CURRENT TRENDS AND
CLINICAL ALERTS
in Nursing Pharacology
presented by:
group 7
Politics
Middle School
A. Technological
Advances to
Prevent
Medication Errors
1. Computerized
physician order entry
• A system that allows prescribers to
(CPOE) electronically
enter orders for medications, thus eliminating the
need for written orders.
• CPOE increases the accuracy and legibility of
medication orders; the potential for the
integration of clinical decision support; and the
optimization of
prescriber, nurse, and pharmacist time (Agrawal,
2009).
• Decision support software integrated into a
CPOE system can allow for the automatic
checking of drug allergies, dosage indications,
baseline laboratory results, and potential drug
interactions. When a prescriber enters an order
through CPOE, the information about the order
will then transmit to the pharmacy and
ultimately to the MAR.
2. Electronic bar codes on
medication labels and packaging
• A patient’s MAR (medication administration
record) is entered into the hospital’s
information system and encoded into the
patient’s wristband, which is accessible to the
nurse through a handheld device. When
administering a medication, the nurse scans
the patient’s medical record number on the
wristband, and the bar code on the drug. The
computer processes the scanned information,
charts it, and updates the patient’s MAR record
appropriately (Poon et al., 2010).
3. Automated medication dispensing
systems (AMDS)
• Provide electronic automated control of all
medications, including narcotics. Each nurse
accessing the system has a unique access
code.
• The nurse will enter the patient’s name, the
medication, the dosage, and the route of
administration. The system will then open
either the patient’s individual drawer or the
narcotic drawer to dispense the specific
medication. If the patient’s electronic health
record is linked to the AMDS, the medication
and the nurse who accessed the system will be
linked to the patient’s electronic record
B. High Risk
Medications
HIGH RISK MEDICATION:
A-PINCH
The acronym A-PINCH is designed to serve as a reminder even a routinely
administered medicines pose a high risk to patient safety
A ANTI-INFECTIVES
P POTTASIUM AND OTHER ELECTROLYTES
I INSULIN
N NARCOTICS AND OTHER SEDATIVES
C CHEMOTHERAPEUTIC AGENTS
H HEPARIN AND OTHER ANTI-COAGULANTS
HIGH RISK MEDICATION:
A-PINCH
High risk medications are those that have a high chance of causing harm if
they are misused or used in error.
They are generally medicines with a narrow therapeutic
index.
This means that the difference between a medicine’s desired effect (efficacy)
and a lethal or toxic dose (potency) is very small.
In other words, a small increase in the medicine’s concentration in the body
could lead to toxic levels and fatal consequences (Roughead, Semple &
Rosenfeld 2013).
C. Safe
Handling of
Cytotoxic
Drugs
C. Safe Handling of Cytotoxic
Drugs
The toxicity of cytotoxic drugs means that they can present significant risks to
those who handle them. Occupational exposure can occur when control measures
are inadequate. Exposure may be through skin contact, skin absorption,
inhalation of aerosols and drug particles, ingestion and needle stick injuries
resulting from the following activities:
• drug preparation
• drug administration
• handling patient waste
• transport and waste disposal, or
• cleaning spills.
C. Safe Handling of Cytotoxic
Drugs
Inadequate control measures could lead to;
• Abdominal pain, hair loss, nasal sores, vomiting, and liver damage
• Contact dermatitis and local allergic reactions.
• Fetal loss in pregnant women and malformations in the children of
pregnant women
• Alterations to normal blood cell count
• Abnormal formation of cells and mutagenic activity or mutations
forming
Anyone working with patients receiving cytotoxic drugs is at risk of exposure. This therefore
includes pharmacists, pharmacy technicians, medical and nursing staff, laboratory staff, and
others.
D. Nursing Care and
Management of
Patients Who Have
Received
Chemotherapeutic
Agents
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agents
Potential duration of excretion of chemotherapy agents and their
metabolites are not well defined. While there is some data derived from
the adult population, the extent to which this is applicable to children is
unclear. Therefore, there is a real potential risk to health care
professionals and parents who are caring for children following the
administration of chemotherapy agents. It is suggested that PPE should
be worn up to 48 hours post administration of intravenous (IV)
chemotherapy agents and for up to 7 days post oral chemotherapy
agents administration.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
AgentsProtective Equipment (PPE)
Personal
• PPE must be worn when handling any patient’s blood or body fluids.
• Plastic Face Shields should be worn when there is a risk of splash, e.g.,
flushing toilet, changing diapers, frequent or unpredictable vomiting.
• Parents must be gloved when handling excreta and diapers up to 7 days
post treatment.
• Gloves should be discarded after each patient use, and when soiled or
contaminated with body fluids, in appropriately labeled containers.
• Gloves and gowns should not be worn outside of the drug
administration area.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agentsof Toilets
Flushing
• All toilets should be flushed twice, as recommended in the literature
but not evidence based (Brown et. al, 2001, p.70).
• The toilet bowl (seat up) should be covered with a plastic-lined,
absorbent pad (absorbent side facing down) prior to flushing. These
pads should be disposed of in biohazard containers after each use.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agentsof Diapers
Disposal
• Diapers should be disposed of in a biohazard container for up to 7 days
after chemotherapy administration.
Disposal of Contaminated Linen
• Contaminated, non-disposable, linen should be handled with gloves and
gowns and should be dealt with in a manner consistent with institutional
policies regarding handling and disposal of infectious linens.
• Parents should not clean up contaminated linens or clothing. This should
be done by gowned and gloved health care personnel.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agentswho go to Other Areas of the
Patients
Hospital
• Personnel in other areas of the Hospital (e.g., Diagnostic Imaging,
Echocardiography) should observe these safe handling guidelines
when handling patients who have received chemotherapy agents.
• These guidelines should be disseminated to all hospital personnel
who may care for oncology patients in other areas.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agentsof Biohazardous Contaminated Materials
Disposal
As per OSHA guidelines – Section IX, all
areas where chemotherapy drugs are
handled should have specific disposable
containers close at hand for easy and
safe disposal.
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agentsof Biohazardous Contaminated Materials
Disposal
• Needles and syringes should be disposed intact.
• Sharps and breakable items e.g. vials, ampoules should be disposed of in
leak proof, puncture resistant containers with labels indicating
chemotherapy (cytotoxic) waste.
• Non-sharp chemotherapy drug waste, e.g. plastic IV bags and tubing,
personal protection equipment, should be sealed in leak proof, puncture
resistant containers with appropriate labels.
• These containers should be of a different colour from regular disposal of
hazardous waste containers
D. Nursing Care and Management of Patients
Who Have Received Chemotherapeutic
Agents Contamination and Chemotherapy Spills
Accidental
Every institution should have policy and
procedures in place for the management of
accidental contamination and chemotherapy
spills.
All health care professionals who handle
chemotherapy agents should be oriented and
familiar with these policy and procedures. It is
strongly recommended that a spill management
kit be readily available within the work area
THANK YOU
