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Medication Administration Notes: 10 Rights, Safety, Dosage Calculations, and Abbreviations

Medication Administration Lecture Notes

  • Course context and objectives

    • Purpose of the week: review the 10 rights of medication administration and prep for dosage calculation and conversions
    • Systems of measurement and household-to-metric conversions reviewed next lecture; dosage calculation conversion factors discussed today
    • Emphasis on types of medications, timing/scheduling, and hands-on practice during clinicals and labs next term
    • Attendance and participation reminders (camera on, presence)
    • Upon successful completion of this module (week’s lecture, lesson, assignments), you will be able to identify dosage measurement systems, perform conversions, and calculate medication dosages
    • ATI dosage calculation and self-medication administration module is required; you’ll do one module (dosage calculation and safe medication administration) and upload a report; grade from that module contributes to the assignment grade
    • ATI quizzes are not proctored or timed; study from ATI modules for the most accurate information
    • Lecture emphasizes that this information is foundational for NUR 125 Fundamentals and your future nursing practice

  • Key message: this is the most important lecture for safe medication administration and has long-term career relevance

The 10 Rights of Medication Administration

  • Right patient

  • Right medication

  • Right dose

  • Right time and right frequency

    • Time considerations: e.g., scheduled times (e.g., BID, TID, QID, Q8H), morning vs. noon vs. night dosing, and hospital routines

  • Right route

    • Examples: oral (PO), intravenous (IV), intramuscular (IM), subcutaneous (SQ), sublingual (SL), buccal, rectal, inhalation, transdermal, etc.

  • Right documentation

  • Right indication (purpose of the medication)

  • Right to refuse

  • Right evaluation (assessing effectiveness after administration)

  • Right education and information (patient and family informed about the medication)

  • Notes on the 10 rights

    • These rights encompass patient safety, proper drug use, and informed consent/education
    • Right indication is emphasized: often a medication has a single, specific approved use; giving a medication for an off-label or unintended indication without physician direction can cause harm or professional penalties
    • Right to refuse is a patient rights consideration; exceptions exist for certain populations (e.g., some mental health situations); if refusal occurs, discuss with the physician and document appropriately
    • Evaluation involves checking for expected outcomes (e.g., pain relief, fever reduction, symptom improvement) within a clinically appropriate time frame
    • Education includes explaining what the med does, potential side effects, and answering patient/family questions; providing printed information from EMAR when available

Verification and patient safety practices

  • Two identifiers before any medication administration
    • Common identifiers: patient name and date of birth; sometimes medical record number (MRN) on the ID band; room number is not a reliable identifier (changes, may not reflect correct patient)
    • Additional safeguards: barcode scanning of patient ID band and medication label; cross-check with EMAR and patient record
    • Always verify at least two identifiers; you can check more, but never rely on just one
  • Medication reconciliation and order verification
    • Verify the physician’s order against the medication label and the patient’s information
    • When a new medication appears in the EMAR, verify the order and educate the patient; printouts from the EMAR can be given to patient and family
  • Roles of pharmacists and scanning systems
    • Pharmacists review medications to catch prescribing and transcription errors before dispensing
    • Scanning of medications prior to administration helps detect mismatches and prevents wrong-drug errors
    • EMAR (electronic medication administration record) supports real-time documentation and reduces missed or duplicated doses
  • The scope of medication safety errors
    • Medication errors harm approximately
    • 1.5 imes 10^6
      people annually
    • In 2020, approximately 7{,}000 ext{ to } 9{,}000 patients died due to medication errors; the majority of those errors were associated with nursing administration, though errors can originate in prescribing and dispensing as well
  • Safeguards in practice
    • “Scan, verify, administer” cycle; ensure label matches the patient and the order
    • Do not document administration before giving the medication; documentation should occur after administration
  • Real-world scenario: safe medication administration video example
    • Demonstrates reviewing MAR, verifying two identifiers, cross-checking the medication label, confirming allergies, and providing patient education
    • Emphasizes asking questions before administration and offering opportunities for the patient to ask questions

Measurement systems, dosage calculations, and ATI guidance

  • Review of systems of measurement tomorrow; focus today on dosage calculations and conversion factors
  • Dimensional analysis and conversion factors
    • Use conversion factors to cancel units and reach the desired units (dimensional analysis) — essential for converting between mg, mL, g, etc.
    • Example concept (not from the video, but foundational): if you need to convert from mg to mL, you multiply by a conversion factor that relates the two units, ensuring units cancel appropriately
  • Weight-based dosing in pediatrics
    • Pediatric dosing often requires weight-based calculations; patients can vary widely in weight (e.g., 4 lb to 90 lb) and dosing must be tailored accordingly
  • Practice resources and strategies
    • ATI: open up under Assessments -> dosage calculation and safe medication administration; complete the lesson, then the quiz, then upload the report; your quiz grade reflects your assignment grade
    • Practice questions can be generated with rationale to show step-by-step reasoning; you can use AI tools (e.g., ChatGPT, Copilot) to generate practice questions with rationale
    • Tutoring services (Learning Center) are available for math/medical math help
  • Practical approach to dosage calculation in this course
    • This course covers basic dosage calculation; more complex calculations (and dimensional analysis with multiple conversion factors) appear in upper-level courses
    • In real practice, you may use calculators and computer systems to perform calculations; understand the underlying concepts and how to verify results
  • Common calculation approaches
    • Dose on hand × (desired concentration / available concentration)
    • Dimensional analysis to ensure correct units and prevent errors
  • The role of technology in calculations
    • Many facilities use electronic systems to perform or verify calculations; always double-check outputs and ensure the order matches the MAR

Routes, onset, and pharmacokinetic principles

  • Routes and their typical onset and duration
    • Intravenous (IV): fastest onset
    • Intramuscular (IM): rapid onset, shorter duration than some routes
    • Subcutaneous (SQ): slower onset, often used for vaccines or weight-loss medications (e.g., Wegovy, Ozempic)
    • Sublingual (SL) and buccal: rapid absorption via highly vascular tissues
    • Rectal: relatively fast absorption; can be unreliable due to content retention or expulsion
    • Inhalation: rapid absorption through lungs; inhalers and nebulizers managed by respiratory therapy in many facilities
    • Transdermal: slow, sustained release; patches or creams for long-acting effects
  • Oral forms and formulation considerations
    • Tablets, capsules, caplets, and powders; some formulations are enteric-coated to protect the stomach; do not crush enteric-coated pills
    • Elixirs and syrups (liquids) for patients who cannot swallow pills; some liquids require reconstitution (aquisolutions or aquisuspensions)
    • Capsules often code for time-release formulations
  • Special considerations with administration timing
    • Time-critical medications (e.g., insulin before meals) require coordination with blood glucose monitoring and meal timing
    • STAT medications: intended to be given immediately; typically trigger pharmacy alerts and are prioritized in emergencies or codes
    • On-call medications: ordered for a specific procedure or situation (e.g., pre-procedure anxiety or sedation)
  • Oral administration timing abbreviations (hospital shorthand)
    • AC: before meals
    • PC: after meals
    • BID: twice daily (often around 9:00 AM and 5:00 PM in hospital schedules)
    • TID: three times daily (commonly 9:00 AM, 1:00 PM, 5:00 PM)
    • QID: four times daily (e.g., 9:00 AM, 1:00 PM, 5:00 PM, 9:00 PM)
    • Q8H: every 8 hours (around the clock)
    • QD or daily: typically around 9:00 AM; exceptions exist for home-time dosing or special orders
    • PRN: as needed, with a defined time frame
    • qXH notation (Q8H, Q12H, etc.) specifies interval and hour of administration
  • Other common abbreviations and terms
    • IM: intramuscular
    • IV: intravenous
    • SQ or SQ: subcutaneous
    • ID: intradermal (e.g., tuberculin test)
    • SL: sublingual
    • PO: by mouth (capsules, tablets, lozenges, liquids)
    • NPO: nothing by mouth (often before procedures or if bowel rest is required)
    • ID: intradermal (skin testing or TB testing)
    • PC and AC as noted above
    • INH and other route-specific abbreviations appear in practice; always verify with facility policy
  • Practice for injections and administration technique
    • IM injections use a relatively long needle (often 1.5 ext{ inches}) and a 90-degree angle; ensure you avoid hitting bone; lifting tissue may help the needle reach muscle
    • Subcutaneous injections use shorter needles (often around 1 inch) at a 45-degree angle; pinch the tissue to lift it away from underlying muscle for older or lean patients
    • Do not dart injections; aim for slow, controlled insertion to reduce patient discomfort and improve accuracy
    • Intradermal injections create a small wheel or bleb under the skin (e.g., tuberculin test)
  • Special injection considerations
    • Intravenous injections: sight into the vein, then advance to ensure proper entry and flow; future sessions will include IV start techniques
    • Weighing the patient and anatomy when choosing needle length and site
    • High-alert and safety considerations in injections to prevent tissue damage or infection (e.g., osteomyelitis from bone injury)

Patient education, consent, and post-administration evaluation

  • Educate the patient and family about the medication
    • Communicate in lay terms; provide printed information when possible
    • Confirm understanding and address questions prior to administration
  • Documentation after administration
    • Document in the EMAR or appropriate system after administration; do not delay documentation
    • Track dose, time, route, and any adverse effects observed
  • Right evaluation after administration
    • Reassess the patient to determine if the medication achieved the intended effect (e.g., pain reduction, fever control)
    • Distinguish evaluation from unrelated observations (e.g., asking about nausea when the med was for pain)
  • Patient rights and ethical considerations
    • Right to refuse medication; if patient refuses, obtain clarification and involve the physician to adjust as appropriate
    • For some populations (e.g., certain mental health scenarios), other policies may apply; always follow legal and institutional guidelines

Practical takeaways and exam-ready tips

  • Build a strong mental checklist around the 10 rights and the two-identifier rule; practice with real MARs and EMARs
  • Use the ATI modules as your primary source of detail for dosage calculations and safe medication administration
  • Practice dosage calculations with rationale to understand each step; consider using AI tools for extra practice questions and explanations
  • Remember common abbreviations and their typical hospital meanings, but verify with your institution’s policy (abbreviations can vary by facility)
  • Review pharmacokinetics concepts like peak, trough, and time to onset; understand how these influence dosing schedules and patient safety
  • Always consider patient-specific factors: age/weight, organ function, comorbidities, current medications, and potential drug interactions
  • When in doubt, delay administration to verify order accuracy and patient safety; seek clarification from a pharmacist or physician when needed
  • The broader goal: minimize medication errors across the prescribing, dispensing, and administration chain to protect patients and support safe clinical practice

Quick glossary of key terms (with practical meanings)

  • ext{BID}
    ightarrow ext{twice daily}
  • ext{TID}
    ightarrow ext{three times daily}
  • ext{QID}
    ightarrow ext{four times daily}
  • ext{Q8H}
    ightarrow ext{every 8 hours}
  • AC
    ightarrow ext{before meals}
  • PC
    ightarrow ext{after meals}
  • PRN
    ightarrow ext{as needed} (with a defined time frame)
  • IM
    ightarrow ext{intramuscular}
  • IV
    ightarrow ext{intravenous}
  • SQ
    ightarrow ext{subcutaneous}
  • ID
    ightarrow ext{intradermal}
  • SL
    ightarrow ext{sublingual}
  • PO
    ightarrow ext{by mouth}
  • NPO
    ightarrow ext{nothing by mouth}
  • Enteric-coated
    ightarrow ext{do not crush; protects stomach lining}

Ethical and professional implications (brief reminders)

  • Medication safety is a shared responsibility among prescribers, pharmacists, nurses, and patients

  • Documentation integrity protects patients from double-dosing and therapeutic errors

  • Respect patient autonomy: informed consent and the right to refuse must be honored with appropriate physician involvement

  • Continuous improvement: use learning resources (e.g., ATI modules, pharmacist consultations) to stay current on best practices

  • Optional contextual notes from the instructor

    • The instructor emphasized the importance of hands-on practice during clinicals to fully integrate theory with practice
    • Personal anecdotes highlighted the evolution of healthcare technology and safeguards (electronic orders, pharmacist involvement, barcode scanning)
    • The instructor shared real-world frustrations with poor practice (e.g., unsafe administration in nursing homes) to underscore safety importance

  • References to future topics in the course sequence

    • Systems of measurement and conversions reviewed tomorrow
    • More on dosage calculations, conversion factors, and pediatric weight-based dosing to come in later terms