Medication Administration Flashcards
Nursing responsibilities for safe administration
Responsibilities:
1. 6 Rights: Right pt, drug, dose, time, route, and documentation; and nursing judgment
- Medication knowledge/sources of information
- Medication standards
- Pt-related variables
- Clarifying orders
Adverse drug events
Adverse events:
1. Inaccurate recording and transcribing orders
- Unclear or erroneous labeling, or expiration of drugs
- Pt misidentification
- Incomplete delivery of drugs
- Verification errors
- Use of inadequate knowledge or inaccurate knowledge base
- Time and performance pressure
New safety measures
Safety instutions:
1. Institute of Medicine (IOM); refer to IOM-QSEN to avoid medication errors
- JCAHO National Pt Safety Goals
- Electronic health record (EHR)
- Newly designed delivery systems
Unit-dose drug distribution system
Pre-packaged, pre-labeled, individualized doses
SAFEST, most efficient, and most economical
Systems of medication safety
Safety systems:
1. Automated medication dispensing systems (i.e. Pyxis)
- Fingerprint/password
- Controlled substances
- Barcode medication administration: Pt barcode is scanned and compared to medication to ensure 6 rights
Drugs and medications
Types of medications:
1. NON-PRESCRIPTION meds. – OTC; FDA-approved and controlled (i.e. Tylenol)
- PRESCRIPTION meds. – Require supervision to safely determine therapeutic vs. toxic effects
- HERBS & BOTANICALS – Determine safety, potency, and drug interactions
Medication order
Components:
1. DRUG NAME – Brand/trade or generic name; Capitalized lettering helps differentiate meds. that look/sound alike
- DOSE & TIME – Strength and frequency
- ROUTE – PO, IM, IV, ID, SC, sublingual, otic, ophthalmic, and transdermal
- PURPOSE – i.e. Pain, fever, N/; medication order must address specific purpose
- SIGNATURE
Types of medication orders
Medication orders:
1. Electronic (EPIC)
- PRN order – requires assessment and nursing judgment
- Routine order – detailed order for a medication given on a routine or regularly scheduled basis (i.e. Insulin)
- Standing protocol – pre-written medication orders and specific instructions to administer a medication to a person in clearly defined circumstances (i.e. Hypoglycemic treatment algorithm protocol)
- Single/one-time order – i.e. Pre-op, emergency-related orders
- Tritation order – the medication dose is either progressively increased or decreased in response to the patient’s status (i.e. Heparin adjustment using PTT)
- Verbal order (rare)
Patient controlled analgesics (PCA)
Method of allowing a person in pain to administer analgesics (i.e. Morphine sulfate, Dilaudid)
Child PCA usually with Narcan drip (narcotic antidote) – Helps reduce side effects, itching, and N/
PCA rates:
1. BASAL: Continuous infusion for pain control
- BOLUS: Pt self-medicated dose as needed; locks to prevent overdose
Principles of drug action
Principles:
PHARMACOKINETICS: What the body does to the drug – i.e. Absorption, distribution, metabolism, and excretion
PHARMACODYNAMICS: What the drug does to the body – i.e. Therapeutic effects, adverse effects, side effects, tolerance, allergic reactions, and toxicity
Medication assessment
Assess:
1. PMHX
- Allergies (and reactions), and intolerances
- Medication history (Past, present, and alleviating meds.)
- Medication record/orders
- Diet and fluid orders
- Laboratory values
Physical assessment
Assess:
1. Ability to swallow – especially infants/children, elderly, and pts with GERD
- GI motility – i.e. PO route is contraindicative if V/D/
- Adequate muscle mass
- Patent venous access
- Vital signs
- Body system assessment (Right response)
- Assessment of knowledge and compliance
Safe medication administration
Nursing safety measures:
1. Interpret order
- Calculate adult/child dosage
- Inform the pt what they are receiving
- Assess pt understanding of medication
- Assess pt allergies and history
- Administer meds. according to 6 rights
Preventing medication errors
Prevent medication error by:
1. Redesigning delivery systems – i.e. POE (provider order entry), infusion pumps
- Creating safety cultures – QI (quality improvement) to instill a culture of pt safety (i.e. reporting errors)
- Maximizing interprofessional communication
- Barcode scanning
- Simulation
- Classifying high risk meds. – i.e. Narcotics, insulin, heparin, potassium which increase risk to cause harm
- Identifying at-risk populations – Pediatric and elderly populations (due to to varying size and weight)
**Critical thinking, and personal judgment, knowledge, and responsibility
Special circumstances
Some medications require: Special handling, refrigeration, or to be prepared a certain way
Children/Elderly:
1. Parent may help administer
- Child should help if possible
- Dilute in small amounts of something the child likes
- Offer assistance to elderly pt
- Use liquids, crush pills, and allow time
