.3 contact hours - $19.99
Expiration Date:  2/28/2014
When patients are on anticoagulant medications, significant safety concerns exist, especially the risk of excessive anticoagulation and hemorrhage. It is important to understand these risks yourself, as a healthcare provider, and to educate the patients in your care on how to minimize their risk and be alert for complications. 

NP: Pharmocology Hours
10.4 contact hours/10.4 advanced pharmacology hours - $44.95
Expiration Date:  2/28/2014
Depending on the state where you work as a nurse practitioner or your area of practice, it may be necessary for you to maintain a certain number of advanced pharmacology hours for your license or certification. 

Need more CE? See our complete list of topical CE collections and our special collections on ‘never events.’ Please be aware that the CE tests for each article must be taken before they expire.

8 rights of medication administration

clock May 27, 2011 00:10 by author Lisa Bonsall, MSN, RN, CRNP

Chances are that some of you may not have known that in addition to the well-known 5 right of medication administration, some experts have added 3 more to the list.When it comes to patient safety, it’s never a bad time to review some of the basics and increase your awareness of newer recommendations. Please add any of your own tips and medication safety advice by leaving a comment. Thanks!

Rights of Medication Administration

1. Right patient

  • Check the name on the order and the patient.
  • Use 2 identifiers.
  • Ask patient to identify himself/herself.
  • When available, use technology (for example, bar-code system).

2. Right medication

  • Check the medication label.
  • Check the order.

3. Right dose

  • Check the order.
  • Confirm appropriateness of the dose using a current drug reference.
  • If necessary, calculate the dose and have another nurse calculate the dose as well.

4. Right route

  • Again, check the order and appropriateness of the route ordered.
  • Confirm that the patient can take or receive the medication by the ordered route.

5. Right time

  • Check the frequency of the ordered medication.
  • Double-check that you are giving the ordered dose at the correct time.
  • Confirm when the last dose was given.

6. Right documentation

  • Document administration AFTER giving the ordered medication.
  • Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug.

7. Right reason

  • Confirm the rationale for the ordered medication.  What is the patient’s history? Why is he/she taking this medication?
  • Revisit the reasons for long-term medication use.

8. Right response

  • Make sure that the drug led to the desired effect.  If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?
  • Be sure to document your monitoring of the patient  and any other nursing interventions that are applicable.

Reference: Nursing2012 Drug Handbook. (2012). Lippincott Williams & Wilkins: Philadelphia, Pennsylvania.

Patient Safety

clock March 7, 2011 03:37 by author Lisa Bonsall, MSN, RN, CRNP

This week is Patient Safety Awareness Week, an annual education and awareness campaign led by the National Patient Safety Foundation. I did a quick search of articles from our nursing journals to bring you some of the great content we have related to patient safety...

Want to read more? We also have an entire collection of resources devoted to the topic of patient safety. In addition to articles and continuing education opportunities, Focus On: Patient Safety includes a PowerPoint presentation on medication error prevention and a quick reference on pressure ulcer prevention. Have a good week!

Knowledge, A Power Source for Nurses

In relation to patient care delivery, knowledge can give nurses greater power to take action and lack of knowledge can leave nurses powerless to provide safe or effective care. Evidence of knowledge as a source of power is that many employers during this difficult economic time prefer to recruit experienced RNs rather than incurring the expense of training new graduates.

Anderson and Willson (2009) offer a conceptual framework for nursing knowledge management that supports using technology to offer health care providers many tools to effectively use data to transform it into knowledge. Clinical decision support software such as those integrated with electronic medical records or those that clinicians access through mobile applications (apps) are examples of using data effectively to support knowledgeable clinical interventions. An example of how powerful this can be is that two nurses sharing a clinical rotation have access to texts for purchase in the books store and mobile apps that they can use on a Smartphone. One nurse feels more comfortable using the text and the other is very adept at navigating information technology including mobile apps. The nurse with the mobile product completes medication administration quicker because he finds all the drugs in his reference while the nurse with a book misses out on recent drug releases requiring an extra step to call the pharmacy or to look up drugs online.

There are many other examples and some that may have life-threatening consequences such as drug to drug interactions that information systems recognize that health professionals frequently overlook. In a time when health care quality is a mandate, organizations and professionals who use knowledge effectively will have the power to take control over costs and attain a higher rate of insurance reimbursement due to fewer complications. 

Reference: Anderson, J. A., & Willson, P. (2009). Knowledge Management Organizing Nursing Care Knowledge. Critical Care Nursing Quarterly , 32 (1), 1 - 9.


Memories of a medication error

clock June 7, 2010 17:20 by author Lisa Bonsall, MSN, RN, CRNP

A recent study published in the Journal of Nursing Care Quality looks at medication errors from the perspective of nurses.  While the researchers sought information about reporting of errors, importance of technology in reducing errors, and current medication administration procedures, they also asked open-ended questions allowing nurses to share their own experiences with medication errors.

"Nurses were asked, "How did you feel when you made a medication error?" This question yielded somewhat surprising results. Many of the medication error incidents had occurred years before completion of the survey yet responses retained the emotions associated with it. Themes that emerged from these comments included concerns about patient harm; violation of trust; culpability, shame, and self-blame; loss of self-esteem and professional self-image; and an awareness that the system had failed them."

When I was a senior nursing student, I neglected to check a patient’s heart rate before giving him a dose of digoxin. I was devastated. As soon as I saw him swallow the pill, it hit me that I hadn’t taken his pulse. I panicked and grabbed his wrist. His pulse was 62; above the “Hold for heart rate less than 60” but not by much. I hadn’t thought about this incident for a long time, but now thinking back, I can remember this clinical day so vividly. My first concern, of course, was for the well-being of the patient and fortunately, his vital signs remained stable. My own feelings of self-doubt and failure, however, stayed with me for quite some time. How could I have forgotten something so important and yet so simple? 

Read the full text of When the 5 Rights Go Wrong: Medication Errors from the Nursing Perspective while it’s on our Recommended Reading list. Please share your own experiences and feelings by leaving a comment!

Where do you get your drug information?

clock April 5, 2010 16:20 by author Lisa Bonsall, MSN, RN, CRNP

As I mentioned in a previous post , one of the most stressful things I experienced in nursing school was memorizing all of the drug information. I can remember preparing for clinical the night before with medication lists for my two patients, a drug reference book by my side, a stack of index cards, pencils, and various color highlighters. The lists would be long as if my instructor picked out my patient assignment solely based on the number of meds I would be administering and it never failed that my patients’ medication lists had no overlap. For example, it seemed that even if both were cardiac patients with a history of hypertension, one was on a diuretic and the other on an ACE inhibitor! The joke was usually on me though, for no matter how well I memorized the drug names, indications, dosages, side effects, and interactions, there were always one or two drug orders that were changed by the time I arrived for clinical. Of course, those newly ordered medications would be the ones my instructor asked me about!  Ahhh…the joys of nursing school!

I had heard a lot about the “reality shock” of starting out as a new RN. I knew I would not be able to research my patients the night before and learn all about their medications ahead of time. How would I manage medication administration? Would I deliver them safely and be alert for every potential side effect? Would I make an error?

One of my most important nursing tools when I was a new graduate was a drug handbook that my preceptor gave me. She advised me to highlight in it, mark pages, take notes, and do anything else to it that made it easier for me to safely administer medications. Through the years I bought new editions but I continued to use it in the same manner as that first book.

It is now easier than ever to access drug information. The internet allows us to get any information within seconds. However, it is so important to make sure the information you are accessing is accurate and up-to-date.

Oftentimes, prescribing information can be found on the pharmaceutical company websites or by searching FDA approved drug products. For safety information, the FDA’s Drug Safety Labeling Changes and the Institute for Safe Medication Practices are good sites to add to your favorites. Also, be sure to check out drug updates here on NursingCenter. We’ll keep you informed about drug news, medication errors, and the latest drug-related articles and CEs that publish in our journals. What resources do you use?

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