Medication

Medication Administration Guidelines

• Timing: Medication may be given within thirty minutes of the scheduled dose.

The Right Route and Documentation

• ERCO: Verifying the proper route to administer the medication (e.g., QIN, IV, sublingual).

• Documentation: Ensure proper documentation of medication administration.

Three Checks of Medication

• The three checks during medication administration include verifying the:

  • Right drug

  • Right dose

  • Right route

  • Right time

• When using the Pyxis, verifying should occur before leaving for administration and after leaving the med room.

• Importance of checking for errors from the pharmacy, particularly if the wrong medication is in the Pyxis.

Patient Verification

• Before administering medications, confirm:

  • Right patient

  • Medications are packaged appropriately for the patient (in baggies, etc.)

• At the bedside, ensure scanning of medications to confirm correctness in the system, including any warnings about underdosing or overdosing.

Administration of Parenteral Medications

• Definition: Administration by injection into body tissue, which is an invasive procedure using aseptic technique.

• Skills Required: Different injections require different skills depending on the type of injection.

Types of Syringes and Needles

• Syringes: Various syringes are designed for specific volumes and tissue types.

• Components: Includes plunger, barrel, and tip.

• Needle Types:

  • Blunt Needle: Used for drawing medication from a vial.

  • Injection Needle: Specific to the type of injection (IN, intradermal, etc.).

  • Gauge Sizes: Vary from 18 to 26; larger gauge = smaller diameter. Color coding aids identification (e.g., pink = 28 gauge).

Medication Measurement and Administering

• Suspensions: Check if cutting pills is needed to ensure proper dosing.

• Aseptic Technique: Avoid contamination:

  • Do not touch the plunger or syringe end.

  • Use disposable syringes appropriate for the medication type.

Injection Techniques by Injection Type

Intravenous (IV) Therapy

• IV Medication Assessment: Inspect hanging IV fluids to ensure correct medication and settings.

• Assessment Frequency: Ensure to check IV sites every hour to catch complications early (e.g., extravasation).

• Signs of Complications:

  • Infiltration: Swelling, leaking at IV site, coolness, and tenderness.

  • Phlebitis: Localized inflammation characterized by redness, warmth, and possible induration. Includes appropriate intervention like warm compresses and notifying the physician.

  • Colloquialism (infiltration of caustic medications): This could lead to necrosis.

Intramuscular Injections (IM)

• Common Sites:

  • Deltoid (shoulder)

  • Ventrogluteal (hip)

  • Vastus lateralis (thigh)

• Gauge Sizes and Lengths: For IM injections, typically use an 18–27 gauge, with lengths from 1 to 1.5 inches, injected at a 90-degree angle.

• Volume: Typical volume for IM is 1 to 3 mL; if over 3 mL, divide into two injections at different sites.

• Z-Track Method: Reduces discomfort and leakage.

Subcutaneous (SubQ) Injections

• Common Sites: Abdomen (1-2 inches from the navels), back of the arms, and thighs.

• Techniques: Inject at 45-90 degrees, ensuring the skin is pinched.

• Gauge Sizes: Usually 25 to 31 gauge; needle length typically ranges from 3/8 to 5/8 inches.

Intradermal Injections

• Uses: Typically for allergy tests; common site is the inner forearm.

• Technique: Inject at a 10-15 degree angle, ensuring to create a wheal (bubble).

• Syringe Size: Utilize a TB syringe (26-27 gauge).

Insulin Administration

• Type of Syringes: Use insulin syringes specifically, variations exist based on units (30, 50, 100 units).

• Double Verification: Insulin is considered a high-risk medication; must always be verified by a second nurse.

• Types: Rapid, short, intermediate, and long-acting insulin; must know onset, peak, and duration to manage blood glucose effectively.

• Insulin Characteristics: Cloudy insulin requires gentle rolling (do not shake).

• Reconstitution: When using powdered medications (e.g., steroids), properly mix according to vial instructions.

IV Push Medications

• Timing for Push: Resources indicating how long to push specific medications (e.g., some require a minute, others five).

• Compatibility in Administration: Ensure medications being connected through IV are compatible.

• Flushing: Importance of flush after medication; this will vary by institution.

Tubing Set-Up for IVs

• Primary and Secondary Tubing: Ensure the primary bag is hung lower than the secondary bag to avoid incorrect flow rates.

• Compatibility Checking: Important to verify compatibility of medications before administration through an IV pump.

• Labeling and Documentation: Always label IV t/primary lines including date, initials, and required changes.

Final Considerations

• Competencies: Have a clear understanding of each medication administered, patient education, and monitoring.

• Practical Skills: Encourage hands-on practice with supervision, especially during skills validation periods and when preparing for clinical exams, including using checklists for validation.