Ten

Week 10 Medication Administration Notes

Date and Instructor

  • Date: November 3, 2025

  • Instructor: Lauralee Ballash

Land Acknowledgement

  • Acknowledgement of the traditional territories and peoples that influence the practice of nursing and healthcare.

Lab Lecture Learning Objectives

  • Purpose and Preparation of Medication Administration Safety Screen (MASS)

    • Understand the goals and processes for ensuring medication administration safety within the Faculty of Nursing.

  • Medication Administration Routes

    • Demonstrate knowledge of different routes including:

    • Oral

    • Topical

    • Eye

    • Suppository

    • Inhaled

  • Registered Nurse Responsibilities

    • Identify valid medication orders.

    • Adhere to the 10 rights and 3 checks of medication administration.

    • Recognize and avoid unsafe abbreviations in medication orders.

  • Documentation Elements

    • Discuss essential components to include in medication administration documentation.

Key Concepts

  • Patient Safety: Emphasizes the importance of caring, compassion, critical thinking, and strict attention to patient safety in medication administration (Kilgour).

Medication Administration Safety Screen (MASS)

  • MASS is a systematic approach to ensure safe medication practices in nursing.

College of Registered Nurses of Alberta (CRNA) Standards

Medication Management Standards (December 2022)

  • Standard 1: Safety

  • Standard 2: Authority

  • Standard 3: Knowledge

  • Standard 4: Ethics

Policies and Standards Related to Medication Administration

  • Faculty of Nursing Clinical Policies and Scope of Practice Guidelines for Undergraduate Nursing Students (on Canvas)

  • Patient Identification Policy (AHS, 2020)

  • Do Not Use Abbreviations Policy (AHS, 2023)

    • Emphasizes the avoidance of specific abbreviations that could lead to medication errors.

  • Medication Reconciliation Policy (AHS, 2019)

  • Controlled Substances Policy (AHS, 2022)

  • Independent Double Check Policy (AHS, 2022)

  • Medication Management Standards (CRNA, 2021)

Clinical Policies for Nursing Students

  • Students may perform certain activities under supervision when:

    • They have received formal education and training.

    • The clinical instructor deems them competent.

    • The clinical agency permits the action.

    • The activity falls within the RN's scope of practice.

    • It is not a specialized procedure requiring certification (e.g., chemotherapy).

    • Most restrictive policies apply in cases of conflicting policies.

  • Supervision levels must be clearly understood (direct vs. indirect).

Case Study: Mr. Springer

  • Patient Profile:

    • 38 years old male

    • Admitted with severe abdominal pain.

    • Medical History: Previous orthopedic issues, no known allergies.

    • Current Medications:

    • Hydrochlorothiazide 25 mg PO for hypertension

    • Acetaminophen 325-650 mg PO for pain as needed

    • Polyethylene glycol 17 g PO for bowel regularity

    • Sennosides as needed at bedtime

    • ECASA 81 mg daily for heart health

Rights of Medication Administration

  • Total Rights Considered: 10 rights of medication administration.

    • Right Drug

    • Right Dose

    • Right Client

    • Right Time

    • Right Route

    • Right Frequency

    • Right Reason

    • Right to Know (Education)

    • Right to Refuse

    • Right Documentation

    • Additionally, rights of assessment, site, technique, approach are emphasized in practice.

Importance of Patient Interaction

  • Establish rapport with the patient before administering medications. Example:

    • Sample Interaction: Greeting Mr. Springer and introducing oneself, confirming patient identity using name and birthdate, checking armband, and explaining medications and their purposes.

Three Checks of Medication Administration

  1. Compare the medication label to the Medication Administration Record (MAR) while removing the drug from storage.

  2. Compare the medication label to the MAR during drug preparation.

  3. Compare the medication label to the MAR after returning the drug to storage.

  • Important Note: Always complete the 3 checks and 10 rights prior to administering any medications (Kilgour, 2020).

Patient Identifiers (AHS Patient Identification Policy PS-06)

  • Use the following to confirm patient identity prior to providing services:

    • Both first and last name (considered one identifier).

    • Full date of birth.

    • Unique lifetime identifier (ULI).

    • Medical Record Number (MRN).

    • Patient ID barcode.

    • Photograph where applicable.

Co-signing Medications

  • Certain medications require co-signatures from a regulated healthcare professional. Specific drugs include:

    • All IV medications

    • Controlled substances

    • High alert medications

    • Pediatric fractional dosages

Independent Double Check Process

  • Involves two healthcare professionals verifying the medication without communication until both have completed the check.

High Alert Medications

  • Defined as drugs with a significant risk of causing severe harm when administered incorrectly (Kilgour). The ISMP categorizes these medications due to their potential for significant patient harm. Examples include:

    • Anesthetics (e.g., ketamine).

    • Anticoagulants (e.g., heparin, warfarin).

    • Chemotherapy agents (e.g., cisplatin).

    • Electrolyte solutions (e.g., potassium).

    • Opioids (e.g., hydromorphone).

Adverse Drug Events

  • Defined as clinical injuries occurring from incorrect medication administration or the lack thereof (Kilgour).

Medication Administration Record (MAR)

  • Essential documentation that includes:

    • Date and time of administration.

    • Name of medication administered.

    • Route of administration.

    • Patient's response and observed effects.

Medication Order Components

  • Must include:

    • Patient’s full name and identification number.

    • Date and time when the order was written.

    • Medication name.

    • Dose to be administered.

    • Route of administration.

    • Time and frequency of administration.

    • Prescriber’s signature.

Prohibited Abbreviations and Symbols

  • Certain abbreviations have been identified as dangerous and should NEVER be used in medication orders:

    • U: For 'unit', should be written out.

    • IU: For 'international unit', should be written as 'unit'.

    • QD: For 'daily', should be replaced with 'daily'.

    • CC: For 'cubic centimetre', should use 'mL' or 'millilitres'.

    • Trailing zeros should be avoided to prevent dose errors.

Medication Administration Errors

  • Shortcuts: Prepoured medications can lead to errors due to failure in safety checks.

  • Communication: Clear orders must be obtained; neglect in addressing patient questions leads to increased risk.

  • Attention to Distractions: Distractions while administering medication must be minimized.

  • Patient Identification: Always confirm patient identity through armband checks.

Routes of Medication Administration

  • Oral: Preferred method, presented in various forms (liquid, tablet, etc.).

  • Topical: Applied to skin/mucous membranes for local/systemic effects.

  • Instillation: Various routes including nasal, eye, and rectal.

  • Inhalation: Medication enters lung airways for rapid absorption.

Documentation Requirements

  • Essential documentation includes:

    • Date and time of medication administration.

    • Route used for administration.

    • Patient's response and observed effects.

Medication Reconciliation (AHS Policy PS-05)

  • A structured process in healthcare for accurate transfer of medication information, especially at transitions of care.

Name Variations of Medications

  • Trade Name: Specific to a pharmaceutical company.

  • Generic Name: A less expensive version with the same active ingredients.

Med Distribution Systems

  • Unit Dose: Medications are provided in specific individual doses.

  • Ward Stock: General stock available within hospital wards.

  • Automatic Dispensing: Automated systems that distribute medications.

Practice Problem

  • Calculation Example: If a medication of 50 mg is to be administered and comes in a strength of 25 mg per 2 mL, calculate the required volume in mL to be given: Answer: 4 mL.

Medication Reconciliation Situations

  • Situations that require reconciliation include patient admissions, discharges, or transfers.

Matching Game for Terminology

  • 1. High Alert Medication

  • 2. Controlled Substance

  • 3. Adverse Drug Event

  • 4. Medication Reconciliation

  • 5. Three Checks

  • 6. Independent Double Check

  • Answers provided: Definitions matching each term to examples or scenarios.

References

  • Gregory, D., Raymond, C., Patrick, L., & Stephen, T. (2020). Fundamentals: Perspectives on the art and science of Canadian nursing. Wolters Kluwer.

  • Kilgour, K.N. (2020). Principles of medication administration.