Medication administration is a common and frequent nursing task in most settings. There are plenty of opportunities to get things wrong….even when surrounded by fantastic resources like an onsite pharmacy and electronic information sources. Correctional nurses don’t often have these advantages, though, and medication administration can take on some interesting configurations. I’ve been in quite a few jails and prisons in my correctional consulting career and have seen many a method for medication delivery to overcome environmental and security challenges. Therefore, it is important to provide checklist before rolling out of the Med room. Here are just a few of the ways medication may be delivered behind bars.
- A window in the med room. Patients may line up outside the room in a hallway or in an outdoor area
- A medication cart rolled to the housing unit and stationed in the common area or a small room in the housing unit
- A cart, room, or even table near the dining hall
- A larege utility shed in the recreation yard
In most of these cases (except the first one, maybe) the nurse must take all the medications and supplies out away from the medical unit and must be prepared for any situation. There is little opportunity to ‘run back to the unit’ for something forgotten or unexpectedly needed. This made me think of airplane pilots who need to know they have everything checked out and ready to go before they take to the air. As a passenger on these flights, I am glad the captain doesn’t rely on memory to be sure everything is in order. Cruising altitude is not a good place to be finding out the gas tank is low.
Here are my suggestions for a pre-flight checklist before you take-off on your medication flight.
- Check that the cart is properly stocked.
- Patient medications
- Medication administration record
- Pen, highlighter, notepad
- Current drug book
- Pill crusher
- Pill cups
- Water/drinking cups
- Waste receptacles
- Any access keys needed such as access to the narcotics box
- Perform the following activities while in the Medication Room.
- Scan MARs for
- Any new medication orders since last administration.
- Any new patients
- That all patients have drug allergies listed or NKA (no known allergies) identified
- Check to see that new medications are available or, if being processed, are added to the cart before starting administration
- Check a drug reference book on any new medications that are unfamiliar
- Perform any calculations for odd dose orders
- Perform hand hygiene
- Each single episode of medication administration should follow the same path in order to habituate safety principles. Here is an example of a workable medication line episode path that includes the safety mechanisms of checking the medication three times and involving the patient in medication verification.
- Ask the patient to recite their full name while checking ID band or card.
- Locate correct MAR page
- Scan page for medications due at this administration time
- Locate patient medication group in medication cart drawer
- Take first card and check against MAR while popping pills into medication cup
- Take next card and check against Mar while popping pills into medication cup
- Continue in like manner until all pills for this administration time are in the medication cup
- Recite medications to the patient while preparing them
- Recheck cup of pills against MAR before handing to the patient
- Ask patient if he/she has any questions about their medications while pouring water
- Watch patient take medication. Perform oral check or confirm officer is doing oral check
- Observe that cups are deposited in waste receptacle and not taken by the patient
- Move to the next patient
- Additional steps in the process might be needed depending on the patient or situation.
- Crushing some or all medications.
- Responding to a patient question or confirming a medication if questioned.
- Unlocking and signing out any narcotics.
- Obtaining a double-check on high risk medications and complex calculations.
Do you have a mental checklist you use when preparing for and administering medications? Share your tips in the comments section of this post.
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