medication administration
Medication Administration Overview
Terminology
MAR: Medication Administration Record
EMAR: Electronic Medication Administration Record
Bar Code Administration: A process using barcodes to track medications to enhance safety in medication administration.
Chemical Name: The scientific name that describes the chemical composition and molecular structure of a drug.
Generic Name: The non-proprietary name of a drug that is universally accepted.
Trade Name: The brand name under which the drug is marketed.
Classifications
Medications: Classified based on: - Method of Action Against Diseases: Classified by their pharmacological effect on bodily systems. - Chemical Composition: Grouped based on chemical properties. - Clinical Indications: Based on the therapeutic effects intended by the clinical use. - Therapeutic Classification: Describes the therapeutic target of the medication. - Pharmacologic Classification: Groups medications based on their mechanism of action, with similar indications, precautions, and nursing implications.
Medication Actions
Therapeutic Effect: The intended beneficial effect of a medication.
Side Effects: Undesired effects that typically occur alongside therapeutic effects.
Tolerance: Reduced effectiveness of a drug due to prolonged use, requiring increased dosages to achieve the original effect.
Toxicity: The degree to which a substance can damage an organism; harmful effects on health.
Idiosyncratic Effect: An abnormal or unexpected response to a drug, unique to an individual.
Severe Adverse Effect: A serious unintended reaction to a drug that may require discontinuation or special management.
Allergic Reaction: An immune system response to a substance that may be harmful or life-threatening.
Anaphylactic Reaction: A severe, potentially life-threatening allergic reaction that requires immediate medical intervention.
Adverse Effects
Synergy/Synergism: Enhanced effect when two drugs are used together compared to the action of each drug alone.
Antagonists/Antagonism: When one drug reduces or counteracts the effect of another drug.
Incompatibility: A condition where two substances, when mixed, do not combine well and can produce undesired effects.
Teratogenic Effects: Drugs that can cause developmental anomalies in a fetus when taken during pregnancy.
Medication Dose Response Terms
Onset: Time taken for the medication to take effect after administration.
Duration: The length of time the medication remains effective in the body.
Peak: The time at which the drug concentration is at its highest and the effect is greatest.
Trough: The lowest concentration of a drug in the bloodstream before the next dose is administered.
Plateau: The stable level of drug concentration in the bloodstream after repeated dosing.
Plasma Concentration: The amount of drug present in the plasma at a given time.
MEC (Minimum Effective Concentration): The lowest concentration at which a drug produces its desired therapeutic effect.
Therapeutic Window: The range between the MEC for a desired response and the MEC for an adverse response.
Half-Life: The time taken for the plasma concentration of a drug to reduce to half its initial value.
Lag Period: The delay before the drug starts to exert its pharmacological effect.
Therapeutic Range: The concentration range in which a drug is effective without being toxic.
Medication Orders
Types of Orders: - Routine Order: A standing order implemented until canceled. - Standing Order: Medication orders administered continuously until specified conditions are met. - PRN (Pro Re Nata): Medications given as needed based on specific parameters. - BTP (Breakthrough Pain): Medications administered for sudden, intense episodes of pain. - Single Order: A one-time medication order. - Stat: An order for immediate administration of a medication.
Telephone or Verbal Orders: Orders received orally that should be documented carefully to ensure accuracy.
Medication Reconciliation: The process of comparing medications the patient is currently taking with new medications ordered to prevent errors.
Medication Administration Essentials
Triple Check Process: - First Check: Verification when reaching for the medication. - Second Check: Verification of the dose while holding the medication. - Third Check: Final verification before administration.
Three Checks (distinct from the triple check): - Verify the medication order. - Check patient's allergies. - Confirm medication expiration date.
Six Rights of Medication Administration
Right Drug: Verify the correct medication is being administered.
Right Dose: Confirm the correct dosage as prescribed.
Right Route: Ensure the medication is given via the correct route (e.g., oral, IV).
Right Time: Administer the medication at the correct time intervals.
Right Patient: Verify the identity of the patient receiving the medication.
Right Documentation: Accurately document all medication administration and responses.
Routes of Medication Administration
Sublingual (SL): Under the tongue.
Buccal: Between the gum and cheek.
Enteral (FT): Via the gastrointestinal tract.
Inhalation: Sprayed into the respiratory tract.
Topical: Applied directly to the skin.
Transdermal (TD): Medication absorbed through the skin via patches.
Ophthalmic: For use in the eyes.
Otic: For use in the ears.
Nasal: Administered in the nostrils.
Rectal: Inserted into the rectum.
Vaginal: Inserted into the vagina.
Parenteral: Administered via injection or infusion, bypassing the gastrointestinal tract: - Subcutaneous: Injected into the tissue layer between the skin and muscle. - Intramuscular (IM): Injected deep into a muscle. - Intravenous (IV): Administered directly into the bloodstream. - Epidural: Injected into the epidural space of the spinal cord. - Intrathecal: Injected into the spinal canal.
Patient’s Rights in Medication Administration (Ethical Considerations)
Right to Information: Patients should be informed about their medications and treatment options.
Right to Refuse: Patients have the right to refuse any medications.
Right to Careful Assessment: Patients are entitled to a meticulous evaluation before medication administration.
Right to Informed Consent: Patients should consent to treatment with a full understanding of the implications.
Right to Safe Administration: Assurance that medications are administered safely and correctly.
Right to Supportive Therapy: Patients should receive assistance for symptom management and care.
Right to No Unnecessary Medications: Avoid administering medications that are not medically necessary.
Pre-Administration Assessment
Comprehensive evaluation involving: - Medication History: Past and current medication use. - Allergies: Documented allergic reactions to previous medications. - Current Medication List: Review to avoid drug interactions. - Diet History/Diet Order: Consider dietary factors that may affect medication absorption. - Neurological Problems: Assess neurological function as needed for medication action. - Current Condition: Evaluate the patient’s presenting condition for appropriateness of prescribed medications. - Lab Values: Relevant laboratory results that affect medication choices. - Physical Assessment: Thorough examination of the patient’s overall physical condition.
Evaluation
Timing: When to evaluate medication effectiveness and safety. - Determine Therapeutic Effect: Assess whether the medication is providing the desired outcome. - Determine Adverse Effects: Monitor for any negative side effects generated by the medication.
Special Considerations in Medication Administration
Polypharmacy: The concurrent use of multiple medications which increases the risk of adverse effects.
Misuse: Incorrect or improper use of medications.
Non-adherence/Non-compliance: Patients failing to take medications as prescribed.
Vitamins, Supplements, and Over The Counter (OTC) Medications: Potential interactions with prescribed medications must be considered.
Age-related Considerations: Adjustments may need to be made for pediatric and geriatric patients due to differing pharmacokinetics and dynamics.
General Administration Principles
Medications should remain in their individual dose packaging until just before administration.
Only the professional who prepared the medication should administer it.
Medications must not be left unattended to avoid unauthorized access or errors.
Medication Security: Proper protocols to protect and manage medications securely.
Verification of administration must be strict.
Unused medications should be disposed of according to established regulations.
Medications can be withheld based on clinical assessments and in collaboration with the physician.
Controlled Substances
Regulated by Federal Law: Stricter laws govern the prescription, dispensing, and administration of controlled substances.
Who Can Prescribe?: Only licensed professionals under specific regulations can prescribe controlled substances.
Specific Record Keeping: Detailed documentation required for all transactions involving controlled substances.
Procedures: Guidelines for dispensing and wasting controlled substances must be followed meticulously.
Medication Errors
Incidence of Medication Errors: Approximately 1.5 million medication errors that lead to harm are reported annually.
Phases Where Errors Occur: - Ordering: Errors in the prescribing phase may occur due to illegibility or misunderstanding. - Transcribing: Poorly documented orders can lead to incorrect medications being administered. - Dispensing: Mistakes during the preparation and delivery of medications to patients. - Administering: Errors made during the final phase of giving medications to patients.
Causes of Errors: Can result from human factors or inadequate systems in medication management.
Factors Leading to Administration-Related Medication Errors
Complexity of Medication Regimens: Multi-drug treatments can lead to confusion and mistakes.
Lack of Staff Training or Experience: Insufficient knowledge and skills can contribute to errors.
Poor Communication: Between healthcare staff regarding medication orders or changes.
Insufficient Time: Rushing due to heavy workloads can lead to oversight.
Inadequate Documentation: Missing or incomplete records can impact administration.
Processes and Systems to Reduce Errors
TallMAN Letters: Use of mixed-case letters to enhance the differentiation of drug names that are often confused.
High Alert Medications: Identification and management of drugs that have a higher risk of causing harm if misapplied.
Dual Verification: Involvement of two qualified professionals in verifying medication orders or administration to minimize errors.