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SMART NURSES SMART CARE Best Practice of Risk Management in Medication Error 24 August 2016 พว.อุรศรี อิ่มสมบูรณ์ หัวหน้าหอผู้ป่วยวิกฤตหัวใจ ศูนย์การแพทย์สมเด็จพระเทพรัตน์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี
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Page 1: Best Practice of Risk Management in Medication Error 24 August … · 2019. 5. 7. · Type of Scheduled Medication Goals for Administration Time Time-Critical Scheduled Medication

SMART NURSES…SMART CARE

Best Practice of Risk Management in Medication Error

24 August 2016

พว.อรศร อมสมบรณหวหนาหอผปวยวกฤตหวใจ

ศนยการแพทยสมเดจพระเทพรตนคณะแพทยศาสตรโรงพยาบาลรามาธบด

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SMART NURSES…SMART CARE

Objectives

• Polices awareness to improve working areas and increase the quality practice required for medication administration

• Reducing harm from Medication Error

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SMART NURSES…SMART CARE

2010 National Patient Safety Goals

Medication Safety Goal ( SIMPLE)

Goal 3:

Improve the safety of using medications.

2015 -National Patient Safety Goals

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SMART NURSES…SMART CARE

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SMART NURSES…SMART CARE

ความเสยง ความปลอดภย คณภาพการก ากบดแลวชาชพสงแวดลอมในการดแลผปวยการปองกนการตดเชอระบบเวชระเบยนระบบจดการดานยาการตรวจทดสอบการเฝาระวงโรคและภยสขภาพการท างานกบชมชนกระบวนการดแลผปวย

การเขาถงและเขารบบรการการประเมนผปวยการวางแผนการดแลผปวยการใหขอมลและเสรมพลงการดแลตอเนอง

ดานการดแลผปวยดานการมงเนนผรบผลงานดานการเงนดานทรพยากรบคคลดานระบบและกระบวนการส าคญดานการน าดานการสรางเสรมสขภาพ

การน า

การวางแผนกลยทธ

การมงเนนผปวยและสทธผปวย

การวด วเคราะห และจดการความร

การจดการกระบวนการ

การมงเนนทรพยากรบคคล

ผลการด าเนนงาน

ตอนท IIIกระบวนการดแลผปวย

ตอนท II ระบบงานส าคญของ รพ.

ตอนท IV ผลการด าเนนงาน

ตอนท I ภาพรวมของการบรหารองคกร

มาตรฐานโรงพยาบาลและบรการสขภาพ ฉบบเฉลมพระเกยรต ฉลองสรราชสมบต ครบ 60 ป

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SMART NURSES…SMART CARE

ความเชอมโยงกบระบบการจดการดานยาในโรงพยาบาล

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SMART NURSES…SMART CARE

มาตรฐานโรงพยาบาลและบรการสขภาพ ฉบบเฉลมพระเกยรตสรราชสมบตครบ 60 ป ฉบบปรบปรง มกราคม 2558

ความเชอมโยงกบระบบการจดการดานยาในโรงพยาบาล

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SMART NURSES…SMART CARE

A medication error is “any preventableevent that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.”

(The National Coordinating Council for Medication Error Reporting and Prevention, 1998)

Medication Error : Definition

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SMART NURSES…SMART CARE

Medication Error : Definition

คอ เหตการณใดๆทสามารถปองกนได ทอาจเปนสาเหตหรอ

น าไปสการใชยาทไมเหมาะสม หรอเปนอนตรายแกผปวย ในขณะท

ยาอยในความควบคมของบคลากรสาธารณสข ผปวยหรอผรบบรกการ

(ธกดาและคณะ , 2548)

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SMART NURSES…SMART CARE

Administration error : Definition

การใหยาทแตกตางไปจากค าส งการใชยาของผส งใชยา

ทเขยนไวในบนทกประวตกการรกษาผปวย

ความคลาดเคลอนทท าใหผปวยไดรบยาผกดไปจากความ

ตงใจในการส งใชยาของผส งใชยา

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SMART NURSES…SMART CARE

Near miss, Close call: ISMP Definition

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SMART NURSES…SMART CARE

Medication Errors

are due to multiple factors in a complex of medical system.

“In most cases, medication error

can’t be blamed on a single person.”

(Paul Seligman, 1993)

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SMART NURSES…SMART CARE

Medication Errors

Recommended that effective interdisciplinary teams “ attending to one another’s safety concerns”.

• Errors in health care should be seen as the result of complex systems rather than the fault of individual clinicians.

(IOM,1999)

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SMART NURSES…SMART CARE

มมมองความผดพลาดตางกนท าใหการจดการตางกน

• หากบคลากรแตละวชาชพ ไดรบการฝกฝนมาด

แนวคดเชงบคคล แนวคด

ดงเดม

• เชอวามนษยทกคนสามารถท าผดไดยอมรบขดจ ากดของมนษย

แนวคดเชงระบบ

แนวคดใหม

จะปฏบตหนาทไดอยางสมบรณแบบ

No error

Active error จากตวบคคล

การปองกนความคลาดเคลอน ,ลง

โทษ,ตกเตอนปกปดความผด

No error

Latent error ความบกพรองของระบบทม

มากอน

การปองกนความคลาดเคลอนตองเปลยน

สงแวดลอมหรอระบบงาน

เสยโอกาสการน าความผดพลาดมา

วเคราะหเพอแกไขเชงระบบ

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SMART NURSES…SMART CARE

Every 5 doses = ERROR

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SMART NURSES…SMART CARE

How many die from medical

mistakes in US Hospitals?1999 IOM “To Err is Human” …. 98,000 /year

2010 The department of Health and Human services

.... 180,000 /year

2013 The Journal of Patient Safety 210,000-400,000

/year

Medication Errors

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SMART NURSES…SMART CARE

48% of errors caught

before reaching patientOnly 2% of errors caught

before reaching patient

Ordering Transcribing Preparing Administering

39% errors 12%errors 11%errors 38%errors

Leape LL et al. “Systems analysis of adverse drug events,” JAMA, 274: 35-43, 1995.

Errors พบไดในทกกระบวนการบรหารยา?

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ตวอยาง Medication Errors : FDA

One patient died !!because 20 units of insulin. โดยแพทยเขยนค าสงยอ insulin 20 u

ผปวยเขาใจผดวา u คอ 0

ผล ผปวยฉด insulin 200 units

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SMART NURSES…SMART CARE

An elderly patient with rheumatoid arthritis died

after receiving an overdose of methotrexate 10 mg OD ซงควรไดรบ 10 mg weekly

ตวอยาง Medication Errors : FDA

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMC

InjectableMedication

Errors

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SMART NURSES…SMART CARE

Injectable Medication Errors

•90 % of hospitalized patient ไดรบ infusion therapy• เกด Error ไดในทกขนตอน มกกอใหเกดอนตรายทรายแรงขนกบ• คณสมบตของยาแตละชนด• Complexity ของ therapeutic action ของยานนๆ

•Significant risk Injury death

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SMART NURSES…SMART CARE

Ross LM, et al (2000) ศกษา Retrospective IOR med error ใน UK 5 ป พบวา

56 % ของการเกด IV medication error สามารถปองกนได 59 % เกดจาก Nurse Administration ทเกยวของกบ

• Dose• Concentration

Kaushal R, et al.(2001) 54 % ของเดกท admit มโอกาสเกด ADEs

Injectable Medication Errors

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SMART NURSES…SMART CARE

Injectable Medication Errors

ANA (2007) ศกษา IV medication error(n=1039)

• 99 % เกด serious effects

• 48 % เกดจาก • Drug preparation• IV medication administration

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SMART NURSES…SMART CARE

73 % เปน error จาก IV bolus administration

95 % เปนการ bolus dose ทเรวกวา recommendation

และเมอวเคราะหสถานการณพบวา เกดจาก

Inadequate training :preparation and IV administration

Lack of knowledge of medication selection and preparation

Taxis K, Barber N.(2003)

ศกษาใน ร.พ. 2 แหง ใน UK (10 ward)

พบวา 41.9 % หลงเกด Error ตองเฝาระวงตออยางใกลชด

Injectable Medication Errors

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SMART NURSES…SMART CARE

Pitfall: Tuberculin VS Insulin syringe

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SMART NURSES…SMART CARE

Insulin syringe

These syringes are marked in increments of 0.01 cc. And the needles are often 26 to 27 gauge in diameter and 1/2 to 5/8 inch in length. ... Insulin Syringes can not be used in place of a Tuberculin Syringe because the units of measure are different and the needle of a TB Syringe is shorter than that of an Insulin Syringe.

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SMART NURSES…SMART CARE

Tuberculin

These syringes are marked in increments of 0.01 cc. And the needles are often 26 to 27 gauge in diameter and 1/2 to 5/8 inch in length. ... Insulin Syringes can not be used in place of a Tuberculin Syringe because the units of measure are different and the needle of a TB Syringe is shorter than that of an Insulin Syringe.

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SMART NURSES…SMART CARE

Pitfall: Labelling

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SMART NURSES…SMART CARE

Labelling container: SyringePatient name , Drug name , Dose

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SMART NURSES…SMART CARE

KCL

Labelling container: ตดฉลากยาเมอผสมยาทนท

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SDMC

Medication Errors

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SMART NURSES…SMART CARE

สาเหตของความคลาดเคลอนจากการใชยา

• การไมเขาใจถงแนวทางปฏบตในการ บรหารยาของโรงพยาบาล • ภาระงานทมาก มกพบความคลาดเคลอนในการใหยา โดยเฉพาะการใหยาผด

เวลาและ การใหยาฉดดวยอตราเรวทผด • การสอสารทไมสมบรณ ระหวางผสงใชยา ผจายยา ผใหยา และผปวยใน

กระบวนการใชยา • การขาดระบบการตรวจสอบซ าจากบคคลอน เมอมการเตรยมยาในหอผปวย• การสงยาของแพทยดวยลายมอ ทอานยาก หรอการสงโดยวาจาทอาจไม

ชดเจนพอและไมม การยนยนค าสงโดยเรว หรอการคดลอกรายการยาทผดพลาด

Barker KN, McConnell WE. The problem of detecting medication errors in hospital. AM J Hosp Pharm 1962;19: 360-9.

Perlstein PH, Callison C, White M, et al. Errors in drug computations during newborn intensive care. Am J Dis Child 1979;133: 376-9.

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SMART NURSES…SMART CARE

สาเหตของความคลาดเคลอนจากการใชยา

• การขาดการจดการระบบยาทด เชน การจายยาไปยงหอผปวยไมทนเวลา ท าใหผปวยไดรบยาไมตรงเวลา

• การขาดความรเกยวกบยาทแพทยสงใช

• การขาด ขอมลจ าเพาะของผปวย เชน ประวตการแพยา ซงจ าเปนตอการประเมนความเหมาะสมของการใชยา

• การไดรบยาผด ขนาด เนองจากความสบสนในหนวย ความซบซอนในการ

ค านวณขนาด

• การเตรยมยาไมถกตอง เชน หยบยา ผดขนาด การเจอจางดวยตวท าละลายทไมเหมาะสม การบดยาทหามบดแบง เปนตน

Barker KN, McConnell WE. The problem of detecting medication errors in hospital. AM J Hosp Pharm 1962;19: 360-9.

Perlstein PH, Callison C, White M, et al. Errors in drug computations during newborn intensive care. Am J Dis Child 1979;133: 376-9.

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMC

กลยทธ การออกแบบระบบการดแลผปวยทปลอดภย

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SDMC

ISMP Guideline

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SMART NURSES…SMART CARE

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SMART NURSES…SMART CARE

ISMP Guideline

Standard Concentrations ofNeonatal Drug Infusions

For• Reduce medication error risk เมอยายผปวย• Stimulate development of standardized infusion device

drug libraries• Preparation standard solutions

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMC

Standard Administration Time schedules

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SMART NURSES…SMART CARE

Standard Administration Time schedules

Type of Scheduled Medication Goals for Administration Time

Time-Critical Scheduled Medication

Hospital-defined time-critical medicatione.g. insulin

Within 30 minutes before or after the schedule time

Non-Time-Critical Scheduled Medication

Daily, weekly, monthly medication

Within 2 hours before or after the schedule time

Medications prescribed more frequency than daily, but nomore than q 4 hrs.

Within 1 hours before or after the schedule time

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SMART NURSES…SMART CARE

Standard Administration Time schedules

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SMART NURSES…SMART CARE

Excellent position to detect and report medication errors

Final point in check and balances triad(Physicians, Pharmacists and other Nurse)

Guideline on preventing medication error

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SMART NURSES…SMART CARE

Pathway for medication safety

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SMART NURSES…SMART CARE

Pathway for medication safety

Pharmacy Information

System

Electronic Medication

Record

Bar code enabled point

of care

Computerized Prescriber

Order Entry : CPOE

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SMART NURSES…SMART CARE

Standard

order set

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SMART NURSES…SMART CARE

Standard Order Set

Designed standard order set Electronic formats : CPOE system Paper formats : Pre-print order forms

For

Best practices communicating through multidisciplinary

Reduce the potential for medication errors Reduce unnecessary calls to physicians

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CPOE System

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SMART NURSES…SMART CARE

ระบบการสงยาเคมบ าบดโดยแพทยผานระบบสารสนเทศ

โปรแกรมสงยาเคมบ าบด Online ( CPOE)

ตรวจสอบสทธออนไลน ลงทะเบยน/นดหมายรอบตอไป

EMR

เวชระเบยนแบบออนไลน Preprint Order Preprint MAR

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMCPre-print order

forms

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMCPre-print MAR

forms

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SDMC

Pre-print Nurse Kardex forms

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SMART NURSES…SMART CARE

ระบบยา

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMCIndependent

Double check

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMC

การทวนสอบขณะรบยา

Double check order กอนใหยา

Patient Identification

Double check rate กอนและ

ระหวางใหยา

สรางระบบทวนสอบในทกกระบวนการ

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMC Patient Identification

before Medication Administration

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMCใหญาตผปวยมสวนรวมในการ Identified

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SMART NURSES…SMART CARESmart Nurses…Smart Care

SDMCBedside Bar-Coding Technology for Drug

Administration System

Patient information

Drug information

Communication of drug orders and MARS

Staff competency and education :

special training

• Common database with the pharmacy system• Single MARS• Available at patient bed side• Standard administration times• Password for all nurses

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SMART NURSES…SMART CARE

Reduce the risks of High Alert Drugs

1.Standardize process to prevent errors

• computerized prescriber order entry (CPOE) systems ,preprinted orders forms, or ordering protocols

• bar coding

• “smart” pumps that have a drug library requiring confirmation

of drug dose limits before they’ll start infusing medication.

• Use dosing and infusion rate charts in patient-care units.

• Standardize/limit drug concentrations and formulations.

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SMART NURSES…SMART CARE

2.Practice drug differentiation

Using “tall-man” lettering for look-alike drug names Ex. DoPAmine , DoBUTamine

3.Restrict high-alert drugs and administration routes. Ex KCL

4.Make patient information readily accessible

5.Include patients in therapy

Reduce the risks of High Alert Drugs

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SMART NURSES…SMART CARE

6.Apply reminders

Reduce the risks of High Alert Drugs

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SMART NURSES…SMART CARE

7.Make errors apparent

• Perform independent double checks. Having another person review the steps you

follow to prepare or administer a medication can uncover a mistake and possibly save a patient’s life. According to facility policy, you may have to add your signature to the MAR to indicate your verification

8.Minimize the consequences of errors

• Store smaller vials of risky drugs

• Closely monitor the patient

Reduce the risks of High Alert Drugs

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SMART NURSES…SMART CARESmart Nurses …Smart Care

DMCS

RIGHTS OF MEDICATION ADMINISTRATION

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SMART NURSES…SMART CARESmart Nurses …Smart Care

DMCS

Right patient

Right drug

Right dose

Right routeRight

technique/Document

Right time

The six Rights

Medication administration

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SMART NURSES…SMART CARESmart Nurses …Smart Care

DMCSThe SixRights

The SevenRights

The Eight Rights

The NineRights

The TenRights

The TenRights

1 Right patient Right patient Right patient Right patient Right patient Right patient

2 Right drug Right drug Right drug Right drug Right drug Right drug

3 Right dose Right dose Right dose Right dose Right dose Right dose

4 Right route Right route Right route Right route Right route Right route

5 Right time Right time Right time Right time Right time Right time

6 Right Documentation/

Technique

Right Documentation/

Technique

Right Documentation/

Technique

Right Documentation/

Technique

Right Documentation/

Technique

Right Documentation/

Technique

7 Right reason Right reason Right action Right Client Education

Right reason

8 Right response Right response Right to Refuse Right Monitoring

9 Right form Right Assessment Right Flow rate( Intraveneous)

10 Right Evaluation Right Dilution or Compatibility

( Intraveneous)

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Rights of Medication Administration

1. Right patient

• Check the name on the order and the patient.

• Use 2 identifiers.

• Ask patient to identify himself/herself.

• When available, use technology (for example, bar-code system).

2. Right medication

• Check the medication label. Label all medications, medication containers (i.e. syringes, medicine cups, basins) or other solutions on or off the sterile field.

• Check the order.

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SMART NURSES…SMART CARE

3. Right dose

• Check the order.

• Confirm appropriateness of the dose using a current drug reference.

• If necessary, calculate the dose and have another nurse calculate the dose as well.

4. Right route

• Again, check the order and appropriateness of the route ordered.

• Confirm that the patient can take or receive the medication by the ordered route.

Rights of Medication Administration

SMART NURSES…SMART CARE

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SMART NURSES…SMART CARE

5. Right time and frequency

• Check the frequency of the ordered medication.

• Double-check that you are giving the ordered dose at the correct time.

• Confirm when the last dose was given.

6. Right documentation

• Document administration AFTER giving the ordered medication.

• Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug.

• very important for rtPa, conscious sedation and the right documentation usually includes forms to help or know the "right monitoring“

Rights of Medication Administration

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SMART NURSES…SMART CARE

7. right technique

8. right monitoring

important for potassium, Dilantin, nitroglycerine drips, chemo drug, etc. record vital sign within 15 minthen 30 min x 2 and q 1 hr

9. right flow rate ( intravenous )

important for insulin chemo drug and Heparin drips

10. right dilution or compatibility ( intravenous )

important for antibiotics chemo drug

Reference: Nursing2012 Drug Handbook. (2012). Lippincott Williams & Wilkins: Philadelphia, Pennsylvania.

Rights of Medication Administration

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SMART NURSES…SMART CARE

Ramathibodi Strategies

Using technology

Improving processes

Zeroing in the errors that cause harm

Building a culture of

safety

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SMART NURSES…SMART CARE

กลยทธ ท 1 ออกแบบระบบเพอปองกนความคลาดเคลอน

ระบบสงยา

• จดใหมระบบการสงยาใหแกหอผปวยอยางสม าเสมอ (unit dose, one day dose, three day dose)

• จดใหมระบบการจดสงยาดวน ภายใน 15-30 นาท เพอลดยาส ารอง ลดโอกาสการหยบยาผดของพยาบาล

Technology

• จดใหมตยาอตโนมตจดเกบยาทส าคญ เชน ยาเสพตด ยาจ าเปน

• มระบบเครองจาย จดยาอตโนมต• มระบบขอมลสนบสนน• Smart Infusion pump• ระบบ CPOE

การส ารองยา• ไมเกบ electrolyte conc. ไวทหอผปวย

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SMART NURSES…SMART CARE

กลยทธท 2 ออกแบบวธปฏบตทสงผลใหสามารถตรวจพบความคลาดเคลอนได

Recheck

• การตรวจสอบ 2 ครง (Independent Double Check)

Monitoring

• การตดตามผลของการใหยาแกผปวยและลงบนทก

Education

• การแนะน าและใหความรแกผปวยเกยวกบยาและแผนการรกษา

• การใหความรแกเจาหนาทเกยวกบการบรหารยา ความรเรองยา การใชอปกรณและเทคโนโลย

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SMART NURSES…SMART CARE

กลยทธท 3 การบรรเทาผลของความคลาดเคลอนเพอลดอนตรายทอาจเกดขน

Early detection

• Phlebitis Monitoring

Emergency response

• Extravasation management

• Anaphylactic kit

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SMART NURSES…SMART CARE

2010

2013

2014 20172015

HAD and Medication Safety Management

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SMART NURSES…SMART CARE

Technology to Reduced Medication Errors SMS program

เครองจดและบรรจซองยาอตโนมต

Barcode : identify

Pharmacy IV Admixture Service ( PIVAS)Computerized physician order entry (CPOE)

NFC/QR code

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SMART NURSES…SMART CARE

SIMPLE

Patient Safety Goalsเขมมงดานการบรการรกษาพยาบาล 2558-2559

Medication

Reconciliationเปาหมาย

• สหสาขาวชาชพท า MR ≥ 80 %• ความแตกตางของรายการยาโดยไม

ตงใจ≤ 10 %

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SMART NURSES…SMART CARE

ลดความผดพลาดจากการบรหารยาในกลม ทมความเสยงสงดวยการใชเทคโนโลย Smart Pump

Safety medication โดยใช functions เชน• Drug library function

- ระบขอมลจ าเปนในการบรหารยาแตละชนด

- ก าหนด Therapeutic range• Sequential function

- ส าหรบการtitrate ยาเชน Chemotherapy , Antibiotic

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Smart pumps are not smart on their ownALERT !!!!

• Bypass the drug library

• Must know how to use drug library• Correct weight• Correct dilution• Correct drug• Correct unit (ex. prescribe as mg/min, in library as

mg/hr)

• Addition to medication safety, not a replacement for critical thinking

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SMART NURSES…SMART CARE

Visual control

Safe Practice for IV medication

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SMART NURSES…SMART CARE

Safe Practice for IV medication

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SMART NURSES…SMART CARE

Safe Practice for IV medication

Example

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SMART NURSES…SMART CARE

Ready to use Sticker for 3 objectivesBag /Syringe type

Infusion type

IV line type

Monitoring

สตกเกอรส าหรบตดหนาเครองInfusion pump

สตกเกอรส าหรบตดbag

สตกเกอรส าหรบตด IV site ex. Portฉดยา,3ways

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SMART NURSES…SMART CARE

Ready to use Sticker : HAD infusion

สตกเกอรส าหรบตดbag

สตกเกอรส าหรบตดหนาเครองInfusion pumpสตกเกอรส าหรบตด IV site ex. Portฉดยา,3ways

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SMART NURSES…SMART CARE

1.IV Bag

2.Infusion pump

3.IV line ดานใกลผ ปวยบรเวณport ฉดยาหรอ 3-ways

มาตรฐานต าแหนงการตดสตกเกอร

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SMART NURSES…SMART CARE

Ready to use Sticker : Do and Don’t

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SMART NURSES…SMART CARE

Labelling : Syringe Labelling

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SMART NURSES…SMART CARE

Other

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SMART NURSES…SMART CARE

Example: Color code syringe

For Oral use only

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SMART NURSES…SMART CARE

Example: Color code syringe

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SMART NURSES…SMART CARE

เภสชกรเตรยมยาและHighlight route

ตด Routeบรหารยาทตว syringe

Highlight Route ทฉลากยาตามสทก าหนด

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SMART NURSES…SMART CARE

เภสชกรเตรยมยาและHighlight route

ตด Routeบรหารยาทตว syringe

Highlight Route ทฉลากยาตามสทก าหนด

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SMART NURSES…SMART CARE

Vincristine

• Antineoplastic Agent, Vinca Alkaloid

• Acute lymphocytic leukemia (ALL): Central nervous system tumors,Hodgkin lymphoma , Non-Hodgkin etc.

• For I.V. administration only. FATAL IF GIVEN INTRATHECALLY

• Vesicant (Avoid extravasation)

• Common ADR: Neurotoxicity, Peripheral neuropathy

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SMART NURSES…SMART CARE

U.S. Boxed Warning

• Not for intrathecal administration For I.V. administration only; inadvertent intrathecaladministration usually results in death.

-To prevent administration errors, recommends dispensing vincristine diluted in a minibag (WHO, 2007)

- Label “For intravenous use only”- fatal if given by other routes

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SMART NURSES…SMART CARE

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Change Order to Change Package

Chemotherapy

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SMART NURSES…SMART CARE

Pre-Mixed KCl

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SMART NURSES…SMART CARE

IV Nurses : Daily Round & Monitoring

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SMART NURSES…SMART CARE

Pharmacist : Consultation

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SMART NURSES…SMART CARE

Sharepoint : การเขาถงเอกสารคณภาพเกยวกบยา

1

เภสชกรรม(ฝาย)

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Shortcut HADs

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NEW ! WI การเตรยมและบรหารยาทมความเสยงสง

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SMART NURSES…SMART CARE

แนวปฎบตการรบค าสงทางวาจา / โทรศพท

Write downRead back

Confirm

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SMART NURSES…SMART CARE

จดท าแนวปฎบตการรบค าสงทางวาจา / โทรศพท

Order by phone verbal

Date ___________Time____________

Read/Repeated to MD. ___________

By RN1 __________ Code _______

Confirm by RN2 ________ Code _______

Cosign by MD __________ Code _______

Date _____________ Time ____________

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SMART NURSES…SMART CARE

MAR

Time Sign

9.10 RN1/RN2

18 RN1/RN2

21.15 RN1/RN2

หลกฐานการทวนสอบใน Document

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Nurse progress note 1

หลกฐานการทวนสอบใน Document

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Nurse progress note 2

หลกฐานการทวนสอบใน Document

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สรางสงใหม เพอขจดจดเสยง และลดภาระงาน

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Phase 1

Phase 2

Phase 3Phase 4

EMAM

การพฒนาระบบ EMAM

EMAM = Electronic Medication Administration Management

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EMAM process

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EMAM process

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EMAM process

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EMAM process

การแพยา : แตะส าหรบรายละเอยด

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Electronic MAR

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SMART NURSES…SMART CARE

การเขาถงฐานขอมลยาผานInternet: wifirama,mu,internetทเขาผานคอมพวเตอรคณะฯ

พมพMicromedex solution

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ระบบการรายงานอบตการณ

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SMART NURSES…SMART CARE

Medication Administration HAD Chemo Therapy & Medication error

ฝกจดยาและ Double check

Goal 3 Safety of Medications

การดแลผปวยไดรบยาเคมบ าบด, Port Care

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NURSES & CARE

SMAR

TQUESTIONS


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