Medication Administration and Calculations

NS A332L Medication Administration and Medication Calculations – Study Notes

Overview of medication administration techniques
Importance of accurate medication calculations
Common routes of administration and their implications
Key formulas for calculating dosages and conversions
Potential side effects and monitoring parameters

Check 1: Verification and Preparation in Medication Room / Cart

Confirm pharmacy has verified the medication order.
Perform hand hygiene.
Open the tray on the side of the medication cart to identify drug locations in the cart.
Check 1: Read the MAR and read the medication label when removing medication from the medication supply system
If medication needs preassessment, place medication in a separate cup. Do not open meds in the med room unless they need to be cut or crushed.
For injections - ensure the appropriate size needle and maintain sterility.
Check 2: Read the label and compare the medication label with the MAR. Check expiration dates and perform calculations, if necessary.
Take meds, supplies, and MAR to the patient bedside.

Check 2: At the Patient’s Bedside – Initial Patient Contact and Identification

In the patient room, Knock, introduce yourself, perform hand hygiene, provide for privacy
Identify the patient. Compare the information with the MAR. The patient should be identified using at least two of the following methods:
- On the patient’s identification band: Check the name; Check the identification number; Check the birth date
- Ask the patient to state their name and birth date.
Check the patient’s allergy bracelet, ask the patient about allergies, verify against MAR or patient chart.
Complete necessary assessments before administering medications.
Explain the purpose and action of each medication.
Scan patient’s identification band.

Check 3: Final Verification and Preparation for Administration

Check 3: Read label and recheck label against MAR prior to administration. Right patient, right medication, right time, right dose, right route, right reason, and expiration date of all medications.
Raise bed to an appropriate height.
Assist the patient to an upright position.
Maintain privacy.

Oral Medication Administration

Steps for oral medication administration:

Scan Medication.
Offer water or liquid of preference.
Remain with the patient until each medication is swallowed.
Never leave medication(s) at the patient’s bedside.

Ophthalmic Medications (Eye Drops)

Steps for ophthalmic medication administration:

Scan Medication.
Offer patient a tissue.
Have patient tilt head back slightly, look up at the ceiling.
Use thumb or two fingers to pull lower lid down and expose the lower conjunctival sac.
Invert the container used to instill eye drops.
Hold the dropper close to the eye, avoid touching eyelids or lashes.
Squeeze the container to instill the prescribed number of drops into the lower conjunctival sac.
Release the lower lid after instillation.
Have the patient close eyes gently.
Repeat the process in the opposite eye.
Remove gloves.
Perform hand hygiene.

Transdermal Medications

Steps for transdermal medication administration:

Scan Medication.
Assess the patient's skin placement site; ensure area is clean, dry, and free of hair.
Remove old transdermal patches. Fold the old patch in half with adhesive sides sticking together and discard.
Gently wash the area.
Remove the new patch from its protective covering and remove the covering of adhesive surface without touching the adhesive.
Apply the patch to the patient’s skin.
Use the palm of your hand to press firmly for a minimum of 30 seconds.
Use fingers to press edges firmly to the skin.
Remove gloves.
Perform hand hygiene.
Initial and write the date and time of administration on a piece of medical tape.
Apply the tape to the patient’s skin (do not write directly on the medication patch).

Injectable Medications – General Administration

Steps for general injectable medication administration:

Select an appropriate administration site, identify the appropriate landmarks.
Cleanse the area around the injection site with an antimicrobial swab.
Use a firm, circular motion while moving outward from the injection site.
Allow the area to dry.

Injectable Medications – Specific Routes and Techniques

Injectable Medications: ID (intradermal): 5{-}15^\text{o} angle

SQ (subcutaneous):
- If < 1 inch of adipose tissue, use a 45^\text{o} angle
- If > 1 inch adipose tissue, use a 90^\text{o} angle
IM (intramuscular): use a 90^\text{o} angle

Injectable Medications (post-injection steps):

Remove needle cap.
Inject medication.
Remove needle at the same angle inserted.
Engage needle safety.
Discard needle in sharps container.

Insulin pen procedures:

Gently roll or invert pen 10 times.
Scrub self-sealing seal end of the pen with an alcohol swab.
Apply needle.
Remove caps.
Prime pen.
Dial dose, administer medication.
Hold pen in place for 10 seconds following medication administration.
Remove needle at the same angle inserted.
Discard needle in sharps container.
Remove gloves and perform hand hygiene.

Post-Administration – Comfort, Positioning, and Call Light

Assist the patient to a comfortable position. Place the bed in the lowest position. Place call light in reach.

Key Concepts and Repeats

The process emphasizes verification at multiple points: with the MAR, with the medication label, and with the patient’s identification band.
The 7 rights (patient, medication, time, dose, route, reason, expiration) are explicitly checked during Check 3 and again prior to administration.
Patient safety steps include: hand hygiene, privacy, proper room procedures, and ensuring the patient is understanding the purpose and action of each medication before administration.
Specific administration techniques are dictated by route, including appropriate needle angles, aseptic technique, and correct handling of patches and eye drops.

Practical Associations and Why These Steps Matter

Verifying order and label alignment prevents wrong drug errors and dosing mistakes, a leading cause of adverse medication events.
Reading MAR and checking expiration dates prevent unsafe or outdated medications from being given.
Skin integrity and site preparation for injections reduce infection risk and ensure proper absorption of the medication.
Documenting administration (initials, time) provides traceability and accountability for patient safety.

Equations and Notations (with LaTeX)

Angles for injections:
- Intradermal (ID): 5^\text{o} \text{ to } 15^\text{o}
- Subcutaneous (SQ):
- If < 1 inch adipose tissue: 45^\text{o}
- If > 1 inch adipose tissue: 90^\text{o}
- Intramuscular (IM): 90^\text{o}
Time for insulin pen hold after dose: 10 \text{s}