NUR304 Pharmacology/Math

Introduction Week 1

Marcia Brown

Tools for Success in Dosage Calculations C l l ti

Practice! Practice!! Practice!!! Use the on-line math review and web resources
See internet resources u de Cou se Documentweek 1 e e esou ces under Course ocu e ee

Attend class regularly and bring your textbook Make an appointment to review your DC quiz results with the professor One-on-one math tutoring is available 5 days/wk. Contact the learning centre in the library to book an appointment.
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Permissible Calculators
Basic, non-programmable, 8-digit calculators must be used. Calculators must not have metric conversions. Calculators must not have the capacity to store information (i.e. formulas). Calculator must be removed from case and/or cover. Ensure the calculator is not set to automatically round your calculations. calculators must not produce sounds when keypads are touched. Each student must have his or her own calculator. Calculators cannot be shared among students students. Substitutes for calculators are unacceptable (i.e. cell phones, pocket organizers). Calculators with large digit displays are unacceptable.

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Medication Administration and Critical Thinking Thi ki

Calculate doses in an organized, systematic manner g , y Estimate what is reasonable amount of drug to be administered Distinguish relevant information Ask for clarification if you are unsure or dont don t understand.never assume!

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What is a medication error?

Medication errors can be classified into three main types: Commissions Omissions Near-miss events All medication errors result in potentially negative outcomes for the patient, including near or actual death

College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors

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Four Medication Phases

Medication errors are preventable events associated p with four phases: Prescribing Transcribing Dispensing Administering g Marcia Brown
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What causes medication errors?

Errors often reflect a problem with the medication system involving one or more of th medication phases. i l i f the di ti h Medication errors may cross professional boundaries and departments (i.e. a medication error may involve the nurse, physician/prescriber, and pharmacist) Medication errors can result from: System Issues Human Factors
College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors
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Human Factors
Reduce the probability of medication errors caused by human factors:

Follow the rights of medication adminstration Document during or after medication administration Be knowledgeable about the medication Communicate clearly Provide clear directions for use of the medication p your Perform an independent double check of y calculations Keep your patient informed of their medications (informed patients reduce the risk of med errors!) Marcia Brown
C ll fN fO t i (2008) M di ti P ti St d d M di ti
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Systems Issues
Medication errors resulting from system issues may involve:
Workload and staffing issues Equipment malfunction (i e calculators infusion (i.e. calculators, pumps) Confusing drug names (sound alike or similar spelled drug names) Drug Manufacturer (similar labels for different drugs, medications that look the same) Using Trade names versus Generic drug names
College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors ISMP C Canada d

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Medication Reconciliation
Medicationreconciliationisaprocessintendedtoprevent medicationerrors.Allmembersofthehealthcareteammay beinvolved.
1. 2. 3. 4. 5. 6. 6 Createanaccuratelistofallcurrentmedicationsandthetimeoflast dose Physician/designateshouldusethelistwhenwritingadmissionorders Comparethelistwiththeadmissionmedicationorders Identifyanydiscrepanciesandnotifytheprescribertomakethe d f d d f h b k h appropriatechanges Communicatethecurrentlistofmedicationstotheclientandcaregivers Comparethemedicationhistorytothetransferdischargeordersto Compare the medication history to the transfer discharge orders to ensure theclientsmedicationsarereconciledattransfer/discharge

CollegeofNursesofOntario.(2008).MedicationPracticeStandard CollegeofNursesofOntario.(2008).MedicationPracticeStandard

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ISMP Canada
The Institute for Safe Medication Practices An independent, non-profit Canadian Agency established for the collection & analysis of medication error reports and the development of recommendations for enhancement of patient safety. Encouraging a Culture of Safety g g y

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When a Medication Error Occurs what i your nursing responsibility? h t is i ibilit ?

Assess your patient A ti t Notify the physician/prescriber and pharmacy Monitor and treat your patient as required Talk to your patient, explain what happened and what interventions are necessary h ti t ti Document the medication error and actions taken t k
College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors

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Preventing Medication Errors

To understand the root cause of medication errors, nurses need to report all errors. To prevent future errors nurses should: errors, Reflect on the incident: What happened? Why did it happen? How can it be prevented from recurring? Seek out assistance, learning resources/courses Advocate for systems to reduce risk and improve patient safety
College of Nurses of Ontario. (2008). Medication Practice Standard: Medication errors Ontario (2008)

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Abbreviations, Symbols, and Dose Designations D i ti

The use of some abbreviations, symbols, and dose designations has been identified as an underlying cause of serious and even fatal medication errors. Can anyone read the written order below?

ISMP Canada, (2006). Safety Bulletin. 6 (4).

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Abbreviations
A list of commonly used abbreviations is posted on Bb under course document. See also Pickar p. 106 Do Not Use: Dangerous Abbreviations, Symbols and Dose DesignationsPlease see p. 77of Lilley 2ed as well as p. 107 of Pickar Abbreviations can vary among institutions and users. check your hospital policy for acceptable abbreviations

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Can you interpret these orders?

a) morphine 10-15mg IM q4h prn b) aluminum hydroxide 30.0 mL po pc tid c) Tylenol supp 650 mg PR stat d) penicillin G 500 000 iu IV qid According to ISMP Canada, Why is it problematic to use a trailing zero? Why is Wh i it problematic t use th abbreviation i ? bl ti to the bb i ti iu? Marcia Brown
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Medication Labels

Can vary greatly in terms of content and clarity It is important to develop the habit of reading labels thoroughly

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Calculation Methods
Formula Method Terms in the Formula
D = Desired dose Ordered in unit of measure desired mg, units, mEq H = Strength available Have on hand in unit of measure available mg, g, units Q = Quantity Unit of measure that carries what is on hand cited in H - tabs, mL, caps H x = Unknown Number of Qs needed to give the prescribed dose

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Steps to Use Formula

1. 1 2. 3. 3 4. 5. 5 6.

Memorize or verify formula from resource Place info in formula and label terms Make sure everything is in same system Apply logic test for reasonable answer Calculate Label answer with correct unit of measure

Note: Convert apothecary and household to metric equivalents when possible metric is the principal system used for medications Marcia Brown
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Practice Formula Method

Mr. Pete was ordered amoxicillin 0.5 g q8h. How many capsules will the nurse administer to Mr. Pete for his afternoon (1400) dose?

Show all calculations

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Ratio and Proportion

Ratio = numerical relationship between two quantities
E.g. 5:10 10:20

Proportion =when two equal ratios are expressed as an equation

E g 5 = 10 E.g. 10 20

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Ratio and Proportion

In a proportion, the product of the means equals the product of the extremes.

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Ratio and Proportion

If two fractions are equal their crossequal, cross products are equal This operation is called cross multiplying cross-multiplying Example:

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Ratio and Proportion

Often need to find a single unknown in unknown med calculations
Example: Available dose is 50 mg in 1 mL mL, ordered dose is 25 mgone unknown: x mL

State known first then unknown first, Sequence must match

Example: mg : mL = mg : mL (left sequence matches right sequence)
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Stated as a Fraction 50 mg 25 mg (known) = (unknown) 1 mL x mL 50x = 25(1) 50x = 25 50x 25 = 50 50 0 0 x = 0.5 mL 05

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Ratio and Proportion: Key Points

Convert everything into same unit of measure before starting calculations Convert to the unit of measure in which the medication is available C Convert i th di ti th t eliminates t in the direction that li i t decimals whenever possibledecimals are sources f error for

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Ratio and Proportion: Key Points

State known or available first known available State unknown or desired second K Keep left and right sides in matching l ft d i ht id i t hi sequence
mg : mL = mg : mL

Label all terms, including x Make mental estimate of logical answer first
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Practice Ratio and Proportion Method

Mr. Pete was ordered amoxicillin 0.5 g q8h. How many capsules will the nurse administer to Mr. Pete for his afternoon (1400) dose?

Show all calculations

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Calculating Doses Involving Tablets & Capsules

Choose the dose strength that allows the least number g of tablets/capsules to be given. When possible, choose a dose strength that does not involve breaking tablets. (breaking tablets can result in variations in dosage) Always consult a drug reference or p y g pharmacist before piercing/opening a capsule or crushing a tablet

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What dose strength would you choose?

Order: Lanoxin 0 125mg po 0.125mg

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When are oral liquid medications preferred?

Clients with dysphagia Clients who require medication via tubes (i e (i.e. gastric tubes) Young children, infants, elderly clients When medications are ordered that cannot be crushed
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Measuring Oral Liquids g q

Pour liquid medications at eye level on a flat surface and read at the meniscus. meniscus Calibrated droppers are not interchangeable between different medications When would a syringe be used to draw up an oral liquid? Should tablespoons or teaspoons be used to measure oral li id ? l liquids?
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