Medication Administration Flashcards
What are the 5 Patient Rights? (“5+5”)
- Right Patient (Identify)
- Right medications –> keep meds in the original packaging
- Right Dose
- Right Route
- Right Time
- Routine Times/daily: TYPICALLY 9 AM; if its BID or twice a day, then it’s given 9AM and 9PM!- PRN (as needed) –> ex: if they need insulin bc they’re blood sugar become suddenly high; pain meds
- Stat (Immediately) –> WITHIN 15-30 mins
- Urgent:
- Time critical vs. Non-time critical
(Time critical: have 30 mins window) (Non time critical: have 1 hour window)
- Right Assessment
- Right Documentation
- Right to Refuse
- Right Education
- Right Evaluation
A medication is ordered to be given BID. What times will the medication need to be given?
9 AM and 9 PM!!
(Remember that if it’s routine times/daily, typically are given at 9am. If it’s BID or twice a day, it’s given at 9AM and 9PM)
How many times should you verify the 5 Rights of med admin? When should you do that?
1st: When medication obtained from AMDS (Automated medication dispensing system)
2nd: During preparation of medication
3rd: At patient bedside immediately prior to administration
What is the Ordering & Administering process?
1st–> Computerized physician order entry
2nd –> pharmacy review
3td –> Medication administration record (MAR)
What are the factors contributing to medication errors?
- failure to follow 5+5 rights
- Failure to check order accuracy
- failure to assess the patient for high-risk variables
- Giving meds before verification
- Incomplete illegible orders with unapproved abbreviations
- Stressful conditions with interruptions (don’t interrupt others when they’re getting meds)
What are the medication reconciliation
- Completed on admission, discharge, and transition to another level of care
- Review all medications (OTC/ over the counter & Herbals)
- Verify what patient is taking and what is ordered
- Educate during process
What is the 7 Safety Processes?
- AMDS (Automated Medication Dispensing System)
- BCMA (Barcode Med admin)
- Three safety checks (5 rights) before administering
- Avoid overrides (unless its a true emergency)
- Avoid workarounds (armbands) –> scan arm band & make sure they stay in the patient’s arm
- Pay attention to alerts
- Question large or small doses
What should you do when medication errors occur?
- Assess patient
- Notify HCP
- Follow protocols related to
- Notify supervisor
- Completing incident report that placed or mentioned in patient’s medical record
- Document appropriately
What are the strategies for reducing medication administration errors?
- Use TWO patient identifiers (name &DOB)
- Use appropriate administration techniques
- Verify dosage calculations (double-check for high risk)
- Notice sound-alike medications
- Clarify unclear orders
- Don’t leave meds at bedside
- Know what you’re doing
- NEED WITNESS for insulin, heparin, TPN, chemotherapy, and narcotic wasting
- Educate patients
- Recognize right to refuse
- Observe/assess before and after PRN and new medications for efficacy and adverse events
- Confirm allergies
What are the Nurses’ & Patients’ rights?
Nurses’ Rights:
1. Complete & clearly written order
2. Correct medication & dose dispensed
3. Accurate information on medications
4. Relevant policies to guide practice
Patients’ Rights:
1. To be educated about the medications
2. To refuse medications
3. To have qualified HCW assess medications hx
4. To be properly advised about medications
5. To receive medications safely
6. To receive appropriate supportive therapy
7. To NOT receive unnecessary medications
8. To be informed if medications are part of research study
What are the med administration process?
- Hand hygiene/gloves
- 2 patient identifiers
- Allergies
- Open unit dose meds AFTER 3rd safety check and scanning
- NEVER leave meds at bedside
- Document VS (vital signs) and assessments related to med admin before leaving bedside
- Separate medications dependent on BP, pulse, or lab data
- Reassess 30 minutes for desired or adverse effects (ex: pain medication)
What are the factors for selecting specific route?
- Costs (oral less expensive)
- Level of unconsciousness (unconscious can’t safely take oral meds)
- Generalized vs Localized effect
- Emergency situations (speed of absorption & desired effect)
- Dosing accuracy
What is Enteral (Oral) – Enter the digestive tract (PO)?
- Liquid vs solid
- Regular vs Extended release, controlled release & enteric-coated –> Extended release, controlled release & enteric-coated CANNOT BE CRUSH!!!
- Less costly
- More convenient
- Safer
- Typically takes longer to start working
- When to avoid:
- When they have nausea or vomiting
- If they have reduced GI motility
- If they aren’t able to swallow
What type of Enteral/oral (PO) medication can NOT be crushed???
Extended release, controlled release & enteric-coated CANNOT BE CRUSHED!
What do you need to know about Nasogastric & Gastrotomy tubes?
1) Check for placement. HOW?
- by using X-RAY
- Aspirate (pull back) to see what it looks like. If u see stomach- looking contents, then there’s a good chance it’s in the stomach
- push air bolus in & listen over the stomach if you hear a griggle
2) Elevate HOB to at least 30 DEGREES to decrease risk of aspiration
3) Prevent clogging by:
- Pills have to be crushed –> usually give liquid
- Before & After meds flush tube with 20-45mL of water
- If clogged, trouble shoot –> usually required reinsertion of tube
