Safe medication management
Chris is a registered nurse who works in the float pool in an acute care facility. He routinely works between a medicine unit and a general surgery unit. Recently, the staffing needs on other units have increased, and Chris has been more frequently assigned to units outside of what he is normally used to. Today, Chris has been assigned to a nephrology unit. While he has received orientation for this unit, he is less familiar with this practice setting.
Chris is reviewing his client’s chart for any new orders. He receives an order which includes two new medications that he is unfamiliar with. Chris is well aware of CARNA’s Practice Standards for Regulated Members and understands that he is expected to:
- be accountable at all times for his actions;
- follow current legislation, standards of practice, and policies relevant to his practice setting;
- practise competently and within his own level of competence;
- use appropriate information and resources that enhance client care and the achievement of desired client outcomes;
- use critical inquiry in collecting and interpreting data, planning, implementing and evaluating all aspects of his nursing practice; and
- regularly assess his practice and take the necessary steps to improve personal competence.
As a result, he decides to conduct the appropriate research to learn more about the medications he is unfamiliar with. After reviewing some information, Chris consults the clinical nurse educator on the unit for additional guidance. The nurse educator provides some education on the medications and also reminds Chris about his responsibility and accountability to adhere to CARNA’s Medication Management Standards. Chris reviews the standards and the criteria applicable to his situation, and uses them to ask himself the following questions:
- Am I fulfilling my responsibility for client safety during medication management? Specifically:
- Do I understand the medication order correctly?
- Have I transcribed the order completely, accurately and according to employer requirements?
- Can the medication be administered safely?
- Are the medications hazardous, and if so, do I know what personal protective equipment is needed?
- Am I following employer requirements surrounding medication administration and documentation?
- Am I adhering to the rights of medication administration? (i.e.: medication, dose, patient, route, time and frequency, reason, documentation, right to refuse, patient education, evaluation).
- Am I following current legislation, standards, and policies related to medication management? Specifically:
- Was the client specific order from an authorized prescriber?
- Is the administration of the medications within my competency and scope of practice, and am I aware of any employer requirements?
- Am I knowledgeable about the medication? Specifically:
- Do I have adequate knowledge about the therapeutic effects and side effects of the medications, its interactions with other medications, and contraindications?
- Do I have sufficient knowledge to provide education or counselling to the client and his family?
- Do I have the knowledge and competence to administer the medications through the specified routes?
- Have I assessed if the medications are appropriate for the client?
- Do I have the knowledge and skills to assess for adverse reactions and to take action if needed?
- Am I following the Code of Ethics for Registered Nurses and ethical principles in all aspects of medication management? Specifically:
- Am I taking the necessary actions to prevent or minimize patient safety incidents?
- Am I practising within my own level of competence and seeking appropriate direction and guidance when aspects of the care required are beyond their individual competence?
- Do I have the necessary information to confirm informed consent by providing education to the client?
Upon increasing his knowledge about the medications and ensuring he meets the applicable criteria within the Medication Management Standards, he determines that he has taken the necessary steps to ensure safe medication administration. Chris reflects on his decision-making process and is confident that he has taken all of the necessary steps to ensure client safety.
Disclaimer: Our case studies are fictional educational resources. While we strive to make the scenarios as realistic as possible, any resemblance to actual people or events is coincidental.