King Fahad Specialist Hospital

NURSING EDUCATION DEPARTMENT

MEDICATION SAFETY COURSE

December 4 & 5, 2019
Hospital Auditorium
• https://PollEv.com/surveys/1dn94ufKXyaUn0r
uBsQD5/respond
 TO ERR IS HUMAN

Medication-related Errors
were a significant cause of
morbidity and mortality which
accounts for one out of 131
outpatient deaths and one
out of 854 inpatient deaths

MEDICATION ERRORS were

estimated to account for more
than 7000 deaths annually.
 5 STAGES
OF MEDICATION PROCESS
MEDICATION ADMINISTRATION

• Defined as preparing, giving and evaluating

effectiveness of prescription and non-
prescription drugs.
WHO CAN ADMINISTER
MEDICATIONS?
 Nursing Responsibilities in
MEDICATION PREPARATION
• Check the Medication Sheet
against the physicians orders
– for changes during the shift,
– ensure that the correct medication
has been selected based on the
medication order and label
All medications administered to patients shall have
a physician’s order

Medications shall be checked against physicians

order DAILY for VALIDITY and RENEWAL
 7 RIGHTS OF MEDICATION
ADMINISTRATION

1. RIGHT PATIENT
To avoid errors use
two identifiers, ask the
patient to state their
name and check the
ID band with the
Medical Record
Number (MRN).
Medications should be prepared for one
patient at a time.
 7 RIGHTS OF MEDICATION
ADMINISTRATION

2. RIGHT DRUG
Know what the drug is
typically used for. If it’s
therapeutic effect does not
match the diagnosis,
question the order or at
least further investigate.
You may see generic and
trade names. Double
check the MD order.
 7 RIGHTS OF MEDICATION
ADMINISTRATION

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.
 7 RIGHTS OF MEDICATION
ADMINISTRATION
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.
 7 RIGHTS OF MEDICATION
ADMINISTRATION

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.
 7 RIGHTS OF MEDICATION
ADMINISTRATION
6. RIGHT FREQUENCY
Confirm when the last dose was given.
 STANDARD MEDICATION
ADMINISTRATION SCHEDULE
FREQUENCY MEANING SCHEDULE

OD Daily 0800 H   

BID  Twice daily / every 12 0800 H 2000 H   

hours
TID Three times daily 0800 H 1400 H 2200 H   

QID Four times daily 0600 H 1200 H 1800 H 2400 H   

Q4H Every 4 hours 0800 H 1200 H 1600 H 2000 H 2400 H 0400 H

Q6H Every 6 hours 0600 H 1200 H 1800 H 2400 H   

Q8H Every 8 hours 0800 H 1600 H 2400 H   

Bedtime At bed time 2200 H   

EXCEPTION TO THE STANDARD
ADMINISTRATION TIMINGS
 7 RIGHTS OF MEDICATION
ADMINISTRATION
7. 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.
WHEN DO WE CHECK THE 7
RIGHTS AND EXPIRY DATE?
• When removing
medications from
shelf/drawer
• When opening the
packaging
• Before administration
of medication to
patient
Unit dose packages
must be opened at the
bedside.
• All drug containers
taken to the bedside,
(including syringes and
other medications
prepared from vials and
ampoules on patient
care units outside of
the patient’s room)
must be labeled with
the drug name, date,
time, strength and
dose, and patient’s
name and medical
record number
CHARTING OF MEDICATIONS
• Copying or transcribing of
physician's order is NOT
allowed. The responsible Staff
Nurse will inform the physician's
to re-write the order on the
Medication Sheet as needed.
• Document on the Medication
Sheet the medication
administered at the Bedside.
• Antibiotic and other medications prescribed for a
specific duration (eg. Injection Albumin for 3days)
can be documented in the medication sheet with
the number of days.
 Withholding Medications
• Any medications that are withheld the
doctor will write the word WITHHOLD or
HOLD on the Medication Sheet. In case of
resuming the withheld medicine, doctor
will write a new complete order.
 Medications NOT GIVEN
• When medication is not given, document
“NOT GIVEN” in the medication sheet
and sign. Write the reason why it was
not given in the Nurse’s Notes.
DISCONTINUED MEDICATION
• When a drug is discontinued the nurse shall.
– Ensure doctor's order was written and physicians'
write Discontinued or D/C to the last dose given
in the medication sheet close appropriate section
with oblique line.
 PRN medications
• Ensure doctors' order was written with
name of medication, dosage, route,
frequency and indication for medication.
Standard Medication Administration Times
• First dose of
parenteral medication
(I.V. / antibiotics, etc)
ordered round the
clock must be given
within maximum of 3
hours after the order
has been written.
Standard Medication Administration Times

• In case a drug is to be given before the due standard

timing (newly prescribe medicines and delayed
medicines), the nurse should sign with time below
the signature at the nearest due standard timing and
the next dose will be given in the proposed standard
time.
0600H
 STAT MEDICATIONS
• "Stat" orders will be given immediately
upon receipt of the medication on the unit
(within15 minutes). The allowance of 1
hour is given from the time the order has
been written to the preparation and
delivery of the medication to the ward.
Time given must be written in the
medication sheet.
REFERENCE MATERIALS
• In case in need of reference prior to administering a
drug by any type of IV push medications, the nurse
may check the available drug resource books.
• IV Admixtures Formulary,
• British National Formulary
• Hospital Drug Formulary
• Antibiotic Policy
• Hospital drug information center to verify correct
dosage and rate of administration).
 HOSPITAL DRUG INFORMATION
CENTER
HOSPITAL WARDS PHARMACIST EXTENTION

Cardio Ward, CCU, CSICU & 1500

CSU
Ph.
Abdulmajeed
MSW, GFSW, MOW Ph. Saad 1515

FMW, MMW, AHO, ER Ph. Gada 1511

ICU, IMCU and BU Ph. Aisha 1520

When giving Narcotics via IV push,
• Baseline VS (blood
pressure, O2
saturation levels,
pulse and
respirations) will be
obtained before and
after administration
every15 minutes for
one hour.
 IV Medications
• All Intravenous Therapy (IV) medications
shall be double checked and counter
signed by Head Nurse or Charge Nurse. If
Head Nurse or Charge Nurse is not
available any Senior Nurse may do so.
Floors-Stock Medications and Supplies

• High risk
medications are
identified by
specialty labels or
color marks (RED
STICKER) and
should be stored
in separate
locked cabinet.
• All medications taken from the floor stock
must be documented in the Floor Stock
Verification list
• Borrowing of medications from another
patient’s supply, or from the Crash Cart is not
allowed except in a life-threatening situation.
MULTIPLE DOSE VIALS/CONTAINER

• Multiple dose vials

shall be labeled with
date opened,
discarding date (new
expiration date) and
refrigerated when
they are opened
unless otherwise
specified by the
manufacturer.
Where do we document DRUG
ALLERGY?
Kardex

Initial Nursing Assessment Form on Admission

Medication Sheet

Pre-operative Checklist

Adult Daily Nursing Re-assessment Form

TOTAL MEDICATION ERROR
January –October 2019

40 Medication Errors
 NUMBER OF MEDICATION ERRORS
PER MONTH - 2019
9
8
7
6
5
9
4
7 7 7
3
5
2
3
1
1 1
0 0 0

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THANK YOU!