A nurse is reviewing the medical history of a client who is luted for surgery. Which of the following findings places the client at risk for a complication of incisional hematoma forming?

A) Provide a dedicated area for the nurse to prepare medications:
Having a dedicated, quiet area for preparing medications is crucial for reducing the risk of medication errors. A designated space minimizes distractions, ensures proper organization, and allows the nurse to focus on the task at hand, which can help prevent mistakes. It also supports a more organized environment where medications can be checked for accuracy, labels can be read carefully, and correct dosages can be administered. This is the best practice to reduce medication errors.

B) Wait to document medications given to clients until the end of a shift:
Delaying the documentation of medications until the end of a shift increases the risk of forgetting to document or making errors. Medications should be documented immediately after administration to ensure accuracy and prevent omissions. Immediate documentation also provides real-time updates on the client's medication history and avoids any discrepancies between what was actually administered and what is recorded.

C) Remove medications from automatic dispensing systems before they are reviewed by pharmacists:
Removing medications from automatic dispensing systems before they are reviewed by pharmacists increases the risk of errors. Medications should be reviewed by the pharmacist to ensure proper drug selection, dosage, and appropriateness for the patient's condition. Pharmacists play an essential role in medication safety, and bypassing their review increases the likelihood of incorrect medication administration, potentially leading to harmful consequences.

D) Prepare medications for multiple clients at the same time:
Preparing medications for multiple clients simultaneously is risky and can lead to confusion and errors. Nurses should focus on preparing medications for one patient at a time to ensure that the correct medication and dosage are administered to the correct person. This practice reduces the likelihood of mixing up medications or administering the wrong drug or dosage.

A) Notify the facility’s ethics committee:
While it may be relevant to involve an ethics committee in certain complex situations, such as when there are concerns about patient autonomy or ethical decision-making, the refusal of a medication by a client is generally a standard issue that does not immediately require ethics consultation.

B) Return the opened medication in the medication cart:
Returning an opened unit-dose medication to the cart is not appropriate. Once a unit-dose medication is opened, it cannot be reused due to safety concerns (e.g., contamination, dosage errors). The opened medication should be disposed of properly according to the facility's policies for medication handling and disposal.

C) Report the incident to the provider:
The provider should be notified when a client refuses medication, especially if the medication is essential for the client’s treatment or health condition. It is important for the nurse to document the refusal and inform the provider so that appropriate follow-up can be arranged, including possible reassessment of the treatment plan, alternative medications, or further education for the client.

D) Fill out an incident report:
An incident report is typically completed for situations that involve safety issues, errors, or accidents that may affect patient safety or quality of care. While refusal of medication is an important event, it does not generally require an incident report unless it involves an unusual or dangerous situation, such as a medication error or patient harm.