Hi, I'm Cathy with Level Up RN.
In this video, we are going to talk about prescriptions as well as safe medication administration.
And if you watch the video until the end, I'll give you guys a little quiz, a little
knowledge check, to make sure you've been listening.
So definitely stay tuned for that.
Let's first talk about the types of prescriptions that you may encounter.
First of all, we have our time-critical scheduled medications.
So what are some examples of time-critical medications?
These can include antibiotics, anticoagulants, as well as insulin.
So for these time-critical medications, we need to give them within 30 minutes of the
scheduled time.
So they can be up to 30 minutes early or 30 minutes late, but it has to fall in that window.
All right.
Next, let's talk about our non-time-critical scheduled medications.
So for medications that are scheduled daily, weekly, or monthly, we can give those within
two hours of the scheduled time.
However, if the medication is prescribed more frequently, so twice a day, which is BID,
or three times a day, which is TID, then we need to give those within one hour of the
scheduled time.
And again, every facility will have its own policies, so definitely follow your facility's
guidelines on when you need to give different medications for your patients.
Then we have our one-time or single-dose prescription.
This is where you give the medication once at a specified time.
And then a STAT order means that you're going to give that medication once immediately.
And then we have our PRN, or as-needed prescriptions.
PRN prescriptions include the dose, frequency, and under what circumstances you can give
the medication.
So the most common PRN medications include pain medications and nausea medications.
Then, finally, we have what's called standing orders.
Standing orders are pre-written medication orders that can be given for defined circumstances
on a particular unit.
So, for example, there are often standing orders for hypoglycemia.
So if your patient experiences hypoglycemia, you can refer to those standing orders and
get them glucagon right away.
That way you don't have to call the doctor and wait for them to call you back, and in
the meantime, your patient is dying from a hypoglycemic coma.
So that's why we have standing orders in place.
Another example of a standing order set may be for chest pain, so that you can automatically
give nitroglycerin to your patient who is having chest pain.
So those are just some examples of standing orders that I've seen at my hospital.
So let's now talk about the components of a prescription.
Every prescription needs to include the patient's name, the date and time of the prescription,
the medication name, the dose, strength, and form of the medication, the frequency of administration,
and the route of administration.
And then if any refills are allowed, that needs to be noted on the prescription.
And then the provider needs to sign that prescription.
So as a nurse, you will be taking telephone orders.
That is standard practice.
So there are some best practices when it comes to taking a telephone order.
So you ideally would like to have a second RN listen in on the call to be sure that you're
getting an accurate prescription.
You want to repeat the prescription back.
So the provider will give you the prescription over the phone.
You want to write that down, and then you want to repeat back what you have written
to ensure accuracy.
And then make sure the provider signs that prescription within 24 hours.
There are a number of abbreviations that you should not use in your prescriptions because
they are error-prone, and a complete list of error-prone abbreviations can be found
with the Institute for Safe Medication Practices, so ISMP.
I've included a smaller list here on card number six with what I feel like are the most
important ones to avoid.
So first of all, we have MS and MSO4, which we should not use when prescribing morphine.
So you want to spell out morphine.
We should not use MgSO4 for magnesium sulfate.
We should also not us a U or IU for units.
We should not use QD for daily or QOD for every other day.
And we should not use SC, SQ, or sub-Q for subcutaneously.
So again, we want to spell out subcutaneously.
Now let's talk about decimals and leading or trailing zeroes.
Definitely important to know best practices.
So let's say your patient is prescribed 0.5 mg of Dilaudid.
You want to put a zero before the decimal point, so 0.5 mg of Dilaudid.
You don't want to have just .5 because if you miss that point, like it's not super visible,
then it looks like 5 mg of Dilaudid, which would be a very bad thing for your patient.
So you always want that leading zero before the decimal point.
Let's talk about that trailing zero.
So if your patient was prescribed 2 mg of Dilaudid and you put 2.0, if you put a trailing
zero, well, if that point is not really visible, it's going to look like 20 mg of Dilaudid,
which you should absolutely question as a nurse, for sure.
So we do not want that trailing zero.
So we just want to write this as 2 mg of Dilaudid, no point zero.
So my little hint for remembering this is you want to be a leader and not a follower.
In terms of the rights of safe medication administration, depending on what textbook
or website you're looking at, you may see 5 rights of safe medication administration,
up to 12 rights of safe medication administration.
So it really varies across sources.
There are kind of 5 core rights that you'll find that are common across all of these sources,
and this includes the right patient, the right medication, the right dose, the right route,
and the right time.
Other rights that may be included in your textbook include the right patient education,
the right for a patient to refuse their medication, the right nursing documentation, meaning charting,
and then the right assessment before and after medication administration.
All right.
Now that you have the rights of safe medication administration down, let's talk about some
other best practices for medication administration.
First of all, you want to identify your patient's allergies before you give them any medication.
You should also question any illegible or incomplete medication order.
Or if you see a prescription for a contraindicated medication or an inappropriate dose, definitely
reach out to the provider to question those prescriptions.
You only want to prepare medications for one patient at a time, and you only want to administer
medications that you have personally prepared.
There are also several high-alert medications that often require an independent double-check
with another RN.
So this may include heparin or insulin.
And then, another thing that's important to remember is that you never want to leave a
medication at the patient's bedside.
So if you go in to give your patient a medication and they're like, "I don't really want to
take it right now.
You can just leave it here at the bedside," no.
You don't want to do that.
You bring it with you, and then bring it back when the patient is willing to take that medication.
And then, finally, you need to complete an incident report for any medication error.
And you never want to include this incident report in the patient's chart or refer to
this incident report in the patient's chart because it's an internal document used for
quality improvement at the facility.
And better yet, how about no medication errors?
Make sure you do your triple checks so you don't perform a medication error and harm
your patient, and so you don't have to fill out one of those incident reports which my
understanding is not really a good time.
So that is it for the material I'm going to cover in this video.
Next up, we have a quiz.
All right.
I have three questions for you.
The first question is a true/false question.
Time-critical scheduled medications should be given within 30 minutes before or after
the scheduled time.
True or false?
The answer is true.
Second question.
Which of the following is correctly written, 0.5 mg, .5 mg, or .50 mg?
The answer is 0.5 mg.
Last question is also a true/false question.
If a medication error occurs, you need to complete an incident report and include that
in your patient's chart.
True or false?
The answer is false.
We do not include that incident report in the patient's chart.
Hope this was helpful.
If you got any of those questions wrong, be sure to go back and watch this video or review
our flashcards so that you can better understand the material.
I'll see you on another video soon.
Thank you so much.
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