Error Error what to do
A medication error has occurred with moderate injury to the patient, requiring an additional night stay in the hospital for monitoring. This is the system that you would write up the event and submit for internal review.
What is RL solutions
You are discharging your patient and they are on a new medication (omeprazole) for GERD and are asking for information about this new diagnosis along with foods to avoid and the medication effects and side effects. What resource will you turn to?
What is Micromedex/Lexicomp
PQRST, Numeric scale, Faces scale, FLACC, Adult non-verbal scale, NIPS, PIPP, NPASS
These are all examples of what?
What are pain assessment tools?
Medications prepared on the unit must be administered within this time frame___
Controlled substances prepared on the unit must be administered within this time frame___
What is 60 min ad 30 min.
A patient taking an Opioid for surgical pain in the first one-two day(s) post-op will most likely not become addicted to the pain medication.
Fact
Name 4 of the most common reasons medication errors occur in the pediatric population
What are: taking shortcuts, not using barcoding, pump integration, pump guardrails, Formula or human milk error (barcoding), Medications expired or fallen off MAR and not reordered. Medications not ordered/given using weight based calculations mg/kg, mcg/kg. Fluids and meds not compatible Secondary meds don't infuse-rollerball not opened
You are preparing your medications for one of your patients and you recognize that the concentration of the medication that you are pulling from the pyxis is different from what you selected. Who would you call?
Who is Pharmacy
Evidence shows that effective pain control after a surgical procedure results in_________ (give 2 out of the 4 answers)
What is
1. Fewer complications
2. Faster healing
3.decreased hospital stay
4. increased patient/family satisfaction
Frequently asking peers to sign off on waste that they did not witness.
Frequently wasting drugs that never reach the patient-medication dropped, pt. refusal
Frequently volunteering to get pain medication for your pt. Your pt. continues to have pain
What are signs/behaviors of possible Drug Diversion
In 2020, with all of the different multimodal drug therapies we are doing a good job in controlling our Cancer patient's pain
Myth
In a recent study of 1308 patient with metastatic CA from 54 centers across the country, 42% of patients in significant pain were not receiving adequate analgesic treatment to control their pain
This is required in the pyxis for all narcotic wastes of unused or partial doses used by an RN
What is a witnessed observation, verification of waste with co-signature confirming the wasted amount, drug, concentration and that the waste is unrecoverable ( not in sharps container or trash)
Your patient has newly diagnosed cancer tumors on his spine that are inoperable. The patient is in significant pain that the every 4 hour Oxycodone treatment is ineffective after an hour. Who would be consulted.
Who is palliative care
Constipation, nausea and vomiting, pruritus, urinary retention, sedation, respiratory depression
What are side effects of opioids
Fear of Retribution
Believing others will think you are incompetent
Not realizing a medication error even occurred
What are top three reasons RNs don't report medication errors or barriers for not reporting an RL
Education of patients and family members is an essential component of a comprehensive pain management plan
Fact
Pt education includes health promotion, disease specific information, self care, preventive care and navigation of the health system. We should take into account health literacy, pt. learning style, needs and preference. Should include different teaching strategies: oral, written, teach back, demonstration
This is where you would find information on the administration of IV monoclonal antibodies (MOAB) procedural checklist
What is Policy Stat
A patient's pain is not being alleviated by the current analgesics ordered. The RN first contacts the MD to report the patients intolerable 9/10 pain. The MD is reluctant to make changes to the current treatment plan. Who would you suggest to call for consult?
What is the pain team or consultants
Fear of addiction, fear of side effects, personal beliefs regarding pain, inadequate pain assessment
What are obstacles/barriers to optimal pain management
Name at least 4 different adjunct drugs commonly used for multimodal pain management control of a patient undergoing surgery besides opioids (can be utilized pre-op, intraop. or post-op)
What are: Analgesics-Acetaminophen, NSAID'S, Anti-convulsant, Anti depressants, neuroleptic agents, Glucocorticoids, local anesthetics. nerve blocks, spinals, epidurals, regional infiltration @ the surgical site
Children don't feel pain the same as adults do and therefore don't require the same treatment plan
Myth
We assess infants and children using different pain scales The faces, FLACC. Pain in children can have an association of fear if not adequately addressed
Using 5-8 medication rights, avoiding interruptions and distraction when preparing medications, being aware of hazardous drugs and high alert medications and the precautions to take, having a second person double check dosages of high alert meds, bar code scanning, using pump guardrails and reporting errors and near misses (blame free)
What are best practice strategies for medication administration and prevention of error. Name 4.
You have a pt. with a hx of drinking 5-6 beers a day who is undergoing a procedure with Moderate sedation and has received several doses of fentanyl and midazolam for sedation. Your assessment of the pt. 20 min into the procedure is HR 46 bpm, O2 sat 96% on 3 LNP, RR is 3, despite respiratory maneuvers, Is unresponsive to verbal or tactile commands, Who will you call
What is the Code team
What do these opioids have in common? MS Contin, Oxycontin, Fentanyl Patch
What are long-acting opioids, risk for addiction
Name 5 non-pharmacological pain management modalities
What is Heat, Ice, massage therapy, ambulation, position change, physical therapy, aromatherapy, guided imagery, deep breathing, laughter, music, biofeedback, progressive relaxation, acupuncture, meditation/prayer
Chronic pain is the result of overuse of opioids, leading to tolerance and decreased effectiveness of the medication(s)
Myth :Chronic pain occurs beyond the normal time of healing or in diseases that healing does not take place: CA, degenerative spine disease, osteoarthritis, rheumatoid arthritis, fibromyalgia, HIV, migraine, diabetic neuropathy Chronic pain consequences: depression, SUD, QOL, suicidal ideation, poor sleep, memory issues, HTN, cardiac issues, sexual disfunction