Safe Medication Administration

What is the chemical name for a drug?

describes chemical composition

what is an official drug name?

• Listed in official publications 

• National formulary 

• Often generic name 

What is a generic medication name? (and example)

• Drug’s active ingredient 

• Derived from chemical name 

• Assigned when drug first developed 

• Acetaminophen 

what is the trade or brand medication name?

• Given by manufacturer 

• Trademark 

• May have several trade names from various manufacturers 

• Tylenol (US)/Paracetamol (UK) 

What are the effects of body on medication?

pharmacokinetics

what steps encompass pharmacokinetics

• Absorption- how will it get in

• Distribution- where will it og

• Metabolism- how is broken down

• Excretion- how does it leave

What is a therapeutic effect?

the intended, desired effect

What are adverse effects?

undesirable effects other than the intended therapeutic effect

what are some other undesirable effects?

• Side effect 

• Cumulative effect 

• Toxic effect (toxicities) 

• Drug tolerance 

• Idiosyncratic effect (paradoxical) - immune mediated or caused by genetic metabolic differenes

• Allergic reaction 

• Drug interactions 

• Antagonist effect- Narcan blocking the effect of an opiod 

• Synergistic effect- works with the medication- makes you higher

why should pregnant women have caution when taking meds?

the medication could be transmitted through breastmilk

what considerations should be taken for newborns and pediatrics and older aduts when giving meds?

• newborn- very small

• pediatrics- careful dosage

• older adults- go low and slow

Who can prescribe medications (4)

• Physicians (MD’s/DO’s) 

• Nurse Practitioners (CRNP’s/CRNA) 

• Physician’s Assistants (PA’s) 

• Pharmacists (PharmD) 

who will be held legally responsible for a medication error?

RN will be held legally responsible for their part in a medication error- be diligent about following rules for medication administration 

Can you administer meds that you did not prepare?

NO!

what does it mean to co sign narcotic wastage?

have to ensure someone sees you get rid of extra narcotic- ensure someone else doesn’t take it

what’s the first thing you do in a medication error?

assess the patient first!

what are the steps for dealing with a med error?

• Assess patient FIRST 

• Notify provider 

• Explain situation to patient 

• Objective documentation in patient chart 

• Chart medication, dose, site, time given 

• Do not document it was an error 

• Report error according to hospital policy (i.e. incident report) 

• Do not discuss incident report in MR/EMR 

what are the physical forms of medicatino orders?

• written/computer

• verbal

• telephone

what is a standing/routine order?

continune until cancelled

what are PRN orders?

as needed

what are single orders?

one time

what is a stat order

one time- immediately

what is an on call order

ex: pre op or pre procedure

what are the parts of a medicatino order (7)

• Patient’s Name 

• Date/time order was written 

• Name of medication 

• Dosage of medication 

• Route of administration 

• Specificy preparation if required 

• Frequency of administration 

• Signature (including title) of prescriber (DEA # if narcotic) 

what is sublingual administration?

under the tongue

what is buccal administration?

cheek

what is subcutaneous administration?

under the skin and the fat

what is intramuscular administration?

in the muscle

what is intradermal administration?

under the skin

what is intravenous administration?

in vein

what is intraarterial administation?

in artery

what is intra-spinal administration?

epidural/intrathecal

What is topical administration?

• transdermal

• eye

• ear

what are forms of inhalation medication?

• inhalers

• nebulizers

what are the 5 rights of medication administration?

• Right patient 

• Right medication 

• Right dose 

• Right route 

• Right time 

what are the 6 additional rights of medication?

• Right reason 

• Right assessment data 

• Right education 

• Right to refuse 

• Right documentation 

• Right response 

how many times should you perform the 5+ rights?

3 times

at what times should you perform the 5+ rights?

• When first retrieving the medication container 

• Immediately before opening or pouring medication after comparison with HCP order 

• When replacing the medication container or immediately before administering medication to patient 

how many mins do you have to give a med order?

30-60 minutes

if a patient questions a drug or dose what should you do?

stop the administraiton?

can you break a pill or tablet if its not scored?

NO!!

can you chew or crush enteric coated tablets or extended release medications?

NO!!

what is an SR/SA/LA medication?

sustained release, sustained action, long acting

what is an XL medication?

extended release

what do you have to ensure the patient does before documenting a med and leaving bedside?

be sure they have actually swallowed the pills!

what should you tell a patient when administering SL and buccal meds?

to hold it in place until its dissolved

when administering oral med via feeding tube when do you flush with water?

between each medication to prevent potential interactions

how do you administer oral med via feeding tube if its connected to suction?

d/c and administer-clamp for 20-30 min then reconnect 

what should you always do wiht an old patch before applying a new one?

remove the old patch before applying a new one

date and time the patch

rotate the sites to prevent skin irritation

what should you have the patient do when administering eye drops?

have the patient look up as you pull down on lower eyelid

where should you apply eye drops?

into the lower conjunctival sac (NOT DIRECTLY TO CORNEA)

How should you ensure medication doesn’t drain into tear duct?

apply gentle pressure to inner cnthus

how should you administering ear medication?

• Tilt head so affect ear is up 

• Straighten ear canal 

• Instill drops 

• Gently push on tragus several times ot help drops reach tympanic membrane 

• Loosely insert cotton ball into external ear canal to prevent medication from leaking out 

what should you push on to help ear drops reach tympanic membrane?

push on tragus several times

What should you do ot prevent medication from leaking out of ear?

loosely insert a cotton ball into external ear canal

what position should the patient be in to receive rectal medications?

left side lying position

how should you administer rectal medications?

• Standard precautions 

• Patient in left side lying position 

• Lubricate suppository and index finger of dominant hand 

• Separate buttocks with non dominant hand to view anus 

• Insert suppository with dominant index finger (3-4 incehs past anal sphincter) 

what should you do with the inhaler before administering it?

shaek it well!

what should you tell the patient to do before giving an inhlaer?

have patient take a deep breath and exhale

what should you tell the patient to do when giving an inhaler?

inhale the med slowly and deeply then hold breath for 5-10 seconds

how long should you wait between inhaler doses?

1 minute

how does a nebulizer work?

Slow deep breaths through mouthpiece or mask until all medication has been aerosolized (15 minutes) 

what is parenteral medication?

injection of medication into body tissues or circulatory system

how does needle gauge size work?

the larger the diamter the smaller the gauge

what do specificy syringe and needle selection depend on?

the type of injection being give and the patient size

what are blunt needles used for?

withdrawing from vials

What is a vial?

• Glass or plastic bottle with self sealing rubber stopper 

• Contains one or more multiple doses of medication

how does one retrieve medication form a vile

• wipe stopper with alcohol swab before each use

• inject air into vial

• turn vial and syring upside down

• withdraw desired amount of medication

how many doses are in an ampule?

one dose- ensure all medication is out of neck

why would you use a filter needle with an ampule?

to prevent risk of small pieces of glass getting into medication

how should you withdraw medication from an ampule?

place on flat surface or turn upside down,

should you inject air into an ampule?

do NOT inject air into ampule as it will break surface tension

how should you get rid of air bubbles in a syringe?

Tap to raise air bubbles out of syringe, then expel them, double check dose after expelling air bubbles

what parenteral route has the longest absorption?

intradermal

when is intradermal medication used?

for allergy tests, TB tests, local anesthesia

how long our intradermal medication needles usually? what is the dose

1/4-1/2 inches/ 26-27 G. <0.5 ml

What is the angle of insertion for an intradermal medication? what is a common insertion site?

5-15 degrees/ bevel up, inner forearm

where are subcutaneous medication inserted?

into adipose tissue just below dermis

what kind of meds are usually given subcutaneously?

insulin, anticoagulants

How big is the needle for subcutaneous administration?

3/8-1 inch, 25-30 G

How much is the dose amount for a subcutaneous medication?

< 1 ml

What is the angle of insertion for subcutaneous medications?

45-90 degrees

where are subcutaneous medications typically inserted?

abdomen, anterior thigh, outer/back of upper arm

what is intramuscular medication administration usually used for?

hormones, vaccines, antibiotics, HAS FASTER ABSORPTION

what is the needle size for intramuscular medication?

5/8-1/5 inches/ 18-25 G

what is the dose amoutn for IM medications (larger musclces, deltoid, children/elderly)

• larger muscles- <5 ml

• deltoid- < 2ml

• children and elderly- < 2 ml

what is the angle of insertion for IM medications?

90 degrees

what sites are used for IM medication administration?

vastus laterlais, ventrogluteal, deltoid

where is the vastus laterlais?

lateral thigh

when is vastus lateralis typically used?

with infants

how do you administer an IM into the vastus lateralis?

divide thigh into thirds horizontally and vertically, administer injection into middle of outer thihg

where is the ventrogluteal sight?

the hip

how should you administer a medication into the ventroglutela site?

place palm of hand on greater trochanter with fingers pointing towards patient’s head

Use R hand for L hip, L hand for R hip

place index finger on anterior superior iliac spine and middle finger on lliac crest

inject between index and middle fingers

what are you at risk for damaging in the deltoid site?

risk for damage to radial nerve

what do you inject into the deltoid typically?

recommended for vaccines

are infants eligible for deltoid vaccinations?

no- not developed enough under 1 year

where is the deltoid injection site?

between acromion process and axilla

how do you clean a parenteral injection site?

circular motion outward from site

what are the steps for injecting a medication?

• Standard precautions (clean gloves) 

• Cleanse site with alcohol pad 

• Circular motion outward from site 

• Inject quickly (dar-like motion) 

• Inject medication 

• Withdraw needle 

• Activate needle cover or retraction device 

• Apply gentle pressure with clean gauze at site 

• Do not massage 

• Dispose of syringe and needle in puncture resisting container without recapping 

• Document 

• Evaluate response to medication 

What should you document after administration?

• Medication name 

• Dose 

• Route 

• Injection site (if applicable) 

• Date and time of administration 

• Nurse’s signature or initials