Medication Administration

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  • (Selide#16) Change to right to education about medication being given- Bullet # 1
  • Medication Administration

    1. 1. Calculate with Confidence 5 th edition Gray Morris Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
    2. 2. Medication Administration Unit Three: Chapter 10 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
    3. 3. Medication Administration: Objectives <ul><li>After reviewing this chapter, you should be able to: </li></ul><ul><ul><li>State the consequences of medication errors </li></ul></ul><ul><ul><li>Identify the causes of medication errors </li></ul></ul><ul><ul><li>Identify the role of the nurse in preventing medication errors </li></ul></ul><ul><ul><li>Identify the role of the Institute for Safe Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors </li></ul></ul>
    4. 4. Medication Administration: Objectives (cont) <ul><li>State the six “rights” of safe medication administration </li></ul><ul><li>Identify factors that influence medication dosages </li></ul><ul><li>Identify the common routes for medication administration </li></ul><ul><li>Define critical thinking </li></ul><ul><li>Explain the importance of critical thinking in medication administration </li></ul>
    5. 5. Medication Administration: Objectives (cont) <ul><li>Identify important critical thinking skills necessary in medication administration </li></ul><ul><li>Discuss the importance of client teaching </li></ul><ul><li>Identify special considerations relating to the elderly and medication administration </li></ul><ul><li>Identify home care considerations in relation to medication administration </li></ul>
    6. 6. Medication Errors <ul><li>Meds administered incorrectly can be harmful or fatal </li></ul><ul><li>Result in emotional and legal consequences for the nurse </li></ul><ul><li>Most common cause of client injury despite advances in technology </li></ul><ul><ul><li>44,000 to 98,000 deaths per year estimated </li></ul></ul><ul><ul><li>540,000 med errors with children per year </li></ul></ul>
    7. 7. Medication Errors (cont) <ul><li>Causes for errors </li></ul><ul><ul><li>Cohen, M. (2007). Medication Errors, 2 ed. </li></ul></ul><ul><ul><li>Failure to identify client and miscommunication </li></ul></ul><ul><ul><li>Lack of information about patient – allergies, meds </li></ul></ul><ul><ul><li>Lack of information about the drug </li></ul></ul><ul><ul><li>Communication and teamwork failures </li></ul></ul><ul><ul><li>Unclear, absent, or look-alike and sound-alike meds </li></ul></ul><ul><ul><li>Unsafe standardization, storage, distribution, and devices </li></ul></ul><ul><ul><li>Calculation errors and failure to adhere to “rights” </li></ul></ul>
    8. 8. Critical Thinking and Medication Administration <ul><li>Definition: A process of thinking that includes being reasonable and rational </li></ul><ul><ul><li>Organizational skills </li></ul></ul><ul><ul><li>Autonomy: Willingness to challenge wrong orders and get clarification </li></ul></ul><ul><ul><li>Reasoning: selection of right tools and client assessment </li></ul></ul><ul><li>Nurse administering med is legally liable —regardless of MOST causes of error </li></ul>
    9. 9. Factors Influencing Medication Dose & Action <ul><li>All must be considered </li></ul><ul><ul><li>Route of administration </li></ul></ul><ul><ul><li>Time of administration </li></ul></ul><ul><ul><li>Age of client </li></ul></ul><ul><ul><li>Nutritional status of client </li></ul></ul><ul><ul><li>Absorption and excretion of the drug </li></ul></ul><ul><ul><li>Health status of the client </li></ul></ul><ul><ul><li>Sex of the client </li></ul></ul><ul><ul><li>Ethnicity and culture of the client </li></ul></ul><ul><ul><li>Genetics </li></ul></ul>
    10. 10. Special Considerations for Elderly <ul><li>Two thirds use Rx and OTC meds </li></ul><ul><li>Most scripts are for older adults </li></ul><ul><li>Number in population will double by 2030 </li></ul><ul><li>Physiologic changes slow function </li></ul><ul><ul><li>Changes in circulation, absorption, metabolism, excretion, and stress response </li></ul></ul><ul><ul><li>Lowered body mass, change in mental status </li></ul></ul>
    11. 11. Special Considerations for Elderly (cont’d) <ul><li>Require lower doses as a rule </li></ul><ul><li>May need </li></ul><ul><ul><li>Special delivery devices </li></ul></ul><ul><ul><li>Visual aid to read labels </li></ul></ul><ul><ul><li>Easy-open lids </li></ul></ul><ul><li>Allow extra time for teaching </li></ul><ul><li>Polypharmacy and Beer’s criteria </li></ul>
    12. 12. Six “Rights” of Medication Administration <ul><li>Right Medication </li></ul><ul><ul><li>Compare medication administration record (MAR) with order </li></ul></ul><ul><li>Right Dose </li></ul><ul><ul><li>Check calculations and labels </li></ul></ul><ul><li>Right Client </li></ul><ul><ul><li>Two unique identifiers </li></ul></ul><ul><ul><li>NOT room number </li></ul></ul>
    13. 13. Six “Rights” of Medication Administration (cont’d) <ul><li>Right Route </li></ul><ul><ul><li>Check orders and drug guides </li></ul></ul><ul><ul><li>Special considerations with feeding tubes </li></ul></ul><ul><li>Right Time </li></ul><ul><ul><li>Time of day and frequency </li></ul></ul><ul><li>Right Documentation </li></ul><ul><ul><li>Accuracy—no documentation leads to double-dosing </li></ul></ul><ul><ul><li>Avoid “Do Not Use” abbreviations </li></ul></ul><ul><ul><li>Outcomes of medications </li></ul></ul>
    14. 14. Figure 10-1 A, Example of a container that holds a day’s medications, stored by hour of administration. B, Container that holds a week’s medications. C, The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A From Ogden SG: Calculation of drug dosages, ed. 8, St. Louis, 2007, Mosby; B From Elkin MK, Perry AG, Potter PA: Nursing interventions and clinical skills, ed. 4, St. Louis, 2008, Mosby.)
    15. 15. Other “Rights” <ul><li>Right to refuse </li></ul><ul><ul><li>Document and notify caregiver </li></ul></ul><ul><li>Kendra’s Law </li></ul><ul><ul><li>Potentially dangerous mentally ill </li></ul></ul><ul><ul><li>Court-ordered assisted outpatient treatment (AOT) </li></ul></ul><ul><li>Emergency Court Orders </li></ul><ul><ul><li>May give forcibly </li></ul></ul><ul><ul><li>Requires Judge’s order </li></ul></ul>
    16. 16. Other “Rights” (cont’d) <ul><li>Right to education about medication being given </li></ul><ul><li>Right to understand interactions with herbals </li></ul><ul><li>Right to medication reconciliation across continuum of care </li></ul>
    17. 17. Teaching Clients About Meds <ul><li>Imperative for preventing errors </li></ul><ul><li>Helps prevent adverse reactions </li></ul><ul><li>Improves adherence </li></ul><ul><li>Include the following: </li></ul><ul><ul><li>Brand and generic names, explanation of amount, explanation of timing for dose, measuring devices, and route </li></ul></ul><ul><li>Follow up on teaching </li></ul>
    18. 18. Home Care Considerations <ul><li>Home health care is increasing with increased population and early discharges </li></ul><ul><li>Special considerations for “home” setting </li></ul><ul><li>Practice requires more autonomy </li></ul><ul><li>Teaching focuses on devices from local pharmacies and calibrated home devices </li></ul><ul><li>Communication is critical! </li></ul>
    19. 19. Routes of Administration <ul><li>Oral (p.o.) </li></ul><ul><li>Sublingual (SL) </li></ul><ul><li>Buccal </li></ul><ul><li>Parenteral </li></ul><ul><ul><li>(IV, IM, Subcut, ID) </li></ul></ul><ul><li>Insertion—in cavities </li></ul><ul><li>Instillation—body cavity, eyes, ears, nose </li></ul>
    20. 20. Routes of Administration (cont’d) <ul><li>Inhalation—metered-dose inhalers, nebulizers, spacers </li></ul><ul><li>Intranasal </li></ul><ul><li>Topical—lotions, ointments, pastes </li></ul><ul><li>Percutaneous—on skin, on mucous membranes </li></ul><ul><li>Transdermal—patches </li></ul>
    21. 21. Equipment for Med Administration <ul><li>Medicine cup (30 mL/1 oz) </li></ul><ul><li>Soufflé cup </li></ul><ul><li>Calibrated dropper—use only supplied dropper </li></ul><ul><li>Nipple—adapted for some infant meds </li></ul>
    22. 22. Figure 10-2 Medicine cup. (Modified from Brown M, Mulholland JL: Drug calculations: process and problems for clinical practice, ed. 8, St. Louis, 2008, Mosby.) Figure 10-3 A, Plastic medicine cup. B, Soufflé cup. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-4 Medicine dropper. (Modified from Clayton BD, Stock YN Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.)
    23. 23. Figure 10-5 Nipple. (From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-6 Oral syringes. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-7 Parts of a syringe. (From Potter PA, Perry AG: Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)
    24. 24. Figure 10-8 Types of syringes. A, Luer-Lok syringe marked in 0.1 mL (tenths). B, Tuberculin syringe marked in 0.01 mL (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked in units (100). D, Insulin syringe marked in units (50). (From Potter PA, Perry AG: Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)
    25. 25. Figure 10-9 A, Acceptable devices for measuring and administering oral medication to children (clockwise): measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated dropper, hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via a syringe. (A, From Hockenberry MJ, Wilson D: Wong’s nursing care of infants and children, ed. 8, St Louis, 2007, Mosby. B, Courtesy Paul Vincent Kuntz, Texas Children’s Hospital, Houston.)

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