Download Medication Errors

Chapter 29
Medications
Drug Nomenclature
• Chemical name — identifies drug’s atomic and molecular
structure
• Generic name — assigned by the manufacturer that first
develops the drug
• Official name — name by which it is identified in official
publications USP and NF
• Trade name — brand name copyrighted by the company
that sells the drug
Drug Preparations
• Oral
– Capsule, pill, tablet, extended release, elixir,
suspension, syrup
• Topical
– Liniment, lotion, ointment, suppository, transdermal
patch
• Injectable
Drug Classifications
• Body system
• Symptoms relieved
• Clinical indication
Mechanisms of Drug Actions
• Drug-receptor interaction — drug interacts with one of
more cellular structures to alter cell function
• Drug-enzyme interaction — combines with enzymes to
achieve desired effect
• Acting on cell membrane or altering cellular environment
Pharmacokinetics
• Absorption — drug is transferred from site of entry into
bloodstream
• Distribution — drug is distributed throughout the body
• Metabolism — drug is broken down into an inactive form
• Excretion — drug is excreted from the body
Factors Affecting Drug Absorption
• Route of administration
• Drug solubility
• pH
• Local conditions at site of administration
• Drug dosage
• Serum drug levels
Adverse Effect of Medications
• Iatrogenic disease
• Allergic effects
• Toxic effects
• Idiosyncratic effects
• Drug interactions
Signs and Symptoms of Drug Allergy
• Rash
• Uticaria
• Fever
• Diarrhea
• Nausea
• Vomiting
• Anaphylactic reaction
Variables Influencing Effect
of Medications
• Developmental considerations
• Weight
• Sex
• Genetic and cultural factors
• Psychological factors
• Pathology
• Environment, timing of administration
Types of Medication Orders
• Standing order — carried out until cancelled by another
order
• Prn order — as needed
• Stat order — carried out immediately
Parts of the Medication Order
• Patient’s name
• Date and time order is written
• Name of drug to be administered
• Dosage of drug
• Route by which drug is to be administered
• Frequency of administration of the drug
• Signature of person writing the order
Medication Supply Systems
• Stock supply
• Individual supply
• Medication cart
• Computerized medication system
• Bar coded medication cart
Systems of Measurement
• Metric — meter (linear), liter (volume), gram (weight)
• Apothecary — less convenient and concise; basic unit or
weight is grain
• Household — least accurate system; teaspoons,
tablespoons, teacup and glass used
Metric System Conversions
• To convert larger unit to smaller unit, move decimal point
to right.
• To convert smaller unit to larger unit, move decimal point
to left.
– 1 kilogram = 1000 grams
– 1 gram = 1000 milligrams
– 1 milligram = 1000 micrograms
Three Checks of Medication
Administration
• Read the label:
– When the nurse reaches for the container or unit
dose package
– Immediately before pouring or opening medication
– When replacing the container to the drawer or shelf
Five Rights of Medication Administration
• The nurse should give:
– The right medication
– To the right person
– In the right dosage
– Through the right route
– At the right time
Controlled Substances
Required Information
• Name of patient receiving narcotic
• Amount of narcotic used
• The hour narcotic was given
• The name of physician prescribing narcotic
• Name of the nurse administering narcotic
Oral Medications
• Solid form — tablets, capsules, pills
• Liquid form — elixirs, spirits, suspensions, syrups
Administration of Oral Medications
• Oral Route — having patient swallow drug
• Enteral route — administering drug through an enteral
tube
• Sublingual administration — placing drug under tongue
• Buccal administration — placing drug between tongue
and cheek
Administration of Parenteral Medications
• Subcutaneous injection — subcutaneous tissue
• Intramuscular injection — muscle tissue
• Intradermal injection — corium (under epidermis)
• Intravenous injection — vein
• Intraarterial injection — artery
• Intracardial injection — heart tissue
• Intraperitoneal injection — peritoneal cavity
• Intraspinal injection — spinal canal
• Intraosseous injection — bone
Sites for Intramuscular Injections
• Ventrogluteal site
• Vastus lateralis site
• Deltoid muscle site
• Dorsogluteal site
Criteria for Choosing Equipment
for Injections
• Route of administration
• Viscosity of the solution
• Quantity to be administered
• Body size
• Type of medication
Preparing Medications for Injection
• Ampules
• Vials
• Prefilled cartridges
Topical Administration of Medications
• Vaginal
• Rectal
• Inunction
• Instillation
• Irrigation
• Skin application
Medical Record Documentation
• Each dose of medication, give as soon as possible after it
is given
• Intentional or inadvertent omitted drugs
• Refused drugs
• Medication errors
Type of Medication Errors
• Inappropriate prescribing of the drug
• Extra, omitted, or wrong doses
• Administration of drug to wrong patient
• Administration of drug by wrong route or rate
• Failure to give medication within prescribed time
• Incorrect preparation of a drug
• Improper technique when administering drug
• Giving a drug that has deteriorated
Medication Errors
• Check patient’s condition immediately; observe for
adverse effects.
• Notify nurse manager and physician.
• Write description of error on medical record and remedial
steps taken.
• Complete special form for reporting errors.
Patient Teaching
• Review techniques of medication administration.
• Remind patient to take the medication as prescribed for
as long as prescribed.
• Instruct patient not to alter dosages without consulting
physician.
• Caution patient not to share medications.