LEC 6: Introduction to Medication Administration Flashcards
What is the RNs role when administering medication?
- Knowing what medications are prescribed
- The therapeutic and non-therapeutic effects
- The medications’ associated nursing implications
- Determining whether a medication is safe to administer based on physical assessment data
- Knowing why the patient needs the medication
- Determining of the patient requires supervision with administration and education
- Monitoring the effects of the drugs
- Reporting and documenting administration and effects
What is the prescriber’s role when aministering medications?
- Prescriber can be the physician, nurse practitioner, or physician’s assistant
- Orders can be written, verbal, or by telephone
What do you do if an order is given verbally?
If given a verbal order, need to write it down on a verbal order sheet and document
What do you do if an order if given by telephone?
If given an order by telephone, need to write on the order sheet
What are the types of orders in acute care agencies?
- Routine
- Single one-time
- Now
- PRN
- STAT
- Protocol order
Order: Routine
Administered until the dosage is changed or another medications is prescribed
- Dose not change and is given on a schedule
Order: Single One-Time
Given one time only for a specific resason
Order: Now
When a medication is needed right away, but not STAT
- When it comes up from pharmacy/ when you get it
Order: PRN
Given when the client requires it
- When patient ask’s for it or when the RN offers
Order: STAT
Given immediately in an emergency
Order: Protocol Order
Set of criteria and orders under which a medication is to be administered
- Two types of protocol orders: Insulin and Heparin
What are the two types of protocol orders?
- Insulin order
- Based on patient’s sugar levels
- Structured set of instructions based on patient’s blood sugar levels - Heparin order
- Looking for APPTT
- Adjust heparin based on protocol order/ clotting factor APTT
What is the pharmacy’s role for medication administration?
- Is to prepare and distribute medications
- Assess for safety of medication for patient
- Make sure there are no allergies
- Make sure there is no drug interactions
*In small hospitals RNs can be the “pharmacists”
What are the three ways for drugs to be distributed?
Distributed System
- Stock supply
- Unit dose
- Automatic dispensing
Distributed System: Stock Supply
Large supply of medications commonly used on unit
- May be different for each unit
Distributed System: Unite Dose
Individually packaged medication
Distributed System: Automatic Dispensing System
Automated computer system that releases the right medication, at the right time, for the correct patient
What do you need a double signature for?
Need double signature to get narcotics out of drawer
What should you check when getting medication ready?
Check the expiration date on all medication
What do drug order consists of?
- Name of patient
- Date and time order written
- Name of drug
- Dose of drug
- Route by which drug to be given
- Frequency/ time of administration
- Prescribers signature
What should you do if an order is not clear/ cannot read the order?
Call the prescriber to clarify the order
- Otherwise can lead to errors
- Be sure you read order properly
- Be sure order can be read
What are the 10 rights of medication administration?
- Right medication
- Right dose
- Right patient
- Right route
- Right time & frequency
- Right patient education
- Right documentation
- Right to refuse
- Right reason
- Right evaluation
What are the 3 checks?
Must check the medication against the MAR 3 times
- When the medication is removed from the medication drawer
- Before or after withdrawing the mediation
- When about to administer the patient at the bedside
When is the 1st check done?
When the medication is removed from the medication drawer
When is the 2nd check done?
Before or after withdrawing the mediation
- Need to get a second check done by another RN for high alert medications
When is the 3rd check done?
When about to administer the patient at the bedside
What is a MAR?
- Legal document
- Tells you all the medication the patient is on for 24 hours
- Tells you when medication is to be adminstered
- Time line will be aligned with medication time
What should you always ask before administering medication?
Ask if the patient has any allergies
What are the assessments the nurse should do before administering medication?
- Medical history
- Why is the patient on medication - History of allergies
- Always ask about allergies; chart them and fill out proper document; send it to pharmacists - Medication data
- Diet history
- Patient’s diet history may determine if you can administer a medication or not, how to administer the medication, or when to administer the medication - Perceptual or coordination problems
- Current condition
- Patient may not be able to take medication as directed; such as oral due to trouble swallowing - Attitude toward medication use
- Is important to know the patient’s beliefs, may be the reason why they don’t take the medication - Knowledge and understanding of therapy
- Client’s learning needs
What are key points to remember regarding adminsitering medication?
- Administer only the medications you prepared
- If a patient questions the medication, do not ignore the patient’s concerns; recheck the medication orders
- Students are not to take verbal or telephone orders
What are the three things you need to do when administering medication?
- MAR and medication (in original package-if oral) taken to bedside
- You MUST observe the patient take their medication
- Medication must be administered within 30 minutes before or after scheduled time
What are the 5 things you need to do when preparing medication for administration?
- Check MAR for when medication is due and check for allergies
- Prepare the medications (as applicable) and perform appropriate assessment
- Take the MAR and medication or medication cart to bedside, hand hygiene
- Directly compare patient ID band with MAR (need 2 identifiers)
- Complete the 10 rights and 3 checks prior to administration
Where do you document scheduled medication?
Only document on MAR (medication administration record)
Where do you document PRN medication?
Document on MAR and in progress notes
What is tall-man lettering?
Look-alike drug names have been mortified using tall man (mixed case) letters to help draw attention to dissimilarities in their to reduce confusion between medications with similar names to prevent medications errors and patient harm
What is a medication error?
Any event that could cause or lead to a client either receiving inappropriate medication therapy or failing to receive appropriate medication therapy
What do you do when a medication error occurs?
- Patient safety
- ABCs: Allert, breathing, conscious
- Is the patient stable - If the patient is unstable, need to manage the situation
- If the patient is stable/ when the patient is stable, let instructor know, nurse looking after the patient, let prescriber know, and let patient know
What are high alert medications?
- Medication bears a heightened risk of causing significant patient harm when used in error
- Requires independent double checks
What is an independent double check?
- Getting a high alert medication checked by another Rn, after doing the 10 rights and 3 checks
- Do not tell the RN what they are checking, just say :can you check my medications”
Narcotics and Controlled Substances
- Stored in a designated locked drawer
- RNs/ LPNs have special key or access codes to the drawer
- Must be signed out on a special record
- Narcotic count: Count all the drugs in drawer and document
- Wasting narcotics: need to account for wasting and have someone watch you dispose of it properly
What is the required monitoring for narcotic administration?
- Baseline for:
- Respiration rate
- Pain
- Sedation scale - Post-Dose:
- IM, PR, SC, PO (immediate release, slow release, and oral liquid): 45 to 60 minutes
- IV: 5, 15, and 30 minutes
What should you do if your patient’s physical assessment, VS, or labs indicate a medication should not be given?
Contact the prescriber and see what they would like you to do
What do you do when a client that you are admitting to the hospital brings in his own medications?
Take the medication to lock up or get the patient to send home. Want to give hospital medication only to know what they are taking.
What is the correct abbreviation for “after meals”?
pc: after meals
What is the correct abbreviation for “by mouth/oral”?
po: by mouth
What are 4 common abbreviations found for dose designations BUT that should always be written out to avoid errors?
- U or u: Unit
- IU: International unit
- D/C: Discharge or discontinue
- QD: Every day
