W4 - Nonparenteral Medications

What is Drug Diversion?

When controlled substances are intentionally transferred from legitimate distribution and dispensing channels

- A medication prescribed for one individual ends up in the hands of another (selling/sharing drugs, drug theft)

Nurse's Role (Drug Misuse/Diversion)

- Promote safe care

- Minimize risk of misuse and drug diversion

- A duty to protect pts from harm

- Best meet pts needs and promote their well-being

- Nurses must report any error, behaviour, conduct, or system issue

- Advocate for pts!!!

Mechanism of Drug Diversion in Hospitals/Clinics? How?

1. Inadequate monitoring

2. Theft of institutional drug supply

3. Partially filled vials and syringes in sharps containers

4. Poor disposal practices

5. Limited surveillance

How to properly dispose of Opioid Patches?

Fold over on itself and use a device that deactivates any remaining drug prior to disposal

Documentation Requirements

Medications held, unavailable, refused, vomited, and wasted

- Record med immediately after administering

- Never chart BEFORE

- Write name of med, dose, route, and exact time

- Record assessment parameters (blood glucose, BP, etc.)

Wasted Medications Policies

- Not to be disposed of into sink, toilet, or garbage can

- MUST be returned to pharmacy or disposed of in a pharmacy-designated container

- Wasted controlled liquid meds are never left in their vials; drawn up using a needleless syringe and disposed of as a liquid

Topical (Skin)

Skin (lotions, pastes, ointments)

- Gloves to prevent absorbing med through applier's skin and for hygienic reasons

- Clean area of application thoroughly with soap and water gently

- Apply topical med as per directions

- Document area where med was applied, name, and condition of skin

- Transdermal patch may remain in place for longer amount of time (12 hrs - 7 days)

When taking Medication History, what should you ask the Patient?

When taking a medication history or reconciling medications, specifically ask the pt if they take any medications in form of patches, topical creams, or any route other than oral route

Should you Document Removal of Patch or Medication?

Yes; document removal of patch or medication on MAR

How do Medications absorb through the Skin?

Medications absorb slowly through the skin

What Patients are at Risk with Topical Skin Medications?

Patients with skin abrasions are at risk for rapid medication absorption and systemic effects

Ways to Apply Medication to Mucous Membranes (Topical)

1. Directly applying liquid or ointment (eye drops, gargling, swabbing)

2. Inserting Medication into body cavity (rectum, vagina suppository)

3. Instilling fluid into body cavity (ear, nose drops; fluid RETAINED)

4. Irrigating body cavity (flushing with medicated fluid the eye, ear, vagina, bladder, rectum; fluid NOT retained)

5. By spraying (into nose or throat)

Eye Instillation

- Common eye medications used by pts are eye drops and ointments (OTC prep as well)

- Many pts receive prescribed ophthalmic meds for eye conditions (glaucoma, cataract extraction)

Conditions for Eye Instillation

- Avoid instilling any form of eye med directly onto cornea

- Risk of transmitting infection from on eye to the other is high SO avoid touching eyelids or eye structures with eyedroppers

- Use eye medication ONLY for affected eye

- Never allow a pt to use another pt's eyedrops

Ear Instillation Administration Steps

1. Have pt assume side-lying position or in a chair or at bedside

2. Perform hand hygiene (gloves if drainage present)

3. Straighten ear canal by pulling auricle down (for children under 3 years of age) or upward and outward (for adults)

4. Hold dropper 1 cm above the ear canal and instill the prescribed drops

5. Ask pt to remain in side-lying for 2-3 mins; gently massage or pressure to tragus of ears with your finger

6. If cotton ball is needed, place cotton ball into outermost part of ear canal; keep it there for 15 mins

Nasal Instillation

Most commonly administered form of nasal instillation is a decongestant spray or drops --> sinus congestion and colds

Nasal Instillation Administration

1. Assist pt to supine and position head properly for nasal passages

2. Support pt's head with nondominant hand to prevent straining of neck muscles

3. Instruct pt to breathe through mouth, which reduces chance of aspirating nasal drops into the trachea and lungs

4. Hold dropper 1cm above nares to avoid contamination of dropper --> instill prescribed # of drops toward midline of ethmoid bone

5. Have pt remain in supine position for 5 mins

6. Offer a facial issue to blot a runny nose but caution pt against blowing nose for several mins

What Routes can Inhalation Medications be Administered through?

Meds can be administered through nasal passages, oral passage, or endotracheal or tracheostomy tubes

- meds administered by hand-held inhalers are dispersed through an aerosol spray, mist, or powder that penetrates the lung airways

Inhalation

- Readily absorbed and work rapidly

- May have either local such as bronchodilation or systemic effects

Vaginal Instillation

- Availabilities as suppositories, foam, jellies, creams

- Pts often prefer administering their own vaginal meds

- Pts should remain on back for 10 mins after instillation

- After instillation, pt may wish to wear a perineal pad to collect drainage

Rectal

Rectal suppositories contain meds that exert local effects, such as promoting defecation, or systemic effects, such as reducing nausea