Download legal aspects of medication administration

LEGAL ASPECTS OF MEDICATION
ADMINISTRATION
CHAPTER 3
LEVELS OF LAW
 FDA WATCHES OVER TESTING, APPROVAL AND
MARKETING OF NEW DRUGS
 1. FEDERAL LAWS
 CONTROLLED SUBSTANCES
 PRESCRIPTION DRUGS
 OTC MEDICATIONS
 2. STATE LAWS AND REGULATIONS
 3. INDIVIDUAL HOSPITALS OR AGENCY RULES
Federal Legislation
 Harrison Narcotic Act of 1914 – limited indiscriminate use
of addictive drugs
 Federal Food, Drug, and Cosmetic Act of 1938 – gave
authority to government to determine the safety of a drug prior
to marketing, labeling, specification, and advertising
 Durham-Humphrey Amendment of 1952 – restricted
number of prescription refills
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
3
CONTROLLED SUBSTANCES
 CONTROLLED SUBSTANCES ACT OF 1970
 5 DRUG SCHEDULES
 1. HIGH LEVEL OF DEPENDENCY
 2. HIGH LEVEL OF DEPENDENCY
 3. HIGH LEVEL BUT LESS THAN 1&2
 4. LOW LEVEL COMPARED TO 3
 5. LOW LEVEL COMPARED TO 4
Controlled Substances
Nurses may possess these only if:
 They are administering the drugs to the patient for whom they
were prescribed
 They themselves are the patient for whom the physician has
prescribed the drug
 They have been delegated the responsibility for the unit supply
 It is a crime for the nurse to have a controlled substance
UNLESS 1 OF THE 3 ABOVE CONDICTIONS ARE MET.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
5
CONTROL OF NARCOTICS
 MUST COUNT THE NARCOTICS BETWEEN AN ON-




COMING AND OFF-GOING STAFF MEMBERS EVERY 8
HOURS
CHART IN MAR AND NARCOTIC BOOK
ALL NARCOTICS FOR A DISCHARGED/ DECEASED
PATIENT ARE RETURNED TO PHARMACY FOR A
COUNT AND DISPOSAL
WASTED/ USED MEDICATION MUST BE WITNESSED
ON DISPOSAL
NO DRUG SHARING
DEPENDENCE
 PHYSICAL DEPENDENCE – PHYSIOLOGICAL NEED TO
RELIEVE PHYSICAL SYMPTOMS
 PHYSCHOLOGICAL DEPENDENCE – ANXIETY,
STRESS, OR TENSION THAT IS FELT IF THE PERSON
DOES NOT HAVE THE MEDICATION
 CAN HAVE ONE, BOTH OR NEITHER
OTC MEDICATIONS
 DO NOT NEED PRESCRIPTION
 PURCHASED AT DRUG STORES
 LOW DOSAGE
 LOW RISK FOR SIDE EFFECTS
 WARNING LABELS AND SPECIAL INFORMATION
AVAILABLE TO PURCHASERS
 HERBAL MEDICATIONS
STATE LAW & HEALTH CARE AGENCIES
 CHECK THE NURSE PRACTICE ACT IN THE STATE IN
WHICH YOU WORK
 PROFESSIONAL REPSONSIBILITY:
 ADMINSTER DRUGS APPROPRIATELY, ETHICALLY AND
TO BEST OF ABILITY
 LEGAL RESPONSIBILITY:
 GOOD JUDGMENT
 PROPER ACTIONS IN CARRYING OUT PROFESSIONAL
DUTY
State Nurse Practice Act
 Determines the level of authority and responsibility of the
nurse
 Different levels of nursing will have different levels of
authority and accountability
 Nurses must adhere to the Nurse Practice Act of the state in
which they are practicing
 Responsibilities may vary in state Nurse Practice Acts
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
10
Nursing Responsibilities
 All nurses have legal responsibility for their actions.
 The Nurse Practice Act determines the level of responsibility
and authority of the nurse.
 Nurses must have the authority to delegate to a person with
the authority to carry out the task.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
11
NURSE LICENSURE COMPACT
 HOLD A LICENSE IN ONE STATE BUT ABLE TO WORK
IN A STATE WITHIN THE COMPACT
 WWW.NCSBN.ORG
 NEW JERSEY IS NOT YET IN THE COMPACT
AGENCY/ INSTITUTIONAL POLICIES
 MAY BE MORE RESTRICTIVE OR SPECIFIC THAN STATE
NURSE PRACTICE ACT
 WRITTEN POLICIES –
 EDUCATIONAL PREPARATION
 POLICIES
 ORIENTATION
 PARTICULAR POLICIES, PROCEDURES, AND RECORD
KEEPING RULES
*EXPECTED TO USE NURSING PROCESS IN MEDICATION
ADMINISTRATION
Question 1
Of the following, who is not permitted by law to prescribe
medication?
1.
2.
3.
4.
Physician assistant
LPN
Dentist
Nurse practitioner
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
14
DELEGATION
 THE RESPONSIBILITY FOR PERFORMING A T ASK IS
PASSED FROM ONE PERSON TO ANOTHER BUT THE
ACCOUNTABILITY FOR WHAT HAPPENS (OUTCOME)
REMAINS WITH THE ORIGINAL PERSON
 MUST HAVE THE AUTHORITY TO DELEGATE
 THE RECEPTOR OF DELEGATION MUST BE ABLE/
HAVE AUTHORITY TO PERFORM THE DELEGATED
TASK
ADMINISTRATION
 CHECK MAR AGAINST THE ORIGINAL ORDER
 BAR CODING FOR MEDICATION DELIVERY
 USE THREE CHECKS FOR SAFETY
 BEFORE TAKING FROM DRUG CART
 BEFORE PREPARING, MEASURING DOSE
 BEFORE OPENING THE MEDICATION AT THE BEDSIDE,
OR PUTTING THE BOTTLE BACK
DRUG DISTRIBUTION CENTERS
 FLOOR STOCK (FROWNED UPON)
 INDIVIDUAL PRESCRIPTION ORDER SYSTEM
 UNIT DOSE
 COMPUTERIZED OR AUTOMATED DISPENSING
SYSTEM (PIXIS)
 NARCOTIC DISPENSING:
 Locked cabinet within locked med room
 Signed out in narcotics book and MAR
 Counted each shift
REQUIREMENTS FOR ORDERS
 PATIENT’S FULL NAME
 DATE WRITTEN
 NAME OF DRUG
 ROUTE, DOSE AND FREQUENCY
 DURATION
 SIGNATURE OF PRESCRIBER
 ADDITIONAL NEEDED DETAILS
 Avoid grapefruit
 Empty stomach
 Take with food, etc
TYPES OF ORDERS
 STANDING ORDER
 EX: TYLENOL 400mg PO DAILY
 STAT ORDER
 BENADRYL 50 mg PO NOW
 SINGLE ORDER
 DEMEROL 50 mg IM X1 ON CALL TO OR
 AS NEEDED (PRN) ORDER
 IBUPROFEN 200mg PO PRN EVERY 6 HOURS FOR TEMP
101 OR GREATER
MEDICATION ERRORS
 OOPSIES DO HAPPEN
 CHECK THE PATIENT STATUS FIRST
 NOTIFY THE PHYSICIAN
 MONITOR THE PATIENT
 NOTIFY NURSING SUPERVISOR
 CHART EXACT CIRCUMSTANCES
 INCIDENT REPORTS GO TO RISK MANAGEMENT; DO
NOT CHART IN PATIENT RECORD THAT AN
INCIDENT REPORT HAS BEEN FILED
INCIDENT REPORTS
 BE EXACT
 BE FACTUAL
 SEQUENTIAL HAPPENINGS AS BEST YOU CAN RECALL
 KEEP A PERSONAL COPY.
 USED TO ASSESS FOR PATTERNS OF ERRORS
 COULD BE A SYSTEM ERROR OR A PERSONAL
DEFICIENCY
MEDICATION SAFETY
 CHECK, CHECK AND CHECK AGAIN
 IF NOT SURE, LOOK IT UP
 DOUBLE CHECK CRITICAL MEDS
 ALWAYS USE 2 CHECKS FOR PATIENT ID
 NEVER LEAVE MEDS FOR THE PATIENT TO TAKE
LATER
 NEVER EVER RECAP A USED NEEDLE
 DISPOSE OF ITEMS PROPERLY
Question 2
Morphine is in the category of:
1.
2.
3.
4.
Supplements.
Unscheduled drugs.
Scheduled drugs, or controlled substances.
Over-the-counter medications.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
23
Question 3
Which of the following statements is true regarding herbal
products?
1.
2.
3.
4.
Very few people try herbal products.
Herbal products are regulated by the federal government.
Herbal products are considered supplements.
There is a great amount of information known about side
effects.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
24
Chapter 4
Foundations and Principles of Pharmacology
Copyright © 2013, 2010, 2006,
2003, 2000, 1995, 1991 by Mosby,
an imprint of Elsevier Inc.
25
Learning Objectives
 Define the key words used in pharmacology and
medication administration
 Explain differences between the chemical, generic,
official, and brand names of medicines
 List the basic types of drug actions
 Describe the four basic physiologic processes that affect
medications in the body
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
26
Drug Names
 Generic name
 Trade name; ® symbol
 Chemical name
 Official name
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
27
Drug Receptor Sites
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
28
Drug Attachment
 Agonist
 Antagonist
 Partial Agonist
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
29
Four Processes of Drug Utilization
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
30
Absorption
How a drug enters the body and passes into
body fluids and tissues
 Absorption processes:
 Diffusion—high concentration to lower concentration
 Filtration—a filter prevents passage of certain molecules
 Osmosis—diffusion through a semipermeable membrane from a less
dense solution to a more dense solution
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
31
Distribution
 Blood system
 Lymph system
 Barriers:
 Blood-brain
 Placental
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
32
Metabolism
 Biotransformation
 First-pass effect
 Affected by genetic and developmental
factors
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
33
Excretion
 GI tract
 Kidneys
 Lungs
 Skin
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
34
Question 1
A nephrotoxic drug is harmful to the:
1.
2.
3.
4.
Skin.
Kidneys.
Lungs.
Liver.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
35
Basics of Drug Action
 Desired action
 Adverse reactions
 Idiosyncratic reactions
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
36
Bioequivalence
 Define
 Brand name versus generic
 Generic equivalent
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
37
Drug Interactions
 Drug action may depend on ability to dissolve quickly or
slowly
 Controlled by medication form
 Oil-based drugs
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
38
Food, Alcohol, and Drug
Interactions
 Food interactions
 Alcohol interactions
 Drugs and laboratory tests
 Chronotherapy
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
39
Question 2
An idiosyncratic response is a drug reaction that is:
1.
2.
3.
4.
Expected.
Predicted.
Unique.
Anticipated.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
40
Question 3
Which medicine is more likely to cause an allergic reaction?
1.
2.
3.
4.
Acetaminophen
Aspirin
Cough suppressant
Antidepressant
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
41
 QUESTIONS?