Follow Safe Process for Responsible Medication Administration (LO6) Flashcards
examples Enteral
Oral medication administration
Rectal medication administration
examples Parenteral
Subcutaneous medication administration
Intramuscular medication administration
Intravenous (IV) medication administration including IV infusion pump use
Intraosseous medication administration
Endotracheal medication administration
Inhalation medication administration
examples Percutaneous
Transdermal medication administration
Sublingual medication administration
Buccal medication administration
Intranasal medication administration
Medication Preparation
begins with you checking the medication to ensure that it is the correct drug, that the drug is not cloudy or discoloured, and that the expiry date has not passed
You then have to determine the correct dose and concentration for that medication
ampoule
a sterile glass container that is designed to carry a single dose of a medication. An example of a medication supplied in an ampoule is epinephrine
Medication Preparation: Vials
A vial is a glass or plastic container with a rubber-stopper top. They may be either single or multi-dose. An example of a medication supplied in a vial is Narcan®.
safe scene practices that include the following:
- If the patient is responsive or if there is another reliable source of information confirm that the patient is not allergic to the drug that has been ordered
- Read the label carefully as you take the vile or syringe from its box and again before you give the drug
note the concentration printed on the label and the drugs date of expiry - Check with your partner to ensure the correct medication is being administered
- Check the defects in the vile, preloaded syringe or ampoule and make sure the fluid inside is not cloudy discoloured or precipitated
• Check whether the container itself appears to be cracked or damaged - If more than one drug is going to be administered to make sure that the drugs are compatible
- Monitor the patient for possible adverse side effects
- Dispose of the syringe and needle safely do not try to recap the needle
If an online physician consultation is required:
- Make sure the physician understands the situation
- Make sure you understand the physician orders clearly
- Always repeat any orders Word for Word back to the physician before administering medication to confirm state in the name of the drug the dose and the route
- Enteral route of administration refers to
any route in which the medications are absorbed through the gastrointestinal tract.
oral administration
Oral medication administrations are given to the patient to take by mouth. Depending on the medication they can be either swallowed whole or chewed.
oral administration Absorption
Since medication taken orally is absorbed by the stomach and intestines, onset of action is delayed sometimes as long as 30-90 minutes.
oral administration Advantages
- Convenient
* Sterility is not needed
oral administration disAdvantages
- Unpleasant taste for patient
- Nausea may result due to gastric mucosa irritation
- Patient must be conscious to reduce the risk of aspiration
- Digestive juices may destroy medication
oral administration Example
is ASA.
Rectal Medication Administration
are inserted into the patient’s rectum.
Depending on the medication it may be in liquid form or in a firm base that is designed to melt at body temperature.
Rectal Medication absorption
Since medication administered rectally is absorbed by the highly vascular rectal mucosa, onset of action is rapid.
Rectal medication Advantage and disadvantage
An option for patients that cannot tolerate the medication orally
Can be uncomfortable for the patient.
Rectal medication equipment
- Water-soluble lubricant
- Syringe
- NPA, ET tube, plastic sheath off IV cathlon or 1 mL syringe
Rectal medication Example
Acetaminophen
Subcutaneous Medication Administration
are given in the loose connective tissue located between the dermis and the muscle layer.
Volumes up to 1 mL can be injected subcutaneously.
45 degree angle
Subcutaneous Medication Absorption
- Since the subcutaneous space does not have a rich blood supply, medications injected into this space have a slower onset of action and prolonged duration of action.
Subcutaneous Medication Advantage
Disadvantage
- No need for patient to be conscious can be used with both conscious and unconscious patients.
- Pain and irritation at site
Subcutaneous Medication Equipment
- 24 to 26 gauge safety needle
* 1 to 3 mL syringe
Subcutaneous Medication example
epinephrine
Intramuscular Medication Administration
are given directly into the muscle. Volumes up to 5 mL can be injected intramuscularly.
90 degree angle
Intramuscular Medication absorption
- Since muscle is more vascular than subcutaneous tissue, medications injected into the muscle have a quicker onset of action than subcutaneous injections.
Intramuscular Medication advantages
- No need for patient to be conscious—can be used with both conscious and unconscious patients.
- Rapid absorption
Intramuscular Medication Disadvantages
- Pain and irritation at injection site
- When administering medication intramuscularly, there is potential for nerve damage so it is important to choose appropriate site and needle size for the patient.
Intramuscular Medication Equipment
- 21 to 22 gauge, 1½ to 2 inch safety needle
* 1 to 5 mL syringe
Intramuscular Medication example
epinephrine
Intravenous Medication Administration
administration introduces the medication directly into the circulatory system.
The medication is injected with a syringe into a needless port on an existing peripheral intravenous line.
Intravenous Medication absorption
- Since this route bypasses most barriers to drug absorption, this is the route for fastest onset of action.
Intravenous Medication Advantages and disadvantages
Advantages
• Direct control of drug concentration in the blood
• Rapid onset
Disadvantage
- Risk of high drug concentrations if injected too fast
Intravenous Medication Equipment
- Luer-lock syringe of appropriate size for concentration of medication.
Intravenous Medication example
D50W.
Intravenous (IV) Infusion Pumps
pump is a mechanical device which infuses fluid by positive pressure.
It controls the flow rate with more precision than traditional gravity.
Check the functioning of the pump’s alarm system
- On and off switch
- Variable volume
- Silencer
The alarm system may activate for any of the following reasons:
- End of infusion
- Occlusion
- Air in line
- Battery low
- Broken/disconnected tubing
- Excessive pressure build-up within the system
Infusion Rate
- Each pump will have a rate of flow (mL/hr) which can be adjusted.
Volume to be Infused
- As a general guideline, set the volume to be infused at 30-50 mL less than what is in the IV bag or volutrol.
Examples:
• New 500 mL bag added to present IV - set amount to be absorbed at 450 mL
• 50 mL in volutrol - set amount to be absorbed at 40 mL
- Your alarm will then sound before total amount in IV bag has been infused.
Assessment of Total Infusion System
- Correct intravenous solution
- Clamps open or closed as appropriate
- Alarm system turned on
- Rate of flow
- Volume to be infused
- Compare the amount to be infused to the amount in the bag or volutrol
- Mechanical problems
- Occlusion
- Air in tubing, etc.
- Connections - luer lock/regular
- Intravenous site
- Last tubing change
Intraosseous Medication Administration
introduces the medication directly into the intraosseous space of a long bone
- The vessels in the intraosseous space drain directly into the central circulation by a network of venous sinuses and canals
Intraosseous Medication absorption
- Onset of action is comparable to intravenous as the medication is introduced directly into the circulatory system.
Intraosseous Medication Advantage and disadvantage
Advantage
- Rapid onset of action
Disadvantage
- May be difficult to infuse due to resistance
Intraosseous Medication equipment
• Safety syringe of appropriate size for concentration of medication
o Ensure the use of a large enough syringe to be able to infuse against the resistance met
• 3 way stop-cock
• Extension set
Intraosseous Medication example
- Any medication that can be administered intravenous can also be administered intraosseous.
Endotracheal Medication Administration
administration is done only as a last resort when intravenous or intraosseous access cannot be established
- It involves the medication being administered down the endotracheal tube and then the patient being ventilated to disperse the medication across the alveoli.
Endotracheal Medication absorption
- Since the region within the respiratory tract is very vascular, the onset of action is usually within 2–3 minutes.
- It is important to administer 2–2.5 times the standard intravenous dose to insure that the medication is adequately dispersed.
Endotracheal Medication advantage and disadvantage
Advantage
- Useful when IV or IO is unobtainable
Disadvantage
- Medications that are not water soluble can cause damage to lung tissue
Endotracheal Medication equipment
safety syringe
select medications that can be administered using the endotracheal tube.
You can remember them by the mnemonic NAVEL: • Naloxone • Atropine • Ventolin / Vasopressin • Epinephine • Lidocaine
Inhalation Route of Administration
refers to when medications are inhaled by the patient and absorbed through the respiratory tract
Inhalation Route Absorption
- Since the region within the respiratory tract is very vascular, the onset of action is usually within 2–3 min.
Inhalation Route advantage and disadvantage
Advantage
- Continuous drug dosing
Disadvantage
• Irritation of mucosa may occur
• Low ambient temperature may affect gases ability to vaporize (nitrous oxide).
Inhalation Route examples
- Nebulizer
- Metered-dose inhaler
- Nitrous oxide
Nebulizer Medication Administration
- A nebulizer is when liquid medication is aerosolized to aid in inhalation.
- The nebulizer is attached to an oxygen or compressed air source.
Nebulizer Medication Equipment
- Nebulizer mask with oxygen tubing
* Oxygen cylinder compressed air source
Examples of medication that may be administered using a nebulizer are:
- Ventolin
* Atrovent
Metered-Dose Inhaler (MDI) Medication Administration
- A metered-dose inhaler delivers a set dose of medication to a patient for inhalation.
- They are most often prescribed to patients for use at home.
Metered-Dose Inhaler (MDI) Medication Equipment
- Metered-dose inhaler
* Spacer device (useful for small children)
Metered-Dose Inhaler (MDI) Medication example
Ventolin
Nitrous Oxide Medication Administration
- Nitrous oxide is administered in a gaseous form via inhalation.
Nitrous Oxide Medication equipment
- Nitrous oxide cylinder
* Mask or mouthpiece
Percutaneous Route of Administration
refers to when medications are applied to and absorbed through the skin and mucus membranes
percutaneous routes:
- Transdermal
- Sublingual
- Buccal
- Intranasal
Transdermal Medication Administration
- Transdermal medication administration is when medication is applied topically on the surface on the patient’s skin.
Transdermal Medication absorption
- Since the medication absorption is slow with transdermal administration, this is a useful route for medication that requires slow, sustained release.
Transdermal Medication advantage and disadvantages
Advantage
- Continuous dosing
Disadvantages
• Effective only for lipid-soluble medication.
• Local irritation may occur.
Transdermal Medication Equipment
- No equipment is needed to facilitate administration of a medication this route.
Transdermal Medication example
- An example of medication that may be administered transdermal is a Nitroglycerin patch.
Sublingual Medication Administration
- Sublingual medication administration is when medication is placed under a patient’s tongue and allowed to absorb.
Sublingual Medication absorption
- Since the region under the tongue is very vascular, the rate of absorption is very quick.
Sublingual Medication advantage
- Direct delivery to general circulation.
Sublingual Medication
Disadvantages
- Irritation to oral mucosa
- Patient must be conscious.
- Useful only for highly lipid-soluble medication.
Sublingual Medication example
Nitroglycerin.
Buccal Medication Administration
- Buccal medication administration is when medication is applied to the region between the cheek and gums and allowed to absorb.
Buccal Medication Absorption
- Since the region between the cheek and gums is very vascular, the rate of absorption is quite quick.
Buccal Medication advantage
- Direct delivery to general circulation
Buccal Medication disadvantage
- Irritation to gastric mucosa
* Only useful for highly lipid-soluble medications
Buccal Medication Equipment
- Applicator (tongue depressor)
- It is important to remember that this route of administration is only safe for those patients that have an intact gag reflex
Buccal Medication example
oral glucose
Intranasal Medication Administration
- Intranasal medication administration is when medication is administered directly into the nasal mucosa.
Intranasal Medication Absorption
- Since the region within the nasal mucosa is very vascular, the onset of action is very rapid
- Intranasal route has a faster onset than intramuscular and therefore has become more popular in recent years in the prehospital setting.
Intranasal Medication advantages
- Rapid onset of action
* Allows medication administration when IV not available
Intranasal Medication Disadvantage
- Specialized device required
Intranasal Medication equipment
- Syringe with mucosal atomizer device attached
Intranasal Medication examples
Lorazepam and Midazolam.
A medication error
the failure to complete a planned action as it was intended; or when an incorrect plan is used at any point in the process of providing medications to patients
Common sources of medication errors include:
- Prescriber ordered wrong dose of medication
- Drug calculation was performed incorrectly
- Drugs were administered wrong route
- Drugs that had similar packaging or names
- Drug given to the wrong patient
- Drugs that are not commonly used
medication error Prevention
- Reduce reliance on memory: Checklists, protocols, computerized tools
- Error-proof processes: “6 rights” of medication administration
- Standardize tasks: Always perform a task the same way every time
- Reduce the amount of hand-offs: Draw up your own medication
The following is the process to follow if a medication error occurs:
- Accept responsibility for the error.
- Inform medical direction of the error immediately.
- Assess and monitor the patient for any adverse effects.
- Document the error.
- Make changes in your personal practice to ensure that error does not occur again.
- Follow your agencies policies on documentation and reporting requirements for medication errors.
mandatory reporting requirements of any critical incident that causes serious adverse health effects to Saskatchewan health. This includes:
- Surgical events
- Product or device events
- Patient protection events
- Care management events
- Environmental events
- Criminal events
When storing medication there are several factors that we must consider:
- We must identify the manufacturer’s recommendations regarding storage.
- We must identify whether the medication is a controlled substance.
In general, medications should be kept out of direct sunlight, away from humidity, and stored in temperatures between 15 and 30 °C.
Controlled Medication Storage
- must be either stored on person (drug pouch) or in a securely locked non-identifying cabinet that cannot be moved or be easily damaged.
- A detailed Controlled Medication Log must be kept identifying the amount of drug on hand, medication used for patient care and any leftover medication that was disposed of
- When signing for medication you must have two signatures, one for the person that has counted, administered or disposed of the medication, and the other signature of a witness.
6 rights of medication
- Right patient
o Verify that it is the right patient confirm the patients name and compare it with wristband or triage tag - Right medication
o Read the drug label at least three times before administration to ensure you have the right medication read it when it is still in the drug box, when you prepare the drug for ministration is coming to show your partner and ask which drug you’re holding in order to confirm, and before actually administering the drug to the patient - Right dose
- Right route
- Right time
6. Right documentation o Name of drug o Dose o Time you administered the drug o Route of administration o Name of paramedic who administered it
, transport of these patients coincides with the scheduled time for their oral medication administration.
- A PCP can assist these patients to self-administration their medication as long as both of the following criteria have been met:
- There is a written order by a physician for the medication.
- The medication ordered is one that normally would be self-administered by the patient in a home setting.
