Medication Administration Notes

Medication Administration

Unit III Overview: Medication Administration

• Upon completing this unit, students should:
  • Demonstrate medication preparation proficiency and safety.
  • Recognize common abbreviations and terminology in medication administration.
  • Demonstrate proficiency in reading medication labels.
  • Use the SIX RIGHTS to administer various medications:
    • Identify the RIGHT CLIENT.
    • Select the RIGHT MEDICATION.
    • Select the RIGHT DOSE.
    • Administer via the RIGHT ROUTE.
    • Identify the RIGHT TIME.
    • Complete the RIGHT DOCUMENTATION.
  • Demonstrate Medication Administration Records (MARS) usage.
  • Identify proper actions for special circumstances in medication administration.
  • Recognize the role of parent/guardian consent for medication administration to children or non-competent adults.

Overview of Medication Administration

• "Drug" and "medication" are often used interchangeably.
  • A drug is a chemical substance altering client function, potentially helpful or harmful.
  • "Medications" commonly refer to drugs with therapeutic or helpful effects.
  • This course uses "medication" for drugs treating clients.
• Administering medications is a critical responsibility requiring great care.
  • It requires undivided focus to prevent errors and potential harm.
  • Avoid distractions during preparation and administration.
  • Do not interrupt the task unless there is an emergency because starting and stopping can cause errors.
  • Administer medication to one client at a time to prevent mix-ups.
  • Mark your place in the MAR before moving to another client.
• Provide an 8 oz. cup of water with medications.
  • A sip of water beforehand may ease swallowing.
  • Assist clients in taking pills one or two at a time, based on their preference.
  • Encourage clients to drink a full cup of water after swallowing medications to ensure they have moved into the stomach and to stay hydrated.
• Prioritize giving medications to clients who do not need assistance first.
• Before administering medications, check for specific information like pulse, blood pressure (BP), or blood sugar readings.
  • Whether to give or hold medication will be based on assessment data.
  • Example: Hold digoxin if pulse is 60 or below; follow agency instructions to report to supervisor.
• Administering oral medications requires awareness of absorption rates.
  • Absorption rate varies based on stomach content and digestive problems.
  • Never administer oral medications to a client who is vomiting; delay until they feel better and can keep medications down.
  • Report delays beyond the allotted time to your supervisor.

Types of Medication Preparations

• Medications come in various forms, which will be listed on the MAR.

Medication Orders

• Four types of medication orders:
  • Routine orders: Given on a routine basis (e.g., every morning at 10 AM).
  • PRN orders: Latin pro re nata, meaning "as needed or necessary".
    • For medications needed periodically, like pain relievers, cough syrup, or laxatives.
    • Include minimum time between doses, listed on the MAR.
    • Example: A medication to be given every 4 hours (q4h) cannot be given unless 4 hours have passed since the last time the client has taken the medication.
    • Report client’s pain to supervisor to be evaluated further.
  • One time orders: Given only once at a specific time and then discontinued.
  • STAT orders: Given immediately or NOW.
    • Must have clear written instructions on the MAR including client, medication, dose, route, and time.
      NOTE: Medication Aides are not to accept verbal or telephone orders. The designated agency person must transfer medication orders from the written prescription documents to the MAR in order for the Medication Aide to administer medications.

Controlled Substances

• Controlled medications are kept locked, often in a special drawer or cabinet.
• The Comprehensive Drug Abuse Prevention and Control Act, 1971, tracks certain medications like depressants, stimulants, narcotics, or medications that may be abused.
• When giving controlled substances, verify the amount listed on the controlled substance list before removing medication, known as "the count".
• Agencies use systems to track:
  • Amount delivered from pharmacy.
  • Amount on hand at shift start.
  • Amount used (given to client).
  • To whom (client) it was given.
  • Who (Medication Aide) gave it.how much was left.
• Record why a client received a PRN controlled medication, such as pain.
• Document the amount of medications removed and count/record the remaining medications.
• Controlled substances are periodically counted, usually at shift changes, and you may be held responsible for missing medications on your shift.

Medication Label

• Individually labeled medication bottles include:
  • Client's full name (RIGHT CLIENT)
  • Name of medication (RIGHT MEDICATION)
  • Strength and amount to be given (RIGHT DOSE)
  • Directions on how to take (RIGHT ROUTE)
  • Directions about when to take, including frequency (RIGHT TIME)
  • Prescriber's name (usually a physician)
  • Issue (dispensed) date
  • Expiration or discard date
  • Pharmacy prescription serial number
  • Name, address, and phone number of issuing pharmacist
  • Quantity dispensed
• Auxiliary labels provide information like "shake well."

Approximate Equivalents Among Measurement Systems

• Liquids (volume):
  • 5 \text{ ml} = 1 \text{ teaspoon}
  • 10 \text{ ml} = 2 \text{ teaspoons}
  • 15 \text{ ml} = 1 \text{ Tablespoon}
  • 30 \text{ ml} = 1 \text{ ounce}
  • 500 \text{ ml} = 1 \text{ pint}
  • 1000 \text{ ml} = 1 \text{ liter} = 1 \text{ quart}
  • 4000 \text{ ml} = 1 \text{ gallon}
• Be alert for decimal points and note that ml (milliliter) does not equal mg (milligram).
• The preferred unit of dispensing liquid medications is using milliliter (ml) or cubic centimeter (cc), which are the same volume. \text{1 cc = 1 ml}
• Use medical measuring devices like medicine cups or metered syringes made for oral medications.
  • Do not use household teaspoons for measurements as they are inaccurate.

Six Rights of Administering Medication

• Safety and accuracy are crucial.
• Medication Aides must always ask these questions:
  1. RIGHT CLIENT
  2. RIGHT MEDICATION
  3. RIGHT DOSE
  4. RIGHT ROUTE
  5. RIGHT TIME
  6. RIGHT DOCUMENTATION

RIGHT CLIENT

• Identify the client each time you give medications.
• Agencies use methods like:
  1. Checking the armband (scanning the ID band).
  2. Matching a photo on the MAR.
  3. Asking the client to state their first and last name or ID number (not “Are you…?”).
• If clients have similar names, have an alert on the MAR (e.g., using date of birth).
• Do not use room numbers as an identifier.
• Keep the MAR with medications until they are taken to prevent errors.
• Many agencies' policy is to take the MAR into the room for the final medication check before giving medications.
• After taking the MAR into the room, be sure it is returned to its correct place when you document the medication has been given.

RIGHT MEDICATION

• Never give medications from memory; always refer to the MAR.
• Perform THREE medication checks:
  1. Check when removing the container from storage.
  2. Check as you pour or open the package.
  3. Check when returning the container to storage or just before giving.
• Ensure medication name, dose, time, and route on the label match the MAR.
• If a client is to receive medications that have been dispensed to them, they must have them in the original bottle with the complete label present.
• Be alert for similar sounding names for medications.
• Never give medication prepared by someone else or that you find at the client's bedside.
• Never give medications that you cannot identify by a written medication label.
• If the client questions the medications, STOP and CHECK the MAR again before giving it. If in DOUBT, ask your supervisor.
• Do NOT BORROW medications from another client.

RIGHT DOSE

• Compare the medication label to the MAR.
• Example: If digoxin 0.25 mg is to be given, and the supply is digoxin 0.125mg, two tablets must be given to equal the RIGHT DOSE.
• A 0 should always precede a decimal but should not follow a decimal.
  • Example: 0.125 mg is correct, not .125 mg. 1 mg is correct, and MAR should not read 1.0.
• Do not mix up ml (milliliter) and mg (milligram).

RIGHT ROUTE

• Route refers to the method of administration (e.g., oral, ear, eye, skin).
• Common routes for medications given by Medication Aides:
  • Oral Routes:
    • Oral (PO): Placed in the mouth and swallowed.
      • Certain people cannot take oral medications:
      • cannot swallow well. clients who do not have a gag reflex and choke easily
        • are confused
        • refuse to take medications by mouth
        • are not to have anything by mouth - NPO ,nothing per oris, nothing by mouth
    • Sublingual: Placed under the tongue to dissolve and be absorbed quickly.
      • The client is not to swallow this tablet, nor to smoke, drink or eat while this tablet is under their tongue.
    • Buccal: Placed between the cheek and gums to dissolve/be absorbed.
      • The client is not to swallow this tablet, nor to smoke, drink or eat while this tablet is in the cheek.
  • Topical Route:
    • Can deliver medication directly to the area needing treatment or they may allow medication to be absorbed to affect the entire body.
    • Areas: skin, eyes, ears, nose, throat, vagina, and rectum.
    • Some topical medications affect the entire body, such as patches.
  • Inhalation Route:
    • Delivers medication to the lungs through an inhaler or aerosol.
    • One way this medication is taken is with an inhaler and a tube that is called a "spacer" or a disc device that allows the powdered form of the medication to be pushed toward the back of the mouth and inhaled.

RIGHT TIME

• Administer medication at the time stated on the MAR and medication label.
• Agencies set standard administration times.
  • bid (twice a day) might be 10 am and 10 pm.
  • before (a.c.) or after (p.c.) meals should be 30 min. before or after meals.
• Once-a-day medications should be given at the same time each day.
• Do not give medication too early or too late.
• Each agency has a limited time window (e.g., 30 minutes to one hour before or after the stated time).
• Always check the time of the last PRN dose before administering a new dose.

RIGHT DOCUMENTATION

• "If it is not documented, it is not done."
• Use the Medication Administration Record (MAR) or medication log.
• Document immediately after administering medications.
• Do not chart medication as "given" before the client takes it (pre-charting).
• Document the date and time the medication was given on the MAR.
• Ensure entries are clear, accurate, and complete, using the agency-approved ink color.
• Don't erase or cover errors; follow agency policy to correctly document.

Initials and Signature

• Initial and sign the signature sheet to associate your name with your initials on the MAR.
• Sign designated page only ONCE per sheet, per month (varies by agency policy).

Documenting PRN Medications

• Record the reason medication was given (symptoms the client reports, signs you see).
• Use only agency-approved abbreviations and follow agency policy.
• Be sure that a nurse or other designated agency personnel responsible for assessment has been involved in determining the need for, and effectiveness of, PRN medications if required by your agency policies and procedures.

Medication Administration Records (MARS)

• A licensed person prescribes the medication.
• The medication order is transcribed onto the MAR by someone specified by the agency.
  DO NOT EVER GIVE MEDICATIONS FROM MEMORY !!!

Three Medication Checks

1. When removing the medication from where it is stored.
2. Just before or after opening the medication and preparing it for your client.
3. Before giving the medication to the client.

• Always double check that you have prepared all the medication that should be given at the designated time as listed on the MAR.

• The MAR is designed to promote safe and accurate medication administration.

• MARs should include:

  • client's name (RIGHT CLIENT)
  • room or bed number (if applicable)
  • agency number (if applicable)
  • medication name (RIGHT MEDICATION)
  • strength of dose or amount of medications to give (RIGHT DOSE)
  • date and time to be given (RIGHT TIME)
  • route to be given (RIGHT ROUTE)
  • date the order was written
  • date the order expires
  • client's allergies (if they have any)
  • special instructions
  • reason why PRN medicine is being given (for example PRN medication "for headache")
  • initials of the personnel transcribing the physician's order to the MAR

• ALWAYS ask your supervisor about anything on the MAR that they do not understand or that is not clear, to keep from making medication errors. Remember, if in doubt, ASK.

• Whenever medications are given, the Medication Aide will need to initial the MAR under the right time and date know as RIGHT DOCUMENTATION.

• Medication Aide needs to document on the MAR that the medication was given (RIGHT DOCUMENTATION).

Special Instructions

• Medications may have special instructions on the medication label and the MAR.
• ASK your supervisor prior to preparing that client's medications if there are instructions you do not understand.
• Examples:
  • Shake the medication well.
  • Keep the medication refrigerated.
  • Have the client drink a full glass of water with this medication.
  • Have the client take the medication on an empty stomach or before eating.
  • Have the client take the medication with food.
  • Have the client take the medication after eating.
  • Do not take the medication with certain foods.
  • Instruct the client not to eat or drink for 30 minutes after taking the medication.
  • Have the client sit up for ½ hour after taking the medication.
  • Crush the medication and mix it with a food product, such as applesauce or pudding.

Special Circumstances

Liquid Medications

• Liquid medications come in many forms - solutions, suspensions, syrups and elixirs.
• Solutions consist of one or more drugs dissolved in water.
• Suspensions are preparations of finely divided, un-dissolved medication in liquid, usually water.
• Syrups are watery, sugar-based solutions used to disguise unpleasant tasting medications.
• Elixirs are medication mixed in alcohol solutions and sweetened with pleasant flavoring; people who are not to take alcohol should not take an elixir.
• Shake well before pouring.
• Hold the label under your hand to protect it from spills.
• Use the correct measuring device, not household measurements.
• Measure liquids on a flat, level surface at eye level.
• Administer liquids in a separate cup from pills and tablets.
• When giving liquid medication to an adult or a child, be sure they are sitting upright or the head of the bed is elevated.
• Use an oral syringe and gently squeeze the medication between the client's teeth and their cheek, which allows them to swallow it easier.
• Squeeze small amounts of liquid at a time, stopping to rest between. This allows the client to more easily swallow the medication and makes it less likely that they will spit it out or get choked.

Oral Syringes

• If the dose is less than 5 cc (the smallest measurement on the side of the metered medicine cup) you cannot get an accurate measurement using the medication cup, and will need to use an oral syringe.

• Also a syringe needs to be used when administering odd amounts of medication (such as 8 ml) that may not be clearly marked on the metered medication cup.

• Use an oral syringe for doses less than 5 cc or for unmarked amounts to ensure accuracy.

• Remove the cap before putting the syringe in the client's mouth to prevent choking.

• If a medication comes with a special dropper, use that dropper ONLY when giving that medication.

  • Be careful and note if the measurements on the dropper are in mg or ml and prepare your client's dose appropriately.

• Draw up the accurate dose of medication, and put it into a medication cup to deliver it to the client.

• Do not use the dropper to give the client the oral medication because that will contaminate the dropper and in turn contaminate the remaining liquid medication.

• Smaller children can be given their medication with a pacifier dispenser.

• Become familiar with the measurement devices used by your agency.

• Cultural differences can affect medication administration (e.g., Chinese soupspoons being larger than Western teaspoons).

Cutting Medications

• Use a pill cutter to divide scored pills (those with a line down the middle).
• Discard unevenly cut pills and clean the cutter after use.
• Pills that are not scored should not be cut because the two pieces may not have equal doses.

Crushing Medications

• Crush pills only if instructed on the MAR, not by personal decision.

• Use clean tools (mortar and pestle or pill-crushing device) and clean them after use.

• Mix crushed medication with a small amount of food like applesauce or pudding to mask bitterness.

• Do not leave medication in foods unattended.

• Note not all medications cannot be cut or crushed.

• Do not ever cut or crush a pill that has an enteric (hard shell) coating, a capsule, or a pill that is sustained release or time released.

Special Needs

• Some clients such as older adults, mentally disabled clients, and young children, may have special needs when taking medications.
• Allow more time for clients needing additional assistance.

Difficulty Swallowing

• Older adults with swallowing difficulties may also require thickened liquids for medication administration.
• If the client is not able to swallow the pill or crushed pill in food, contact your supervisor, RN, pharmacy, or the physician's office for ideas of alternate methods of administration.

Administering Medications to Children

• Children younger than 5 years old are too young to swallow a pill and will need a different type of the medication.
• Use only the measuring device provided with the medication, to be sure the correct amount of medication will be delivered.
• Agency must have a written order from a physician and a current permission form with the parent's signature.
• Specific instructions must be part of the instructions provided with the medication.
• A good policy is NEVER to give a medication that has not been given by the parent at home first, in case there is a reaction to the medication.
• Both prescription and over-the counter medications should be in the original container from the drug store, which includes all the parts of the label.
• All medications should be in childproof containers and stored in a LOCKED container/cabinet/drawer.
• Prior to administering the medications, check to make sure it is not expired.
• Explain to the parent or guardian how you will administer the medication so they can understand and assist you.
• Gently hold the child's chin and slowly inject the medication along the side of the mouth between the gums and the cheek, which prevents the child from choking and from spitting out the medication.
• If you are not sure whether a medication has been swallowed, ask the client to open their mouth and check to see if the medications have been swallowed.
• Always document the medication administration on the Medication Log or other documentation forms.

Allergies

• Medication Aide is responsible for looking at the MAR before medication administration.
• Types of allergic reactions:
  • Hypersensitivity: Mild signs and symptoms including rash, hives, and itching.
  • Anaphylaxis: Symptoms: Shortness of breath, wheezing, noisy breathing, fast heart rate, and low blood pressure.
• Adverse drug reactions:
  • An adverse drug reaction (ADR) is any unwanted response to a medication, including an exaggerated or absent response and unusual or dangerous side effects that require treatment.
  • Report anything unusual to your supervisor, giving a clear description about the client's response to medications or any unusual behavior or signs of illness that you notice.