출처: 매들린 래쉬, MSNEd, RN 및 케이티 바라키, MSN, RN, 간호 대학, 유타 대학, UT
1999년 의학연구소(IOM) 보고서에 따르면 Err는 인간입니다: 안전한 건강 시스템을 구축하는것은 병원 환경에서 피할 수 있는 환자 사망에 중요한 기여를 합니다. 따라서, 환자의 안전을 유지하고 약물 오류를 방지하기 위해, 모든 간호사가 안전한 약물 관리의 적어도 5 “권리”를 준수하는 것이 중요합니다. 이 다섯 가지 “권리”는 올바른 환자, 올바른 약물 치료, 올바른 약물 투여 량, 적절한 투여 시간 및 올바른 관리 경로를 참조합니다. 간호사는 중재 관리 프로세스의 세 가지 체크 포인트에서 이 다섯 가지 “권리”를 확인해야합니다 : 1) 약물을 인출 할 때 약물 관리 기록 (MAR)을 비교하는 동안, 2) 취득 한 약물과 MAR를 비교하는 동안, 3) 침대 옆의 약물 및 환자 식별자 모두에 MAR를 비교하는 동안. 이 비디오는 약물 관리의 획득 구성 요소를 보여 줄 것이며, 이는 첫 번째, 두 번째 및 세 번째 검사점 동안 다섯 가지 “권리”를 수행하는 것으로 구성됩니다.
약물 분배 시스템 (MDS)에서 약물을 취득하기 전에 간호사는 환자의 건강 상태, 약물 알레르기 및 현재 임상 상태를 감안할 때 약물이 적절한지 여부와 약물의 이전 투여가 투여 되었을 때 고려해야합니다. 또한, 특정 약물은 투여 전과 제2약물 안전점검 전에 대비가 필요할 수 있다. 경검사 MAR뿐만 아니라 MDS의 다른 유형을 포함하여 다른 전자 MAR 소프트웨어가 있습니다. 각 시스템의 일반적인 단계는 동일하며 이 비디오에서는 이러한 소프트웨어 도구 중 하나를 사용하여 수행되는 단계를 보여 주지만 이 섹션에서 강조 표시된 안전 검사는 보편적으로 적용됩니다.
Acquiring medication from a medication dispensing device and administering it involves using the five "rights" of medication safety at 3 different safety checkpoints. The first safety check that includes the five "rights" occurs after acquiring the MAR and entering the medication dispensing device. The second safety check occurs after the medication has been removed and prepared according to best practices and facility protocols. At each safety checkpoint, the medication is verified with the patient's electronic MAR, confirming the right patient, right medication, right dose, right route, and right time. The third and final safety check is completed at the patient bedside, prior to medication administration.
A common mistake in the medication administration process is neglecting to perform the second check after the medication has been removed from the mediation dispensing device and prepared for administration. This step is critical because it will help the nurse to ensure that the proper doses have been prepared. Some medications provided by the pharmacy are at a dose that are below or above what has been prescribed. It is the nurse's responsibility to ensure that the correct dose has been prepared for the correct medication administration route and using best practices.
Errors in drug administration pose a great and potentially deadly risk to patients. It is therefore important that health care professionals, especially nurses, know and practice the “five rights” of safe medication administration. These five rights refer to the right patient, right medication, right dose, right route, and right time. It is important that these are followed and checked during the process of administering medications to prevent harm and maintain patient safety.
This video will illustrate the use of these five “rights” at three essential safety checkpoints in the medication administration process. Although, the procedure will be demonstrated on a specific type of software tool for Medication Administration Record, or MAR, and medication dispensing system, or MDS, the steps shown are universally applicable.
Prior to acquiring medications from the MDS, a nurse must consider if the drug is appropriate given the patient’s medical conditions, medication allergies, and current clinical status. A nurse should also confirm when the last dose of the same medication was administered.
Always start by washing your hands using soap and warm water. Rub your hands vigorously for 10-20 seconds, rinse well, and dry with a disposable paper towel. Sanitizers may also be used, if hands are not visibly soiled.
Proceed to the medication preparation area, log into the patient’s electronic medical record, and access the MAR to determine the medications prescribed. In this case, the prescription is Acetaminophen 650 mg every 4 hours PRN. With this information at hand, log into the MDS. Select your patient from the list and review the patient name in the MAR and the MDS. This completes the “Right Patient” check for the first checkpoint.
Next, in the MDS, open the patient medication administration list, and from the list, select the medication to be administered. Click the “remove now” button. Now stand back and look for the drawer with a flashing signal and open that drawer. Once open, select the appropriate bin, indicated by a flashing light. Remove the medication from the drawer, and hold the package next to the MAR and compare the medication name with the medication listed on the MAR. At this point, the “Right Medication” step is complete.
At the same time, compare the medication dose-amount and units-listed on the label with the dose listed on the MAR. At this point, the “Right Dose” step is complete. For some items listed on the MAR, you may need to remove more than one medication package to achieve the correct dose.
Also, check the route on the medication package label with the one on the MAR. This is the “Right Route” check. Notice that some medications’ routes may not be listed on the label, and the nurse must determine the appropriateness of the form provided for the administration route. For example, tablet equals oral administration.
Finally, review the MAR to identify the time the drug should be administered. Compare that time to the actual time listed on the clock in the medication preparation area. This completes the “Right Time” check. Now close the medications storage area, select “exit” on the computer screen, and log out of the MDS.
In the preparation area, prepare and label the medication according to best practices and procedures. Refer to other videos in this collection to learn about preparation and administration of different types of medications delivered via different routes.
After the medication has been prepared and labeled, perform the second safety check. Again, hold the labeled medication next to the computer screen and compare the label information to that listed on the MAR. Match the patient’s name for the “Right Patient” check and the medication name for the “Right Medication” check. Next, compare the dose and the route for the “Right Dose” and “Right Route” check, respectively. Complete the second safety check by referring to the time of administration in the MAR and checking the time on a clock or wristwatch.
You may now leave the preparation area and proceed to the patient’s room to complete the third and final check prior to administering the medication. In the patient’s room, ask them to state their name and date of birth. Compare this information with what is provided on the name band the patient is wearing. Access the bedside computer and log into the Electronic Medical Record to open the patient’s MAR. Confirm that you have the “Right Patient” by comparing the patient’s identification band information-name, date of birth, and medical record number-to the one listed in the MAR on the computer screen.
Next, hold the medication close to the computer screen and compare the label information to the one provided in the MAR in the patient’s electronic medical record. Again, match the medication name, dose, and route of administration information on the label, to the one listed in the MAR. “Right Medication,” “Right Dose,” and “Right Route” check is now complete for the third safety checkpoint.
Finally, review the time of administration in the MAR, and check the time on the clock in the patient’s room to confirm that it is the right time for administering the medication. This completes the three medication administration safety checks.
“A common mistake made in the medication administration process is neglecting to observe the second check after the medication has been removed from the medication dispensing device and prepared for administration. This step is critical because it will help the nurse ensure that the proper doses have been prepared. Note that some medications provided by pharmacy are at a dose that are below or above what has been prescribed, and it is the nurse’s responsibility to ensure that the correct dose has been prepared and correctly administered to the patient using best practice.”
You’ve just watched JoVE’s video demonstrating the usage of the “five rights” of medicine administration at the three essential safety checkpoints in the medicine administration process. As always, thanks for watching!
