Dimensinal Analysis

1. Dimensinal Analysis Chapter 6 Reading Oral medication labels

2. 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.

3. Nurse Charged With Felony In Medication Error Death • 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.

4. Nurse Charged With Felony In Medication Error Death • 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.

5. 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.

6. Nurse's suicide highlights twin tragedies of medical errors • 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.

7. Nurse's suicide highlights twin tragedies of medical errors • “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.

8. Safe Drugs • U.S. Food and Drug Administration (FDA)

9. 1938: The Federal Food, Drug & Cosmetic Act • Federal regulation • Drugs must be labeled with directions • Manufactures had to prove meds were safe • Government inspections

10. Thalidomide • Morning Sickness pill • 1950’s / Europe • Severe birth defects -limbs

11. Medication Orders: components 1. Patient identify information • Name • DOB • Medical Record # • Dr.

12. Medication Orders: components 2. Date and time of order

13. 24-hour clock / military time

14. 24-hour clock / military time

15. On a 24-hour clock what time would 6:30 PM be? • 0630 • 1430 • 1630 • 1830 • None of the above?

16. On a 24-hour clock what time would 10:15 PM be? • 1015 • 1215 • 0815 • 2015 • None of the above

17. On a 24-hour clock what time would 8:00 PM be? • 0800 • 1000 • 2000 • 2200 • None of the above

18. On a 24-hour clock what time would 12:45 PM be? • 1245 • 0045 • 1445 • 1045 • None of the above

19. On a 24-hour clock what time would 6:30 AM be? • 0630 • 0830 • 1830 • 1630 • None of the above

20. On a 24-hour clock what time would 12:30 AM be? • 1230 • 0230 • 0030 • 1430 • None of the above

21. On a 24-hour clock what time would 7:30 PM be? • 1930 • 1730 • 1530 • 0730 • None of the above

22. On a 24-hour clock what time would 1:30 AM be? • 1330 • 0030 • 0330 • 0130 • None of the above

23. Medication Orders: components 3. Name of medication

24. Medication Orders: components 4. Medication dosage • 500 mg • 20 mEq • 100 units • 30 mL

25. Medication Orders: components 5. Route of administration

26. Route: enteral • Oral (by mouth) • PO • Tablets • Capsules • Caplets

27. Route: enteral • Rectal (per rectal) • PR • suppositories

28. Route: enteral • Via tubes (GT or NGT)

29. Route: Parenteral • Intravenous • IV

30. Route: Parenteral • Intramuscular • IM

31. Route: Parenteral • Subcutaneous • Subcut

32. Route: Parenteral • Intradermal • ID

33. Route: Other • Sublingual • SL

34. Route: other • Transdermal

35. Medication Orders: components 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

36. Before meals • ac • After meals • pc

37. Medication Orders: components 7. Prescriber’s name & credentials • Mary Jones, MD • John Gonadal, DO

38. Medication Orders: components 8. Name of person transcribing the order • Noted: E. Keele, RN

39. The 6 rights & 3 checks Rights Checks • Patient

40. The 6 rights & 3 checks Rights Checks Check medication While pulling After pulling Before giving • Patient • Drug • Dose • Route • Time • Documentation

41. Oral Mediations • Tablets • Scored tablets • Enteric coated tablets • Capsules • Controlled release capsules • Gelatin capsules

42. Tablets • Tablets • Scored tablets • Enteric coated tablets

43. Capsules • Capsules • Control release capsules

44. Gelatin capsules

45. What are these capsules made of? • Gelatin • Plant starch and cellulose

46. Can a scored tablet be divided in half? Giving only half of a tablet to a patient? • Yes • No

47. Can a gelatin filled capsule be divided in half - giving only half of a capsule to a patient? • Yes • No • I don’t know – I’ll wait until Mrs. Keele shows me the right answer!

48. Can a capsule be divided in half? Giving only half of a capsule to a patient? • Yes • No

49. Can you open a capsule and give a patient the medication without the capsule casing? • Yes • No

50. May you open a time release capsule and give a patient the medication without the capsule? • Yes • No