Ordering meds and med errors student copy.1.2010

Ordering Meds/ Medication Error Worksheet/Student Copy Directions - To complete the following questions, please reference the following Policies and Procedures: - Guidelines for Ordering and Administration of Medications -Medication Errors and Adverse Drug Reaction Reporting CASE STUDY #1 M.M., a 76-year-old retired schoolteacher that has just underwent an ORIF of his right femur. Dr. B writes the following postoperative orders: - Vital Signs and Neuro Circ Checks - RRR then every 4 hrs, then routine -Home Medication Reconciliation Sheet (checked and signed by surgeon) Diet: Clear progressing to general as tolerated ❑ ADA Bowel Program IV: Lactated Ringers at 125 mL/hr until PO intake adequate then lock IV O2 via non-rebreather mask x 2 hours post-op Lab: ❑ Hemogram in A.M. ❑ Daily INR beginning in A.M., call for anticoagulation orders Medications: ❑ Enoxaparin (Lovenox) administer 1st dose 12 hrs after end of surgery ❑ Cefazolin 2gms every 8 hrs x 2 doses for patients 16 years old and older. Cefazolin 30mg/kg IV (dose not to exceed 2gms) every 8 hrs x 2 doses for patients 15 years old and younger ❑ Acetaminophen 325mg PO 1-2 every 3 hrs PRN temp. >101º (Max. dose 8 tabs/24 hrs) ❑Ketorolac 30mg IM/IV every 6 hrs PRN pain (reduce to 15mg if >65yo, renally impaired or <110 lbs) ❑ Hydrocodone/APAP 5/500 (Vicodin) 1-2 PO every 3 hours PRN mild pain OR ❑ Hydrocodone/APAP 7.5/500 (Vicodin ES) 1-2 PO every 3 hrs PRN moderate pain (Max. dose 8 tabs/24 hrs)or ❑ Oxycodone/APAP 5/325mg (Percocet) 1-2 PO every 3 hrs PRN moderate severe pain (Max. dose 12 tabs/24 hrs)or ❑ Oxycodone 5mg 1-2 PO every 3 hrs PRN severe pain or consider deleting if unavailable ❑ Morphine 6-10mg IM every 3 hrs PRN severe pain 1. Medication orders should include the following: (See Guidelines for Ordering and Administration of Medications) 2. M.M. needs additional pain medication. The nurse calls Dr. O. and receives an order for Morphine Sulfate 2-4 mg IV every 4-6 hours prn for pain. When obtaining physician orders, the 3-step process will be followed. Outline and explain the 3-step process. 3. Upon completion of reviewing the postoperative orders for M.M. the RN shall: 4. M. M. is refusing to take the Ketorolac IM. The nurse calls Dr. O. and explains that M. M. does not want the Ketorolac injection until he talks with Dr. O the next morning. Dr. O. states, “Hold the Ketorolac until further notice.” Explain the procedure for “Holding Medications.” Will Dr. O. need to rewrite the Ketorolac order? 5. Identify the list of “standing orders” that do not require a physician signature prior to dispensing and administration of medications. 6. M. M. has been on Ferrous Gluconate 325mg PO BID at home. Explain if M. M. will automatically get this medication postoperatively since it is his usual home medication? 7. M. M.’s routine medications will be administered within ________________minutes of the designated time. 8. Outline the Administration Tips for Medication Administration from Guidelines for Ordering and Administration of Medications 10. The nurse gives M. M. 6 mg of Morphine IV instead of Morphine 6 mg IM as ordered. Immediately, the nurse identifies she has made an error. Identify what steps should be followed for medication errors.

Source: http://extranet.yakimamemorial.org/pdf/aces-ws3-ordering-meds.pdf