Dimensinal Analysis Chapter 6 Reading 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 time Standard 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 time Standard 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. 0630 B. 1430 C. 1630 D. 1830 E. None of the above? On a 24-hour clock what time would 10:15 PM be? A. 1015 B. 1215 C. 0815 D. 2015 E. None of the above On a 24-hour clock what time would 8:00 PM be? A. 0800 B. 1000 C. 2000 D. 2200 E. None of the above On a 24-hour clock what time would 12:45 PM be? A. 1245 B. 0045 C. 1445 D. 1045 E. None of the above On a 24-hour clock what time would 6:30 AM be? A. 0630 B. 0830 C. 1830 D. 1630 E. None of the above On a 24-hour clock what time would 12:30 AM be? A. 1230 B. 0230 C. 0030 D. 1430 E. None of the above On a 24-hour clock what time would 7:30 PM be? A. 1930 B. 1730 C. 1530 D. 0730 E. None of the above On a 24-hour clock what time would 1:30 AM be? A. 1330 B. 0030 C. 0330 D. 0130 E. 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 • At bedtime • At bedtime time • Daily • daily • Twice a day • bid • Three times a day • tid • 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. 2. 3. 4. 5. 6. Patient Drug Dose Route Time 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. Yes B. No Can a gelatin filled capsule be divided in half - giving only half of a capsule to a patient? A. Yes B. No C. 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. Yes B. No Can you open a capsule and give a patient the medication without the capsule casing? A. Yes B. No May you open a time release capsule and give a patient the medication without the capsule? A. Yes B. 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 Have = what to give 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 Have 12.5 mg = _____ tablets 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 = ? tablets Have: 0.25 mg 0.625 mg / 0.25 mg = 2.5 tablets Give 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. Yes B. No