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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. 3/27/2017 If dose not given 3/27/2017 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 08/24/10 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) 08/24/10 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). 08/24/10 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 28