1807NRS Safe Administration Of Medications

Table of Contents

Question:

One of the most common nursing clinical practice activities is medication administration.

Safe medication administration is essential for quality patient care.

There are many errors that can be made in the administration, prescribing, and dispensing of medication.

Nurses can help reduce medication errors by understanding the factors that affect the regulation of medications, pharmacology, and error-producing conditions.

Q1 Pharmaceutical companies conduct clinical studies to assess the safety and efficacy of a medication.

Let’s briefly outline the FOUR (4) phases involved in clinical trials

a) Briefly outline the major responsibility of the Therapeutic Goods Administration.

b) Describe TWO (2) methods that the TGA regulates medication use in Australia

Q3 Describe briefly the terms pharmacokinetics (4 marks), AND pharmacodynamics (3 marks).

Q4 Explain the phenomenon known as ‘hepatic First Pass Effect’ in relation to oral medication.

a) Briefly explain why GlycerylTrinitrate 600 microgram tablets should only be taken sublingually

b)List TWO (2) areas of education that you should give to the patient, and only concern the medication Glyceryl Trinitrate

Q6 Outline five (5) roles and/or responsibilities for the:

A Registered Nurse

c)Pharmacist who is involved in safe medication use

Q7: Describe five (5) types of medication errors and the possible causes

a) Explain the differences between the person-centred approach (5 points) and the system-approach for human error

b) Security, safeguards and barriers are all part of James Reason’s (1990), ‘Swiss Cheese Model.

These factors can help prevent medication errors from happening.

c)Defenses are compromised by latent and active conditions.

Identify medication errors:

i.THREE (3) possible latent conditions

Q9: Describe FIVE (5) possible causes of medication error and the factors they contribute to it.

Answer:

Pharmaceutical companies conduct clinical trials to determine the safety and efficacy of a medication.

Let’s briefly outline the four phases of clinical trials.

Each phase of the clinical trials is broken down into four steps. Each step has a specific goal.

Phase 1:

First, the drug must be tested on volunteers.

The number of volunteers required to test the drug on them ranges between 20 and 80.

This phase allows for the testing of the drug’s metabolism and excretion, as well as monitoring any side effects.

Phase II:

This phase can last from several months up to two years. It is used to evaluate the effectiveness of the drug on volunteers.

This phase is mostly blinded and involves two groups of volunteers. One group receives the drug while the other receives a placebo or standard medicine.

Safety of the drug for patients is also being tested.

Phase III:

This phase tests the safety, efficacy and effect of the drugs on patients.

This phase sees the participation of many more volunteers.

Phase IV:

This is a “Post-marketing surveillance” phase of the drug to verify its safety, effectiveness, and quality of life for patients who have been given the drug.

This stage also includes comparisons with other drugs on the market.

(Overview of Clinical trials).

2 A) A Brief Overview of The Principal Responsibility For The Therapeutic Goods

Administration (TGA).

Answer: The TGA regulates therapeutic goods, including drugs and medical devices.

The TGA is responsible for ensuring that the quality of drugs on the market meets the specified standards.

TGA is responsible for advertising for therapeutic goods and importing/exporting drugs in Australia.

(Australian Government Department of Health).

B) Describe (2) The TGA Regulates Medication.

Because all therapeutic products have some risk and benefits, TGA conducts scientific and clinical testing to determine if there are any side effects.

Assessing the potential risks of drug use.

Any corrective measures that can be taken to reduce or eliminate the risk

To ensure the safety of the drug, it is important to monitor the progress once corrective measures have been taken.

These processes result in two numbers being assigned to the medicines depending on the type of drug.

The Australian Register of Therapeutic Goods registers high-risk medicines. It evaluates the quality of the drug and its safety.

After the clinical trials, they are issued the AUSTR number.

The AUST L number is given to Listed Medicines such as vitamins and herbal medicines that contain low-risk ingredients and have been pre-approved. They can be bought in health shops or supermarkets.

(Australian Government Department of Health.

Three Briefly Define the Terms Pharmacokinetics and Pharmacodynamics.

These are the Four Phases of Pharmacokinetics:

Absorption- This phase determines the drug’s course from the moment it is administered until it enters the bloodstream.

Distribution – The drug is then transported from the bloodstream to its intended destination.

Depending on the drug’s action, distribution will vary.

It occurs in the liver.

Excretion is when the drug is removed from the body after metabolism (The Free Dictionary 2017, 2017).

This branch of pharmacology studies the effects of drugs and their biochemical, molecular, and physiological effects on the human body.

This research is used to determine the dosage of a drug, as well as predict how it will react to specific illnesses.

Any disorder, age or involvement of drugs in the system can affect the pharmacodynamics of a drug.

Q 4: Explain the Phenomenon Also Known as The in Relation To Oral Medications.

“Hepatic First Pass Effect”

The liver’s first pass effect, also known as the first pass metabolism, is when some of the drug’s active substances are removed from the bloodstream before they enter the circulation system.

Through the first pass effect, drug concentration is decreased.

This effect is known as the Hepatic First Pass Effect, because the site of drug metabolism is the liver.

This is the process that occurs during drug absorption and transfer from the administration site to site of action.

Study.com, 2017, identifies the potential metabolism sites as the gut wall and liver.

When a drug is taken orally, it passes through the stomach and into the liver.

Portal veins in the hepatic systems transport the drug to the liver.

The drug is metabolized by the liver with potential enzymes. Only a small amount of potentially active ingredients can escape to the circulatory system.

The hepatic second pass effect greatly reduces the drug’s bioavailability.

To metabolize the drug, enzymes in the liver, gut wall and hepatic systems act on it.

The drugs with a high hepatic effect first pass are often given in higher doses to ensure that at least some active ingredients reach the potential site (and the circulatory system) after passing through the liver.

Diazepam and morphine are two examples of such drugs (Encyclopedia.com 2016, 2016).

Q.5: Briefly describe why Glyceryl Trinitrate 600 microgram Tablets must only be administered sublingually.

Below the cheek and tongue are many capillaries, which are tiny blood vessels.

This allows medication to be absorbed directly into the bloodstream instead of going through the digestive system and the liver.

Glyceryl trinitrate is a drug that helps improve the functioning of the heart.

It must be taken immediately in the event of seizures or heart attacks. Therefore, it is administered sublingually.

Two (2) areas of education that you should give to your patient only concern Glyceryl Trinitrate are listed below

Glyceryl Trinitrate must be used with care. Follow these instructions:

The tablets should not be chewed or sucked.

The tablets should be placed under your tongue and allow to dissolve slowly.

To avoid dizziness, it is important to sit down while using the tablet.

In the event of severe heartburn, the tablet should be placed under your tongue. A repeat dose is possible if the chest pain persists.

If the pain continues for more than 15 minutes, you should seek medical attention.

6.Outline (5) The Different Roles and/or Responsibilities of the RNs, Doctors and Pharmacists in Safe Use Of Medications

Registered nurse

Registered nurses (RNs) play a vital support role in hospitals, clinics and other healthcare facilities.

They are responsible for the care of patients and participating in their diagnosis and treatment.

These are the duties of a registered nurse

Register, monitor, and record the conditions of patients (changes, stability and so forth)

Keep accurate and detailed records of the changes and conditions.

Inform patients about the proper dosages and times to take drugs

To make medication changes, interpret reports and evaluate diagnostic tests

Preparing patients for examination, and assisting the consultants during physical examination (Greenwood 2017).

Clinics and hospitals have a significant role for consultants or doctors.

The Doctors are classified according to their specialization.

Based on the condition of the patient, diagnose and prescribe medication.

Perform surgery, including emergency procedures, whenever and wherever necessary.

Major operations require the involvement of surgeons in a variety of roles, including that of neurologists, cardiologists, and aesthetics.

The doctor makes important decisions regarding patient care. They also instruct nurses and health care workers on how to administer medications or give instructions to primary caregivers.

The doctor has the power to change medication dosages, increase drug doses or prescribe new drugs to patients to improve their condition.

A pharmacist should be:

Ability to prescribe the appropriate medication to patients.

Must have the ability to manage and use computers effectively in emergency situations.

Assist the doctors and other health care professionals to provide medication as prescribed and when necessary.

Be familiar with the medication, its use and any side effects.

Supervise pharmacy and provide advice and guidance to patients about nutrition and health.

You can specialize in prescribing medication that is appropriate for a particular purpose such as cancer or heart conditions.

These are the Possible Errors and Causes.

Incorrect prescribing can include wrong dosage, wrong route of administration or frequency, incorrect drug or time, and even wrong timing.

Dispensing errors include incorrectly prepared infusion solutions, dispensing an expired drug, equipment defects (syringe defect), IV fluid leak or the line struck, and dispensing a drug to late.

Infusion pump – Forgetting to set the infusion lines, no written communication, or failure to comply (Allard and al., 2008).

Fragmented care errors include poor communication between the doctor and the health care professional.

False drug preparation error: Where the intravenously administered medicines are given orally, or vice versa.

A lapse in memory is when a nurse forgets that a patient is allergic.

Distraction can cause this.

Memory lapse can also occur when you forget to take your maximum daily dose or administer more than is necessary.

System problems, such as the inability to label drugs categorically, the proximity of medicines with similar names, or the absence of bar coding, can lead to errors.

Health workers may not have the right knowledge or understanding to remember or administer drugs with generic names.

Errors can be caused by insufficient information, such as past history and allergies.

Overworked nurses or health care workers might make mistakes due to exhaustion.

8. Explain the Difference Between The Person-Centered Approach and The System-Approach to Human Error

The person-centered approach means that the entire system from drug administration to care revolves around the patient.

This approach places the patient at the center and educates him to administer the prescribed dosage.

Problem is, the patient might not be sufficiently knowledgeable to know how to administer the prescribed dosage.

A system-centered approach places the system in the middle and all involved, including doctors, nurses, and health care workers.

This error is caused by a variety of factors such as poor communication, inadequate lighting, staff overwork, negligence, and lapses in memory.

B) The Components of James include defences, barriers, and safeguards

Reason (1990) “Swiss Cheese Model”

These factors can help prevent medication errors (4 marks).

According to the Swiss cheese model, defence layer is a preventive measure against errors.

Many hospitals use high-tech alarm systems and physical barriers to prevent errors.

These barriers could be in the form of ‘holes,’ which are not aligned with one another. A health worker might need to report to the nurse about the drug administered to pinpoint the problem.

One point failure may not necessarily lead to total error, as there might be several layers of’safeguards’ within the system.

Doctors- Nurses- Health care workers- Patient – The whole sequence can become difficult to understand, as ‘holes’ and ‘errors” can be reversed due to non-alignment. This is similar to the Swiss cheese model.

The model predicts that having one system over another, or having “defenses” (in line), can prevent errors from happening.

The nurse monitoring the patient can immediately correct the error if one of the lines fails (e.g., a health worker misplaced information).

The Swiss Cheese model is a good option for error defection (Duke University School of Medicine 2016, 2016).

c) Active failures or latent conditions can cause holes in the defenses.

Identify medication errors:

Sometimes, these conditions are inevitable, but sometimes they can be latent.

Nurses and other health workers are under pressure.

Overworking, inadequate staffing and insufficient equipment

There are no alarms, efficient indicators, standard procedures or design flaws in the equipments.

Latent failures may or might not lead to an error. However, the person in charge or monitoring the system may prevent it from happening.

Latent conditions can, however, cause long-lasting holes in the system if they are persistent (Reason 2000).

Three (3) Possible Active Failures

Nursing and health workers who are directly in contact with patients can cause violations, such as slips, errors in drug administration and violations of procedure.

Instructions that are not properly understood, not correctly read or ignored.

Negligence in administering IV fluids or drugs, or while reading patients’ allergy reports.

9 Describe FIVE (5) Factors that Contribute to Medication Error and A

Every system is susceptible to errors, and even the medical field is not immune.

Many factors can contribute to medication mistakes.

Drug administration errors: Using the wrong doses or drug, or failing to treat allergy symptoms.

Causes: Look-alike and should-like medicines can lead to confusion among health care workers. There is no system for information to be transmitted, no knowledge of how to administer drugs, or to understand instructions.

Professionals might use medical abbreviations that can lead to confusion and possibly make serious mistakes (Medcom Trainex 2017).

Nursing errors and doctor mistakes in prescribing drugs, where the patient’s condition was not properly monitored and the wrong medication was given.

Causes: Poor communication between health care workers, nurses, doctors, patients, nurses, doctors, and patients.

Not being able to clearly identify allergic symptoms.

Method of administering the drug: An IV fluid administered orally, orally, orally, or by infusion can lead to serious errors.

Causes: This could be due to poor communication, insufficient knowledge about the drug, or improper administration techniques.

A wrong or incomplete diagnosis of a disease, illness or condition

Causes: Insufficient knowledge or lack of communication between patients and doctors, patient not able relate problems clearly to doctor, errors in diagnosis report.

Nursing care errors due to negligence

Causes: Uncooperative patients, overworked staff, insufficient knowledge of conditions, and no system to allow essential information to be shared between care providers and consultants.

U.S. Food and Drug Administration Commissioner (2017).

The Drug Development Process – Step 3: Clinical Research.

Center Watch (2017).

Overview of Clinical Trials.

Australian Government Department of Health.

Therapeutic Goods Administration.

About the TGA.

Australian Government Department of Health.

Therapeutic Goods Administration.

Listed medicines: The role and responsibilities of Australia’s medicines regulator.

Australian Government Department of Health.

Therapeutic Goods Administration.

TGA classifications and medicines.

Duke University School of Medicine (2016)

Swiss Cheese Model.

The Free Dictionary (2017).

Clinical Pharmacology – Overview of Pharmacodynamics.

The First Pass Effect in Pharmacology.

GTN sublingual tablets, glyceryl trinitrate.

The Role of a Nurse In Health Care.

What are the duties for a pharmacist?

Medication errors: Prevention, Causes and Reduction.

Medcom Trainex 2017

Medcom Trainex (2017).

Terry’s Post (2013).

Describe Person-Centred Methods of Administering Medicines While adhering to Administration.

Models and management of human error.

West J Med., 172(6), 393-396.

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