Medication Administration Validation

-place unopened unit-dose package in medicine cup after completing 1st and 2nd checks

-pour liquid in med room, but take medicine bottle to bedside for 3rd check

-obtain pill crusher if needed

How do you correctly prepare meds for PO?

-select appropriate med

-select appropriate syringe and needle: 3-5mL Hypodermic syringe

-prepare correct dosage

How do you correctly prepare meds for IM?

-select appropriate med

-select appropriate syringe and needle: 1 mL Tuberculin syringe

-prepare correct dosage

How do you correctly prepare meds for ID?

-select appropriate med

-select appropriate syringe and needle: 1-3 mL or U-100 syringe (for insulin only)

-prepare correct dosage

How do you correctly prepare meds for SC?

-before pulling med

-before preparing med

-before administering med

When do we perform medication checks?

-right patient

-right medication

-right dose

-right route

-right time

-right reason

-right documentation

What are the 7 rights of medication administration?

-name of medication (brand & generic)

-reason for medication

-common side effects

-expected effects

-adverse effects/when to call nurse or HCP

What client education do we give prior to administration?

-Introduce yourself and role to client: "Hi, my name is _____. I am a nursing student at Wallace State and I am going to be assisting in your care today."

-Explains to client and/or family what they are doing: "I am here to administer your morning medications"

-Performs proper hand hygiene using soap/water or hand sanitizer: "I am going to wash my hands first (student washes hands/hand sanitizer)"

-Verifies client by asking name & DOB comparing to client armband and MAR: "Can you verify your name and DOB? (Student checks armband against MAR)"

-Verifies client allergies: "Do you have any allergies?"

-Dons gloves

What do we do when we enter the client's room?

-raise the head of the bed

-you can say "I am going to raise the head of your bed to administer your medications"

What position do we put clients in to administer PO meds?

-ensure water is available at bedside

-perform 3rd check for each oral medication by comparing med label to MAR and stating med name to client

-open unit dose packaging at bedside and put into medicine cup

-verbalize that you would stay with client until they took the medication and would not leave meds at bedside

How do we administer PO meds correctly?

-place medication packaging and equipment in garbage can

-if pill is cut in half, the half not administered should be placed in sharps container or approved facility bin

How do we dispose of trash after PO meds correctly?

-inner mid-forearm

-clavicular area of chest

-scapular area of back

What sites do we use for ID injections?

provide education and document the refusal in the MAR

What do we do if the client refuses medication?

-swab using circular motion from inner to outer

-DO NOT fan or blow site once cleaned

-allow to air dry

How do we correctly swab the ID injection site?

-pull skin taut

-needle SHOULD NOT point towards fingers

What do we do with the skin before giving ID injection?

-5-15 degrees

-outline of needle under skin

-approx. 1/2 of needle length is inserted

What angle do we insert the needle in ID injection?

1 mL/10 sec

What rate do we administer meds for ID?

-wheal/bleb

-it is okay if bleb pops or disappears as long as it is seen by instructor

What should form when doing ID injection correctly?

-the same angle from which it was inserted

-5-15 degrees

What angle should you remove the needle in ID?

-immediately engage safety

-if no safety, point needle to ceiling at eye level and walk to nearest sharps container

-DO NOT RECAP DIRTY NEEDLE FOR VALIDATION

What do you do immediately with needle after ID injection?

-dispose in sharps container, use container correctly

-DO NOT stick hands in sharps container

How do you dispose of needles in ID injection?

-DO NOT rub or massage site

-may use gauze or cotton ball to lightly wipe any blood

What do we NOT do to the skin after ID injection?

-abdomen (2 inches from umbilicus)

-upper outer arm

-upper outer thigh

-upper back

-upper buttock

What sites are used for SC injections?

-swab using circular motion from inner to outer

-DO NOT fan or blow site once cleaned

-allow to air dry

How do we correctly swab SC injection sites?

pinch up the skin

What do we do with the skin before giving SC injection?

45 or 90 degrees

What angle do we insert the needle for SC injections?

1 mL/10 sec

What rate do we administer SC injections?

-the same angle from which it was inserted

-45 or 90 degrees

What angle do we remove the needle for SC injections?

-immediately engage safety

-if no safety, point needle to ceiling at eye level and walk to nearest sharps container

-DO NOT RECAP DIRTY NEEDLE FOR VALIDATION

What do you do immediately with needle after SC injection

-dispose in sharps container, use container correctly

-DO NOT stick hands in sharps container

How do you dispose of needle after SC injections?

-DO NOT rub or massage site

-may use gauze or cotton ball to lightly wipe any blood

What do we NOT do to the skin after SC injection?

-Deltoid: acromion process & axilla

-Vastus lateralis: lateral femoral condyle & greater trochanter

-Ventrogluteal: greater trochanter, anterior superior iliac spine, posterior iliac crest

-Dorsogluteal: posterior iliac crest & gluteal fold

What sites (with respective landmarks) do we use for IM injections?

-swab using circular motion from inner to outer

-DO NOT fan or blow site once cleaned

-allow to air dry

How do we swab the injection site for IM injections?

90 degrees

What angle do we insert the needle for IM injections?

Aspirate:

-withdraw plunger back slowly for 10 seconds

-look for blood return in syringe

-No blood = good to go!

-Blood = in a vessel, withdraw needle and start over in new site

What do we do before pushing down plunger to administer med?

1 mL/10 sec

What rate do we give IM injections?

-remove needle at the same angle inserted

-90 degrees

What angle do we remove needle in IM injections?

-immediately engage safety

-if no safety, point needle to ceiling at eye level and walk to nearest sharps container

-DO NOT RECAP DIRTY NEEDLE FOR VALIDATION

What do you do with needle immediately after IM injection

-dispose in sharps container, use container correctly

-DO NOT stick hands in sharps container

How do you dispose of needle after IM injections?

-remove gloves

-perform hand hygiene

-ensure client is comfortable

-place bed in lowest position

-ensure 2 or 3 side rails are up

-place call light within reach

-ask client if they need anything

-verbalize when you will return: pick a random time

What do we do before we leave the client's room?