High-Alert

Medications and Safe Practices

A study guide for nurses

Marla Husch, RPh Jennifer M. Groszek, RN, BSN, MJ Denise Rooney, RN, BSN, OCN

CONTENTS
About the authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 General safety principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Intravenous heparin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Potassium chloride . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Phosphorus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Intravenous calcium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Sodium chloride 3% (hypertonic saline) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Warfarin (Coumadin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Neuromuscular blocking (paralytic) agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Chemotherapy agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Exercise answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 Nursing education instructional guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Instructions for obtaining your nursing contact hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Nursing education exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Nursing education evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

High-Alert Medications and Safe Practices: A study guide for nurses

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General safety principles

The following safety principles are applicable to the administration of all medications: • Two unique patient identifiers should be assessed prior to administering medications. Reliable choices include those on the wristband or those that the patient can verbalize, such as name, age/date of birth, and medical record number. Never use room number or location as an identifier. • Allergy status is assessed prior to administration. • The nurse understands the medication’s intended purpose and ensures the “Five Rights”: 1. Right patient 2. Right dose 3. Right route 4. Right frequency 5. Right time • The nurse documents in a timely manner having checked the five rights. • The patient is informed of the drug, dose, potential side effects, and any relevant laboratory values. • “Read back and verify” is performed by anyone receiving a telephone or verbal order. • Only hospital-approved abbreviations, acronyms, and symbols