Pharmacological Principles and the Seven Drug Rights
SCENARIO
Mary K. Emerson is a patient at Felder Community Hospital. She was admitted six days ago due to a diabetic episode and an upper respiratory infection that left her unresponsive at work. She was admitted to the ICU, and medical staff attempted to stabilize her condition. Unfortunately, there were some problems with her care due to the wrong information being entered into the patient’s medication record in her chart.
When the nursing staff was trying to update her medications from a previous admission, they chose Mary J. Emerson, who was also a patient admitted around the same time to another unit, instead of the current patient, Mary K. Emerson. To treat Mary K. Emerson’s respiratory infection, penicillin was ordered based on Mary J. Emerson’s chart that showed no known allergies. Mary K. was given the penicillin but was found to have an extreme allergy, which sent her into acute respiratory distress. The penicillin was administered and documented on Mary J. Emerson’s chart before the clinical staff noticed the error.
As Mary K. remained in the ICU and drifted in and out of consciousness, clinical staff tried to make sure she remained on schedule with her medications. On two noted occasions, the scheduled dose of 30 units of insulin that was to be administered subcutaneously with meals was delayed during the shift. On a separate occasion, the nurse tech drew up 40 units to be administered intramuscularly instead of the prescribed subcutaneous route. This resulted in the incorrect angle and depth of the injection used for the prescribed insulin.
On the fifth day of her admission, Mary K. was exhausted from the testing and medication changes. When the nurse came in to administer her scheduled dose of insulin, she stated “Please, no more meds!”
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A. Discuss the basic principles of pharmacology by doing the following:
1. Discuss the four stages of the drug cycle.
2. Discuss the physiological factors involved in drug absorption and drug distribution.
3. Discuss the difference between a side effect, a contraindication, and an adverse reaction to a medication.
a. Provide an example of a side effect, a contraindication, and an adverse reaction to a medication.
B. Using the scenario, discuss the seven drug rights that should be checked when auditing documentation for a patient encounter by doing the following:
1. Describe how each of the seven drug rights were violated in the scenario.
2. Discuss the process an HIM professional would need to take to report the violations in the scenario to the appropriate internal party.
C. Explain the roles of OSHA, the FDA, and the DEA in enforcing the Controlled Substances Act.
D. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
E. Demonstrate professional communication in the content and presentation of your submission.
PHARMACOLOGICAL PRINCIPLES
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Pharmacological Principles
A. 1. The four stages of the drug cycle are absorption, distribution, metabolism, and excretion. Absorption refers to the drug entering the body, usually through the gastrointestinal tract, the skin, or the respiratory system. Distribution refers to the drug moving throughout the body, often through the bloodstream, to reach the organs and tissues where it is needed. Metabolism refers to the body breaking down the drug, often in the liver, to deactivate it. Excretion refers to the body eliminating the drug, usually through the kidneys and urine.
2. Several physiological factors can affect drug absorption and distribution. For example, food in the stomach can slow the absorption of some drugs, while others may require food to be absorbed effectively. The permeability of the gastrointestinal tract, the presence of inflammation, and the blood flow to the area can also impact absorption. For distribution, the amount of body fat, the person’s size, and the extent of protein binding in the blood can all affect how quickly and effectively a drug reaches its target site.
3. A side effect is an unintended consequence of taking a medication. Side effects are typically mild and do not warrant discontinuing the medication. For example, a person may experience drowsiness when taking an antihistamine. A contraindication is a situation where a drug should not be used because it could harm the patient. For example, a person with a known allergy to penicillin should not be given this antibiotic. An adverse reaction is a more severe and unexpected response to a medication. Adverse reactions can be life-threatening and may require immediate medical attention. For example, anaphylaxis is a severe allergic reaction that can occur in response to a medication.
B. 1. The seven drug rights are as follows:
* Right patient: The medication record for Mary K. Emerson was mistakenly updated with information from another patient's chart. This means the right patient needed to be correctly identified when medications were being prescribed and administered.
* Right drug: Due to the mix-up with the patient charts, penicillin was prescribed and administered to Mary K. when she has an allergy to the drug. This error could have been avoided if the right medicine had been defined based on the correct patient's chart.
* Right dose: The incorrect insulin dosage was given to Mary K. on two occasions. Once, she was given 40 units instead of the prescribed 30 units, and the dose was delayed another time, which could have resulted in dangerous blood sugar fluctuations.
* Right route: The nurse tech gave Mary K. an insulin injection intramuscularly instead of subcutaneously, as prescribed. This incorrect route of administration could impact the medication's effectiveness.
* Right time: As mentioned above, there was at least one occasion when Mary K.'s insulin dose was delayed. This could affect her blood sugar levels and could have serious consequences.
* Right documentation: The penicillin given to...