Responsible Drug Administration chapter 7 pharmacology

Skills & Responsibilities of Drug Administration

• Adequate and Up-to-Date Information: Requires being thoroughly informed about all medicines to be administered, including their indications, contraindications, dosages, side effects, and potential interactions. This includes staying updated with the latest research and guidelines.

• Wisdom and Judgement: Requires accurately assessing patient needs by considering their overall health, medical history, and current condition. It also involves evaluating responses to medicine, recognizing adverse reactions, and planning appropriate interventions. Critical thinking and clinical reasoning are essential.

• Skill in Delivery: The administration of drugs must be meticulous, adhering to the correct techniques for each route of administration (e.g., intravenous, intramuscular, oral). Proper documentation including the date, time, drug, dose, route, and patient response is also necessary.

• Patient Education: Providing comprehensive information to patients including the name of the medication, its purpose, how and when to take it, potential side effects, adverse reactions, and interactions with other medications or foods. Tailor the education to the patient's level of understanding and provide written materials as needed.

Familiarity with Medications

• Healthcare professionals should be thoroughly familiar with the medications they administer, including their pharmacokinetics, pharmacodynamics, and therapeutic uses.

• In an office setting, providers typically prescribe a limited range of drugs regularly, allowing them to gain expertise with these medications.

• Drug representatives often promote new medications by providing information and samples, but providers may prefer familiar options due to their established efficacy and safety profiles.

• Insurance coverage can be a significant barrier to prescribing new drugs, especially if they are expensive and not yet widely accepted by insurance companies. Prior authorizations may be required.

• Providers often stick with established medications due to their proven effectiveness, lower cost, and to avoid potential insurance issues and patient confusion.

Dealing with Unfamiliar Drugs

• Never administer a drug without being thoroughly familiar with it, including its indications, contraindications, warnings, precautions, adverse effects, dosage, and administration.

• Consult reliable resources such as the Physician's Desk Reference (PDR), reputable online resources like AHFS Drug Information and USP DI, package inserts, drug formularies, and pharmacists.

• Before administration, know all precautions, contraindications, and potential interactions with other medications, foods, or supplements that the patient may be taking.

Patient Assessment

• Assessment involves taking a patient's history and evaluating their condition before administering any drug to identify potential risks and contraindications.

• A comprehensive plan includes assessment, interventions, and evaluations of drug therapies to optimize patient outcomes and minimize adverse effects.

• Gather the patient's complete history, including medical problems, allergies (drug, food, environmental), current medications (prescription and over-the-counter), herbal supplements, and illicit drug use.

• Assess a patient's vital signs (temperature, blood pressure, pulse, respiration), posture, skin color, skin temperature, and facial expressions before and after drug administration to monitor for adverse reactions or therapeutic effects.

Safe Administration Practices

• Safe drug administration requires proper training in medication delivery methods, including oral, intravenous, intramuscular, subcutaneous, and topical routes.

• Administer pills from a medicine cup with water rather than directly from hand to mouth to prevent contamination and ensure accurate dosing.

• Maximize drug effectiveness while minimizing patient discomfort by using appropriate techniques and considering patient preferences.

• Consider patient-specific challenges, such as difficulty swallowing (dysphagia), impaired mobility, or cognitive deficits, and adapt administration techniques accordingly.

• If a patient can't swallow or a medication cannot be crushed, consult with a pharmacist or physician to consider alternate dosage forms (e.g., liquid, suppository) or routes (e.g., transdermal, injectable).

• Always trust the patient's experiences, and listen to their difficulties and concerns regarding medication administration, such as pain, anxiety, or side effects.

Patient Considerations & Difficulties

• Always trust the patient and take the patient's difficulties into consideration. For example, if a patient says they cannot swallow a pill, do not try to trick them; instead, explore alternative formulations or routes of administration.

Patient Education

• Patient education is essential for safe and effective drug administration and to promote medication adherence and prevent errors.

• Patients must understand how to take medications correctly, including the correct dosage, timing, and method of administration, as well as potential side effects and interactions.

• Provide verbal and written instructions in a language they understand, using clear and simple terms, and demonstrate techniques such as using an inhaler or administering an injection.

• Ensure instructions are clear and avoid potential misinterpretations by using standardized instructions and asking the patient to repeat the instructions back to you.

• If there are multiple ways to do colonoscopy preps, do not give all ways on one sheet to avoid confusion; prioritize the most appropriate method based on the patient's individual needs and preferences.

Moral, Ethical, and Legal Responsibilities

• Administering medications involves moral, ethical, and legal responsibilities to ensure patient safety and well-being.

• Rules and regulations may vary by institution and jurisdiction, so consult those in authority, such as supervisors or legal counsel, when in doubt.

• Always document medication administration and patient education accurately and completely in the patient's record, including the date, time, drug, dose, route, and any adverse reactions or patient concerns.

Medication Errors (CPOE)

• Computerized Provider Order Entry (CPOE) systems help reduce errors by ensuring prescriptions are legible, accurate, and complete, and by providing decision support tools such as drug interaction alerts.

• CPOE helps avoid issues related to bad handwriting, misinterpreted abbreviations (periods looking like ones), and provider distractions by standardizing the ordering process and providing prompts and reminders.

Medication Errors

• Administering drug to the wrong patient due to misidentification or lack of verification.

• Giving the wrong drug due to similar packaging or confusion with drug names.

• Administering the drug via the wrong route (example: ear drops given in the mouth) due to a lack of attention to detail or improper labeling.

• Administering the drug at the wrong time, such as giving a medication that should be taken on an empty stomach with food.

• Wrong dosage due to incorrect calculations or misinterpretation of the medication order.

• Improper/wrong documentation, such as failing to record the date, time, drug, dose, route, or patient response to the medication.

If a Mistake is Made

• Immediately alert someone. Immediately alert your supervisor or whoever's in charge so that corrective action can be taken to mitigate the potential harm to the patient.

• Patient's records need to reflect what corrective action has been taken for justification in case of legal proceedings, and an incident report also needs to be done as a legal requirement to document the error and identify contributing factors.

• Failure to report errors appropriately jeopardizes the patient's welfare and increases the possibility of a civil suit and loss of certification.

Reporting Medication Errors

• The US Pharmacopoeia (USP) established the MER Program (Medication Error Reporting Program) to collect and analyze medication error data and identify trends and patterns.

• The Institute for Safe Medication Practices (ISMP) is a patient safety organization with error reporting programs for vaccines and medications, providing recommendations for preventing future errors.

Medication Reconciliation

• Medication reconciliation compares a patient's current medications to those ordered by the provider to identify discrepancies and prevent potential adverse drug events.

• Patients should bring a list of their medications, including supplements and over-the-counter drugs, to appointments to ensure accurate reconciliation.

• The goal is to ensure the patient is not on the same medication twice, that there are no contraindications or drug interactions, and that all medications are appropriately prescribed.

• According to the Joint Commission, medication reconciliation involves five steps: develop a list of current meds, develop a list of medications to be prescribed, compare the medicines on the two lists, make clinical decisions based on the comparison, and communicate the new list to caregivers and the patient.

Principles of Administration: Preparing Medications

• Maintain cleanliness in the preparation area to prevent contamination and ensure patient safety.

• Wash your hands thoroughly with soap and water before preparing medications to reduce the risk of infection.

• Keep medications and supplies organized in appropriate areas to prevent errors and ensure efficient workflow.

• Prepare medications in a well-lit area away from distractions to minimize the risk of errors.

Six Rights of Medication Administration

• Right medication to ensure the patient receives the correct drug for their condition.

• Right amount to ensure the patient receives the appropriate dose of the medication.

• Right time to ensure the medication is administered at the optimal time for therapeutic effect.

• Right route to ensure the medication is administered via the correct route for absorption and distribution.

• Right patient to ensure the medication is administered to the intended individual.

• Right documentation to ensure accurate and complete record-keeping of medication administration.

Right Medication and Dosage Form

• Never give medications when the name is obscured or illegible, as this increases the risk of errors.

• Compare the medication on hand to the medication order to ensure they match exactly, including the name, strength, and dosage form.

• Be aware of drugs with similar names but different effects, e.g., NovoLog and NovoLin 70/30, and use strategies like "tall man lettering" to differentiate them.

• Use strategies like "tall man lettering" to differentiate similar-looking drug names and reduce the risk of confusion.

• Be aware that some medications have both capsule and tablet forms with different uses, e.g., hydroxyzine (Atarax vs. Vistaril), and understand the indications for each form.

• If questions arise due to handwriting, misspelling, or potential allergies/interactions, question the provider or pharmacist to clarify the order and ensure patient safety.

• Never give medications prepared by someone else, as this increases the risk of contamination or errors.

• Never leave medications at the bedside unless ordered by the provider, as this can lead to unsupervised self-administration and potential overdose.

• Return medications if the patient cannot take them or refuses them, and discard opened medications to maintain sterility and prevent misuse.

• Do not open a unit dose pack until the patient is ready to take the medicine to prevent contamination or degradation of the medication.

Right Amount

• Ensuring the right amount is crucial because drug dosing can be very dangerous and can have serious consequences if administered incorrectly.

• Carefully look at the packaging, bottle, and unit dose to ensure accuracy and that the correct concentration and volume are being used.

• Recheck doses expressed in decimals or fractions to prevent errors due to misplacement of the decimal point.

• Alert someone if the dose is less than half a tablet or more than two milliliters, as this may indicate an error in the order or preparation.

• Medication administrators have the right and the responsibility to question any dosage that is unusual or seems inappropriate to ensure patient safety.

Right Time

• Giving drugs at the right time is important for maximum effectiveness and to maintain therapeutic blood levels.

• Some drugs must be given on a prescribed schedule to maintain a therapeutic blood level and prevent fluctuations that could lead to toxicity or reduced efficacy.

• Medications may be prescribed at regular intervals around the clock or before/after meals (AC/PC) to optimize absorption and minimize interactions with food.

Right Route

• The route of administration may need to be changed based on the patient's condition, such as if they are unable to swallow or have impaired absorption.

• The administration route cannot be changed without a physician's order to ensure that the new route is appropriate for the medication and the patient's condition.

• Even changing to a smaller needle requires a physician's order due to potential molecular breakdown of the medicine, as the smaller needle may not be compatible with the medication's formulation.

Right Patient

• Check the patient's wrist identification before administering medication to verify their identity and prevent errors.

• Call the patient by name or ask them to state their name to confirm that you have the correct individual.

• Use barcode scanning to verify that you have the right patient and medication by matching the barcode on the medication package to the barcode on the patient's wristband.

Documentation

• Document every medication given in the patient's record, including the dose, time, route, and injection location, to create an accurate and complete record of medication administration.

• Note any unusual or adverse events, such as allergic reactions or side effects, to track and manage potential complications.

• For PRN medications, document the effectiveness of the medication to evaluate its efficacy and adjust the treatment plan as needed.

• The person administering the medication signs and initials the record to ensure accountability and traceability.

• If a patient refuses medication, document the refusal and inform the provider to address any concerns and determine the appropriate course of action.

• Record narcotics administered on a special controlled substance record to comply with legal and regulatory requirements.

• Two health care professionals must witness and sign off on the disposal of narcotics to prevent diversion and misuse.

MedWatch

• The FDA issued a form in 1993 to help health care professionals report serious adverse events or product quality problems to improve drug safety and surveillance.

• The FDA has issued warnings, made labeling changes, required post-marketing studies, and ordered product withdrawals based on these reports to protect the public from unsafe drugs.

• MedWatch encourages voluntary