Safety and Ethics
2.1 Safety and Ethics Introduction
Learning Objectives
- Identify drug administration guidelines for registered nurses in Canada
- Identify nursing responsibilities to prevent and respond to medication errors
- Identify nursing responsibilities associated with controlled substances
- Identify ethical responsibilities as they relate to medication errors
- Explain client-centered care and cultural safety during medication administration
- Outline nursing actions within the scope of nursing practice as they relate to the administration of medication
- Identify nursing responsibilities associated with safe client medication administration and education
Key Terms
- black box warnings
- BC College of Nurses and Midwives
- Canadian Nurses Association (CNA)
- Code of Ethics for Registered Nurses
- controls on practice
- cultural safety
- do not crush list
- drug diversion
- error-prone abbreviations
- health literacy
- high-risk
- inappropriate polypharmacy
- look-alike and sound-alike drugs
- nursing
- nursing process
- polypharmacy
- practice standards
- professional standards
- registered nurse (RN)
- root cause analysis
- safety culture
- scheduled medications
Medication administration is an essential task that nurses perform while providing client care. However, safe medication administration is more than just a nursing task; it is a process involving several members of the health care team, as well as legal, ethical, social, and cultural issues. The primary focus of effective medication administration by all health professionals is client safety. Although many measures have been put into place over the past few decades to promote improved client safety, medication errors and adverse effects continue to be a common event. The World Health Organization (WHO) estimates, “Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually.” [1] This chapter will examine the safety and ethical foundations of medication administration by nurses, as well as the practice standards and cultural and social issues that must be considered to ensure the safe and effective administration of medication.
- World Health Organization. (2019). Patient safety. https://www.who.int/patientsafety/medication-safety/en/. ↵
The strongest warnings issued by the Federal Drug Association (FDA) that signify a drug carries a significant risk of serious or life-threatening adverse effects.
The regulating body for nurses in British Columbia
A professional organization that represents the national and global interests of Canadian nurses.
Developed by the CNA as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
Explains the bases for nurses' scope of practice. There are four levels of controls on registered nurses' practice.
Outcome-based respectful engagement that addresses power imbalances from a societal and health care systems lens.
A list of medications that should not be crushed, often due to a sustained-release formulation.
The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use.
Abbreviations, symbols, and dose designations that are frequently misinterpreted and involved in harmful medication errors.
The ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life course
Drugs that bear a heightened risk of causing significant patient harm when they are used in error.
Present when one or more medicines are prescribed that are not or no longer needed.
Medications that require special safeguards to reduce the risk of errors and minimize harm.
the application of professional nursing knowledge, skills, and judgment for the purpose of: (a) promoting, maintaining, and restoring health; (b) preventing illness, injury, or disability; (c) caring for persons who are sick, injured, disabled, or dying; (d) assisting in pre-natal care, childbirth, and postnatal care; (e) health teaching and health counselling; (f) coordinating health care; or (g) engaging in administration, teaching, or research.
Standards of Practice that include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing patient care.
The concurrent use of multiple medications.
Guide and direct nurses' practice. They set out levels of performance that BCCNM nurse registrants are required to achieve in their practice.
Statements about levels of performance that nurses are required to achieve in their practice. They reflect the values of the nursing profession, clarify what the profession expects of nurses, and represent the criteria against which nurses’ practice in British Columbia is measured by clients, employers, colleagues, themselves and others
An individual who is educationally prepared and licensed by province or territory to practice as a registered nurse.
An analysis after an error occurs to help identify not only what and how an event occurred, but also why it happened. When investigators are able to determine why an event or failure occurred, they can create workable corrective measures that prevent future errors from occurring.
The culture of a health care agency that empowers staff to speak up about risks to patients and to report errors and near misses, all of which drive improvement in patient care and reduce the incidence of patient harm.
classification tool for drugs, substances, and certain chemicals that are used to make drugs. Defined by medical use, potential for misuse, and safety or dependence liability.