Transcript Administration of medications

Administration of medications
JANA HEŘMANOVÁ
ICM II, 24 February 2014
What does it involve?
 Prescribing – MD, nurse practitioner, medical
student
 Administering – RN, health care assistant, NA,
radiology assistant, MD
 Taking – the patient
 What’s missing? Who’s missing?
 Dispensing – clinical pharmacist, pharmacology
assistant
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What is a medication?
 a substance given to a person (or animal) with the
aim to cure disease, relieve symptoms, prevent
disease or help with diagnosis
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What’s in the picture?
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Forms of medications
 Solid
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Powder, tablets, capsules, coated tablets, lozenges
 Semisolid
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Suppositories, creams, ointments, gels, patches
 Liquid
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Solutions, suspensions, syrups, elixirs, drops, mouth
wash
 Inhalants/sprays
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ICM II, 24 February 2014
Routes of administration
 Enteral
 By mouth p.o.
 Rectal
p.r.
 Parenteral
 Intradermal
 Subcutaneous
 Intramuscular
 Intravenous
 Intraarticular
 Intraosseal
 Intrathecal
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i.d.
s.c.
i.m.
i.v.
i.a.
i.o.
i.t.
 Topical
 Skin
 Nose
 Ear
 Vaginal
 Intrauterine
 Inhalation – sprays,
inhalers, nebulization
Let’s play a game!
 Can you name the forms and methods of
administration?
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What are the roles of the persons involved?
 MD
 Know the patient – medical history, other drugs taken,
allergies, weight, height, dietary habits, activities
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Know the drug – recent developments, references, dosing,
available products (positive list)
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Write legibly, follow the prescription guidelines
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Inform/educate the patient
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Monitor the effects of medications
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 Pharmacist
 Check the order
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Consult with doctor if in doubt
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Check for possible incompabilities
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Inform the patient
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Educate the medical and nursing staff
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 Nursing staff
 Read the order carefully
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Consult with MD when in doubt
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Know the medication, consult when giving new drugs
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Identify the patient!
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Follow the administration guidelines
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Document
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 The patient
 Compliance – to what extent does the patient follows the
doctor’s orders, recommendations, treatment regime
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Compliance is influenced by many factors – age, level of patient
information, side effects, food interference, doctor – patient
communication, patient’s expectations, impact on ADL, leisure
activities
Communication – honest, open
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Increase the compliance - For the little ones
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Hooray for the apps!
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Prescription guidelines – be complete!
 Name of the drug
 Form of the drug
 Strength of the drug
 Route of administration
 Dose
 Time/frequency
 Ibalgin tbl. 400 mg p.o. 1 – 1 - 1
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Complete
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Not so complete
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Specifics
 Antibiotics – use exact times for timed adm
 Chemotherapy – dose prescribed by BSA (body
surface area)
 Infusions – define the drip rate or length of
administration
 PRN orders – define criteria for adm., the maximal
daily dose
 Define measurable goals/target effect in specific
meds such as insulin, hypertensives, etc.
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Examples of prescription
Wrong
Right
 Paralen 1 – 1 – 1
 Paralen 500 mg tbl. 1–1–1 p.o.
 Unasyn 1,5 g a 6h i.v.
 Unasyn 1,5g/100 ml FR i.v. give
 Novalgin 1 amp i.m. prn
 Actrapid 50U/50ml FR 1-
10ml/hr
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over 30 min at 12-18-24-6
 Novalgin 1amp (5ml) i.m. by
VAS over 3, max a 6 hours
 Actrapid 50U/50ml FR
continuously 1 – 10ml/hr
according to glycemia (goal 3,5
– 6,5mmol/l)
Prescription guidelines – be legible!
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…and clear
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Administration guidelines
 According to doctor’s order
 Do not transcribe orders (might differ within countries)
 Prepare at bedside
 From original container (might be problematic with
patient’s meds brought to the hospital)
 Avoid giving all daily doses at one time
 Use protective equipment when giving chemotherapy
 Do not give when exspiration over
 Follow the “5 Rights” rule
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The 5 Rights of Medication Administration
 Right patient
 Right drug
 Right time and frequency administration
 Right dose
 Right route of administration
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The 6th Right - documentation
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Monitoring the effects
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Medication errors
 “A preventable event that may cause or lead to
inappropriate medication use or patient harm while
the medication is in the control of the healthcare
professional, patient or consumer”
“Any error in the prescribing, dispensing, or
administration of a drug whether there are adverse
consequences or not”
National Coordination Council for Medication Error Reporting and Prescription
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The most common causes of medication errors
 Missing patient information
 Missing drug information
 Illegible, incomplete, misheard order
 Look alike/sound alike, faulty drug identification
 Drug storage or delivery problems
 Drug delivery device problems
 Environmental, staffing, workflow
 Lack of staff education, patient education,
physician’s knowledge
 Failure to monitor closely
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Sentinel events related to medication errors
 Medication not given
 Medication given to wrong patient
 Wrong rate of administration
 Wrong dose/concentration/form
 Wrong time of administration
 Wrong route of administration
 Wrong medication
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Prevention of medication errors
 Prescription related
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Good patient history
Be legible, type or print orders
Use computerized prescription systems
Know the drugs
Avoid abbreviations (PRN, AZT, FeSO4)
Always use zero, e.g. 0.5 mg, never .5 mg
Be aware of LASA (Lasix - furosemide, Losec – omeprazol,
Amiloride, Amlodipine)
Follow guidelines for verbal orders (only in emergency, always follow
with written order, read back the order to the physician, document
immediately, never use verbal orders for chemotherapy or high alert
drugs)
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Prevention of medication errors
 Administration related
 Identify the patient!
 Check for allergies
 Double-check dosage calculation of high alert drugs by another
staff member (insulin, KCl, chemotherapy)
 Store LASA separately
 Store high alert drugs separately, label properly
 Prepare medication at bedside
 Minimize interruptions
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Label safely
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Store safely
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Real life clinical stories
 1. Warfarin order 11/2 – 11/2 – 0 (What was the meant dose?
What dose was given?)
 2. Verbal order of 500ml 10% G to run at 100ml/hr for
the patient with critical hypoglycemia (Doctor fell asleep,
did not follow with written order. Dose too low, what
could have happened?)
 3. Wrong rate of insulin infusion (10 x faster) due to
mistake with managing the i.v. lines, poor work
organization (What are the risks? What should change?)
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Summary…let’s go to the movies 
 Administering oral medications
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Safety of the patient first!
 Assess..Diagnose…Treat…Monitor…Communicate
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