ISPN Review Prevention of Medication Errors 用药差错的预防
The drug regimen process, which includes prescribing, dispensing, and administering a drug to a patient, has a series of checks along the way to help to catch errors before they occur. These include the physician or nurse practitioner who prescribes a drug, the pharmacist who dispenses the drug, and the nurse who administers the drug. Each serves as a check within the system to catch errors—the wrong drug, the wrong patient, the wrong dose, the wrong route, or the wrong time. Often the nurse is the final check in the process because the nurse is the one who administers the drug and is the one responsible for patient education before the patient is discharged to home.
Nurse’s Role 护士的职责
The monumental task of ensuring medication safety with all of the potential problems that could confront the patient can best be managed by consistently using the seven “rights” of medication administration. These rights are as follows: right drug, right storage, right route, right dose, right preparation, and right recording.
Patient and Family Teaching 患者及家人宣教
Patient and family education plays a vital role in the prevention of medication errors. Encourage patients to be their own advocates and to speak up and ask questions. Include the following key elements in any drug education program.
1. Name, dose, and action of drug: Ensure that patients know this information. This knowledge is crucial to ensuring safe and effective drug therapy and avoiding drug–drug interactions. Urge patients to keep a written list of the drugs that they are taking to show to any health care provider taking care of them, and in case of an emergency when they are not able to report their drug history.
2. Timing of administration: Teach patients when to take the drug with respect to frequency, other drugs, and meals.
给药时间安排：教育患者何时服药，包括次数、是否有其他药物、及就餐相关情况。
3. Special storage and preparation instructions: Inform patients about any special handling or storing required. Some drugs may require refrigeration; others may need to be mixed with a specific liquid such as water or fruit juice. Be sure that patients know how to carry out these requirements.
4. Specific OTC drugs or alternative therapies to avoid: Prevent possible interactions between prescribed drugs and other drugs or remedies the patient may be using or taking. Many patients do not consider OTC drugs or herbal or alternative therapies to be actual drugs and may inadvertently take them along with their prescribed medications, causing unwanted or even dangerous drug–drug interactions. Prevent these situations by explaining which drugs or therapies should be avoided. Encourage patients to always report all of the drugs or therapies that they are using to health care providers to reduce the risk of possible inadvertent adverse effects.
5. Special comfort measures: Teach patients how to cope with anticipated adverse effects to ease anxiety and avoid noncompliance with drug therapy. If a patient knows that a diuretic is going to lead to increased urination, the day can be scheduled so that bathrooms are nearby when they might be needed. Also educate patients about the importance of follow-up tests or evaluation.
6. Safety measures: Instruct all patients to keep drugs out of the reach of children. Remind all patients to inform any health care provider they see about the drugs they are taking; this can prevent drug–drug interactions and misdiagnoses based on drug effects. Also alert patients to possible safety issues that could arise as result of drug therapy. For example, teach patients to avoid driving or performing hazardous tasks if they are taking drugs that can make them dizzy or alter their thinking or response time.
7. Specific points about drug toxicity: Give patients a list of warning signs of drug toxicity. Advise patients to notify their health care provider if any of these effects occur.
8. Specific warnings about drug discontinuation: Remember that some drugs with a small margin of safety and drugs with particular systemic effects cannot be stopped abruptly without dangerous effects. Alert patients who are taking these types of drugs to this problem and encourage them to call their health care provider immediately if they cannot take their medication for any reason (e.g., illness, financial constraints).
Vocabulary for Today
monumental – a. 作为纪念的，不朽的
confront – v. 面对，直面
remedy – n. 药物，治疗法
inadvertently – ad. 不注意地，非故意地
misdiagnosis – n. 误诊
discontinuation – n. 停药，中止
margin – n. 边缘，空白
margin of safety – 安全范围，安全限度
Test 1. When performing an assessment about medication, the drug history should include:
A. Complete vital signs
B. Client’s goal of therapy
C. Reason for medication
D. Administration of OTC medications 2. The volume of SC medication must be no more than:
A. 0.5 Ml
B. 1.0 mL
C. 1.5 mL
D. 3.0 mL
本期ISPN Review答案： 1. D. Administration of OTC medications. The nurse should determine if the client is taking any other medications, especially OTC medications because their effects are often minimized. Other choices are important part of assessment, but choice D is the most accurate answer. 2.B.1.0 mL. The maximum amount of fluid that can be injected into the SC space is 1.0 mL.
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