Medication Administration Notes

Nurse Responsibilities

• Critically think through the task.

• Follow protocol.

• Advocate for the patient.

• Question what you don't know.

10 Rights of Medication Administration

• Right client: Verify the client’s identity using two client identifiers (e.g., client's name, date of birth, or medical record number).

• Right medication: Confirm the name and form of the medication is correct.

• Right dose: Check the medication you have against the order in the medical record. Clarify the dose with the provider if in doubt.

• Right route of administration: Confirm the route (IV, IM, SC, etc.). Use the route intended by the provider.

• Right time of delivery: Confirm the time the drug is to be given and the last time the drug was administered. Time-critical medications (e.g., insulin, antibiotics) should be administered within 30 minutes of their scheduled time.

• Right documentation: Document the time the drug was given and any pertinent remarks immediately after administration.

• Right Assessment: Confirm that the medication is appropriate for the client’s condition. Assess contraindications, pertinent lab results, vital signs, allergies, and possible medication interactions.

• Right to refuse: Client has the right to refuse the medication. Investigate the reasons for refusal, attempt to dispel any fears or misconceptions, and notify the provider. Make the appropriate documentation in the client’s medical record.

• Right Education: Provide adequate education addressing what medication the client is taking, expected benefits, and side effects. Explain why the medication has been prescribed and which side effects they need to report.

• Right Evaluation: Observe the client’s response to the drug. Evaluate the effect of the medication.

Nursing Process & Clinical Judgment

• Recognize Cues (Assessment/Data Collection)

• Analyze Cues and Prioritize Hypothesis (Diagnosis)

• Generate Solutions (Planning)

• Take Actions (Implementation)

• Evaluate Outcomes (Evaluation)

Names of Medications

• Brand (trade) name: The name given to a medication by the pharmaceutical company, prominently displayed on packaging.

• Generic name: The name of the active ingredient in the medication, often in smaller print alongside the brand name.

Reading Medication Labels

• Brand Name and Generic Name

• Dosage Strength

• Form of Medication

• Directions for Use

• Expiration Date

• Warnings and Precautions

• Storage Instructions

Types of Prescriptions

• Routine Prescriptions: Prescribed for a specific time or frequency.

  • Examples: daily, twice per day, three times per day, four times per day, at bedtime/hour of sleep, every other day, weekly, or monthly.

• Standing Prescriptions: Protocol-based and contain a list of directives to implement in specific situations.

  • Example: A critical care unit has standing prescriptions to treat a client who has asystole.

• Single (One-Time) Prescriptions: One-time doses, such as those seen with preoperative medications.

• Stat Prescriptions: Immediately one time. Should be administered within 30 minutes of the provider placing the prescription.

• PRN Prescriptions: Prescription specifies the medication, dose, route, frequency, and reason indicating its implementation. Use clinical judgment and the client’s subjective report.

• Urgent or Now Prescriptions: Urgent, now, or ASAP (as soon as possible) prescriptions should be administered within 30 minutes to 1 hour after the provider’s prescription.

Prescription Components

• Date and time the prescription was written

• Client’s full name

• Name of the medication.

• Indication.

• Dose: amount, times or frequency of administration, and strength.

• Route of administration.

• Dispensing instructions related to quantity, directions for the client, refilling parameters, and any special cautions (such as to not take with food).

• Provider’s signature

Serum Drug Concentration

• Peak: Highest concentration of medication in an individual.

  • Timing of measurement depends on route of administration:

    • Intravenous (IV): 15-30 minutes

    • Intramuscular (IM): 30-60 minutes

    • Oral: ~60 minutes

• Trough: Lowest concentration of medication in an individual.

  • Measured immediately before the next dose.

• Therapeutic Index

Additional Patient Rights Related to Medication Administration

• Right to refuse: Client has the right to refuse the medication.

• Right assessment: Confirm that the medication is appropriate for the client’s condition.

• Right education: Provide adequate education addressing what medication the client is taking, expected benefits, and side effects.

• Right response/evaluation: Observe the client’s response to the drug.

Medication Administration Routes

• Oral Route

  • Most common route. Involves swallowing medications (pills, liquids).

  • Advantages: Convenient, safe, and non-invasive.

  • Disadvantages: Delayed onset of action, drug degradation in the digestive tract.

  • Examples: Tablets, capsules, syrups.

• Sublingual and Buccal Route

  • Sublingual: Under the tongue.

  • Buccal: Between the cheek and gum.

  • Advantages: Rapid absorption, bypasses digestive system.

  • Disadvantages: Limited to certain drugs.

  • Examples: Nitroglycerin (sublingual), testosterone (buccal).

• Transdermal Route

  • Patches applied to the skin for systemic absorption.

  • Advantages: Sustained release of medication over time.

  • Disadvantages: Slow onset, potential skin irritation.

  • Examples: Nicotine patches, hormone replacement therapy patches.

• Inhalation Route

  • Medications delivered directly to the lungs.

  • Advantages: Rapid absorption, ideal for respiratory conditions.

  • Disadvantages: Requires proper technique.

  • Examples: Inhalers (asthma), nebulizers.

• Topical Route

  • Application on the skin or mucous membranes.

  • Advantages: Localized effect, minimal systemic absorption.

  • Disadvantages: Limited to certain areas.

  • Examples: Creams, ointments, eye drops.

• Parenteral Routes

  • Intramuscular

  • Subcutaneous

  • Intradermal

  • Intravenous (IV)

• Rectal Route

  • Medication administered via the rectum.

  • Advantages: Useful for patients unable to take oral medications.

  • Disadvantages: Variable absorption, discomfort.

  • Examples: Suppositories, enemas.

Common Prescription Abbreviations

• bid: twice per day

• tid: three times per day

• qid: four times per day

• q (e.g., q8h): every (e.g., every 8 hours)

• PRN: as needed

• IM: intramuscular

• IV: intravenous

• Subcut: subcutaneously

• SL: sublingual

• PO: by mouth

• NPO: nothing by mouth

• pc: after meals

• ac: before meals

Look-Alike and Sound-Alike Medications

• Look-alike medications: cycloserine (used in the treatment of tuberculosis) and cyclosporine (an immunosuppressant).

• Sound-alike medications: cetirizine (an antihistamine) and sertraline (an antidepressant).

Common Medication Errors

• Administering the wrong medication

• Administering the wrong medication strength

• Calculating the dose or infusion rate incorrectly

• Administering the medication to the wrong client

• Administering a medication by the wrong route

• Administering medication at the wrong time

• Administering a medication when the medical record indicates the client is allergic to it

• Administering a medication beyond its expiration date

• Erroneously discontinuing a medication or an IV fluid infusion

Adverse Reactions to Medications

• Mild: Drowsiness

• Severe: Anaphylaxis, dysrhythmias, cardiovascular failure.

• Dermatological: Tingling, hives, itching, flushing, warmth

• Respiratory: Bronchospasm, edema, dyspnea, cough, wheezing, cyanosis

• Gastrointestinal: Dysphagia, abdominal cramping, vomiting, diarrhea

• Cardiovascular: Hypotension, tachycardia, palpitations, syncope, cardiac arrest

• Neurological: Anxiety, coma