(F) SAFE AND QUALITY MEDICATION ADMINISTRATION - PHARMA - DC Flashcards
6 RIGHTS OF MED ADMINISTRATION
PDD RTD
➢ Right Patient
➢ Right Drug
➢ Right Dose
➢ Right Route
➢ Right Time
➢ Right Documentation
➢ Requires at least 2 forms of identification before
drug administration * Stated by patient (Full Name
and Birthday) versus ID Band and Medication
Administration Record * Photo ID on the band,
affixed are patient’s name and birthday * Adult with
cognitive disorder/child is- thru a family member
➢ Sometimes depend on Hospital Policy (with photo)
➢ Abroad: electronic health records, nurse scans the
barcode from patient’s ID band
RIGHT PATIENT
➢ Determine the right drug before administration
* Nurses next step is to scan the medication
label to automatically validate the time, date
and nurse administering the medication
➢ Medications Order: done only by licensed HCP
* MDs, dentist, certified nurse practitioner,
physician asst, veterinarian, Optometrist
➢ Prescription maybe handwritten by the nurse taking
the order; directly by an MD or by telephone order
* Nurse will write the name of the prescribing
HCW and that the order was verified
* Order will be completed after the MD has
affixed his signature (within 24hours)
RIGHT DRUG
➢ Refers to verification by the nurse that the dose
administered is the amount ordered, and that it is
safe for the patient for whom it is prescribed
➢ Based on patient’s physical status
* Weight (Pediatrics, Medical-surgical cases,
critical care situations)
* Renal and Liver functions (clearances of
some drugs)
* Sodium and potassium level
➢ Always recheck the dose calculations especially if
the drug is within the fraction or an extremely large
dose
➢ If with doubt about the amount to be administered,
consult a nurse peer to validate the right amount
RIGHT DOSE
➢ Administer drugs at the specified time
➢ Administer drugs that are affected by food, 30 mins
to 1 hour before meals or 2 hours after a meal
➢ Some foods are absorbed better after eating (given
after meals) or those that can irritate the stomach
➢ Adjust medication schedule to fit the patient’s
lifestyle activities, tolerances, preferences as much
as possible
➢ Check for patients who is scheduled for any
diagnostic procedures that contraindicate the
administration of medications
➢ Check the expiration date
▪ If it has passed, discard the carton or return to
pharmacy
➢ Administer antibiotics in an even time intervals (3
x a day versus every 8 hours) to maintain
therapeutic blood levels
➢ Patients ongoing hemodialysis
▪ Withhold during hemodialysis (BP is lower )
➢ refers to the time the prescribed dose is
ordered for administration
➢ Daily drug dosages are given in a specified
intervals, such as:
* OD-once a day
* BID-twice a day
* TID- three times a day
* QID 4 x a day
* Q 6 hours
* Prn- pro re nata; as needed
* Hs –at bedtime
➢ After meals, before meals
➢ Uses military time, based on a 24-hour clock
▪ Reduces administration errors and decreases
documentation
RIGHT TIME
➢ Necessary for appropriate absorption
➢ Oral (most common)
➢ Form:
▪ Liquid (syrup, elixir, suspension)
▪ Pill (Tablets, capsule)
▪ Sublingual (under the tongue for venous
absorption)
▪ Buccal (between cheek and gum)
▪ Feeding (enteral
▪ Topical: applied to skin
▪ Inhalation (aerosol)
▪ Otic (inside ear canal), ophthalmic, nasal
sprays
▪ Supposity (vaginal or rectal)
▪ Parenteral
* Intradermal, Intramuscular,
intravenous, subcutaneous
RIGHT ROUTE
➢ Requires the nurse to record immediately the
appropriate information about the drugs
administered (errors, side effects, A/E)
* Name of drug
* Dose
* Route
* Time and date
* Nurse’s initial or signature
➢ Oldest documentation method: Medicine
Administration Record thru paper
* Computerized with personal identification
(nurse’s initial)
➢ Delay in charting may result in forgetting to chart
the medications
RIGHT DOCUMENTATION
Process of identifying the most accurate list of all
medicines that the patient is taking at transitions in
care *
DRUG RECONCILIATION
- Before administration of drugs, ALWAYS
CHECK FOR PROPER TUBE
PLACEMENT and assess the gastric
residual
o Residual versus aspiration/electrolyte
imbalance/poor nutrition - Placed in high fowlers or elevate head for
at least 30 degrees to avoid aspiration - Drug should be crushed (ensure feasible);
allow to flow by gravity - Flush with 10-15ml of water per drug
administration to maintain patency of
tubing. 30ml when finished or as prescribed
by AP (I/O) - 30 mins clamped before the need to suction
so as meds will be absorb
NGT/OGT
- Solid medical preparation that is cone or
spindle shape for insertion into the rectum
(globular or egg shape for vagina and
pencil shape into urethra) - Made in glycerinated gelatin/polyethylene
glycol
SUPPOSITORY
Useful in babies, uncooperative
patients and in cases of vomiting or certain
digestive disorders
* Can be lubricated/refrigerated prior to
insertion
* Explain procedures on insertion. Use
gloves during the procedure;
* SIMS position, breath slowly thru mouth
* Small amount of water soluble lubricant
* Insert beyond the sphincter
* Remain flat or on one side for at least 30
mins
RECTAL
: inserted gently thru an applicator
* Lithotomy position
* Lie for sometime to allow medication
absorption
* Provide patient with sanitary pad; if able
can be inserted by the patient herself
▪
* preferred areas are lightly pigmented, free
of lesions, hairless
* G25-27, ¼ to ½ inch long; tuberculin
syringe
* 1 ml calibrated in increments of 0.01
* Disinfection in a circular motion; inner to
outer
* 10-15 degree angle; bevel up
* Inject to form a bleb
* Not recommended to place a cotton or
gauze or plaster
* Assess for allergic reaction 24-72h
(induration)
VAGINAL
- Absorb thru capillaries; slower than IM
route - Usually may contain 0.5 to 1 ml
- G25-27, 3/8 to 5/8 inch long; 3/8 inserted
in 90 degree angle; 5/8 in 45 degree angle - Uses 1-3 ml syringe and can deliver 0.5 to
1ml amount of medication - Grasp or gently pinch the area with fingers
of non dominant hand - Gently apply pressure and bandage
SUBCUTANEOUS (SC)
- Effect more rapid than SQ
- used for solution that are viscous
- Many risk hence should be extra careful
- Consider: volume of drug to be
administered, site location, angle of
injection (90degree angle), patient position,
advantage and disadvantage of site.
o Underweight should be evaluated for
adequate muscle mass - Flatten the skin area using thumb and index
finger and inject between them (hold skin
taut) - Use g18-25, 5/8 to 1 and ½ length needle
- Syringe can hold 1-3ml
- Preferred sites: ventrogluteal, Deltoid
o Replace first needle with second needle
to ensure that it will penetrate the
muscle - No blood flow on aspiration, can inject the
medication - Allow needle to remain inserted x 10
seconds for the medicine to disperse evenly
INTRAMUSCULAR (IM)
- More rapid than IM and SQ
- accessible peripheral veins are preferred
o Adults: cephalic, basilic, median
cubital *antecubital; dorsal vein of
hand
o Newborns/infant: feet lower leg,
head after other sites are exhausted - G20-21, 1-1 and ½ inches; (infants g24 1
inch; children g22 1 inch) - Large volume or rapid infusion,
continuous; for viscous drugs; whole
blood; infusion controller, pump - Application of tourniquet-insertion of
catheter on visualized vein-feed up until
blood returns-remove the tourniquetstabilize IV Catheter and apply dressingflush with normal saline/IVF to check for
patency-monitor flow rate
INTRAVENOUS
