Download Medication Administration

Medication
management
Generic overview for RN students – Carolyn Kirker,
08/24/10
1
IV CNS, CCDHB
Session objectives
• Understand RN student responsibilities related
to medication administration
• Recognise the national medicines chart and
it’s components
• Understand medication administration
principles
08/24/10
Student policy/procedure
• The medicines are legally prescribed.
• The patient receiving the medicine is informed that it will be
administered by a student, and agrees to the process.
• The registered nurse/midwife supervises the student from
the selection of medicine through to its administration and is
responsible for the safety and risk management of the
procedure.
• If the medicine being administered requires double checking
eg. Opioid administration, two registered nurses/midwives
are required to carry out this procedure. The student is not
used as part of the double checking process.
• Review medicines administration in CCDHB/HVDHB policy –
3/27/2017
available in capitalDoc or local system.
3
Administration checklist
5 rights and...
... other
• Right medicine
– Name, formulation, frequency, expiry
• Right route
• Right dose
• Right time
– Check prn, stat administration sections
of drug chart.
•
•
•
•
Right patient
Right reason
Right documentation
Right to refuse
3/27/2017
• Allergy status
• Drug interactions
• Equipment
• Environment
• Personnel
National medication chart
3/27/2017
Administrators instructions
• Record time of administration using 24-hour
clock
• i.e. 0600 or 1800
• For variable route, record actual route used
• i.e. 50-100mg prescribed, 50mg given
• For variable dose, record actual dose given
• Giv/chck – given checked by.
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If dose not given
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Administrators rights
• Every nurse has a responsibility to ensure they
can clearly read and understand the order
before administering any medicine. The
prescriber should be contacted to clarify
incomplete or unclear orders.
• It is appropriate to withhold a medicine if
there is a known allergy or adverse reaction to
it, until the prescriber has been contacted for
instructions.
3/27/2017
Medication Routes
• Enteral (via digestive tract)
– Oral (by mouth, PO)
– Sublingual (under the tongue, SL)
– Rectal (via the rectum, RE)
All in scope for RN students to administer
Core IV Study Day
Medication Routes
 Parenteral
– Topical
– Inhalation (IH)
– Endotracheal (ET)
– Transdermal (TD)
– Subcutaneous (SC)
– Intramuscular (IM)
All in scope for RN students to administer
Core IV Study Day
Medication Routes
 Parenteral
– Intravenous (IV)
– Intraosseous (IO)
Not in scope for RN students to administer
Core IV Study Day
Patient assessment
•
Ask yourself about the patient, are there any conditions
you will have to note:
•
Renal
•
Liver
•
Cardiac
•
Diabetes
Plain
 Release profile has not been
modified (immediate release)
 Examples: Frusemide,
Amitryptiline
 Often sugar coated/uncoated
tablets or capsules
 In general tablets may be crushed
or capsules opened
 Do not crush cytotoxics,
hormones, buccal or sublingual
preparations – risk of exposure
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Enteric Coated
• Special coating to ensure drug released into
body in small intestine
• “EC”, “EN”
• Protect drug from stomach acid (eg PPIs) OR
• Protect stomach from drug (eg NSAIDs)
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Modified release
Release into the body has been modified




Controlled release
Sustained release
MR, SR, CR, XL, LA
Examples: Diltiazem (Cardizem CD) Isosorbide
Mononitrate (Duride) Morphine (M-Eslon)
Oxycodone (Oxycontin)
08/24/10
Reasons for crushing oral medications
• Difficulty swallowing
• To be passed through a NG or PEG
tube
If a drug CAN’T be crushed, what are
the alternatives?
• Dispersible tablet
• Liquid / Syrup
• Non-oral route
Points to consider when using a NG or PEG tube
• Placement
• Tube size
• Number of medications to be given
• Patient’s diet
Infection prevention
Drawing up needles
Filters
Allergies vs adverse drug reactions
08/24/10
Allergies
 Unexpected reactions to a medicine, food
(such as seafood, gluten, eggs, peanuts),
substance (eg, iodine, preservatives,
sulphur) which has been administered,
taken, or used in the intended way.
 Anything that has caused a skin rash,
urticaria (hives), facial or throat swelling,
or anaphylaxis should be documented
as causing an allergy.
 Allergies can also include reactions to
plasters or latex.
3/27/2017
Adverse reactions
 Adverse reactions are commonly listed in the
medicine’s data sheet as a known side effect.
 Adverse reactions tend to be more common
patient occurrences than allergies (such as
diarrhoea with penicillin or nausea with
morphine).
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Allergic reaction
•
Allergen causes mast cells to
produce histamine and other
mediators
– Bronchoconstriction >
Dyspnoea
– Angiooedema (swelling of the
head and neck)
– Vasodilation > Hypotension
– Skin reactions > rashes
Immediate actions
•
•
•
•
•
•
Remove allergen
Call for help
ABC
Administer 0.5ml (0.5 mg) of 1:1,000 Adrenaline
intramuscularly
100% O2 via mask
Fluids if needed – which?
Case - Amiodarone IV
Infection
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