Pediatric Informatics: Computer Applications in Child Health (Health ...

358 C. Garger et al.
team members. Shared awareness is maintained, reviewed, and updated by staff
on patient rounds, at nursing shift changes and other handoffs. Knowledge of the
drug regimen is summarized and communicated when the patient is discharged
to home or transferred from the unit.
2. Medication storage and retrieval: the handling of medications prior to delivery
and administration to the patient is usually a shared function between pharmacy
and nursing. For formulary drugs, pharmacy personnel deliver labeled drug
doses to the care unit. For controlled drugs, the nurse formally acknowledges
receipt of the doses. In most cases, doses are placed in secure storage until actual
delivery to the patient. Storage facilities may provide environmental control
(such as temperature). Emergency drugs may be stored for rapid access by nursing
during resuscitation. Special items (such as chemotherapy and biological
materials (live vaccines, breast milk) ) may need to be stored, prepared, and
tracked separately.
3. Dose preparation and verification: the reconstitution of a drug dose into its
final form before delivery or application to the patient may be performed by
pharmacy or on the unit. The nurse identifies and checks patient, drug, dose,
and form, other constituents (oral or intravenous carrier fluids) and the route by
which the drug dose are to be given.
4. Dose delivery/application (and verification): the action of giving a drug dose
directly to a patient according to prescription/order and assuring that the dose has
been delivered/applied to the patient (according to the 5 Rights), usually performed
by nursing, but the patient and/or family may be involved (such as in
patient-controlled analgesia). In the case of children on oral medications, it may
involve direct observation that swallowing has occurred. For inhaled medications,
the respiratory therapist may hold the responsibility for dose preparation
and administration, or it may be shared with nursing.
5. Monitoring: observation and response as needed for a patient’s reaction to a
drug dose, usually performed on a regular basis by nursing in conjunction with
prescribers and other care providers.
6. Documentation: systematic tracking and recording of a patient’s planned
drug dosing schedule (including biological products and investigational
drugs), drug doses administered (or omitted) and other clinical observations, performed
principally by nursing. For prescribers, the order sheet/prescription form/
order entry system tracks ordering of medications. For nursing, the medication
administration record (MAR) is the principal documentation and tracking tool.
28.3 Medication Administration Risks
Studies suggest that approximately 20% of all adverse patient events are related
to medications. In a study of medication errors in an inpatient acute care setting,
approximately 40% of errors were deemed to be due to problems during the
medication ordering process; 10% were associated with the order-transcription and