Hazards of Medication Administration

Prepared by: Rachel Rowe 2020

Contributions from: Binol Rajesh Balachandar
Feb. 2019
Hazards of Medication Administration

Toxicity
Overdose
Drug Interaction
Cumulative effects
Adverse interactions
Lack of efficacy
Contamination
Infection transmission
Hazards of Medication Administration

Allergic reaction

Tolerance and dependence

Teratogenic effects

Thromboembolic complications
Irritation/ damage/ necrosis of
skin and mucous membrane
Abscesses/Infections

Hematoma

Septicaemia
 Preventing Medication Hazards
Follow the 10 rights of medication administration.

Provide correct instructions to the patient

Correct storage of a drug –by pharmacist, care givers or

patient
Out-dated drug- read labels

Update knowledge –care providers

CASE STUDY #1: A Young Doctor
A young girl who grew up in a poor village in a polygamous household
struggles to get school fees to complete her secondary education. She has
always wanted to be a doctor and worked so hard that she passed her 'A' levels
with good points and is admitted into medical school. The boyfriend from the
same village has just graduated as a lawyer and they plan to marry after her
internship.
The young medical student accidentally pricks herself with a needle she had
used on an HIV positive patient while she was trying to recap it.

She tells no one about it. She got married as a virgin to her childhood
sweetheart, fell pregnant and during ante-natal screening, tested HIV positive.
She was devastated and could not figure out how she could possibly have got
the virus as she trusted her husband and she herself was faithful to her
husband. She is worried and keeps it to herself for some weeks wondering if
her husband had been unfaithful. Eventually she confronted her husband who
in turn was angry and turned on her accusing her of being unfaithful with other
doctors at the hospital.

In the same year she was asked to facilitate a workshop and it was during a
presentation that she remembered the needle stick seven years back and
realized that must have been the time she got infected with the virus.
Preventing Medication Hazards –parenteral
Follow aseptic techniques –Hand washing, avoid
contamination of equipment and drugs.
Blood or plasma should be infused through an adequate
filter.
Avoid vein in lower extremities as much as possible
Select large veins for intravenous infusions
Do not irrigate a clotted infusion.
Ensure that drugs are completely dissolved when
reconstituting medications.
Check solutions for particulate matter.
MEDICATION ERRORS
Medication Errors
Inaccurate prescribing

Administering wrong medication

Using wrong route

Wrong time

Wrong dose

Omitting meds

Potter et al 2012
Treating with Medication errors

CASE STUDY #2: Gloria

 Gloria is a young woman that has worked in the laundry in one of the
regional hospital for the past year. She is married with 2 children, both still in
primary school. The husband works as a watchman in nearby hotel.
She is a very diligent worker and is always punctual and willing to do extra work
whenever the need arises. On this fateful day at 2 minutes after 5.00 pm when she
is about to change to go home, a laundry bag from the medical ward was brought in
for laundry. The supervisor requested her to help sort the laundry before putting it
in the washing machine as the wards were running out of clean linen.
Unfortunately, a nurse had left a syringe and needle used for injecting a
terminally ill AIDS patient among the sheets to be sorted. Whilst sorting the linen,
Gloria accidentally was pricked by this needle.
She continued and finished sorting the linen then took the syringe and
needle to her supervisor. The supervisor advised her to wash her fingers and gave
her a note to go and see a doctor immediately.
Gloria went to the Out-Patients Department and saw that the queue for the
doctor was very long. She was in a hurry to return home to cook for her family so
she left the hospital without seeing the doctor and ignored the injury.
Ten years later during a programme for Voluntary Counseling and Testing
(VCT), Gloria decided to go for testing and tested positive.
Treating with Medication Errors

Assess and examine patient’s condition

Notify health care provider ASAP

Report to supervisor or manager

Prepare incidence report within 24 hrs

Report even if patient suffers no harm

Potter et al 2012
Preventing medication errors

CASE STUDY #3 Amos

Amos is the newly trained nurse at the Kibare District Hospital Out-Patients
Department, who has just resumed duty at the treatment room on a busy Monday
morning. Outside the room is a long queue of patients waiting for treatment.

He gets the card of the next patient. While reading the prescription on the card, he is
called to answer the telephone.

Upon returning, the patient whose card he was reading before the phone call had gone
to the toilet. He calls ‘next!’ and the next patient in the queue walks in. Amos washes
his hands, checks the dose on the card and draws the exact amount of 80 mg.
Gentamycin into a newly opened 2mls. Vanish Point retractable syringe from his
clean injection trolley.

The patient tried to draw to his attention that he had not come for an injection but
instead for a dressing, but because Amos is in a hurry to clear the patients, without
paying attention, he asked the old man to get behind the screen for the injection the
doctor had prescribed for him.

Amos went ahead and gave the injection at the outer upper quadrant of the left
buttock and immediately dropped the used syringe and needle in a safety box
supplied by John Snow, Inc. The patient began to sweat and shiver immediately.
Preventing medication Errors

Prepare meds for one person at a time

Follow the 10 rights of medication administration

Read labels at least three times before administering

medication
Use at least two patient identifiers

Review patient’s allergies when administering a

medication
Potter et al 2012
 Preventing Medication Errors
Double check all calculations and other high risk
medication processes and verify with another nurse
Do not interpret illegible hand writing clarify with
prescriber
Reflect on what went wrong and ask how could you have
prevented the error
Document all medications as soon as they are given
Question unusually large or small doses

Potter et al 2012
 Preventing Medication Errors
Evaluate the situation in which the error occur to determine
if there are necessary resources for safe medication
administration
Ensure you are well rested when caring for the patient

Involve and educate the patient when administering

medications
Address patient’s concerns about medication before
administering
Follow established policies and procedures when
using technology to administer medication.

Potter et al 2012
 References
http://www.safety.duke.edu/safetymanuals/university/
V-HazardousDrugs.pdf
Potter, P. , Perry, A., Stockert, P. & Hall, A. (2012).
Fundamentals of Nursing (8th ed.). St Louis, Missouri:
Mosby