Medication Administration

13 nonparenteral routes of administration

1. oral

2. buccal

3. sublingual

4. via NGT

5. topical

6. eye drops

7. ear drops

8. nasal instillations

9. metered-dose inhalers

10. dry powder inhalers

11. small volume nebulizers

12. vaginal suppository

13. rectal suppository

buccal

cheek

sublingual

under-tongue

5 parenteral routes of medication administration

1. intramascular (IM)

2. subcutaneous (SQ)

3. intradermal (ID)

4. epidural

5. intravenous (IV)

3 system checks of all med administration

1. provider

2. pharmacy

3. nurse

what does the provider do in terms of the system check of meds

• selects medication, dose, route, time, based on patient state

• writes the order

what does the pharmacy do in terms of the system check of meds

• receives order from provider directly or TO/VO through nurse

• processes order and inputs into MAR in EHR

TO

telephone order

VO

vocal order

MAR

medication administration record

EHR

electronic health record

what does the nurse do in terms of the system check of meds

• may take a verbal or telephone order from provider

• carries out medication administration using MAR within EHR, including checking 7 rights of each med 3 times

7 rights of med administration

1. right patient

2. right medication

3. right dose

4. right route

5. right time

6. right indication

7. right documentation

3 times when to check the 7 rights of med administration

1. when gathering meds

2. when preparing meds

3. at bedside

how do i know it is the right time for med administration

administration times are assigned by pharmacy in the MAR

most meds have a _____ hour window to administer while some meds may have a ____ hour window

two; one

10 steps for medication administration

1. know how the med works

2. complete priority physical assessments

3. gather meds and prepare meds

4. enter patient room

5. scan armband

6. confirm allergies with the patient and HER

7. scan meds

8. hit confirm which will double check scan

9. if all correct, give meds as ordered

10. document

4 things to know in terms of how the med works

1. MOA/class

2. onset, peak, duration of action

3. therapeutic, side, and adverse effects

4. contraindications/interactions

3 things in terms of priority physical assessments

1. lung sounds, BP, FSBS, edema, UOP, etc.

2. check allergies

3. hold meds when appropriate

3 parts of evaluation in terms of med administration

1. reassess VS or body systems for effectiveness

2. check with patient about any adverse effects

3. patient reporting of symptom worsening/improvement

5 parts of patient centered care in terms of med administration

1. medication education

2. open communication

3. printed materials

4. family involvement

5. culture considerations

4 steps when reporting a medication error

1. assess patient conditions

2. notify provider when error identified

3. report to supervisor/manager

4. file incident report within 24 hours

a nurse who violates the patient rights is _______ _________ for the error, in addition to others involved in the error

legally responsible

___% of medication errors are a result of a workplace distraction

43%

3 special considerations in terms of med administration

1. sweeten bitter oral preparations

2. mix with applesauce, pudding, ice cream, juice, etc.

3. do not use a molded medicine cup for amounts less than a teaspoon

3 aspects to remember when administering meds through an enteral feeding tube

1. liquid preferred

2. if liquid not available, oral medication tablets may be crushed or dissolved first

3. put suction on hold 30min-1 hr after administration of meds to let them digest

do not crush _______, ______________, or ________ _______ _____

sublingual, sustained-release, enteric coated tabs

3 steps to applying topical medications to the skin

1. local effects can create systemic effects if absorbed through the skin

2. wear gloves to protect against accidental exposure

3. clean the skin or wound thoroughly before applying a new dose of topical meds

how to administer eye medications

eyedrops, ointments, intraocular discs

• administer eye meds to the conjunctival sac, not the cornea

how to administer ear medications

usually instilled by drops

• administer at room temperature

3 types of nasal med instillations

sprays, drops, or packing/tampons

how to use sprays and drops for nasal instillations

sprays and drops are used to relieve sinus congestion and cold symptoms

how to use nasal packing or tampons for nasal instillations

nasal packing or tampons treated with epinephrine to slow bleeding are used to treat severe nosebleeds

how to use a metered-dose inhaler (MDI)

• disperses med into the airways through an aerosol spray or mist by activation of a propellant

• dosage is usually delivered in 1 to 2 puffs

• a spacer or breath-activated MDI may be used to ensure correct delivery of med to lower airways

how to use a dry power inhaler (DPI) medications

• delivered when patient inhales through a reservoir containing medications

• device is breath activated and is no need to coordinate puffs with inhalation

compared to MDIs, DPIs deliver _____ medication to the lungs

more

how to use small volume nebulizers

• add medications or moisture to inspired air by mixing particles with air

• droplets in the mist are much finer than those created by MDIs or DPIs

• face mask or mouthpiece held between the teeth delivers nebulized mist

vaginal medications are available in what forms

foam, jelly, cream, or suppository

rectal suppository

• acts when it melts and is absorbed into rectal mucosa

• may exert local effects on GI mucosa or systemic effects

• not as reliable as oral or parenteral route in terms of drug absorption and distribution

geriatric considerations when using a rectal suppository

• loss of sphincter control

• assistance

5 main takeaways in terms of med administration

1. follow the rights of med administration

2. know the meds

3. educate the patient on the meds you are giving: purpose, common side effects

4. stay with patient until med is taken

5. respect patients right to refuse meds