Dimensinal Analysis

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.


• 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.


• 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.


• 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.


• “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.


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?


A. 1015B. 1215C. 0815D. 2015E. None of the above





On a 24-hour clock what time would 6:30 AM be?









3. Name of medication


4. Medication dosage– 500 mg– 20 mEq– 100 units– 30 mL


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


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


7. Prescriber’s name & credentials• Mary Jones, MD• John Gonadal, DO


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!


• 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.


• 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


• 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


• 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?


• Formula– Desire = __#__ tablets

Have• Desire– 0.625 mg

• Have– 0.25 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!


• If 10 mg is ordered give…?– D: 10 mg = ?– H: 5 mg– 10 mg / 5 mg =

• 2 Tablets

Answers!


• 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!


• 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!


• If the doctor orders you to give 240 mg how many capsules would you give?

Answer!


• 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


• 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


• 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

Dimensinal Analysis

Documents

medication errors

medication errordeathgant

wi nurse

fellow nurse

julie thao

death of ob patient

criminal neglect

lethal drug