LEC 6: Introduction to Medication Administration

Question 1

What is the RNs role when administering medication?

Answer 1

• 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

Question 2

What is the prescriber’s role when aministering medications?

Answer 2

• Prescriber can be the physician, nurse practitioner, or physician’s assistant
• Orders can be written, verbal, or by telephone

Question 3

What do you do if an order is given verbally?

Answer 3

If given a verbal order, need to write it down on a verbal order sheet and document

Question 4

What do you do if an order if given by telephone?

Answer 4

If given an order by telephone, need to write on the order sheet

Question 5

What are the types of orders in acute care agencies?

Answer 5

• Routine
• Single one-time
• Now
• PRN
• STAT
• Protocol order

Question 6

Order: Routine

Answer 6

Administered until the dosage is changed or another medications is prescribed
- Dose not change and is given on a schedule

Question 7

Order: Single One-Time

Answer 7

Given one time only for a specific resason

Question 8

Order: Now

Answer 8

When a medication is needed right away, but not STAT

- When it comes up from pharmacy/ when you get it

Question 9

Order: PRN

Answer 9

Given when the client requires it

- When patient ask’s for it or when the RN offers

Question 10

Order: STAT

Answer 10

Given immediately in an emergency

Question 11

Order: Protocol Order

Answer 11

Set of criteria and orders under which a medication is to be administered
- Two types of protocol orders: Insulin and Heparin

Question 12

What are the two types of protocol orders?

Answer 12

1. Insulin order
   - Based on patient’s sugar levels
   - Structured set of instructions based on patient’s blood sugar levels
2. Heparin order
   - Looking for APPTT
   - Adjust heparin based on protocol order/ clotting factor APTT

Question 13

What is the pharmacy’s role for medication administration?

Answer 13

• 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”

Question 14

What are the three ways for drugs to be distributed?

Answer 14

Distributed System

• Stock supply
• Unit dose
• Automatic dispensing

Question 15

Distributed System: Stock Supply

Answer 15

Large supply of medications commonly used on unit

- May be different for each unit

Question 16

Distributed System: Unite Dose

Answer 16

Individually packaged medication

Question 17

Distributed System: Automatic Dispensing System

Answer 17

Automated computer system that releases the right medication, at the right time, for the correct patient

Question 18

What do you need a double signature for?

Answer 18

Need double signature to get narcotics out of drawer

Question 19

What should you check when getting medication ready?

Answer 19

Check the expiration date on all medication

Question 20

What do drug order consists of?

Answer 20

• 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

Question 21

What should you do if an order is not clear/ cannot read the order?

Answer 21

Call the prescriber to clarify the order

• Otherwise can lead to errors
• Be sure you read order properly
• Be sure order can be read

Question 22

What are the 10 rights of medication administration?

Answer 22

1. Right medication
2. Right dose
3. Right patient
4. Right route
5. Right time & frequency
6. Right patient education
7. Right documentation
8. Right to refuse
9. Right reason
10. Right evaluation

Question 23

What are the 3 checks?

Answer 23

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

Question 24

When is the 1st check done?

Answer 24

When the medication is removed from the medication drawer

Question 25

When is the 2nd check done?

Answer 25

Before or after withdrawing the mediation | - Need to get a second check done by another RN for high alert medications

Question 26

When is the 3rd check done?

Answer 26

When about to administer the patient at the bedside

Question 27

What is a MAR?

Answer 27

- 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

Question 28

What should you always ask before administering medication?

Answer 28

Ask if the patient has any allergies

Question 29

What are the assessments the nurse should do before administering medication?

Answer 29

1. Medical history - Why is the patient on medication 2. History of allergies - Always ask about allergies; chart them and fill out proper document; send it to pharmacists 3. Medication data 4. 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 5. Perceptual or coordination problems 6. Current condition - Patient may not be able to take medication as directed; such as oral due to trouble swallowing 7. Attitude toward medication use - Is important to know the patient's beliefs, may be the reason why they don't take the medication 8. Knowledge and understanding of therapy 9. Client's learning needs

Question 30

What are key points to remember regarding adminsitering medication?

Answer 30

- 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

Question 31

What are the three things you need to do when administering medication?

Answer 31

1. MAR and medication (in original package-if oral) taken to bedside 2. You MUST observe the patient take their medication 3. Medication must be administered within 30 minutes before or after scheduled time

Question 32

What are the 5 things you need to do when preparing medication for administration?

Answer 32

1. Check MAR for when medication is due and check for allergies 2. Prepare the medications (as applicable) and perform appropriate assessment 3. Take the MAR and medication or medication cart to bedside, hand hygiene 4. Directly compare patient ID band with MAR (need 2 identifiers) 5. Complete the 10 rights and 3 checks prior to administration

Question 33

Where do you document scheduled medication?

Answer 33

Only document on MAR (medication administration record)

Question 34

Where do you document PRN medication?

Answer 34

Document on MAR and in progress notes

Question 35

What is tall-man lettering?

Answer 35

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

Question 36

What is a medication error?

Answer 36

Any event that could cause or lead to a client either receiving inappropriate medication therapy or failing to receive appropriate medication therapy

Question 37

What do you do when a medication error occurs?

Answer 37

1. Patient safety - ABCs: Allert, breathing, conscious - Is the patient stable 2. If the patient is unstable, need to manage the situation 3. 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

Question 38

What are high alert medications?

Answer 38

- Medication bears a heightened risk of causing significant patient harm when used in error - Requires independent double checks

Question 39

What is an independent double check?

Answer 39

- 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"

Question 40

Narcotics and Controlled Substances

Answer 40

- 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

Question 41

What is the required monitoring for narcotic administration?

Answer 41

1. Baseline for: - Respiration rate - Pain - Sedation scale 2. Post-Dose: - IM, PR, SC, PO (immediate release, slow release, and oral liquid): 45 to 60 minutes - IV: 5, 15, and 30 minutes

Question 42

What should you do if your patient's physical assessment, VS, or labs indicate a medication should not be given?

Answer 42

Contact the prescriber and see what they would like you to do

Question 43

What do you do when a client that you are admitting to the hospital brings in his own medications?

Answer 43

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.

Question 44

What is the correct abbreviation for "after meals"?

Answer 44

pc: after meals

Question 45

What is the correct abbreviation for "by mouth/oral"?

Answer 45

po: by mouth

Question 46

What are 4 common abbreviations found for dose designations BUT that should always be written out to avoid errors?

Answer 46

1. U or u: Unit 2. IU: International unit 3. D/C: Discharge or discontinue 4. QD: Every day