Study Notes on Medication Administration and CPE Process

Overview

  • Discussion surrounding the administration of medication for nursing students in a clinical lab.

Materials Provided for Clinical Performance Evaluation (CPE)

  • Three sheets of paper:
    • Two laminated sheets, one non-laminated.
    • The non-laminated sheet referred to as the IS bar.
  • IS Bar:
    • Contains essential information about the patient and the medications to be administered.
  • Doctor's Orders:
    • Written instructions from the physician about patient care and medications.

Timing and Procedure for CPE

  • The CPE has a maximum time limit of 20 minutes.
  • The timer only begins after reading the IS bar and doctor's orders.
    • Recommended reading time: 2-3.5 minutes.
  • After reading, clinical judgement and critical thinking are required to calculate dosages and procedures for medication administration.

Patient Case Example

  • Patient: JB, 64-year-old male, Room 234 at Galen Clinical Lab Hospital.
  • Diagnosis: Bacterial infection at the wound site.
  • Past Medical History: Includes atrial fibrillation.
  • Vital Signs:
    • Temperature: 97.8°F
    • Blood Pressure: 142/78 mmHg
    • Pulse: 78 bpm
    • Respiratory Rate: 18 breaths/min
    • SpO2: 100% on room air.
  • Pain Level: 7 out of 10 at the wound site.
  • Wound Status: Clean, dry, intact with small serous drainage.
  • Time for medication: 07:30.

Six Rights of Medication Administration

  • The critical elements to remember when administering medication:
    1. Right patient
    2. Right medication
    3. Right dose
    4. Right route
    5. Right time
    6. Right documentation
  • Importance of verbal confirmation between student nurse and instructor (teach-back method).

Verification Process

  • Need to verify patient information:
    • Multiple forms of patient identifiers are referenced (name, date of birth, allergies).
  • Confirm that the orders match with the medication administration record (MAR).
  • Context is provided to confirm that only medications due for administration at the stipulated time (07:30) are to be given.
    • Example: Keflex, Heparin, Morphine are medications being reviewed.

Medication Administration Guidelines

  • Emphasizes academic integrity:
    • Discussing administered medications during CPE with peers is strictly prohibited and may lead to academic violations.
  • Acknowledges the importance of understanding the pharmacological action and side effects of medications prescribed.
  • Specific instructions for giving injections and oral medications as well as performing verification checks during the administration process.

Medication Preparation and Administration Process

  1. Medication Check:
    • Ensure that the pulled medication matches the MAR for dosage and timing.
    • The importance of examining expiration dates on medications.
  2. Drawing Up Heparin:
    • Calculate volume required using conversion between units and milliliters.
    • Use of a blunt-tip needle for drawing up medications, with the emphasis on not utilizing the same needle for injections.
  3. Patient Interaction:
    • Introduction to the patient, hand hygiene, and verification of patient identity.
    • Discussion of side effects and instructions regarding the medications to be administered.
    • Example exchanges discussed regarding the specific medications (Heparin and Keflex) that clarify what the medications are for, potential side effects, and administration techniques.

Documentation

  • Immediate documentation post-administration is critical; it acts as proof that the medication was given.
  • In the MAR, include initials but do not write the time explicitly since it will already be assumed based on the 07:30 administration time.
  • Responsible for maintaining accurate and complete medical records for each patient.

Conclusion

  • Importance of following protocols for patient care and receiving instruction properly.
  • Be aware of the gravity of failing to follow the medication administration standards as it can lead to significant health risks.
  • Reinforcement of the idea that neglecting proper medication administration can lead to serious consequences in clinical practice.