Medication Administration Part 2

Seven Rights of Medication Administration

  • The seven rights are:
    • Right patient
    • Right medication
    • Right dose
    • Right route
    • Right time
    • Right indication (reason)
    • Right documentation

Medication Orders

  • Medication orders can be written, electronic, verbal, or via telephone.
  • Each order must include:
    • Patient's name
    • Drug ordered
    • Dosage
    • Route of administration
    • Time(s) of administration
  • Common types of orders:
    • Standing orders (longterm)
    • PRN orders (as needed)
    • Single orders (STAT or NOW - one-time order, good until expiration)
  • Important practices:
    • Check three times
    • Educate the patient
    • Only give what you've prepared
    • Write it down and read it back to confirm

Sample Orders and Prescriptions

  • Example of an order: Ciprofloxacin 500 mg for UTI, take 1 tablet by mouth twice a day for 7 days.
  • Example of a prescription: Metformin 500mg, specify route and time; used for Diabetes and PCOS (medication can be used for multiple things).

Right Patient

  • Verification methods:
    • Look: Check the patient's name and DOB.
    • Ask: Use two identifiers to confirm.
    • Compare: Verify information with the medication order.

Patient Identifiers

  • Always use at least two patient identifiers.
  • Wireless barcode scanners are used for safety at the bedside.
  • An extra safety step is to verify allergies.

Barcode Scanning

  • Barcode scanning is required on all medications, vaccines, and over-the-counter (OTC) drugs in healthcare agencies.
  • Benefits of using bar codes:
    • Improves accuracy of patient identification.
    • Alerts for potential medication errors.
    • Improves medical record keeping.
  • All medications need a provider's order and pharmacist approval.

Right Medication

  • A medication order is required for every medication administered.
  • Compare the prescriber’s orders with the medication administration record (MAR) or electronic MAR (eMAR) when the medication is initially ordered.
  • Provide accurate list of meds and compare MAR vs ordered med

Automated Medication Dispensing System (AMDS)

  • AMDS is a variation of unit-dose and floor stock systems.
  • It's secure, provides automatic documentation, and has considerations for controlled substances.
  • If you need to waste medication, make sure someone watches and documents it.

Right Dose

  • Important considerations:
    • Double-checking
    • Using standard measurement devices
    • Splitting and crushing pills (refer to the Do Not Crush List)

Right Route

  • If the route of administration is missing or not recommended, consult the prescriber immediately.
  • Medication errors involving the wrong route are common.
  • Ensure the right route is used every time, especially with IV and feeding tubes.

Routes of Administration

  • The route depends on the medication’s properties, desired effect, and the patient’s physical and mental condition.
  • Collaborate with the prescriber to determine the best route.
  • Non-Parenteral:
    • Oral
    • Buccal
    • Sublingual
    • Topical
    • Transdermal
    • Suppository
    • Inhaled
    • Eye or ear drops
    • Nasal spray
  • Parenteral:
    • Intramuscular (IM)
    • Subcutaneous (SC)
    • Intradermal (ID)
    • Epidural
    • Intravenous (IV)

Right Time

  • Administer according to prescribed dosage schedules.
  • Consider when it is okay to deviate from set dosage schedules.
  • Useful considerations: serum level, therapeutic level.
  • Educate using the teach-back method.
  • Prioritize medications like antibiotics, insulin, anticoagulants, and BP meds.

Right Indication (Reason)

  • Ensure the right medication is given for the right reason.
  • Empower patients by informing them of the medication's purpose.
  • Improve adherence by making sure the patient understands the indication.
  • PRN medications require an indication; always know the indication and educate the patient.

Right Documentation

  • Documentation allows communication and improves medication safety.
  • Always document accurately.
  • Do not document medications until after they are given.
  • Document at the bedside.

Medication Administration Record

  • Includes the patient's information, allergies, active medications (scheduled, continuous, PRN, one-step), and completed medications.

Bonus Right

  • Right Evaluation: Assess if the medication had the desired effect.
  • Patients can refuse medication; educate them but cannot force them.

Medication Distribution Checks

  • Verify medications multiple times:
    • Healthcare provider orders the right drug for the right purpose.
    • Pharmacist ensures the appropriate drug is ordered correctly and provided to the unit correctly.
    • Nurse verifies the drug before administration; verify it 3 times

Three Checks

  • Before removing the container from the supply drawer or shelf.
  • As the amount of medication ordered is removed from the container.
  • At the patient’s bedside before administering the medication to the patient.

Patient and Family Teaching

  • A well-informed patient is more likely to take medications correctly.
  • Thoroughly assess a patient’s learning needs and abilities.
  • Individualize your approach to teaching.
  • Include family caregivers or home care providers in your instruction.
  • Evaluate teaching effectiveness.

Case Study: Mrs. Rossi

  • Mrs. Rossi is a 64-year-old female patient newly diagnosed with hypertension.
  • Furosemide 20 mg by mouth QD has been prescribed.
  • Key actions:
    • Look up the medication in a drug reference book.
  • Considerations:
    • What is the therapeutic effect?
    • What potential other concerns (side effects, adverse effects)?
    • What are some safety considerations for medication administration in the elderly?
    • What assessment should the nurse do prior to administration of this medication?
    • How will the nurse know if this medication is effective?
    • What medication teaching should be done with this client?
  • Furosemide is a diuretic or water pill.
  • Expected therapeutic effects: Diuresis and decreased fluid/edema, decrease in BP.
  • Potential concerns: may worsen or cause hyponatremia, monitor sodium concentrations closely.
  • Assessments: Check BP and pulse, monitor for decrease in edema, decrease in BP, and increase in urinary output.
  • Teaching: Take as directed, diabetics watch blood glucose levels, hypertension lifestyle changes, change positions slowly.

Adverse Reactions and Side Effects

  • Include hypotension, constipation, diarrhea, dehydration, dry mouth, hypocalcemia, nausea, vomiting, hypochloremia, BUN, hypokalemia, hypomagnesemia, excessive urination, hyponatremia, blurred vision, hypovolemia, dizziness, metabolic alkalosis, headache, muscle cramps.