Medication Administration Flashcards
Name the 7 components of a medication order
○ Client's Full Name ○ Date and Time of Medication Order ○ Name of Medication ○ Route of Administration ○ Dosage of Drug ○ Frequency of Administration ○ Physician/Provider's Signature
What is the 3rd leading cause of death in the US?
Medication errors
What is medication reconciliation?
The process of checking home meds vs meds ordered in the hospital when admitted and when discharged
Who can write a medication order?
Who can write an order?
- MD, DO
- Nurse Practitioner
- Nurse Midwife
- Physician Assistant
- Pharmacists & CRNAs
- Per state and facility policy
4 Types of Medication Orders
- Written Orders – preferred
- Verbal Orders (VO) – should only be done in critical situations (e.g., “push epi”)
- Telephone Orders (TO)
- Protocols (set orders that a nurse can initiate if the conditions are right. ie a set protocol for nitroglycerin for chest pain, nurse is allowed to give w/out contacting provider)
What is a RBVO?
Read Back Verbal Order. The practice of repeating back an order that is given verbally in person or over the phone. It is done to ensure accuracy.
List the steps for RBVO
Step 1. Write down order first.
Step 2. Read back what you wrote.
What is a routine order?
Give order until discontinued
ex: Cephalexin 500mg PO every 6 hours X 7 days
What is a now order?
Patient not in emergency situation, but want to get meds to patient ~ 15 min; since of urgency
What is a stat order?
Administer med as soon as possible; emergent
ex. Morphine 4 mg IV stat
What is a one time order?
Give single dose and then discontinue; think: pre-op
ex: Atropine 0.3 mg subcutaneously on call to OR
What is a PRN order? What should this order always have on it?
PRN: as needed – should always have interval and indication statement
ex. Morphine 2 to 4 mg IV q 4 hours prn pain
What happens after a provider orders a medication?
- Checked by pharmacy
- Checked by RN
- If paper system, may be transcribed by unlicensed person.
What does the RN check after a provider orders a medication?
- Allergies
- Appropriate med
- Appropriate dose
- Checking total order to make sure it is something the patient should be getting (refer back to chart – things can get changed quickly)
What drug information do you need to know to give the medication safely?
Know the:
- Action of the drug – mechanism of action/pharmacological classification
- Normal dose ranges and routes
- Any contraindications
- Drug interactions
- How to evaluate therapeutic effects
- Give w/ or w/o food,
- Patient teaching, etc.
What things do you need to review re: the physical assessment of the patient before giving medication?
- Are they alert? Oriented?
- Ability to swallow
(Should meds be crushed? Can the meds be crushed?) - NPO or not
- Ability to follow instructions
- GI motility
(Post-operative period – maybe GI function hasn’t returned? - Muscles mass (IM) – choose needle size based on muscle mass
- Water at the bedside to take meds
What initial assessments may be needed before giving medications?
- B/P if giving a HTN medication
- Pulse if giving cardiac drugs like Digoxin
- Pain rating if giving pain med
- Temp if giving antipyretic
What is the most common general medication administration time rule?
Give up to 30 minutes before to 30 minutes after (dosage window)
Name 3 common medications that require checking drug levels?
Digoxin, Dilantin, Theophylline
You sometimes need to check electrolytes, name a medication in which you need to do this?
Lasix – check K+ levels
What does the RN need to check before giving insulin or any oral hypoglycemic?
Blood glucose
Places to find meds! What is a mobile cart?
- Locked cassettes or drawers for each patient
- May have “floor stock” drawer
Places to find meds! What is often kept in an automated medication-dispensing systems (Pyxis)?
Opiods
Can patients bring medications from home?
Yes but must have order and checked by pharmacist
If you only need to use a half vial of a medication that is a controlled substance, what do you do with the rest?
Waste it. Must be witnessed and documented by another nurse
How is inventory done with controlled substances?
Done by 2 nurses at set intervals.
Beginning of medication preparation, what is the the first step, after proper hand hygiene?
Assemble the medications in the medication room/mobile med cart.
In the beginning of medication preparation, after you have assembled the meds, what do you do?
Check for drug expiration date, check for the five rights against the MAR
What are the 3 checks of medications (triple check!!)
1) Against MAR before preparing medication (e.g., getting it from Pyxis)
2) Against MAR after preparing the medication
3) At the bedside
How many medications should you prepare at a time?
One
What should you do with syringes if not in the original container BEFORE removing from medication room
Label syringes
5 rights review: How to check if the right patient?
- “State your name and date of birth”
- Compare with armband and medical record
5 rights review: How to check if the right drug?
- Compare drug to MAR
- Note expiration date
- Know indication: “Why is the patient taking this medication?”
5 rights review: How to check if the right dose?
- Know the usual dose and question any dose outside of safe range
- Validate calculations of divided doses with another nurse
- Check high alert medications (ie heparin, insulin, digoxin) with another nurse
5 rights review: When is the appropriate window to give meds?
- Medication given 30 minutes before or 30 minutes after time ordered is acceptable.
- Refer to policy and procedure manual.
- *Standard administration times are set by each facility.
ex: Once daily dose: 1000; BID dose 0900, 2100
5 rights review: How to check if the right route?
- Double check it is the right route of administration in drug book/MAR
- If a change in route is needed, request new order from physician
ex: Tylenol 650mg suppository cannot be changed to PO route without a new order!
What should you know for any PRN drug?
Know the last time of administration
It’s time to go to the room and administer medication. What are your first steps?
- Bring MAR and medications to patient room
- Check 5 “Rights”
- Compare wristband to MAR
- Ask about allergies
When possible, what do you tell the patient when you are giving them a medication?
- Name of medication
- Dosage
- Indication for use
- Pertinent patient teaching
What position is best for the patient to be in to administer most meds?
High fowler’s
After administration, what/when do you document on the MAR?
- As soon as possible AFTER administration
- Document time administered
- Document client response
- Especially document for _____ medications and the first time a ____ medication is administered
PRN, new
If a medication is not given/refused, what do you document?
Document reason (e.g., blood sugar low – no insulin, pt. refusal)
What do you monitor for after giving?
Effect – did it do what it was supposed to?
What do you do if/when you make a medication error?
1) Make sure the patient is okay!!
2) Notify the provider/charge nurse
3) Complete an incident report
Never crush what kinds of oral meds?
Sustained release, controlled release, or enteric coated pills
Capsules cannot be ______, but they can be ______
split, opened
More than ____ (ex. vials) to equal a dose is a RED FLAG
3
*ex: IV med that takes 10 vials doesn’t seem right…double check the order!
