NUR 116 Medication Administration Check Off

site IM Deltoid

muscle: deltoid landmarks: acromion process, axillary fold gage: 20-25 gauge needle length: 1-1.5 inches volume: 1-2 ml angle: 90 degrees

site:IM ventrogluteal

muscle: gluteus medius, gluteus minimus landmarks: iliac crest, ant-superior iliac spine, greater trochanter gauge: 18-25 gauge needle length: 1-1.5 inches volume: 1-4 ml angle: 90 degrees

site: IM vastus lateralus

muscle: vastus lateralus landmarks: greater trochanter, anterolateral thigh, lateral fem condyle gauge: 18-25 gauge needle length: 5/8 to 1.5 inches volume: 1-4 ml angle: 90 degrees

site: SQ

landmarks: outer aspect of upper arm, abdomen below costal margin to iliac crest, 2-3 inches from umbilicus, anterior aspect of thighs gauge: 25-30 gauge for insulin needle length: 3/8-1 inches at 90 degrees, 5/8 inches at 45 degrees volume: 1 ml angle: 45-90 degrees

first thing you do in the skill

verifies providers orders and facility policies, gather supplies and check expiration dates

1st check

verify health care provider’s orders against the MAR, verify patient name and DOB and time, verify medication name, dose, route, and frequency, and indication gather medications

2nd check

verify that medication aligns with the MAR as each medication is prepared, verify patient and DOB and time, verify medication dose, route, frequency, expiration date, 2 nursing considerations, and 2 adverse effects, performs calculations if needed, label syringes with drug name and dose, any insulin administration must have a 2nd check by another nurse

basic safety skills and situational assessment

hand hygiene, don PPE if indicated, greet patient, introduce self, provide privacy, verify patient name and DOB and allergies, emergency equipment, check for clutter and hazards, explain you’re giving medications, answer patient questions, raise bed

3rd check

verify medication time, dose, route, frequency against MAR before administering, education patient on medication indication, 2 side effects

Oral (PO) medications

raise HOB, have patient take a sip of water for swallow test, administer medication

parenteral medication

apply clean gloves, select and verbalize an appropriate administration site to the instructor

cleaning IM or SQ

Cleanse the injection site using an alcohol wipe, using a firm circular motion, moving outward from the injection site, never cross over injection site again once its been cleaned, allow the area to dry without fanning

prepare IM or SQ

remove the needle cap by pulling it straight off, IM: displace the skin using the z-track technique, SQ: pinching up the skin and underlying fatty tissue

administering IM or SQ

dart the needle through the skin using appropriate IM or SQ angle, 90 degrees, use thumb and forefinger of nondominant hand to hold the lower end of the syringe, place dominant thumb to end of plunger, inject medication slowly, for SQ, hold for 10 seconds

removing IM or SQ

withdraw the needle at the same angle it was inserted, IM: maintain traction or taut skin until the needle is completely removed, once the needle is removed, release the skin, apply light pressure if oozing is present, apply bandaid if needed, do not massage the site

disposing IM or SQ

activate the needle protection device, do not use your hands, immediately dispose in sharps container, dispose of supplies used

basic safety skills

verbalize you are leaving, 4 P’s, raise rails, bed in lowest position, bed alarm, bed brakes, call light, hand hygiene

Documentation on the MAR

right medication, right patient, right dose, right route, right time, right reason, right assessment data, right documentation, right response. reassess for PRN medications: PO 1 hr, IM 30 min, IV 10 min