Dimensinal Analysis
Chapter 6Reading Oral medication labels
Nurse Charged With Felony In Medication Error Death
• Medication error could send nurse to prison for up to 6 years in death of OB patient.
• A former Madison, WI nurse was charged with criminal neglect in the death of 16-year-old Jasmine Gant, who died in July of a medication error while giving birth. Julie Thao, 41, of Belleville, faces a count of neglect of a patient causing great bodily harm, which carries a maximum prison sentence of six years in prison.
Nurse Charged With Felony In Medication Error Death
• Gant allegedly died after an epidural anesthetic was allegedly mistaken for a prescribed dose of penicillin. Thao is alleged to have taken the drug from a locker and administered it to the patient intravenously even though the container carried a warning that it was not for IV use.
• The patient died within an hour, but the infant survived when doctors performed an emergency ceasarian delivery.
Nurse Charged With Felony In Medication Error Death
• A criminal complaint alleges that Thao ignored every safeguard put in place to prevent medication errors at Madison's St. Mary's Hospital and Medical Center. The prosecutor alleges Thao ignored the hospital's "Bridge System," used to scan medication labels before drugs are administered, took a potentially lethal drug from a storage locker without authorization and didn't read the label of a drug she injected into Gant.
Nurse's suicide highlights twin tragedies of medical errors
• For registered nurse Kimberly Hiatt, the horror began last Sept. 14, the moment she realized she’d overdosed a fragile baby with 10 times too much medication.
• Stunned, she told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had happened. “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse, Michelle Asplin, in a statement to state investigators.
Nurse's suicide highlights twin tragedies of medical errors
• In Hiatt’s 24-year career, all of it at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the only serious medical mistake she’d ever made, public investigation records show.
Nurse's suicide highlights twin tragedies of medical errors
• “She was devastated, just devastated,” said Lyn Hiatt…
• That mistake turned out to be the beginning of an unraveled life, contributing not only to
• the death of the child, 8-month-old Kaia,• but also to Hiatt’s firing, • a state nursing commission investigation • and Hiatt's suicide on April 3 at age 50.
Safe Drugs
• U.S. Food and Drug Administration (FDA)
1938: The Federal Food, Drug & Cosmetic Act
• Federal regulation• Drugs must be labeled with
directions• Manufactures had to prove meds
were safe • Government inspections
Thalidomide
• Morning Sickness pill– 1950’s / Europe
• Severe birth defects -limbs
Medication Orders: components
1. Patient identify information– Name– DOB– Medical Record #– Dr.
Medication Orders: components
2. Date and time of order
24-hour clock / military timeStandard clock 24 hour clock
1:00 AM 0100
2:00 AM 0200
4:00 AM 0400
6:00 AM 0600
8:00 AM 0800
10:00 AM 1000
10:30 AM 1030
11:00 AM 1100
11:15 AM 1115
11:30 AM 1130
24-hour clock / military timeStandard clock 24 hour clock
12:00 PM 1200
12:45 PM 1245
1:00 PM 1300
2:00 PM 1400
3:00 PM 1500
4:00 PM 1600
5:00 PM 1700
8:00 PM 2000
10:00 PM 2200
On a 24-hour clock what time would 6:30 PM be?
A. 0630B. 1430C. 1630D. 1830E. None of the above?
On a 24-hour clock what time would 10:15 PM be?
A. 1015B. 1215C. 0815D. 2015E. None of the above
On a 24-hour clock what time would 8:00 PM be?
A. 0800B. 1000C. 2000D. 2200E. None of the above
On a 24-hour clock what time would 12:45 PM be?
A. 1245B. 0045C. 1445D. 1045E. None of the above
On a 24-hour clock what time would 6:30 AM be?
A. 0630B. 0830C. 1830D. 1630E. None of the above
On a 24-hour clock what time would 12:30 AM be?
A. 1230B. 0230C. 0030D. 1430E. None of the above
On a 24-hour clock what time would 7:30 PM be?
A. 1930B. 1730C. 1530D. 0730E. None of the above
On a 24-hour clock what time would 1:30 AM be?
A. 1330B. 0030C. 0330D. 0130E. None of the above
Medication Orders: components
3. Name of medication
Medication Orders: components
4. Medication dosage– 500 mg– 20 mEq– 100 units– 30 mL
Medication Orders: components
5. Route of administration
Route: enteral
• Oral (by mouth)–PO• Tablets• Capsules• Caplets
Route: enteral
• Rectal (per rectal)–PR• suppositories
Route: enteral
• Via tubes (GT or NGT)
Route: Parenteral
• Intravenous–IV
Route: Parenteral
• Intramuscular–IM
Route: Parenteral
• Subcutaneous–Subcut
Route: Parenteral
• Intradermal–ID
Route: Other
• Sublingual–SL
Route: other
• Transdermal
Medication Orders: components
6. Frequency &/or time• Daily• daily
• Twice a day• bid
• Three times a day• tid
• At bedtime• At bedtime
• Every 2,4 or 6 hours• q2hr• q4hr• q6hr
• Before meals–ac
• After meals–pc
Medication Orders: components
7. Prescriber’s name & credentials• Mary Jones, MD• John Gonadal, DO
Medication Orders: components
8. Name of person transcribing the order • Noted: E. Keele, RN
The 6 rights & 3 checks
Rights
1. Patient
Checks
The 6 rights & 3 checks
Rights
1. Patient2. Drug3. Dose4. Route5. Time6. Documentation
Checks
• Check medication–While pulling–After pulling–Before giving
Oral Mediations
• Tablets• Scored tablets• Enteric coated tablets• Capsules• Controlled release
capsules• Gelatin capsules
Tablets
• Tablets• Scored tablets• Enteric coated tablets
Capsules
• Capsules • Control release capsules
Gelatin capsules
What are these capsules made of?
• Gelatin• Plant starch and cellulose
Can a scored tablet be divided in half? Giving only half of a tablet to a
patient?A. YesB. No
Can a gelatin filled capsule be divided in half - giving only half of a
capsule to a patient?A. YesB. NoC. I don’t know – I’ll wait until Mrs.
Keele shows me the right answer!
Can a capsule be divided in half? Giving only half of a capsule to a
patient?A. YesB. No
Can you open a capsule and give a patient the medication without the
capsule casing? A. YesB. No
May you open a time release capsule and give a patient the
medication without the capsule? A. YesB. No
Unit Dosage label
• Each tablet or capsule is packages separately
Unit Dosage label
Example
• Trade name• Generic/official name• Dosage strength• Unit of measure• Manufacturer• Exp date:
Multiple dose label
• More than one tablet / capsule in a package
• What is the difference?
Example
• Trade name?• Generic name?• Dosage strength?• Unit of measure?• How many tablets in
this bottle?
U.S.P & N.F.
• U.S.P – United States
Pharmacopeia
• N.F.– National Formulary
Exp.
• Exp.– Expiration date
• Make a habit of checking the expiration date on labels!
2 medications in one pill
• Contains 2 medications– Carbidopa– Levodopa
• Ordered by the trade name & # of tablets to be given.
• 2 dose amounts – 25-100
You Turn!
• What is the generic name?
• What is the trade name?
• What is the dosage strength
• How many capsules in this bottle?
Tablet/capsule dosage calculation
• Medication records will tell you the name and amount of drug to be given, it will not tell you how many tablets or capsules to give!
Tablet/capsule dosage calculation
• Learn to question orders for more than three tablets or capsules.
• An unusual number of tablets or capsules could be a warning of an error in prescribing, transcribing or your calculations.
Tablet/capsule dosage calculation
• Regardless of the source of the error, if you give a wrong drug or dosage you are legally responsible for it.
• Trade name?• Generic name?• Dosage strength?• Number of tablets in
the bottle?
How much medication to give?
• Give Aricept 12.5 mg• Formula:
Desire = what to give Have
How much medication to give?
• Give Aricept 12.5 mg– What do we desire to
give / What did the doctor order?• 12.5 mg
– What do we have / what is the unit dose?• 5 mg
How much medication to give?
• Give Aricept 12.5 mg• Formula:
Desire 12.5 mg = _____ tablets Have 5 mg
** THE DOSAGE METRIC UNIT MUST MATCH!
Give Halcion 0.625 mg
• Trade name?• Generic name?• Dosage strength?• Number of tablets in
the bottle?
Give Halcion 0.625 mg
• Formula– Desire = __#__ tablets
Have
• Desire– 0.625 mg
• Have– 0.25 mg
Give Halcion 0.625 mg
• Formula– Desire = __#__ tablets
Have
Desire: 0.625 mg = ? tabletsHave: 0.25 mg
0.625 mg / 0.25 mg = 2.5 tabletsGive 2 ½ tablets
Your turn!
• What is the dosage strength?
• If 10 mg is ordered give…?
• If 2.5 mg is ordered give…?
• If 7.5 mg if ordered give…?
Answers!
• What is the dosage strength?
• If 10 mg is ordered give…?– D: 10 mg = ?– H: 5 mg– 10 mg / 5 mg =
• 2 Tablets
Answers!
• What is the dosage strength?
• If 2.5 mg is ordered give…?– D: 2.5 mg = ?– H: 5 mg– 2.5 mg / 5 mg =
• 0.5 mg• ½ tablet
Answers!
• What is the dosage strength?
• If 7.5 mg if ordered give…? – D: 7.5 mg = ?– H: 5 mg – 7.5 mg / 5 mg =
• 1.5 tablets• 1 ½ tablets
Your turn!
• What is the dosage strength?
• If the doctor orders you to give 240 mg how many capsules would you give?
Answer!
• What is the dosage strength?
• If the doctor orders you to give 240 mg of Verelan how many capsules would you give?– D: 240 mg = ? Capsules– H: 120 mg– 2 capsules
Another question
• What is the dosage strength?
• The doctor orders Terbutaline Sulfate 3.75 mg. How much will you give?– D: 3.75 mg = _?_ tablets– H: 2.5 mg
• 1.5 tablets• 1 ½ tablets
One more example
• What is the dosage strength?
• The doctor orders 250mg of Azulfidine. How many tablets should you give?– D: 250 mg = _?_ tablets– H: 500 mg
• 0.5 tablets• ½ tablets
Should an enteric coated tablet be cut in half or crushed – before giving to a patient?
A. YesB. No
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