Chapter 3 Legal Aspects Affecting the Administration of

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Learning Objectives • List the names of major federal laws concerning drugs and drug use • Explain in what way the nurse is responsible for controlled substances Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 3

Learning Objectives (cont. ) • Describe the differences between authority, responsibility, and accountability • Describe some of the risks associated with common over-the-counter (OTC) medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4

Medication Regulation • Federal Guidelines (government) • State Guidelines (Board of Nursing) • Facility Guidelines (where you are practicing) Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5

Federal Legislation Three drug categories in the United States: • Controlled substances – drugs that may be easily abused, are dangerous, and require a prescription • Prescription, or legend, drugs – drugs that require a prescription but are not as easily abused • Over-the-counter (OTC) medications – drugs patients may buy without a prescription Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6

Federal Legislation (cont. ) • Harrison Narcotic Act of 1914 – limited indiscriminate use of addictive drugs • Federal Food, Drug, and Cosmetic Act of 1938 – gave authority to government to determine the safety of a drug prior to marketing, labeling, specification, and advertising • Durham-Humphrey Amendment of 1952 – restricted number of prescription refills Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 7

Controlled Substances Nurses may possess these only if: – They are administering the drugs to the patient for whom they were prescribed – They themselves are the patient for whom the physician has prescribed the drug – They have been delegated the responsibility for the unit supply Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8

Prescription, or Legend, Drugs • • Carefully tested prior to marketing Use is carefully controlled Prescription is required Majority of drugs nurses administer in the hospital • Geriatric patients are at special risk • Safety may not have been determined for children Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 9

Over-the-Counter Medications • Low risk for patient when taken appropriately • Low dosage • Patients buy on their own • May have hidden chemicals • Require a prescription in the hospital • Herbal medications have not been tested for safety and effectiveness Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10

Learning Objectives • List rules of states and agencies that affect how nurses give drugs • Explain in what way the nurse is responsible for controlled substances • List what information is included in a medication order or prescription Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 12

Learning Objectives (cont. ) • Define and give examples of the four different types of medication orders • List what you need to do if you make a medication error Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13

State Nurse Practice Act • Determines the level of authority and responsibility of the nurse • Different levels of nursing will have different levels of authority and accountability • Nurses must adhere to the Nurse Practice Act in the state in which they are practicing • Responsibilities may vary in State Nurse Practice Acts Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 14

Nursing Responsibilities • All nurses have legal responsibility for their actions. • The Nurse Practice Act determines the level of responsibility and authority of the nurse. • Nurses must have the authority to delegate to a person with the authority to carry out the task. Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 15

Ordering Procedure • Step 1: Physician orders medication • Step 2: Order is transcribed onto Kardex • Step 3: Charge nurse verifies accuracy of order and transcription • Step 4: Order is sent to pharmacy • Step 5: Medication is dispensed to floor • Step 6: Nurse administers according to guidelines Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 17

Drug Distribution Systems • • Floor or ward stock system Individual prescription order system Unit-dose system Computerized or automated dispensing system Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 19

Medication Orders • Required information includes: – – – – Patient’s full name Date Name of medication Dosage Frequency Duration Route Signature of physician Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 20

Types of Medication Orders • • Standing orders Emergency, or “stat, ” order Single order As-needed, or “prn, ” order Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 21

Medication Errors • Immediately assess the patient • Notify the physician and implement any orders • Continue to assess the patient • Notify supervisor • Document findings in patient record • Complete facility documentation Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 22