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DRUG SAFETY Research has shown that around 75% of all medication errors occur at the ordering or administration phase.Safe management of drug therapies is an important element of achieving favorable outcomes in ambulatory surgical services. See if you and your staff can get a perfect score on this year's medication management quiz.
1. Why would Intralipid (Fat Emulsion) be on the code cart in an ortho center?
a) as a long-acting analgesic
b) challenge cardiotoxicity induced by bupivacaine
c) emergency treatment of unexplained hypertension
d) as an adjunct for malignant hyperthermia emergency reversal
2. Why would Romazicon (flumazenil) be on the code cart in an endo or ophthalmic center?
a) reverse opioid toxicity induced by drugs such as fentanyl or meperidine
b) reverse airway obstruction
c) reverse the effects of benzodiazepines such as midazolam
d) none of the above
3. Dantrolene sodium is used to treat methemoglobinemia.
a) true
b) false
4. True or false: Fentanyl comes as 100 mcg./2 ml. If you were asked to administer doses of 25 mcg., you would administer 0.5 ml.
a) true
b) false
5. Which is true according to safe injection practice guidelines?
a) Multiple-dose vials can be used for as many patients as needed as long as the vial is properly handled.
b) Multiple-dose vials can be used for as many patients as needed provided they are discarded at the end of the work day.
c) Multiple-dose vials used in the OR or other patient care areas can be used for 28 days after first entry.
d) According to current standards, multiple-dose vials used in patient care areas should be used for one single patient only.
6. One ounce is 30 ml. One gram is 1000 mg. One teaspoon is 5 ml. Midazolam 3 mg. is a reasonable dose for an adult. Fentanyl 100 mg. is a reasonable dose for an adult. The best way to write fifty mg is 50 mg. rather than 50.0 mg.
a) all of the above are true
b) all of the above are false
c) some of the above are true
d) some of the above are false
7. If a patient declares an allergy to opiates, which of the following is incorrect?
a) Patient is not to be given APAP with Codeine
b) Patient is not to be given Percocet
c) Patient is not to be given Fentanyl
d) Actually, all of the above are correct answers
8. Safe abbreviations are an important component of the National Patient Safety Goals. Three of these dose abbreviations should not be used. Which 2 are okay to use?
a) 1 mg
b) 1.0 mg
c) .1 mg
d) 10 mg.
e) 10.0 mg.
a) yes
b) no
a) yes
b) no
a) August 1, 2016
b) August 31, 2016
c) Expiration dates don't really matter
12. Propofol vials are to be used for single patient use only
a) true
b) false
a) true
b) partially true
c) false
14. A patient states an allergy to "sulfas." Which drugs would be contraindicated in this patient?
a) Bactrim
b) Diamox
c) Propofol
d) both a & b
e) all of the above
15. Which treats glaucoma?
a) Acetohexamide
b) Acetazolamide
c) Acetaminophen ophthalmic solution
d) Acetyl drops
16. Do we have to label a syringe that's drawn and then not laid down before it's injected into the patient?
a) yes
b) no
17. Quick matching quiz. Sometimes generic names are so frequently used that we have to be aware of both the proprietary (trade) name as well as the generic, as in the case of Demerol and meperidine. Match the names on the right column to those on the left:
Benadryl a) naloxoneNarcan b) hydrocodone
Robinul c) diphenhydramine
Vicodin d) hydromorphone
Dilaudid e) glycopyrrolate Show Answer
18. These 2 Dextrose syringes are exactly the same, they just differ in volume.
a) true
b) false
19. Malignant hyperthermia preparedness is not only required by standards, but also it is a well-known safety expectation. There are several known drug "triggers" in a susceptible patient. Which of the following is a "trigger"?
a) succinylcholine
b) rocuronium
c) vecuronium
d) all narcotics
e) nitrous oxide
20. The safe handling of controlled drugs is likewise a regulatory requirement as well as a sound business practice. Which of the following is not a recommended practice and leaves the facility and all of its stakeholders at risk?
a) Discarding controlled drugs without a licensed person witnessing.
b) Discarding controlled drugs at the end of the day rather than in real time.
c) Not expelling remaining amounts of controlled drugs in syringes and placing the unexpelled product in the syringe in the sharps container.
d) all of the above
21. True or false? High-alert drugs are those that administered in error have the potential to result in severe and catastrophic outcomes.
a) true
b) false
22. Is it okay to "stretch" prefilled syringes by withdrawing portions of contents?
a) yes
b) no
SAFE SOLUTION
Finding the Right Compounder for Your Cataract Drops
AVOIDING COMPLICATIONS Ensure the compounding pharmacy creating your cataract medications is registered with the FDA.More and more eye centers are turning to compounded eye drops to treat their cataract patients. These drops often combine several pre- or post-op medications into a single solution — think an antibiotic, a steroid and an NSAID for post-op, and a pupil dilation drug and an anti-inflammatory for pre-op. The drops can increase efficiency and the likelihood of patient drop compliance, but they tend to be available only through compounding pharmacies. So, how do you choose a compounder that's safe? Here are a few tips:
- Know their status. First, look to see if the pharmacy is registered with the FDA and, if so, how they're classified, says Tracy A. Rhodes, RN, BSN, director of nursing at The Eye Center of North Florida in Panama City. Compounding pharmacies can be deemed 503A or 503B. Ones designated 503B must follow current Good Manufacturing Practices (cGMP), which means they're subject to the same inspections and oversight as large pharmaceutical manufacturers, according to the FDA. While 503B pharmacies can prepare sterile compounds without a patient prescription, 503A ones must have individual prescriptions. You can check if a compounder is 503B at osmag.net/XzvY2G.
- Do your homework. Ask the compounder to send you a copy of its state license, and if it's located out-of-state, a non-resident license from your state's pharmacy board, says Ms. Rhodes. You also want to search for any recalls on the FDA's website. "Make sure you check for their 'sister companies,' too," she adds. "And take extra care if you are planning to purchase from a pharmacy outside of the U.S."
- Consider word of mouth. Heather Hernandez, RN, director of nursing at the Eye Surgery Center of Augusta in Georgia, says that after her docs saw the convenience of compounded post-op drops in action at another facility, she spoke to that ASC's administrator to find out which company she used, the costs and the overall experience. "We've seen the company's drops in practice, and the facilities I've spoken to really like working with them," she says.
- Go with your gut. "If it seems to good to be true," notes Ms. Rhodes, "it usually is."
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