Transcript Medication Administration

Medication Administration
Unit VI
Part 3 (lab 2)
Keith Rischer, RN, MA, CEN, CCRN
Today’s Objectives…






Differentiate the roles of various health team members in
medication preparation and administration.
State the essential parts of a drug order.
Describe nursing actions which maintain physical safety
of clients receiving medications.
Discuss factors that determine appropriate routes for
drug administration.
Demonstrate preparation, administration, and charting of
medications.
Identify the most common medication errors made by
nurses and what can be done to decrease errors in the
clinical setting.
Roles of Health Team Members
Physicians
 Advanced practice nurses
 Pharmacists
 Unit Secretaries
 Registered nurses
 LPN
 Medical technicians

Medication Order Components








Full name of client
Date and time order is written
Name of the drug to be given
Dosage of the drug
Route of administration
Frequency of administration
Reason for medication (PRN meds)
Signature and licensure of the person writing the order
Atenolol 50mg po daily Nathan Bowler, MD
9/3/2010, 1500
Types of Orders

Based on frequency/urgency of order
 Standing
orders
 PRN orders
 One time orders
 Stat orders
 Now orders
 Prescriptions
Nursing Actions r/t Med Administration


Review medical history
Check the MAR




Assess for “poly-pharmacy”
Check for allergies
Know normal dose ranges
Critical lab values
 K+ (3.5-5.0)
 Mg+ (1.8-2.6)
 AST, ALT, (<50) albumin (3.1-5)
 Creatinine (0.6-1.4)
Nursing Actions r/t Med Administration

Assess:
 ability to swallow
 GI motility
 muscle mass (for injection)
 venous access (for IV)
 vital signs
 BP,

HR, O2 sats
Evaluate response
Patient Medication Education
Name-dose-action
 When to take?

 With/without
meals
Coping with expected/most common SE
 Warnings of toxic effects

The Six Rights

Right medication
 Avoid
verbal orders
 Does drug make sense with pt’s history?

Right dose
 Double

check all drug calculations
Right time
 Timing
of critical meds
The Six Rights

Right route
 Best

route considering needs
Right client
2
identifiers
 Check for allergies
 Drug-drug interactions

Right documentation
 Always
AFTER med given
Practice Guidelines

These guidelines are necessary for the safe
administration of all medications
Patient assessment (HR-BP-LOC)
 6 rights
 3 checks before administration
 #1 - Check with MAR as pull drugs
 #2 -Recheck drugs to be administered with MAR
 #3 - Recheck drugs to be administered with MAR
at bedside

– Verify Pt ID
– Verify MAR with patient at bedside
Practice Guidelines

Give medications one at a time


Educate on meds while giving


Keep in unit dose wrapper til given
“do you know why you are taking_______?”
If knowledge deficit apparent incorporate in plan
of care that day




Why taking & what it does…at their level
Most common side effects
With food?
When to take and how often
What to do if…
Your patient is lethargic and confused
after receiving a prn dose of Morphine
 Patient drops a tablet on the floor
 Drops his HR from 72 to 52 after Atenolol
 Develops a red raised rash with itching
after a first dose of Ampicillin
 Refuses his medication that is ordered by
the physician

Medication Safety Tips

Nursing responsibilities
 Follow
the 6 rights of med administration
 Read med labels comparing with MAR 3
times
 Use 2 client identifiers
 Name,
 Avoid
DOB or MR#
interruptions during the med admin
process
 Clarify illegible handwriting with prescriber
 Question unusually large or small doses
Medication Safety Tips
 Nursing responsibilities
 Double check all calculations – verify with another RN
as needed
 When you have made an error, reflect on what went
wrong and how it could have been prevented.
 Follow extra care and safeguards around High Alert
meds – these have a high potential for error and
adverse effects.
– Heparin
– Insulin
What Influences Med Errors…



Nurses <5 yrs or >20 yrs highest error %
Shift with most med errors?
Average amount of med errors annually by
RN’s?


Which violation of the 5 rights most common?



1-2/year
Wrong time
Wrong dosage
Interruptions during med pass

Each interruption increased liklihood of error 12.7%
Are These med Errors???

Crushing tablets that should not be crushed.

Use of discontinued or out-of-date medications.

Pushing an IV medication too rapidly or undiluted (when it
should be diluted for patient safety).

Giving a patient (with a K+ 5.2) the prescribed KCL 20
meq po daily.

Administering Furosemide 40 mg po to a patient with a
BP of 84/40.

Not documenting the site of an intramuscular injection
Would you ? these orders…

Tamsulin (Flomax) 0.4 mg po now
 54

Hydromorphone (Dilaudid) 12 mg IV now
 28

yr old female with current kidney stone
yr male-pain with sickle cell disease 9/10
Morphine 10 mg IV now
 32
yr female with acute abd pain 10/10
What can Be Done to Decrease…
No interruptions during med pass
 Critical thinking & questioning
 Healthy collaborative physician
relationships
 EMR: computerized MD order entry

What if Med Error made???



Assess pt. response/safety
Contact physician
Document in chart just the facts





Do not mention a safety report was filled out
Document in facilities Safety Report (incident
report)
Risk management reviews
Manager provides follow up/remediation
If severe incident, notify nurse manager or
supervisor ASAP
Cognitive Skills Required








Basic knowledge of pharmacology
Drug name
Types of preparation
Types of orders
Drug classification and action
Side effects/adverse effects
Drug dose calculations
Knowledge of how to prepare and administer
drugs safely
Technical skills

Ability to implement
techniques for safe
and effective
preparation and
administration of
meds
Interpersonal skills
Ability to communicate clearly and
effectively
 Ability to establish trusting relationships as
a basis for teaching and counseling

 The
student nurse is also an EDUCATOR
Ethical/legal Skills
Commitment to safety and quality; strong
sense of responsibility and accountability
 Knowledge of institutional policy and
procedure manual related to
administration of meds
 Commitment to report medication errors
and to follow agency policy for working to
prevent their recurrence
