Medication Administration

Flashcards covering medication administration routes, safety rights, dosage forms, and nursing procedural guidelines.

Medication Safety

Safety in medication administration is critically important. Often, there are additional safeguards provided by institutions in order to ensure safe practices (not meant to find workarounds). Always critically think when reviewing medication orders/administering medications (Does this make sense? Now? For this patient?)

5 Rights of Drug Administration

The foundational medication safety principles abbreviated as TRAMP: Right Time, Right Route, Right Amount, Right Medication, and Right Person.

6 Rights of Drug Administration

The expanded medication safety protocol (TRAMP D/E) consisting of Right Time, Right Route, Right Amount, Right Medication, Right Person, and Documentation/Education.

Right Patient Verification

Requirement to verify patient identity using $2$ forms of ID (full name, date of birth, and medical record number) by checking the ID bracelet each time medication is administered.

Right Drug Verification

Ensuring the exact prescribed medication is given by making sure that it scans and the scan goes through as well as checking and reading the drug label 3 times.

Three Label Checks

The safety protocol of reading a drug label at three specific times: $1$) when removing from cabinet, $2$) when preparing the drug, and $3$) when administering to the patient.

Right Dose

Administering the exact dose prescribed within safe guidelines based on the patient’s physical status, renal/hepatic function, weight, and age.

Dose Rechecking

Safety protocol requiring a recheck of calculations and consultation with a peer or pharmacist if a medication dose appears extremely high or questionable.

Right Time

Administering medication at the specified scheduled time to maintain plasma drug levels at a therapeutic level. Important to know whether the drug is administered with or without meals.

Military Time

A $24\text{-hour}$ time system used in healthcare to reduce administration errors and decrease documentation clutter.

Time Window Policy

Institutional policies allowing medication administration within a designated window around the scheduled time, such as one hour before or after the prescribed time.

Right Route

Selecting and verifying the designated administration path necessary for adequate drug absorption. Always check the ability to swallow before administering and confirm the patient is not vomiting or nauseous prior to administering.

Sublingual Route

Medication route where the drug is placed under the tongue for systemic absorption without being swallowed.

Buccal Route

Medication route where the tablet is placed between the gum and cheek until completely absorbed.

Parenteral Injection Angles

The specific needle insertion angles required for administration routes: intramuscular ($90^\text{o}$), subcutaneous ($45^\text{o}$), intravenous ($25^\text{o}$), and intradermal ($10^\text{o}$ to $15^\text{o}$).

Right Assessment

Nursing right requiring pre-administration evaluation of vital signs, physical status, head-to-toe assessment, lab results, and health history before giving drugs.

Right Evaluation

Nursing right requiring post-administration monitoring to assess the therapeutic effect and adverse responses to medication.

Right to Refuse

The legal and ethical patient right to decline any medication after being educated on its purpose and potential consequences.

Valid Drug Order Components

Required elements of a prescription: patient name and DOB, order date, provider signature, drug name and strength, frequency, route, duration, refills, and quantity.

Qualifying Phrase

A specific condition added to a medication order, such as PRN or as needed for pain.

PRN Order

A medication order executed 'as needed' based on a specified qualifying phrase or patient clinical condition.

Leading Zero Rule

Mandatory writing standard requiring a zero before a decimal point (e.g., $0.5\text{ mg}$) to prevent misreading dosages.

Trailing Zero Rule

Prohibition against writing zero after a decimal point (avoiding $5.0\text{ mg}$) to prevent ten-fold dosing errors.

Verbal Order Protocol

Safety standard to avoid verbal orders, requiring the nurse to repeat the order out loud to confirm accuracy if taken.

Bar Code Point-of-Care Scanning

Scanning the patient ID and drug barcode at bedside prior to administration to ensure safe delivery.

Pre-Admin Lab Review

Essential nursing intervention to review pertinent laboratory results before giving medications affected by organ function or blood levels. All orders should be checked against original orders.

Tablets and Capsules

Most common drug form; convenient, inexpensive, and does not require additional supplies. Should not be mixed with large amounts of food or beverage or with contraindicated foods. Enteric-coated and time-released capsules should be swallowed whole.

Oral Admin Contraindications

Clinical conditions where oral drugs are withheld, including vomiting, absence of a gag reflex, or coma.

Irritating Oral Meds Strategy

Intervention of administering gastrointestinal-irritating medications with food to decrease GI discomfort.

Sublingual/Buccal Oral Rules

Instruction that SL and buccal meds must remain in place until fully absorbed without consuming food or fluids.

Elixir

A clear, sweetened hydroalcoholic liquid used in the preparation of oral liquid medications.

Emulsion

A liquid medication form consisting of a mixture of two liquids that are not mutually soluble.

Suspension

A liquid medication containing solid particles that are dispersed but not dissolved, requiring shaking before use.

Liquid Shaking Requirement

Rule stating suspensions and emulsions must be shaken before administration, whereas elixirs do not require shaking. Always read labels to determine if dilution or shaking is required.

Liquid Reconstitution Care

Storage protocol where many oral liquid medications require refrigeration after being mixed or reconstituted.

Meniscus

The slightly concave curved line of a dose of liquid, measured at its lowest point to determine exact dosage.

Never Crush Medications

Includes tablets that are long-acting, enteric-coated, or sustained-release properties, as crushing can alter the medication's effectiveness and lead to potential side effects.

Enteric-Coated Tablet

A tablet coated to resist disintegration by gastric juice, requiring swallowing whole without crushing or chewing.

Sustained-Release Formulation

A long-acting oral medication designed for gradual drug release over time; must NEVER be crushed or split.

Scored Tablet

A tablet manufactured with a line across the center, allowing it to be split into equal halved doses.

Silent Knight

A mechanical device used by nurses to crush oral tablets into powder for patients unable to swallow whole pills.

Transdermal Patch

A drug-infused patch applied to the skin, providing slow, continuous systemic absorption through the skin. Provides more consistent blood levels than oral and injection forms and avoids GI absorption problems associated with oral medications.

Transdermal Glove Protocol

Requirement for nurses to wear gloves during application and removal to avoid accidental absorption of the drug.

Transdermal Site Care

Procedure of thoroughly cleansing skin, drying, removing old patch, and rotating application sites on clean intact hairless skin.

Patch Alteration Rule

Strict guidelines prohibiting the cutting of transdermal patches unless specifically directed by a healthcare provider.

Transdermal Patch Disposal

Folding the removed patch in half with sticky sides together without touching the drug surface prior to proper disposal.

Topical Medication

Medication applied directly to clean, dry skin or mucous membranes using gloves, tongue blades, or cotton tipped applicators.

Topical Container Safety

Contamination rule requiring a fresh sterile applicator each time entering a topical drug container. Gloves and applicators that come in contact with a patient should not be reinserted into the container.

Instillation

Administration of liquid medication as drops, sprays, or ointments into body cavities such as eyes, ears, or nose in the form of eye drops, eye ointment, ear drops, and nose drops/sprays.

Ophthalmic Drop Technique

Position the client upright with head tilted back, tissue to client, non-dominant hand on lower orbit gently pulling down lower lid, dominant hand on forehead, dropping medication into conjunctival sac (avoiding cornea), blotting, and document.

Ophthalmic Ointment Technique

Squeezing a $\frac{1}{4}\text{-inch}$ strip of ointment directly into the lower conjunctival sac.

Conjunctival Sac

The lower eyelid pouch formed by gently pulling down the skin over the lower orbit to receive ophthalmic drops or ointment.

Administering Otic Medications

Have the client sit or lie, turning the head to the unaffected side.

Otic Canal Straightening

Pulling the pinna up and back for adults/children > 3 years old, or down and back for children < 3 years old.

Otic Solution Warmth

Warming eardrops to room temperature prior to instillation to prevent dizziness or nausea.

Otic Post-Care

Release the pinna and gently massage after instillation, and maintain the head position for several minutes before documenting.

Metered-Dose Inhaler (MDI)

Handheld device delivering a measured dose of medication to the lower respiratory tract.

Inhalation Capsule Safety

Wearing gloves when handling drug capsules for certain inhalers (MDI) to avoid skin absorption.

Spacer

An attachment chamber used to enhance the delivery of medication from the MDI to the lungs. Do not put the mouthpiece in mouth unless using a spacer.

Nebulizer

A device that converts liquid medication into a fine aerosol mist for inhalation into lower, smaller airways. Handheld nebulizers deliver a very fine-sized particle spray of medication.

Inhalation Positioning

Placing the patient in semi-Fowler's or high Fowler's position when administering inhaled medications such as MDI or nebulizers.

Suppositories/Enemas

Medications administered as suppositories or enemas can be given rectally for local and systemic absorption.

Rectal Suppository Storage

Refrigeration of rectal suppositories prior to use because they melt or soften at room temperature.

Rectal Suppository Insertion

Placing the patient on left side breathing through the mouth to relax anal sphincter, lubricating suppository, inserting past internal anal sphincter against the rectal wall, and have the patient remain on the side-lying for 20 minutes.

Vaginal Suppositories

Similar to rectal suppositories with the patient in lithotomy position. Generally inserted with an applicator supplied with the medication and internal creams.