DISPENSING HIGH RISK/ALERT MEDICATIONS. Lana Gordineer, MSN, RN Diabetes Educator

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2 DISPENSING HIGH RISK/ALERT MEDICATIONS Lana Gordineer, MSN, RN Diabetes Educator

3 HIGH RISK/ALERT MEDICATIONS (or DRUGS) Medications that have a high risk of causing serious injury or death to a patient if they are misused. Errors with these products are not necessarily more common but their results are more devastating. Examples of high-alert medications include heparin, warfarin, insulin, chemotherapy, concentrated electrolytes, opiate narcotics, neuromuscular blocking agents, thrombolytics, and adrenergic agonists. ISMP

4 HIGH RISK/ALERT MEDICATIONS How can we fine tune our organizational skills? Considering the following work related problems: -Interruptions -High patient acuity -Staffing -Change in assignment -Intimidation

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6 HIGH RISK MEDICATIONS What steps can we take to eliminate medication errors?

7 High Risk Medications High Risk-High Alert Medications should be closely monitored. These drugs pose an increased risk of causing significant patient harm when used in error. ALWAYS GET YOUR HIGH RISK MEDICATION DOUBLE CHECKED AND COSIGNED.

8 HIGH RISK MEDICATIONS Independent Double Check: A procedure in which two individuals, preferably two licensed practitioners, separately check each component of the work process. An example would be one person calculating a medication dose for a specific patient and a second individual independently performing the same calculation (not just verifying the calculation) and matching results.

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10 HIGH RISK MEDICATIONS What are some of the ways we can highlight the high risk medications so they just jump out at you? TALL MAN labeling High Alert labeling

11 Preventing Medication Errors The Five Rights of Safe Medication Administration RIGHT DRUG (does it look right) RIGHT ROUTE RIGHT DOSE RIGHT TIME RIGHT PATIENT (use 2 identifiers) Right to refuse Right to know

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13 Preventing Medication Errors Key Elements: Understand the entire medication system Take a cognitive and proactive approach to error

14 OOPS, SORRY WRONG PATIENT! Wrong patient errors, occur in a variety of ways and may originate during any phase of the medication use process, not just during drug administration.

15 DISPENSING HIGH RISK MEDICATIONS It is essential that the Nurse be aware of all the information regarding high risk medications and the potentially lethal results when these medications are given not using proper guidelines and recommendations.

16 DISPENSING HIGH RISK MEDICATIONS Bayhealth policy states: High alert medications are medications frequently implicated in medication errors, with the potential for significant adverse patient outcomes. To have in place guardrails/processes to prevent errors involving the interchange of sound alike/look alike medications. (policy B )

17 Medication Administration Procedure Research drugs that are unfamiliar to you using available references. Check each patient s MAR for drug dose, route and time before beginning patient care each shift. Know your patients status, what are their vital signs, are they NPO, etc. Bring patient s s MAR and medications into the room with you before opening the medications. Know the proper procedures to use when giving medications IV, oral, subcutaneous, rectal, and IM.

18 Medication Administration Procedure Medications that are verified (double checked) with another nurse before administration are: Insulin Heparin Parenteral Digitalis All calculations for fractional dosages

19 Adverse Drug Reactions Any unintended and/or unexpected response to a medication which causes or prolongs hospitalization and/or requires treatment with a prescription drug and/or is fatal or life-threatening. threatening. Report Report all reactions or suspected ADRs to the Adverse Drug Reaction Hotline: (KGH ; MMH ).

20 Adverse Drug Reactions ADRs-is a subset of ADEs that includes any clinical manifestation that is undesired, unintended, or unexpected that is consequent to and caused by the administration of medications or IV fluids. American Hospital Association, Health Research & Educational Trust, and the Institute for Safe Medication Practices

21 List of High Risk Medications The list is actually very long but we are going to concentrate on the following groups of High Risk Medications: Anticoagulants Insulins Electrolytes Opiates Chemotherapeutic Agents Adrenergic agonists, IV (e.g., epinephrine)

22 ANTICOAGULANTS Prevent blood clot formation by interfering with different factors in the thrombosis formation cascade causing increased bleeding times. Require ongoing lab monitoring. Medications include: ASA, Heparin, Coumadin, Lovenox, Arixtra. Using more than one anticoagulant can increase the bleeding time, Check to see if using as a bridge therapy or if it was an oversight by the prescribing physician.

23 INSULINS Wide variety of insulins are available. Know the duration of each type of insulin, when it is to be administered, and if it is compatible with other types of insulins Hypoglycemia is the most common adverse reaction. Always look up a medication you are unfamiliar with-keep your patient safe.

24 ELECTROLYTES Electrolytes are the life energy of the cell and of life. Too much or too little can be severe and life-threatening. The sodium-potassium pump is a prime example of this. It is no wonder that electrolytes such as potassium, phosphate, and sodium chloride >0.9% are included with high risk medications.

25 OPIATES Narcotic agents that control or eliminate pain. When in excess will cause respiratory depression, often requiring a reversal agent. Patients are also at risk for fluid deficit due to N/V, falls, and anaphylactic reactions.

26 Chemotherapuetic Agents or Antineoplastic Agents Treatment of choice for malignancies of the hematopoietic system and for solid tumors, including solid tumors that have metastasized regionally or distally. Chemotherapeutic agents are mutagenic, teratogenic or carcinogenic. They can cause localized skin irritation or damage. They are considered hazardous. Healthcare workers should take precautions to avoid direct contact.

27 ADRENERGIC AGONISTS (e.g., epinephrine) Results in relaxation of cardiac and bronchial smooth muscle and dilation of skeletal muscle vessels. Available in different concentrations (e.g., 1:1000, 1:10,000). In emergencies often are drawn up into unlabeled syringes or put in unlabeled or incorrectly labeled cups or pans.

28 JCAHO 2007 National Patient Safety Goals Goal 1 Improve the accuracy of patient identification Goal 2 Improve the effectiveness of communication among care givers Goal 3 Improve the safety of using medications Goal 7 Reduce the risk of health care-associated infections Goal 8 Accurately & completely reconcile medications across the continuum of care Goal 9 Reduce the risk of patient harm resulting from falls Goal 13 Encourage patients active involvement in their own care as a patient safety strategy Goal 15 The organization identifies safety risks inherent in its patient population

29 What can happen when the rules are not followed. Reports from the Institute of Safe Medication Practice (ISMP). Chemotherapeutics Insulin Narcotics Electrolytes Anticoagulants Adrenerics

30 Worse Practice Using unapproved abbreviations Rushing (not using a double check) Not knowing the facts about the medications you are dispensing Not following the 5 Rights of Safe Medication Practice Failing to initiate the medication reconciliation form Failing to question or investigate when your RED flag pops up. Failing to follow Bayhealth policies

31 Best Practice Use only approved abbreviations Always get high risk medications double checked Initiate Medication Reconciliation form Follow the 5 Rights of Safe Medication Administration Research all medications you are dispensing If your RED flag pops up :question and/or investigate Always follow Bayhealth policies- you can t t go wrong

32 DISPENSING HIGH RISK MEDICATIONS ANY QUESTIONS?