Medication dose Assignment

Medication dose Assignment

Medication dose Assignment

Medication dose Assignment

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Weight was transcribed incorrectly from emergency room sheet. Medication dose was calculated on incorrect weight; therefore, patient was given double the dose

CHAPTER 6 • MANAGING AND IMPROVING QUALITY 79

required. Error discovered after first dose and corrected. Second dose omitted per physician’s order.

Patient B. Tegretol dosage written in Medex as “Tegretol 100 mg chewable tab—50 mg po BID.” Tegretol 100 mg given po at 1400. Meds checked at 1430 and error noted. 50 mg Tegretol should have been given two times per day to total 100mg in 24 hours. Doctor notified. Second dose held.

Patient C. During rounds at 3:30 p.m. found .9% sodium chloride at 75 mLs per hour hanging. Order was written for D5W to run at 75 mLs per hour. Fluids last checked at 2:00 p.m. Changed to correct fluid. Doctor notified.

Diagnostic Procedure Any incident occurring before, during, or after such procedures as blood sample stick, biopsy, X-ray examination, lumbar puncture, or other invasive procedure is categorized as a diagnostic procedure incident.

Patient A. When I checked the IV site, I saw that it was red and swollen. For this reason, I discontinued the IV. When removing the tape, I noted a small area of skin breakdown where the tape had been. There was also a small knot on the medial aspect of the left antecubital above the IV insertion site. Doctor notified. Wound dressed.

Patient B. Patient found on the floor after lumbar puncture. Right side rail down. Examined by a physician, BP 120/80, T 98.6, P 72, R 18. No injury noted on exam. Patient returned to bed, side rail placed up. Will continue to monitor patient condition.

Medical–Legal Incident If a patient or family refuses treatment as ordered and prescribed or refuses to sign consent forms, the situation is categorized as a medical-legal incident.

Patient A. After a visit from a member of the clergy, patient indicated he was no longer in need of medical attention and asked to be discharged. Physician called. Doctor explained potential side effects if treatment were discontinued to patient. Patient continued to ask for discharge. Doctor explained “against medical advice” (AMA) form. Patient signed AMA form and left at 1300 without medications.

Patient B. Patient refused to sign consent for bone marrow biopsy. States side effects not understood. Doctor reviewed reasons for test and side effects three different times. Doctor informed the patient that without consent he could not perform the test. Offered to call in another physician for second opinion. Patient agreed. After doctor left, patient signed consent form.

Patient or Family Dissatisfaction with Care When a patient or family indicates general dissatisfaction with care and the situation cannot be or has not been resolved, then an incident report is filed.

Patient A. Mother complained that she had found child saturated with urine every morning (she arrived around 0800). Explained to mother that diapers and linen are changed at 0600 when 0600 feedings and meds are given. Patient’s back, buttocks, and perineal areas are free of skin breakdown. Parents continue to be distressed. Discussed with primary nurse.

Patient B. Mr. Smith appeared very angry. Greeted me at the door complaining that his wife had not been treated properly in our emergency room the night before. Wanted to speak to someone from administration. Was unable to reach the administrator on call. Suggested Mr. Smith call administrator in the morning. Mr. Smith thanked me for my time and assured me that he would call the administrator the next day.

 

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