Drug administration

1. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Patient’s RightsPatient’s Rights
Because of the risks involved in drugBecause of the risks involved in drug
administration patients have the right to:administration patients have the right to:
- be informed of the name, purpose, action- be informed of the name, purpose, action
& potential side effects of drugs& potential side effects of drugs
- refuse a medication regardless of the- refuse a medication regardless of the
consequencesconsequences

2. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Patient’s Rights (con’t)Patient’s Rights (con’t)
- receive labelled medications safely in- receive labelled medications safely in
accordance with the five (5) rightsaccordance with the five (5) rights
- be adequately informed of the- be adequately informed of the
experimental nature of any drug and signexperimental nature of any drug and sign
a written consenta written consent
- not receive unnecessary medications- not receive unnecessary medications

3. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
The nurse is also responsible for ensuringThe nurse is also responsible for ensuring
that they have the knowledge to ensurethat they have the knowledge to ensure
the correct administration of drugs. Thisthe correct administration of drugs. This
includes pharmacology, anatomy andincludes pharmacology, anatomy and
physiology, and legal issues.physiology, and legal issues.

4. WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL
MEDICATION ORDERMEDICATION ORDER
Medication charts are legal documentsMedication charts are legal documents
and must be completed accurately andand must be completed accurately and
unambiguously in order to ensure thatunambiguously in order to ensure that
patients receive safe and optimal drugpatients receive safe and optimal drug
therapy.therapy.

5. WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL
MEDICATION ORDERMEDICATION ORDER
Medication Charts should be writtenMedication Charts should be written
legibly in the prescriber’s own handwritinglegibly in the prescriber’s own handwriting
and include:and include:
 Patient’s surname, first name, medicalPatient’s surname, first name, medical
record number (MRN), ward/clinicrecord number (MRN), ward/clinic
- if a patient ID label is used it must be- if a patient ID label is used it must be
affixed to every medication chart andaffixed to every medication chart and
signed for verification by the prescribersigned for verification by the prescriber

6. WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL
MEDICATION ORDERMEDICATION ORDER
 Drug name (generic), dosage form,Drug name (generic), dosage form,
strength and dose requiredstrength and dose required
 Complete, clear and unambiguousComplete, clear and unambiguous
directions for each item – directions shoulddirections for each item – directions should
be written in plain English (only approvedbe written in plain English (only approved
abbreviations may be used)abbreviations may be used)

7. WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL
MEDICATION ORDERMEDICATION ORDER
 Prescriber’s printed name, signature andPrescriber’s printed name, signature and
date of order - the prescriber’s fulldate of order - the prescriber’s full
signature and date of order must besignature and date of order must be
written for EACH DRUG orderedwritten for EACH DRUG ordered
 Weight should be provided for any drugWeight should be provided for any drug
dosed by weight.dosed by weight.

8. WHAT CONSTITUTES A LEGALWHAT CONSTITUTES A LEGAL
MEDICATION ORDERMEDICATION ORDER
 N.B. Each medication order must beN.B. Each medication order must be
legible, complete and unambiguous solegible, complete and unambiguous so
that the correct patient is administered thethat the correct patient is administered the
correct drug at the appropriate dose. Acorrect drug at the appropriate dose. A
nurse cannot administer the drug and anurse cannot administer the drug and a
pharmacist cannot dispense a drug to apharmacist cannot dispense a drug to a
patient unless all details are correct andpatient unless all details are correct and
complete.complete.

9. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
Every registered nurse is legally responsible forEvery registered nurse is legally responsible for
the correct administration of drugs. This includesthe correct administration of drugs. This includes
the five “rights” of administration:the five “rights” of administration:
• Right patientRight patient
• Right drugRight drug
• Right doseRight dose
• Right routeRight route
• Right timeRight time

10. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Right PatientRight Patient
– check the patient name & hospital numbercheck the patient name & hospital number
against the chart & I.D. band.against the chart & I.D. band.
– ask the patient to state his/her name, & theirask the patient to state his/her name, & their
date of birth (D.O.B)date of birth (D.O.B)

11. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Right DrugRight Drug
Identify the drug from the M.O.’s order. ClarifyIdentify the drug from the M.O.’s order. Clarify
with the M.O. if in doubt.with the M.O. if in doubt.
Check the drug three times:Check the drug three times:
- before removing it from the trolley or shelf- before removing it from the trolley or shelf
- when the drug is removed from the container- when the drug is removed from the container
- before the container is returned to storage- before the container is returned to storage
- check the expiry date of the drug- check the expiry date of the drug
Check the drug with another RN for S4 & S8 drugsCheck the drug with another RN for S4 & S8 drugs

12. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Right DoseRight Dose
- check the dose, read the container label,- check the dose, read the container label,
calculate the dose & check with a RN ifcalculate the dose & check with a RN if
necessarynecessary
- use proper measuring devices for liquids, do not- use proper measuring devices for liquids, do not
crush tablets or open capsules unless directedcrush tablets or open capsules unless directed
to by the pharmacist. (do not crush entericto by the pharmacist. (do not crush enteric
coated tablets).coated tablets).
- if a drug is required in another form you may get- if a drug is required in another form you may get
it from the pharmacy.it from the pharmacy.

13. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Right RouteRight Route
- make sure the M.O.’s order is clear &- make sure the M.O.’s order is clear &
only give the medications by the routeonly give the medications by the route
designated.designated.
- know the abbreviations for the different- know the abbreviations for the different
routes.routes.

14. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• Right TimeRight Time
- check the time interval ordered by the- check the time interval ordered by the
M.O. & give the medication at theM.O. & give the medication at the
prescribed time.prescribed time.
- drugs should be given within 20 minutes- drugs should be given within 20 minutes
of the prescribed time.of the prescribed time.

15. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
• AllergiesAllergies
Check if your patient:Check if your patient:
1. has any known drug allergies1. has any known drug allergies
2. has had any previous adverse drug2. has had any previous adverse drug
reactionreaction

16. THE ROLE OF THE NURSE IN DRUGTHE ROLE OF THE NURSE IN DRUG
ADMINISTRATIONADMINISTRATION
Another responsibility of the nurse is toAnother responsibility of the nurse is to
monitor the effect of the drugs that aremonitor the effect of the drugs that are
administered to a client, i.e.administered to a client, i.e.
- whether the drug had the required effect- whether the drug had the required effect
- little or no effect or- little or no effect or
- if any adverse reactions occurred.- if any adverse reactions occurred.

17. Terms and DefinitionsTerms and Definitions
• Drug InteractionsDrug Interactions
• The combined effect of two (2) or more drugsThe combined effect of two (2) or more drugs
acting simultaneously. Each drug may haveacting simultaneously. Each drug may have
either a positive or negative effect on theeither a positive or negative effect on the
working of the others, i.e. they may beworking of the others, i.e. they may be
• antagonisticantagonistic- lessening the effectiveness of- lessening the effectiveness of
another druganother drug
• synergisticsynergistic- enhancing or improving the- enhancing or improving the
effectiveness of another drugeffectiveness of another drug

18. Terms and DefinitionsTerms and Definitions
• Adverse ReactionsAdverse Reactions
-- unwanted and/or unintended effects ofunwanted and/or unintended effects of
the administration of a drug.the administration of a drug.
May be: IatrogenicMay be: Iatrogenic
Drug sensitivity/allergyDrug sensitivity/allergy

19. Terms and DefinitionsTerms and Definitions
• Adverse Reactions (con’t)Adverse Reactions (con’t)
Iatrogenic disease- caused unintentionallyIatrogenic disease- caused unintentionally
by drug therapy, i.e.induced by medicalby drug therapy, i.e.induced by medical
practitioners.practitioners.

20. Terms and DefinitionsTerms and Definitions
• Adverse Reactions (con’t)Adverse Reactions (con’t)
Drug sensitivity/allergy - occurs in anDrug sensitivity/allergy - occurs in an
individual who has been previouslyindividual who has been previously
exposed to the drug and has developedexposed to the drug and has developed
antibodies. Drug allergies can beantibodies. Drug allergies can be
manifested in a variety of symptomsmanifested in a variety of symptoms
ranging from minor to serious.ranging from minor to serious.

21. Terms and DefinitionsTerms and Definitions
• Adverse Reactions (con’t)Adverse Reactions (con’t)
- the reaction can occur immediately after- the reaction can occur immediately after
the client received the medication, or bethe client received the medication, or be
delayed for hours to days.delayed for hours to days.
- some of the signs and symptoms are skin- some of the signs and symptoms are skin
rash, urticaria (itching), nausea andrash, urticaria (itching), nausea and
vomiting.vomiting.

22. Terms and DefinitionsTerms and Definitions
ANAPHYLAXISANAPHYLAXIS
A life-threatening immediate reaction isA life-threatening immediate reaction is
called anaphylaxis. There is respiratorycalled anaphylaxis. There is respiratory
distress, sudden severe bronchospasm,distress, sudden severe bronchospasm,
and cardiovascular collapse. It may resultand cardiovascular collapse. It may result
in death if not treated immediately.in death if not treated immediately.

23. NAMES OF DRUGSNAMES OF DRUGS
Drugs can have three types of names:Drugs can have three types of names:
a. chemicala. chemical
b. genericb. generic
c. trade/brand/proprietaryc. trade/brand/proprietary

24. NAMES OF DRUGSNAMES OF DRUGS
a.Chemical name:a.Chemical name:
- a very precise description of the drug’s- a very precise description of the drug’s
chemical composition, identifying thechemical composition, identifying the
drug’s atomic and molecular structure.drug’s atomic and molecular structure.
- this name is of significance to the- this name is of significance to the
pharmacist.pharmacist.

25. NAMES OF DRUGSNAMES OF DRUGS
b.Generic name:b.Generic name:
- the name assigned by the manufacturer- the name assigned by the manufacturer
who first develops the drug. Often thewho first develops the drug. Often the
generic name is derived from thegeneric name is derived from the
chemical name.chemical name.
- the official name is the name by which- the official name is the name by which
the drug is identified in the officialthe drug is identified in the official
publication.publication.

26. NAMES OF DRUGSNAMES OF DRUGS
c.Trade/ Brand/ Proprietary name:c.Trade/ Brand/ Proprietary name:
- is selected by the drug company selling- is selected by the drug company selling
the drug and is copyrightedthe drug and is copyrighted
- a drug can have several trade names- a drug can have several trade names
when produced by differentwhen produced by different
manufacturersmanufacturers

27. NAMES OF DRUGSNAMES OF DRUGS
e.g. Chemical name= Acetylsalicylice.g. Chemical name= Acetylsalicylic
acidacid
Generic name = AspirinGeneric name = Aspirin
Trade names include Aspro, DisprinTrade names include Aspro, Disprin
Be aware that in different countries genericBe aware that in different countries generic
and trade names will also differ, e.g. inand trade names will also differ, e.g. in
Australia & the United States one drug has theAustralia & the United States one drug has the
generic names of paracetamol &generic names of paracetamol &
acetaminophen, i.e. Panadol/Tylenol.acetaminophen, i.e. Panadol/Tylenol.

28. Categories/ClassificationsCategories/Classifications
of Drugsof Drugs
Drugs can be classified from different perspectivesDrugs can be classified from different perspectives
e.g. drugs may be classified by -e.g. drugs may be classified by -
(a) body systems(a) body systems
i.e. drugs affecting the respiratory systemi.e. drugs affecting the respiratory system
drugs affecting the cardiovascular systemdrugs affecting the cardiovascular system
OROR
(b) the symptom relieved by the drug, or the(b) the symptom relieved by the drug, or the
clinical indication for the drug i.e. analgesic,clinical indication for the drug i.e. analgesic,
antibioticantibiotic

29. COMMOM ABBREVIATIONS USED INCOMMOM ABBREVIATIONS USED IN
MEDICATION ORDERS/frequencyMEDICATION ORDERS/frequency
• MANEMANE
• MIDIMIDI
• NOCTENOCTE
• BDBD
• TDSTDS
• QIDQID
• STATSTAT
• PRNPRN
• morningmorning
• middaymidday
• NightNight
• twice a daytwice a day
• three times a daythree times a day
• four times a dayfour times a day
• give immediatelygive immediately
• when required when necessarywhen required when necessary

30. COMMOM ABBREVIATIONS USED INCOMMOM ABBREVIATIONS USED IN
MEDICATION ORDERS/frequencyMEDICATION ORDERS/frequency
• acac
• pcpc
• q.h.or 1/24q.h.or 1/24
• q2h or 2/24q2h or 2/24
• q4h or 4/24q4h or 4/24
• before mealsbefore meals
• after mealsafter meals
• every hourevery hour
• every two hoursevery two hours
• every four hoursevery four hours

31. COMMOM ABBREVIATIONS USED INCOMMOM ABBREVIATIONS USED IN
MEDICATION ORDERS/routeMEDICATION ORDERS/route
• BUCBUC
• O/P.OO/P.O
• S/LS/L
• IDID
• IMIM
• IMIIMI
• SCSC
• inside cheekinside cheek
• oral/per oraloral/per oral
• sublingalsublingal
(under the tongue)(under the tongue)
• intradermalintradermal
• intramuscularintramuscular
• intramuscularintramuscular
injectioninjection
• subcutaneoussubcutaneous

32. COMMOM ABBREVIATIONS USED INCOMMOM ABBREVIATIONS USED IN
MEDICATION ORDERS/routeMEDICATION ORDERS/route
• SCISCI
• IVIIVI
• IVTIVT
• NEBNEB
• PRPR
• TOPTOP
• VAGVAG
• subcutaneoussubcutaneous
injectioninjection
• intravenous injectionintravenous injection
• intravenous therapyintravenous therapy
• nebulisernebuliser
• per rectumper rectum
• topical/skintopical/skin
• vaginalvaginal

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