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1. no I will confirm with my staff  nurse and explain that 10 tablets might be too much
2. do the checks before giving medication to patient
3. They might overdose and it might be fatal to them
4. If I'm in doubt I should always clarify with someone such as staff nurse first

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1. nope, i will withhold the medication first and confirm the order with the doctor as serving 10 tablets is too dangerous as it might cause overdose to the pt.
2. We could prevent this error by ensuring to perform the 5 rights and 3 checks before administering the medication.
3. Patient health is risked and will suffer from the adverse effects of the drug due to overdosage of medication. Longer stay in hospital and the nurse administering the medication will be at risk of losing the job.
4. I have learned the seriousness of making medications error, even if the doctor ordered, we still have to double-check if is appropriate to the patient as doctors might make mistakes too. & also to clarify anything when im not sure.

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1. I would not serve the medication first and check with the staff nurse

2. Can be prevented by clarifying with another staff nurse

3. Nursing licence will be suspended. Longer hospitalisation for the patient.

4. I will clarify with the staff nurse before I administer the medication that it’s seems indifferent

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1. no, i will make doubt about the order and check with staff nurse and doctor to decide the correct dosage following the sbar
2. I will follow the 10 right madication checking and three checks with the staff nurse
3. when we give the wrong dosage and wrong administration, the patient will encounter fatal issues
4. I learned that we should always be conscious when we serving medication.

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1. If i were the nurse incharge, i will not administer the medication but instead i will confirm with the doctor about the dosage

2. Ensuring the 10 rights and always confirm with the doctor

3. Such implications involved death. Patient can lose their life.Nurses can face disciplinary charges

4. Clarifying with the doctor to avoid any risk

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1. No. I will check with the doctor for the right dosage.
2. Check with the doctor, and properly do the 3 checks.
3. Patient will have a longer stay at the hospital as her health is threatened and is in danger due to the adverse side effects of donepezil.
4. i have to familiarise with the medications and always clarify with the doctor before serving.

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1. For the medication order of donepezil 50mg om (10 tablets), I would countercheck with the nurse-in-charge to double confirm. After doing so, I would clarify with the doctor if the prescription is correct. This is because 10 tablets for the same medication is too much. I would also withhold the medication until the medication error has been fixed.

2. This medication error could be prevented if the doctor has double-checked and has written the correct dosage. In addition, if the dosage seems to be illogical and out of the norm, the nurse giving the medication should not happily give the medication and clarify with the doctor.

3. A possible implications of the medical error for Madam Nora would a longer hospital stay and discomfort. In addition, a much more expensive hospital bill to treat the symptoms of the medication error. The nurse could be sued and lose her nursing license.

4. I learnt that it is every important to follow the 3 medication checks. As well as, ensure that I know my medications in order to prevent medication error from occuring.

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1. No. I would withhold the medication because it is impossible for a prescription of 10 tabs of donepezil. i would firstly confirm with the doctor about the dosage before prescription.

2. This can be prevent by having basic knowledge about the common drug's normal dosage, adverse effects and also by clarifying with doctor about the dosage as that the dosage seems off.

3. Possible complication is that Madam Nora with suffer from severe adverse effects which might even cause death.

4. i have learnt to always clarify any doubts about the meds with the doctors before prescribing to the patients.

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1. if I was the nurse, I would double-check the order with the doctor, and ensure I serve the correct dosage.
2. This error can be prevented if I do all 3 checks for administering medications properly.
3. patient may have a longer stay in the hospital due to the overdose.
4. When I am unsure about a doctor's order, I would double confirm with the doctor, or another nurse that is more experienced than me.

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1) I would withhold the administration and check with the doctor on the right dosage because 50mg which is 10 tablets is not exactly reasonable.
2) To double check with the doctor on the appropriate dosage of the medication.
3)Madam Nora: Increased morbidity and mortality, increased hospitalization costs. Nurse: Guilt, face discipline inquiry.
4) To be always on the look out of weird prescription and medication order.

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I will ensure to tally and check the medication and dosage correctly before administration of medication .

This can be prevented by performing 3checks of administration or 10 right

Patient get worsen then she is. Nurse might get sues or fired.

TO always be vigilant and always performed checks

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1. I will withhold the medication and clarify with the doctor before serving the medication.
Rationale: Knowing the usual dosage of donepezil is around 5 mg, I will clarify with the doctor again to prevent medication error.

2. This error can be prevented by reviewing the transcribed medication before prescribing or administering to the patient.

3. For Madam Nora, she will experience the adverse effect of donepezil such as nausea, vomiting and bradycardia and for the nurse, she will need to write an incident report for administering the wrong dose of donepezil.

4. I have learned that I should double check the prescription and clarify any doubts before administering the medicaiton.

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1)If i were the nurse taking care of Madam  Nora, i will not serve the medication as serving 10 tablets of the same medication is dangerous.
2)This error can be prevented by checking with the doctor about the dosage of the medication
3)Possible implications such as Madam Nora's condition can worsen thus resulting in a longer period of stay in the hospital.
4)If unfamiliar with medication dosage or unsure if the dosage is right, clarify with the doctor

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1. i would not have served the medication. i would have confirmed the dosage with the doctor before serving it.

2. this error can be prevented by checking all that is needed and being careful

3. the patient might have a longer hospitalization stay and have a higher cost to pay as well. the nurse could experience stress as well.

4. we should always clarify with someone if we are unsure of anything and should not do anything blindly.

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1) I would not serve the medication as 10 tablets of the same drugs can lead to overdose to the patient. Instead,I will withhold the order and clarify the doctor again.
2) We have to ensure the 5 important medication rights , 3 checks before serving the medication.
3) Patient may experience morbidity or death. If not, patient may undergo, longer hospitalisation stay. This will then lead to financial and emotional stress for patient and caregiver
4) Always clarify with the staff nurse or doctor-in charge before serving the medication

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1. No, i will clarify with the doctor first before serving.
2.This error can be prevented by clarifying it with another staff and the doctor.
3. Longer stay for the patient, hospitalization cost will be higher and the nursing license for the nurse might get suspended and cause emotional and mental stress for the nurse.
4.I have learned that you should not serve medications if it seems indifferent and should clarify with your colleagues first and the doctor first.

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Q1. I would definitely withhold the medication order of  Donepezil 50mg OM (10 tablets), check back with the doctor on the prescription and not serve this medication to Madam Nora. This is because as nurses, its our duty to provide a standard of care which avoids risk or minimizing it.

Q2.  This error can be prevented by clarifying any unclear orders, illegible handwriting or abbreviations.

Q3. One possible implication would be she could have her practicing licence removed.

Q4. I learnt that we should always be alert when serving medication, clarify when in doubt and dont get distracted.

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1) i would not serve immediately as the normal dosage for donepezil is 10 mg and not 50 mg
2)This error can be prevented by clarifying with the doctor for the medication dosage as 50 mg is too much.
3)Madam nora can suffer from bradycardia, nausea and vomiting which results in a longer hospitalization. The nurse might not be confident with her skill anymore and might have many doubts when serving medication
4) I have learned that we should all double check the medication and if something is wrong we should always clarify with the doctor before administering to the patient

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1. Firstly, I will check one more time against the transcription if the dose was prescribed accurately. Then, I’ll call the doctor in-charge and verify with him if the dosage is correct. Being cautious deter us from making a fatal/serious error- medication error. Furthermore, with that extra verification the doctor can make necessary changes if there’s any error.
2. It is important that healthcare professionals play a part by adopting the five medication rights. Implementing the 5 rights allows us to be more careful when administering medications. It is also important that the nurse in-charge has a basic knowledge on the medication that he/she is about to prescribe. With necessary knowledge on the medication, the nurse may know appropriate health education and if a possible medication error may occur.

3. Madam Nora may experience serious implications such as death which may carry legal implications. The nurse may face self-doubt and embarrassment and face disciplinary inquiry.

4. Everyone plays an important role in curbing medication error. Medication error is preventable if everyone is careful and implement their 3 checks/ 6 rights. If fail to do so, patient together with other healthcare professionals may experience serious implications. As healthcare professionals, we are handed the responsibility to take good care of others loved ones hence being careful especially when administering medications is very important.

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1.     If you were the nurse taking care of Madam Nora, what would you do if you saw the medication order of donepezil 50mg om (10 tablets) prescribed by the nursing home doctor? Explain your rationale.

50mg of donepezil is 10 tablets of 5mg. Having Madam Nora, a 75-year-old patient to take 10 tablets each time rings a bell as it is too many to swallow for one at her age. Furthermore, a regular dosage of donepezil is 5-10mg for AD and it leads to bradycardia. Taking a much higher dose than suggested increases the risk of bradycardia. With this, I would clarify with the senior nurse/doctor the dosage of donepezil and recommend the doctor the appropriate dose to change to.

2.     How can this error be prevented?

This error can be prevented if I am knowledgeable beforehand about the proper medication dose and adverse effects.

3.     What are the possible implications of the medication error on Madam Nora?
- Longer hospitalisation stay
- Bradycardia leading to morbidity

4.     What have you learned from this medication error incident?

I have learnt the consequences of medication error and how important it is to know a medication’s adverse effects. With prior knowledge of these factors, the above error would have been avoided. Also, it is essential to vigilantly take note of the doctor’s orders and not to follow blindly as doctors make mistakes as well.

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1. No, i would not serve the medications as it is too much thus i will check again against the drug prescription and ask the doctor to clarify the dosage.
2. Clarify unclear or elligible handwriting
Ensure accurate transcription
Check for right drug, dosage and frequency
3. Healthcare worker  worker may be penalised due to such error
Patient may have to stay longer and it increases cost
4. If there is doubt, clarify with the doctor instead of administering it. Always check before administering.

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1) no, check with the dr to ensure dose is correct
2) do the 3 checks prior to serving the medication and check for 5 rights (esp right dose)
3) overdose, increased length of hospital stay, emotional distress to pt and family
4) always check with staff nurse or dr if unsure

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1. i would not serve the medication as 10tablets is very suspicious
2. clarify with doctor before serving medication
3. madam nora was in critical condition and it could have been fatal. the nurse will need to write a medication error report and her license could be suspended
4. i’ve learnt to always be vigilant and clarify if i’m unsure of anything

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1. I will withhold the medication and clarify with the doctor. This is to prevent any adverse effect and to protect patient.
2. Check the recommended dose based on manufacturer and check with doctor before administering to the patient.
3. Madam Nora may suffer morbidity or death which may carry legal implications. She might stay longer in the hospital which results in increase in health care costs and even time separated from family. Nurse may suffer self-doubt and embarrassment and face discipline inquiry.
4. familiar with the recommended dosage of the drug before calculating the actual dose. Clarify with doctor if ordered doe varies too much from the recommended dosage.

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1) i would not serve the medication first. i would confirm with another staff nurse if the order is correct as it is dangerous to serve 10 tablets of medication to a patient

2) do the 3 checks before administering medication to the patient

3) patient may have to stay longer due to the drugs adverse effect, and our nursing license may also be suspended

4)when in doubt, clarify with another staff nurse or a doctor

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1. Inform the staff nurse to let the doctor know about the dosage

2. This error can be prevented by checking with the doctor that wrote the order

3. The possible implications on the patient, is the adverse effects of the drugs. For the nurse it’ll be medication error.

4. To always check the dosage before serving the medication, and check with a staff nurse if the dosage doesn’t look right.

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1. No, I will confirm with the doctor to ensure that’s the right dosage.
2. Always ensure the 10 rights before serving the medication.
3. - Long stay of hospitalization

- Possible death to the patient

- Emotional stress to the nurse

- Financial stress to the nurse
4. When there’s doubt, we need to clarify with the staff nurse and doctor before serving the medications.

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1.I don’t give the drugs first. Due to the side effects of Donepezil (nausea vomiting diarrhea), I will first confirm with the doctor whether to give 10 tables
2. Double-check with doctor before giving medication.
3.Severe cases can result in the patient losing her life. Nurse may be fired.
4.In the case of dosing in doubt, it is necessary to confirm with the doctor first to avoid the risk of patients due to dosing errors.

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1.     If you were the nurse taking care of Madam Nora, what would you do with the medication order of donepezil 50mg om (10 tablets)? Would you serve the medication accordingly? Explain your rationale.

·       No, I will withhold serving the medication as it is illogical and dangerous to serve 10 tables of Donepezil 50mg. I will clarify the order with the doctor and ask the doctor to rewrite the prescription.

2.     How can this error be prevented?

·       Make sure to note the units of medication and prescribe the medication according to hospital policy.

3.     What are the possible implications of the medication error on Madam Nora and the nurse?

·       Madam Nora may have experienced worsen condition and expecting a longer admission in the hospital thus increases the cost. As for the nurse, he or she may face disciplinary actions that may resulted in their licensed being suspended.

4.     What have you learned from this medication error incident?

·       I have learned to always stay alert in serving medication and always implement the 10 rights before serving medications.

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1) acetylcholinesterase inhibitor: donepezil
Rivastigmine.
n-methyl d-aspartate receptor antagonist. eg: memantine
2) wet: nausea and vomitting, urinary incontinence
digest: gastrointestinal bleeding gi bleeding
rest: bradycardia

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1.       If you were the nurse taking care of Madam Nora, what would you do with the medication order of donepezil 50mg om (10 tablets)? Would you serve the medication accordingly? Explain your rationale.

2.       How can this error be prevented?

3.       What are the possible implications of the medication error on Madam Nora and the nurse?

4.       What have you learned from this medication error incident?