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Chapter 35: Medication Administration (Part 2) Bonnie M. Wivell, MS, RN, CNS Routes Of Administration • • • • • • • PO – Oral SL – Sublingual Buccal Inhalation Nasal Ears, Ears Topical / Skin Application • Rectal • Vaginal • • • • IM - Intramuscular IV – Intravenous SC – Subcutaneous ID - Intradermal Process of Administration • • • • Identify the client Inform the client Administer the drug Provide adjunctive interventions as indicated • Record the drug administered • Evaluate the client’s response to the drug Types Oral of Medications • SOLID FORMS – Caplets – Capsules – Tablets • Scored – Gel Caps – Enteric Coated – Extended Release • LIQUID FORMS – Elixir – Extract – Acqueous Solution/ Suspension – Syrup – Tincture Oral Administration Of Medication Cont’d. • Other Oral Forms – Troche/ Lozenge • Not meant to be swallowed – Aerosol • Topical Oral Administration • • • • Swallowed Dissolved in Liquid Crushed and put in applesauce/pudding Crushed and given via tube (pg. 718) – Gastric Tube (G-tube or PEG) – Enteral Feeding Tube – Nasogastric Tube (NG) • Always refer to drug book or check with pharmacist before crushing a medication Oral Administration Cont’d. • Cutting and Crushing Tablets • Do not crush: • Enteric Coated • Capsules • Beads from capsules – Cut only “scored” tablets • Do not swallow or chew sublingual tabs unless directed to do so Buccal and Sublingual Administration • Buccal – between the cheek and gums – – – – Tablet Semi-Solid Paste Thick Liquid • Sublingual – under the tongue Topical and Transdermal Application • Types of meds given topically – Anti-arthritis (Heat) – Cardiac Meds (NTG Paste) – Pain Med (Patch) • Fentanyl (Duragesic) – Other Patches • • • Nicotine Estrogen Scopolamine • What is the prescribed length of time for application? Topical Application • Sprays – – – – Oral Topical Nasal Inhaled • MDI • DPI • Vaginal / Rectal – Suppositories – Creams • Ear Drops – Position ear • Eye Drops • Irrigations Parenteral Administration • • • • • Intramuscular Subcutaneous Intradermal Intraosseous Intravenous Equipment • Syringes – Insulin – TB – Hypodermic Luer Lok vs Non Luer Lok Types of Insulin Pens Parts of Needle Sizes of Needles • Length 3/8” to 3” • Gauge 30 – 19 • 20-22G, 1-1.5” for IM • 25-30G, 3/8-1/2” for SQ Filter Needle Single Dose Ampule Single Dose Vial Multi-dose Vial Insulin Preparation • • • • • • • Rapid, short, intermediate, and long acting Know onset, peak and duration ONLY regular insulin can be given IV Sliding scale based on blood glucose Gently roll cloudy DO NOT SHAKE Prepare last and administer first if mixed because regular can become “contaminated” and action can be affected • CLEAR to CLOUDY Injection Angles Intradermal Injection Intramuscular • • • • PAIN MEDICATION ANTIBIOTICS VACCINATIONS SUPPLEMENTS – IRON – B12 IM Injection Sites Deltoid IM Injection Site 4/11/2016 NRS 105.320 W2009 40 Carpuject Tubex Where Do You Get IV and Injectable Medications? • IV Solutions are standard, mixed for the patient in the pharmacy or ordered from the outside – IVPB (IV Piggyback) meds are mixed in the pharmacy – Pre-mixed – Add-Vantage • Injectable Medication – Unit dose • • • Carpuject Ampules Vials NEEDLELESS SYSTEMS 3ml Luer Lock Syringe + Clave Adapter Where do Drugs Come From in LTC FACILITY? • MEDICATIONS ARE DELIVERED FROM AN OUTSIDE PHARMACY – ORDERS ARE FAXED TO PHARMACY – MEDICATIONS ARE DELIVERED BY THE PHARMACY • SOME STOCK DRUGS AND NARCOTICS ARE ON SITE FOR PRN USE Medication Safety “SIX”(OR SEVEN) RIGHTS RIGHT MEDICATION RIGHT DOSE RIGHT PATIENT RIGHT TIME RIGHT ROUTE RIGHT DOCUMENTATION THE RIGHT OF THE PATIENT TO REFUSE The RIGHT Medication • As the physician prescribed? • Trade name or generic? • Does the drug match the MAR? (medication administration record) • Is the drug appropriate for the patient? • Does it make sense?? The RIGHT Dose • DOES THE DOSE OF MEDICATION IN YOUR HAND AGREE THE DOSE ON THE MAR? • ARE THE MG, MCG, ML THE SAME? • IS THIS THE TIME TO DO MATH OR GO ON A BREAK!? The RIGHT Patient – HAVE YOU CHECKED USING TWO PATIENT IDENTIFIERS? – PATIENT STATES…VERIFIES BD – PATIENT ARMBAND – COMPARE PT. ID NUMBER TO MAR – WHAT IF THERE IS NO ARM BAND? The RIGHT Time • • • • • • AM or PM Q4 Tid Bid Qid qd The RIGHT Route • • • • • • • PO IV SC (SQ) TRANSDERMAL RECTAL IM DOES IT MAKE SENSE?? 4/11/2016 NRS 105.320 W2009 57 Patient Controlled Anelgesia PCA PUMP MOD – Medication on Demand •The Radio Frequency Identification (RFID) based wrist band, the first of its kind to be implemented successfully, assist nurses by automating the process of administering patient medication.