✅ Quality & Safety in Nursing

QSEN Competencies:

• 👩‍👩‍👧 Patient & family-centered care
• 🤝 Collaboration & teamwork
• 📚 Evidence-based practice
• 📈 Quality improvement
• 🛡️ Safety
• 💻 Informatics

💊 10 Rights of Medication Administration

1. Right patient – 2 identifiers, bar code, ID band, family verify, name-alert sticker if needed.
2. Right drug – provider order, scan label, triple-check, allergies, diagnosis match.
3. Right dose – verify calculation, weight-based if needed, double-check with another RN for high-risk meds.
4. Right time – follow policy, military time, food interactions, expiration, procedure schedules.
5. Right route – correct method (oral, IV, IM, etc.), swallowing ability, don’t crush unless safe, aseptic technique.
6. Right documentation – record immediately: drug, dose, route, time, date, nurse initials/signature, patient response.
7. Right reason – make sure the med is appropriate for the diagnosis/condition.
8. Right response – monitor for desired effect (e.g., pain relief, BP lowering).
9. Right education – inform patient about drug purpose, side effects, how to take it.
10. Right to refuse – respect patient’s choice, document refusal, notify provider if necessary.

⚖️ Just & Safe Culture

• Culture of safety: errors reported without blame → fix the system.
• TJC (The Joint Commission): safety goals, limit unsafe abbreviations.
• FDA: black box warnings.

Other Safety Measures:

• Medication reconciliation – keep updated, accurate list of all patient meds.
• Disposal – kitty litter mix, sealed bag, remove labels, use take-back programs.
• Sharps safety (OSHA Act): safer devices, workplace policies, training, injury prevention.

🚨 Medication Safety Risks

• Tablet splitting – not always safe.
• Buying drugs online / counterfeit drugs – wrong or no active ingredients, contamination.
• Crushing meds – unsafe with extended/sustained-release drugs.
• High-alert meds – insulin, epinephrine, potassium chloride (require extra checks).
• Look-alike / Sound-alike drugs – Ephedrine vs Epinephrine, Zyrtec vs Zyprexa.
• Error prevention – distraction-free safety zone, ISMP resources, FDA database.

🧠 Clinical Judgment: Medication Safety

• Recognize cues: Assess if medication is safe.
• Analyze cues: Identify teaching needs.
• Generate solutions: Verify dose, avoid distractions.
• Take action:
• Calculate correctly, follow hygiene.
• Never give meds prepared by another nurse.
• Use 2 identifiers for every patient.
• Evaluate outcomes: Confirm safe admin, correct effect, no harm.

👶 Pregnancy & Medications

• Categories/subsections explain risk/benefit for:
• Mother
• Fetus
• Breastfeeding child
• Labor & delivery

📝 Medication Administration Guidelines

• Preparation – follow agency policy, check labels carefully.
• Administration – apply 10 rights consistently.
• Documentation – complete, accurate, timely record.