Independent Double Checking
What are the five rights?
Right Patient, right drug, right dose, right route, right time
When do you need to document pain reassessment for oral meds?
1 hour
An Aflac RN came to give a chemo drug to your patient, what needs to occur before the Aflac RN leaves the floor?
The MAR needs to be pulled up and meds need to be reviewed with CIRU RN (Transfer of Care)
What is the purpose of doing an Independent Double Checking vs witnessing?
To get an unbiased second set of eyes to verify drug calculations to ensure any discrepancies are caught before reaching patient
At what point do you discuss your answer with the independent double checker?
After you both complete the dosage calculation and have the final result
It is necessary to assess and document LOC and respiratory rate when giving these type of pain meds _____.
Opioids
What PPE should be used when drawing up a med to be given through a central line?
Gloves and Mask
The doctor has written for Tylenol and Motrin for pain. Can you give these?
No, the doctor must specify different PRN reasons for each medication
In what circumstances would the independent double checker need to go into the room?
For any continuous medications, such as TPN/Lipids, PCA pumps, etc.
At what point do you document pain reassessment for IV meds?
At peak effect, differs from med to med
When wasting an entire dose of a controlled substance that has been opened, what needs to be done?
Med needs to be brought down to pharmacy to waste.
When witnessing a Controlled Substance waste in the med omnicell, what is expected of the 2nd RN?
To watch the 1st RN dispose of the extra medication down the sink
What is included under “Right Drug”?
Drug matches MAR, med is not expired, patient not allergic, correct drug indication
Is it necessary to document pain reassessment on scheduled meds?
No, as long as they are not opioids. If they are, respiratory rate and level of consciousness should still be assessed at peak effect of drug.
Jack has IV fluids that run at night into his port, how often should his tubing be changed?
q 24 hours
What are your steps when a medication dose is outside of preset guardrails?
Bring in 2nd RN to check calculation, then escalate to pharmacy to check calculation, then escalate to MD to confirm dose before over-riding
What do you need to show your Independent Double Checker when checking high alert meds?
The MAR and the medication vial/container
Sam is 19 and globally delayed. He is grimacing, has his legs drawn up, and is occasionally moaning. What pain scale would you use for Sam?
FLACC
What type of meds is it critical to give on time?
Immunosuppressant drugs
In which policy can you find information about which meds have to be given on time and also includes the Staggering Medication Administration Times Chart?
The "Scheduled Medication Administration Times" policy