General High-Alert Medications

Transcription

1 for High-lert Meitions Generl High-lert Meitions Sope: Unless otherwise stte, these items pertin to the high-lert meitions inlue in this ssessment (if use in the fility) n those on the fility s list of high-lert meitions. Self-ssessment Items Tehnology 1 OMPUTRIZ PRSRIR ORR NTRY systems re use to trnsmit nonemergent orers for highlert meitions in ll settings in the fility (e.g., emergeny eprtments, post-nesthesi re units, linis, inptient units). 2 MHIN-RL OING is use to verify ll se solutions n itives (inluing verifition prior to tthment to utomte ompouners) when prepring OMPOUN STRIL PRPRTIONS of high-lert meitions. Soring guieline: hoose Not pplile only if OMPOUN STRIL PRPRTIONS of high-lert meitions re never prepre in your fility. 26 FQ 3 4 For OMPOUN STRIL PRPRTIONS ontining high-lert meitions, the se solution n ll itives (inluing the tul volume in syringes) re INPNNTLY OUL HK y prtitioner (even if initilly prepre y phrmist) prior to mixing when no tehnology-ssiste vlition is in ple to onfirm the orret prouts n volumes. (The SYRING PULLK MTHO is not use s prt of the verifition proess.) Soring guieline: hoose Not pplile only if OMPOUN STRIL PRPRTIONS of high-lert meitions re never prepre in your fility. MHIN-RL OING is use in the following lotions n/or for the following tsks: (sore eh item iniviully) In the phrmy for seletion of high-lert meitions prior to ispensing or leving the phrmy 5 When filling s with high-lert meitions, snning eh meition or solution iniviully efore stoking it Soring guieline: hoose Not pplile only if s re never use in your fility. When removing high-lert meitions from s vi overrie or from open/multiple-ose mtrix rwers Soring guieline: hoose Not pplile only if s re never use in your fility. t the ptient s esie prior to ministrtion to ientify oth the ptient n the meition/ose emrs re essile t the ptient s esie n use for referene uring the rug ministrtion proess. ontinue on pge 27

2 for High-lert Meitions 6 FQ 7 8 SMRT INFUSION PUMPS with tivte OS RROR-RUTION SOFTWR (RS) re use to minister IV n/or epiurl high-lert meitions. xeption: IV push meitions ministere y prtitioner, n smll volume vesint infusions whih, when ministere vi the peripherl IV route, shoul only e infuse y grvity n not y n infusion/syringe pump. Soring guieline: hoose Not pplile only if high-lert meition infusions re never ministere in your fility. SMRT INFUSION PUMPS re integrte with the omputer orer entry systems n HR; n utoprogrmming of high-lert meition infusions ours through this lose-loop tehnology iretly vi the meition orer. Soring guieline: hoose Not pplile only if SMRT INFUSION PUMPS re never use n/or high-lert meition infusions re never ministere in your fility. Presriers, phrmists, n nurses n esily n eletronilly ess the most urrent inptient n outptient lortory vlues while working in their respetive linil lotions. Tehnology lerts 9 10 ll inptient n/or outptient orers re entere into omputer orer entry system n sreene eletronilly ginst the ptient s urrent meitions n meil profile to ientify potentil ontrinitions, intertions, n uplite therpy efore high-lert meitions re ministere, unless ely in ministrtion oul result in ptient hrm. The following tehnology systems use in the fility re teste t lest nnully to ensure tht MXIMUM OS lerts re funtionl for high-lert meitions; n lerts re rete for those tht re not present: (sore eh item iniviully) omputer orer entry systems (presrier n phrmy) utomte ompouning evies Soring guieline: hoose Not pplile only if utomte ompouning evies re never use n/or PRNTRL prouts re never ompoune in your fility. SMRT INFUSION PUMPS Soring guieline: hoose Not pplile only if SMRT INFUSION PUMPS re never use n/or high-lert meition infusions re never ministere in your fility. The HR n/or omputer orer entry system lerts the user if the ptient s oumente weight or height exees threshol tht suggests the possiility of n error (e.g., entering weight in pouns inste of kg, swithing height n weight entries, entering weight tht exees fility-efine perent gine or lost). omputer orer entry systems re iretly INTRF or integrte with the lortory system n utomtilly lert prtitioners who re pling n/or verifying orers to norml vlues, initing potentil nee to moify therpy with high-lert meitions. n tive omputer surveillne system (e.g., T MONITORING SOFTWR) is use to monitor ville t soures to optimize therpy n ientify ptients t risk of hrm from high-lert meitions (e.g., erese pltelet ount in ptient reeiving heprin), n to notify n uthorize prtitioner of intervention opportunities in rel time. ontinue on pge 28

3 for High-lert Meitions ispensing 14 Orers for weight se high-lert meitions nnot e verifie, ispense, or ministere until the ptient s reent, tul weight (not stte, estimte, or historil weight) in metri units hs een entere in the phrmy omputer orer entry system (i.e., orers nnot e verifie until the weight fiel hs een populte). xeption: mergent orers for whih ely in ministrtion oul use ptient hrm. 15 Phrmists work onsite in ptient re res t lest 8 hours eh y performing linil tivities (e.g., reviewing meition orers, verifying meitions, ttening interisiplinry rouns, proviing input into the seletion n ministrtion of meitions, euting ptients) where high-lert meitions re orere n ministere. evie Mngement 16 efore purhsing new ministrtion evie to eliver high-lert meition (e.g., insulin pen, SMRT INFUSION PUMP, elstomeri pump, intrthel pump) the fility onuts PROTIV RISK SSSSMNT using smple evie n implements strtegies to minimize the risk of errors. ministrtion 17 When infusions of high-lert meitions re strte, reonnete, or hnge (new g or syringe), or the rte is juste, the tuing is tre y hn from the solution ontiner, to the pump, n then to the ptient for verifition of the proper pump/hnnel n route of ministrtion. Soring guieline: hoose Not pplile only if high-lert meition infusions re never ministere in your fility. 28 INPNNT OUL HKS When strting or restrting n IV or epiurl high-lert meition infusion, n with eh new g/ottle/syringe or hnge in the infusion rte, one prtitioner reies the solution n seon prtitioner, using the HR/orer/MR/eMR n ville tehnology (e.g., integrte SMRT INFU- SION PUMPS, RO SNNING THNOLOGY), inepenently verifies the following efore strting the infusion: ptient; rug/solution; rug onentrtion; rte of infusion; line n pump tthment; n hnnel seletion (for multiple-hnnel pumps). (The ltter two elements require verifition y prtitioner even if tehnology is employe to verify the other elements.) xeption: Frequent rte hnges to titrte meition (e.g., vsopressors) to effet. Soring guieline: hoose Not pplile only if IV or epiurl high-lert meition infusions re never ministere in your fility. For IV or epiurl high-lert meition infusions, n INPNNT OUL HK etween the onoming n outgoing nurse t shift hnge is require to verify the ptient, rug/solution, rug onentrtion, rte of infusion, line n pump tthment, n hnnel seletion (for multiple-hnnel pumps). Soring guieline: hoose Not pplile only if IV or epiurl high-lert meition infusions re never ministere in your fility n/or there is no trnsition etween stff ring for ptients or shift hnges. xpression of rug oses 20 The revition U or u is never use for units when expressing meition (e.g., heprin, insulin) oses in ny pper, lel, or eletroni formt use to ommunite meitions in the fility. ontinue on pge 29

4 for High-lert Meitions Triling zeros re not use when expressing meition oses (e.g., 5 mg, never 5.0 mg), n leing zeros re use when expressing oses less thn 1 mesurement unit (e.g., 0.3 mg, never.3 mg) in ny pper, lel, or eletroni formt use to ommunite meitions in the fility. Orers for weight-se high-lert meitions for neontl n younger peitri ptients elow fility-speifie weight (e.g., 40 kg) inlue the sis for the ose (e.g., mg/kg or mg/kg) long with the totl lulte ptient-speifi ose (e.g., morphine 0.1 mg/kg x 15 kg = 1.5 mg IV every 4 hours PRN severe pin). Soring guieline: hoose Not pplile only if your fility never ministers high-lert meitions to neontes or younger peitri ptients. Stnr protools, orer sets, n orers express IV n neurxil high-lert meition infusions/ oses in mnner (e.g., mg, mmol, mq, mg/kg, mg/kg/min) n sequene tht mthes the entries on MRs/eMRs, phrmy lels n/or UTOMT SYSTM LLS, infusion pumps, n utomte ompouners (if utilize). Soring guieline: hoose Not pplile only if IV n/or neurxil high-lert meitions re never ministere in your fility. Prout ifferentition 24 When more thn one stnr onentrtion is neee for high-lert meition infusions (for ult, peitri, or neontl ptients), the fility uses onsistent terminology n visul ues to istinguish etween the onentrtions on lels, MRs/eMRs, n eletroni (e.g., omputer orer entry systems, s, SMRT INFUSION PUMPS) sreens. Soring guieline: hoose Not pplile only if high-lert meition infusions re never ministere in your fility To minimize errors with high-lert meitions tht hve similr or onfusing lels, pkging, n/or rug nmes, proess strtegies (e.g., RO SNNING THNOLOGY, TLL MN LTTRING) n environmentl strtegies (e.g., segregte storge, lie omprtments in s) re in ple. Rpi Response Tem 26 rpi response tem is ville 24 hours y, 7 ys week (or whenever the fility is open), n onsistently respons to ptient, fmily, n stff onerns out inresing instility n/or linil eteriortion of the ptient. Stff ompeteny n ution Prtil, hns-on tehniques suh s SIMULTION TRINING re use t lest nnully with prtitioners n tems (e.g., rpi response tems) to promote initil n ontinuing ompetene with highlert meitions n emergeny responses to verse rug events; n known error-prone onitions re emee in the trining to help stff voi them, etet them, n/or mnge their effets. Prtitioners who presrie, ispense, n minister high-lert meitions reeive ongoing informtion out ssoite risks n errors tht hve ourre in the orgniztion n hve een reporte y externl orgniztions, n out strtegies to minimize these risks n errors. Ptient ution (Inlues regiver ution When pproprite) 29 riteri hve een estlishe to trigger n utomti onsulttion with phrmist or other ptient eutor for ptients who tke or will e tking fility-efine high-lert meitions t home. ontinue on pge 30

5 for High-lert Meitions 30 Ptients presrie therpy with high-lert meitions re provie with informtion out the ommon types of errors known to e prolemti with these rugs (e.g., methotrexte invertently presrie ily for rthritis, wrong ose errors ue to frequently hnging wrfrin orers, mix-ups etween rpi-ting n SL INSULINS), n how to prevent n etet these errors. Lerning ulture 31 e 32 e f g FQ 33 The orgniztion routinely reviews the following t n reports; n onvene interisiplinry tem investigtes ientifie prolems, lerns their uses, n reommens/filittes tion for improvement: (sore eh item iniviully) Stff ompline with protools, guielines, n orer sets relte to high-lert meitions Stff ompline with tehnology (e.g., RO SNNING THNOLOGY rtes, tivtion of SMRT INFUSION PUMP OS RROR-RUTION SOFTWR [RS], overries) Tehnology lerts (e.g., MXIMUM OSS, serious rug intertion, llergies) ssoite with highlert meitions to etermine whether prtitioners re responing to them ppropritely Internl reports of risk, errors, n verse events relte to high-lert meitions xternl reports of risk, errors, n verse events relte to high-lert meitions The following investigtive resoures re use to ientify risks or errors with high-lert meitions n to emonstrte sustine improvement fter implementtion of risk reution strtegies: (sore eh item iniviully) Meition event reports verse rug retion reports Phrmy interventions (e.g., phrmist suggestion of therpeuti hnge to improve the sfety of meition orer) Rpi response tem lls Use of reversl gents or ntiotes (e.g., flumzenil, nloxone, sugmmex, vitmin K 1, fresh frozen plsm, prothromin omplex onentrtes, ntrolene) ertin lortory or monitoring results (e.g., PTT or INR greter thn x; heprin-inue thromoytopeni [HIT] ntioy; hypoglyemi n hyperglyemi) Other linil TRIGGRS (e.g., irwy interventions, unplnne or prolonge hospitliztion, inility to omplete proeure [setion filures], opioi-inue respirtory epression or unintene vning setion) Stff re nonymously surveye every 1 to 2 yers to ssess the orgniztion s SFTY ULTUR; n the finings re use to vne the orgniztion s SFTY ULTUR. 30