Part one Foundations of Nursing: Medication Administration & Pain

Six Rights of Medication Administration ( Bolded ), Additional Patient Rights Related to Medication Administration ( not bolded )

• Right client: Verify the client’s identity using two client identifiers.

• Right medication: Confirm the name and form of the medication is correct.

• Right dose: Check the medication you have against the order in the medical record.

• Right route of administration: Confirm the route (IV, IM, SC, etc.).

• Right time of delivery: Confirm the time drug is to be given and the last time the drug was administered.

• Right documentation: Document the time the drug was given and any pertinent remarks.

• Right reason: Drug is given for the correct indication.

• Right to refuse: Client has the right to refuse the medication.

• Right assessment: Confirm that the medication is appropriate for the client’s condition.

• Right education: Provide adequate education addressing what medication the client is taking, expected benefits, and side effects.

• Right response/evaluation: Observe the client’s response to the drug.

The 3 Checks: Safety Strategies for Medication Administration

• Checking the medication against the Medication Administration Record or medication information device upon removal of the drug from the dispensing device.

• Checking the drug upon preparation.

• Checking the drug just prior to administration.

Identifying the Patient: The first Identifier

• Validating the patient’s name

• Checking the identification bracelet/armband AND

• Asking the patient to state their name, if possible

Identifying the Patient: The second Identifier

Validating the patient’s identification number, medical record number, and/or birth date

• Checking the identification bracelet/armband AND

• Asking the patient to state their birthdate, if possible

• Comparing the identification bracelet with the MAR

Types of Medication Orders Standing order:

written in advance; carried when needed

Types of Medication Orders: Routine order

carried out until cancelled by another order

Types of Medication Orders PRN order

as needed

Types of Medication Orders Single or one-time order

order only happens once

Types of Medication Orders Stat order:

Carried out immediately.

Complete Medication Order Should Contain

• Client’s name

• Date/time order written

• Drug name (generic)

• Dosage

• Route of administration

• Frequency

• Indication for use

• Provider’s signature

Routes of Drug Administration: Enteral

administered directly into the gastrointestinal (GI) tract

Routes of Drug Administration: Topical

applied directly to the skin, mucous membranes of the eyes, nose, respiratory tract, vagina, rectum, and urinary tract

Routes of Drug Administration: Parenteral

administered by injection using a needle and syringe or a catheter

Enteral Medications: Solid form

tablets, capsules, pills

Enteral Medications: Liquid form

elixirs, spirits, suspensions, syrups

Enteral Medications: Oral route

having patient swallow drug

Enteral Medications: Enteral route

administering drug through an enteral tube

Enteral Medications: Sublingual administration

placing drug under tongue

Enteral Medications: Buccal administration

placing drug between tongue and cheek

Topical Medications

MEMORIZE

• Skin applications

• Eye instillations and irrigations

• Ear instillations and irrigations

• Nasal instillations

• Vaginal applications

• Rectal instillations

Parenteral Medications

MEMORIZE

Subcutaneous injection: subcutaneous tissue

• Intramuscular injection: muscle tissue

• Intradermal injection: corium (under epidermis)

• Intravenous injection: vein

• Intra-arterial injection: artery

• Intracardial injection: heart tissue

• Intraperitoneal injection: peritoneal cavity

• Intraspinal injection: spinal canal

• Intraosseous injection: bone

Preparing Medications for Injection

• Ampules.

• Vials.

• Prefilled cartridges or syringes.

• Mixing medication (insulins) in one syringe.

• Reconstituting powdered medications.

Criteria for Choosing Equipment for Injections

• Route of administration.

• Viscosity of the solution.

• Quantity to be administered.

• Body size.

• Type of medication.

Parts of a Needle and Syringe

• Needle gauges and length.

• Angles of insertion for various injections.

Criteria for Choosing Equipment for Injections

• Route of administration.

• Viscosity of the solution.

• Quantity to be administered.

• Body size.

• Type of medication.

Sites for Intramuscular Injections

• Ventrogluteal site.

• Vastus lateralis site.

• Deltoid muscle site.

• Dorsogluteal site is no longer recommended

Intradermal Injections

• Administered into the dermis, just below the epidermis

• Has the longest absorption time of all parenteral routes

• Used for sensitivity tests and local anesthesia

• Body’s reaction to the substances is easily visible

Intradermal Injections sites:

• commonly used are the inner surface of the forearm and the upper back, under the scapula

Intradermal Injection needle type

A 1/4″ to 1/2″, 25- or 27-gauge needle is used and the angle of administration is 5 to 15 degrees

• The dosage given intradermally is small, usually less than 0.5 mL

Subcutaneous injections

Administered injections into the adipose tissue layer just below the epidermis and dermis

Subcutaneous injections sites used

Outer aspect of the upper arm

• Abdomen (from below the costal margin to the iliac crests)

• The anterior aspects of the thigh

• The upper ventral or dorsogluteal area

Intravenous Administration

Delivers the drug directly into the bloodstream

Medication has an immediate effect and cannot be recalled or actions slowed

Route most often used in emergency situations

Intravenous Administration is administered in

• Peripheral line

• Central line

Medical Record Documentation

• Name and dosage of the medication

• Route and time of administration

• Name of person administering medication

• Site used for an injection

• Location of topical or transdermal applications

• Naris, eye, or ear used for those administrations

• Intentional or inadvertently omitted drugs

• Refused drugs

• Medication errors

High-Alert Medications: A-PINCH

• High-alert medications are drugs that are associated with an increased risk of causing considerable client harm when they are administered in error

• One strategy to reduce the risk of harm is manual independent double checks with two nurses verifying identical information before these drugs are administered.

High-Alert Medications: A-PINCH types are

Insulin, opiates, narcotics, intravenous heparin, and injectable potassium chloride

Time Critical Medications

Time-critical medications are those that when administered 30 minutes before or after the scheduled administration time can cause harm to client or substandard pharmacological effect.

Type of Medication Errors

• Inappropriate prescribing of the drug

• Extra, omitted, or wrong doses

• Administration of drug to wrong patient

• Administration of drug by wrong route or rate

• Failure to give medication within prescribed time

• Incorrect preparation of drug

• Improper technique when administering drug

• Giving drug that has deteriorated

Medication Errors steps

Prevention is 1st

• Check patient’s condition immediately; observe for adverse effects

• Notify nurse manager and primary care provider

-Complete form used for reporting errors, as dictated by the facility policy:

• Unusual occurrence report

• Incident report

Patient Teaching

• Drug indications

• How/when/how long to take the medication

• Expected side effects and how to manage

• Unwanted adverse effects, how to manage, and when to alert a medical professional

• Safe medication storage and handling

• Do not alter dosages without consulting a provider

• Do not share medications