Download Medication Administration

Medication
Administration
Stephanie Stevens, MSN, RN, CNE
Naming of Medications
A medication can have as many as three
different names
 Chemical
 Generic
 Trade or Brand
Classification of Medications

Medication classification can indicate the:
 effect of the medication on a body system.
 symptoms that the medication relieves.
 medication’s desired effect.
Medication Forms

Manufacturers make many medications in
several forms such as tablets, capsules,
elixirs, and suppositories.

When administering a medication, be certain
to use the proper form. SeeTable 19-2
“Drug Preparations”, p. 401
Distribution Systems

Special areas used for
stocking and dispensing
medications (carts, rooms,
cabinets, storage units in
patient’s rooms)
Distribution Systems

Types of Systems
 Unit-Dose
 Automated Medication-Dispensing
 Self-Administered Supply
 Bar code
Medication Administration
Types of Distribution Systems
Unit Dose System
Portable carts w/drawers
 Keep a 24-hour supply of
meds for each patient
 Each tablet or capsule is
individually wrapped
 May be a “bingo” card
 Also contains limited amounts
of PRN medication
 Designed to reduce number
of medication errors and saves
steps in dispensing
medications

Types of Distribution Systems
Automated-Medication Dispensing System





Contains routine,
PRN, controlled
substances
Useful for the control
of narcotics
Individual security code
for access
Select pt’s name,
desired drug, and route
System dispenses
desired med, records it,
and charges it
Types of Distribution Systems
Bar Code Medication Administration
Uses a laptop computer, handheld laser
scanner, and bar codes
Improves patient safety by adhering to the
rights of medication administration
Types of Distribution Systems
Self-Administered Supply
Stored at patient’s bedside
Allows for patient independence and
responsibility
Allows for evaluation of patient adherence
and safe medication management before
discharge
Nonprescription and Prescription
Medications

Nonprescription

Prescription

Herbs & Other Botanicals
Components of Medication
Orders
Patient’s full name
 Date and time the order is written
 Name of the medication
 Dosage of the medication
 Route of administration
 Time and frequency of administration
 Purpose or indication for use
 Signature of the prescriber

Types of Orders

Five common types of medication orders
based on the frequency or urgency of the
order
 Routine
 PRN
 Standing Protocols
 Single
 Stat
Types of Orders

Routine Orders
 Orders carried out until the health care provider
cancels it by another order or until a prescribed
number of days elapse
 May indicate a final date or number of dosages
Types of Orders
PRN Orders




Medications given only when the patient requires it
Use subjective & objective assessment to determine
its need
Usually has set time intervals to be given
Document:
 Assessment data you used to determine the need
of the medication
 Evaluate the effectiveness of the medication
Types of Orders

Standing Protocols
 Administered in specific situations with criteria
for administration
 Usually used for patients on a particular unit
Types of Orders

Single Orders
 Given only once at a
specified time
 Common for preoperative
medications or diagnostic
examinations
www.ibiblio.org
Types of Orders

Stat Order
 Medication given
immediately & only once
 Usually written in
emergency situation
when there is a sudden
change in patient’s
condition
Types of Orders

Now Order
More specific than a stat order
 Administered quickly, but not
immediately
 Up to 90 minutes to administer
the medication
 Only administer now
medications one time

Receiving Medication Orders

Verbal Order



Medication or treatment order received in the presence
of the prescriber
Enter the order to the pt’s medical record & transcribe
them the same way as if the prescriber wrote them himself
Telephone Order


Medication or treatment orders the prescriber gives over
the telephone
TJC requires the nurse who takes the order to read
back the complete order after entering it on the patient’s
chart.
Receiving Medication Orders
Order required before
administration of drug
 Only to be given verbally or by
telephone by the prescriber to
the nurse when written or
electronic communication is not
possible

Correct Transcription and
Communication of Orders
Once you receive and “process” a medication
order, place the order on the MAR or eMAR.
 Includes
 Pt’s name
 Room/bed number
 Names, dosages, routes and frequencies of med

Correct Transcription and
Communication of Orders
As a nurse, you complete or update the MAR
 Nurse checks all medication orders for accuracy
and thoroughness.
 If an order seems incorrect, verify with prescriber.
 When you give the wrong medication or incorrect
dose, YOU are legally responsible for the error.

Legal Aspects of Med
Administration
 Food & Drug Administration
 Nurse Practice Acts
 Institutional Medication Policies
 Patients’ Rights
 Controlled Substances Act
 Substance Abuse
Pharmacokinetics

What is pharmacokinetics?
 It is the study of how a medication enters the
body.

Four Phases
 Absorption
 Distribution
 Metabolism
 Excretion
www.thebody.com
Absorption
Passage of medication molecules into the
blood from the site of administration
 Influential Factors

 Route
 Ability to dissolve
 Blood flow to the site
 Food
Absorption-Route of
Administration

Each route has a different rate of absorption
 Skin
 Oral
 Mucous membranes & respiratory airways
 Intravenous
Absorption-Ability to Dissolve

Depends largely on its form of preparation
Absorption-Food
Presence/absence of food in the stomach
affects absorption
Distribution
After absorption, the
medication is distributed
to organs and tissues and
to its specific site of
action
 Factors affecting
distribution
 Circulation
 Membrane
permeability
 Protein binding

Distribution-Circulation

Medication enters the bloodstream and it is
carried to specific tissues and organs.

How fast it gets to the specific area
depends on its vascularity
Distribution-Membrane
Permeability

Some membranes serve as barriers to the passage of
medications.

Older adults are very susceptible.

Some membranes are non-selective.
Distribution-Protein Binding
The degree to which medication bind to serum
proteins e.g., albumin affects medication
distribution.
 Medications bound to albumin do not exert any
pharmacological activity.
 Unbound or free molecules are considered the
active form of the drug.
 Older adults, and patients with liver disease or
malnutrition have decreased albumin causing more
unbound medication and increasing risk for toxicity.

Metabolism
 Also known as biotransformation
 Occurs under the influence of enzymes that
detoxify and transform toxic substances
 Liver is the primary organ for metabolism
 If there is a decrease in liver function, the
body eliminates med more slowly increasing
risk for toxicity resulting in need to decrease
dosage.
Excretion

Process of removing the drug or its
metabolites from the body
 Chemical make up of the drug determines which
organ excretes the medication
 Kidneys are primary organ
for excretion process.
Renal impairment increases
risk for toxicity resulting in
need to decrease dosage.
Types of Medication Action—
Therapeutic Effects
Intended or desired physiological response of
a medication
Each medication has a desired therapeutic
effect
 Can have many therapeutic effects

Types of Medication Action—
Therapeutic Effects
It is important to know the expected
therapeutic effect of each medication the
patient receives
Types of Medication ActionAdverse Effects




Undesired, unpredictable, unintended responses to
medication.
May not have been discovered during the drug’s clinical
trials
Medication MUST BE discontinued
Obligation to report the adverse reaction
Types of Medication Action Side Effects

A predictable and often unavoidable secondary effect
produced at a usual therapeutic dose.

Usually discovered during clinical drug testing
May or may not be harmful
 Prescriber may D/C the med if the side effects
outweigh the benefits of the medication.
 Common SE

Types of Medication ActionTolerance
When an increased dosage of medication is
required in order to achieve the same effect as
previously experienced.
Types of Medication Action—
Allergic Reactions
Mild Allergic Reaction
 Unpredictable reaction in which the patient
becomes immunologically sensitized to a
medication after taking the first dose.
 Need allergy bracelet if known history
 Symptomology
 Pruritis
 Urticaria
 Rhinitis
Types of Medication ActionAllergic Reactions
Anaphylactic Reaction
 Severe allergic reaction
 Requires immediate emergency intervention
 Symptomology
 Tachycardia
Wheezing
 Edema of oropharynx/tongue
 Dyspnea
 Hypotension

Types of Medication Action—
Toxic Effects
 Can have lethal effects, depending on
type of medication
 May be caused by:
Overdose
Prolonged intake of a drug
Medication accumulates in the blood
d/t impaired metabolism or excretion
processes.
Pharmacodynamics
Medication Interactions

When one medication modifies the action of
another medication

Interactions may be synergistic or
antagonistic

Can be therapeutic as well as
nontherapeutic
Pharmacodynamics
Synergistic

An effect resulting from two drugs—the effect of the two
drugs combined is greater than the effects of the
medications when given separately.

Synergistic interaction can result in a nontherapeutic
effect.

Synergistic interaction can result in a therapeutic effect.
Pharmocodynamics
Antagonistic

An effect resulting from two drugs—the effect of one drug
reduces or abolishes the effect of the other drug

Antagonistic interaction can result in a nontherapeutic
effect.

Antagonistic interaction can result in a therapeutic effect.
Pharmacodynamics
Compatibility

Must be determined when mixing more than
one drug in a syringe or IV tubing

May need to be administered separately
Medication Dose Responses
Terms Associated with Medication Actions
Onset
 Time it takes after you administer a drug to
produce a response
Peak
 Time it takes for a drug to reach its highest
effective concentration
Duration
 Time during which the drug is present in a
concentration great enough to produce a
response

Initial Assessment
Medication History
Assess ALL medications
 Prescription
 Nonprescription
 Herbal supplements
 Length of time patient has been on medication
 Current dose schedule
Medication Reconciliation
Process recommended by TJC that exists for
comparing current medications with those
ordered for the patient.
Rationale: Reduces the risk of transitionrelated med errors
Initial Assessment
Allergies/Intolerances

All health care team members need to know patient’s
medication and food allergies—

All allergies and types of reactions should be noted
on patient’s admission notes, H&P, and medication
records
Initial Assessment
Medical History

Obtain/review a medical history before
giving medications
 Provides indications/contraindications for drug
therapy
 May also discover medications patient may
need
Diet History
Effective dosage
schedule is planned
around normal eating
patterns and food
preferences
 Teach patients to avoid
foods that interact with
medications

Assessment Before Med Admin

MAR

Diet and Fluid Orders

Lab Values

Physical Assessment
Assessment Before Med Admin
Perceptual /Coordination Problems

Physical or mental limitations
can hinder patient’s ability to
correctly take medications .

Assess patient’s ability to
prepare doses and administer
medication

May need to assess whether
family or friends are willing and
able to assist
Patient’s Attitude About
Medication Use
 Affects compliance of medication
 May reveal dependence or avoidance
 Observe behavior for evidence of
medication dependence or avoidance
 Assess patient’s cultural beliefs
Medication Errors






Most common type of medical error
1.3 million patients harmed each year
Costs=3.5 billion (Medical cost treating drugrelated injuries in hospitals each year
400,000 PREVENTABLE injuries in
hospitals
530,000 PREVENTABLE injuries in OP
clinics
800,000 PREVENTABLE injuries in LTC
facilities
Medication Errors

Possible Causes
 Inaccurate prescribing
 Administering the wrong medication
 Administering extra doses
 Failing to administer a dose
 Giving the medication at the wrong time
 Wrong dose (too much/too little)
Medication Errors
When an error occurs, client safety and wellbeing are top priority
 If an error occurs

 Assess well-being of patient
 Notify MD or prescriber of the incident
ASAP
 Report to manager/supervisor
 Complete incident report – usually filled out
within 24 hours
The Six Rights of Medication
Administration
Right Patient
 Right Medication
 Right Dose
 Right Route
 Right Time
 Right Documentation

Right Patient
Verify using two appropriate patient
identifiers. (TJC)
Right Medication



Order required when giving any medication
Always compare order in chart with MAR
Meds from bottles or containers
 Compare the label of the medication container with the
MAR (3) times Before removing the container from the drawer or
shelf
 As you remove the medication ordered from the
container
 Before returning it to storage
Right Medication

Unit-Dose Medications
 Check medication label and dosage when taking
it out of the medication dispensing system
 Verify all medications at the patient’s bedside
with the MAR.
Administer ONLY the medications that YOU
prepare.
Right Dose

Greater risk of error when preparing from
stronger dose than needed or converting to
another unit of measurement
Right Route

Medications can be given by more than one route

Always consult with prescriber when route is not
specified – DO NOT ASSUME

If the prescribed route is not a recommended route,
notify the prescriber immediately
Right Time

Know why medication is ordered for certain
times of the day

Prescriber often gives specific instructions
about how to administer
Right Time

All routine ordered medications should be
given within a 60-minute window of the
prescribed time.

Some meds may require your clinical
judgment when determining the proper time
for administration
Right Documentation
Document on MAR immediately after
administration.
 Document any other needed information.
 NEVER document prior administering.
 If a dose is missed, document the reason.

Right Documentation
 Record in nurses’ notes how the
responds to the medication(positive or
negative). If negative, inform MD.
 If refuses, investigate WHY.
 Document any refusal or withholding of
medication
Knowledge and Understanding




Affects the patient’s ability to
comply or adhere
If patient understands reason of
taking a drug, likelihood of
compliance is enhanced.
Teach medication purpose, proper
administration techniques, and
possible side effects
If patient cannot afford
medications, discuss financial
resources.
Learning Needs of the Patient
 Many patients do not understand their
medications
 To assess learning needs, ask patients
the purpose, expected side effects,
correct administration techniques, etc.
of their meds
Noncompliance/Nonadherence
The failure of a patient
to take their medication
as prescribed
Why?

Not uncommon, especially
in the older adult
spacing.ca
Patient and Family Teaching

Without good patient teaching, noncompliance is
likely.

It is essential to provide information about the
purpose, action, and effects.



Easy to read pamphlets
Handouts
Pt must also be aware of consequences if
noncompliant.
Patient and Family Teaching

Daily Injections



Must learn to prepare and administer injection correctly
using aseptic technique
Good to teach family/caregiver if patient becomes ill or
physically unable
Side Effects/Toxicity
Family/caregiver also needs to be aware of symptoms of
medication side effects or toxicity esp. if they are
cognitive or behavioral in nature.
 Learning the basic guidelines for medication safety can
ensure proper use and storage of medications in the
home

Special Considerations for
Administering Medications

Older Adults
 Physiological changes
 Behavioral changes
 Economic factors
Evaluation
Remember….evaluation is assessing a pt’s
response to teaching as well as their
response to medications
It is an ongoing process …
 Requires YOU to know desired effect, side
effects, nursing implications, etc.
 May use a variety of evaluative measures, e.g.
rating scales, physiological measurements,
observation of behavior, oral questioning, etc.
End of Part I