Giving meds safely

Nursing,  Mar 2000  by Przybycien, Peggy

• E-mail
• Print
• Link

USE THE "FIVE RIGHTS" TO AVOID ONE WRONG!

The physician orders furosemide (Lasix), 40 mg intravenously (I.V.) stat. The nurse takes a vial of Lasix out of the cupboard in the medication room. The label reads "Lasix 40 mg." She draws up the vial (5 ml) and administers the medication I.V. push.

This nurse may have done the standard three checks:

1. read the label "Lasix 40 mg" as she took the vial from the cupboard

2. read the label "Lasix 40 mg" as she drew it up in the syringe

3. read the label "Lasix 40 mg" before she threw the vial away.

But without reading the complete dosage on the label, she really didn't do three valid checks. The complete label read "Lasix 40 mg per milliliter." So this nurse administered 5 ml-five times the ordered dose.

This happens more often than you might think, but it's a reminder to read labels completely before you give a drug. In fact, that's just one of the steps you need to follow to ensure your patients' safety.

You also should:

1. check the physician's order. In many institutions, secretaries transcribe physicians' orders. As the nurse administering the medication, you need to confirm that the order was transcribed correctly. Make sure the drug name is spelled correctly, the dosage is clear and accurate, and the scheduled times are correct.

2. check your drug handbook. Look up the medication to determine the safety of the dose. Make sure you know the drug's classification-it's why you're giving it-and find out what you need to do before administering it. For example, do you need to check the patient's apical pulse before giving digoxin?

3. check the complete medication label three times against the medication Kardex before you administer it. Be thorough: With the labeled package in your hand, read the entire dosage (1) when taking the medication out of the drawer or cupboard; (2) when preparing the medication, whether pouring or drawing it up in a syringe; and (3) after you prepare the medication, before discarding the package.

if you need to assess the patient before administering the drug, don't open the package until you've done so. For example, if you're giving digoxin and the patient's apical-radial pulse is below 60, how will you know for sure which pill in your cup is the digoxin you should withhold?

SAFE ADMINISTRATION

Once you've safely prepared your medications, you need to administer them safely as well. Remember these three A's:

Armband: Check the patient's ID band against the medication Kardex to make sure you have the right patient. Ask him to tell you his name, if he can speak. Allergies: Ask the patient if he has any medication allergies. Even if "no known drug allergies" or NKDA is written on the medication Kardex, always ask before administering any medication.

Assessment: Are any assessments needed before you administer this drug? Can the patient swallow pills, for example, or does he need an elixir?

These multiple checks may seem repetitious and time-consuming, but once you incorporate them into your practice, they'll become second nature. Absorbing these safety checks into your practice will improve your chances not only of avoiding a drug error but also of keeping your patients safe.

Peggy Przybycien is an assistant professor of nursing at Onondaga Community College, Syracuse, N.Y.

Copyright Springhouse Corporation Mar 2000
Provided by ProQuest Information and Learning Company. All rights Reserved