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Drug Administration

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Drug Administration

  1. 1. Drug Administration B. Eric E. Desquitado, M.D. Olivarez College Health-Related Sciences
  2. 2. Introduction <ul><li>Drug administration is a basic activity in nursing practice. </li></ul><ul><li>Nurses must know all the components of a drug order. </li></ul><ul><li>They must question orders that are incomplete, unclear, or if the prescription is outside the known recommended range. </li></ul>
  3. 3. Introduction <ul><li>Nurses are accountable for the safe administration of medications. </li></ul><ul><li>They are legally liable if they give a prescribed drug with an incorrect dosage or if the drug is contraindicated for the patient’s health status. </li></ul>
  4. 4. Introduction <ul><li>If you are not sure about the expected therapeutic effect, contraindications, dosage, potential side effects, or adverse reactions and interactions of a medication, do not administer it. </li></ul><ul><li>Familiarize yourself with it first. </li></ul>
  5. 5. Medication Errors <ul><li>Potentially serious to life-threatening. </li></ul><ul><li>Each of the traditional five rights of drug administration increases client safety and helps to minimize the risk of litigation. </li></ul>
  6. 6. Traditional Five Rights <ul><li>Right client </li></ul><ul><li>Right drug </li></ul><ul><li>Right dose </li></ul><ul><li>Right time </li></ul><ul><li>Right route </li></ul>
  7. 7. Right Client <ul><li>Can be assured by checking the client’s identification bracelet and by having the client state his or her name. </li></ul><ul><li>Client identification should be verified each time a medication is administered. </li></ul>
  8. 8. Right Client <ul><li>Clients with similar last names should have warnings on identification tools. </li></ul><ul><li>Identification bracelets may have codes for allergy status. </li></ul><ul><li>Some clients may not have identification bracelets. </li></ul>
  9. 9. Right Drug <ul><li>Medications may only be prescribed by a physician, dentist, podiatrist, or a licensed health care provider with authority from the state to order medications ( e.g. , an advanced practice registered nurse). </li></ul>
  10. 10. Right Drug <ul><li>Prescriptions may be written on a prescription pad or an order sheet (institutionalized client) and signed by the duly authorized person. </li></ul><ul><li>A telephone order (TO) or a verbal order (VO) for medication must be cosigned by the health care provider within 24 h. </li></ul>
  11. 11. Right Drug <ul><li>An incomplete drug order should never be administered or followed. </li></ul><ul><li>To avoid drug error, the drug label should be read: </li></ul><ul><ul><li>At the time of contact with the drug bottle or container </li></ul></ul><ul><ul><li>Before pouring the drug </li></ul></ul><ul><ul><li>After pouring the drug </li></ul></ul>
  12. 12. Right Drug <ul><li>Drugs may be given as standing orders, one-time or single dose, PRN, or STAT. </li></ul><ul><li>First dose, one-time, or PRN medication should always be checked against the original orders. </li></ul>
  13. 13. Components of a Drug Order <ul><li>Date and time the order is written </li></ul><ul><li>Drug name (generic preferred) </li></ul><ul><li>Drug dosage </li></ul><ul><li>Route administration </li></ul><ul><li>Frequency and duration of administration </li></ul>
  14. 14. Components of a Drug Order <ul><li>Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness, or laboratory results </li></ul><ul><li>Physician or other health care provider’s signature (or name if TO or VO) </li></ul><ul><li>Signatures of licensed practitioners taking TO or VO </li></ul>
  15. 15. Right Dose <ul><li>The dose prescribed for a particular client. </li></ul><ul><li>Normally within the recommended range for the particular drug. </li></ul><ul><li>Must consider drug availability, the prescribed drug dose, and the client’s weight range. </li></ul>
  16. 16. Right Dose <ul><li>Drug administration has been automated with links to the pharmacy information system and current clinical client data. </li></ul><ul><li>Two methods of drug distribution: </li></ul><ul><ul><li>Stock Method </li></ul></ul><ul><ul><li>Unit Dose Method </li></ul></ul>
  17. 17. Drug Distribution Methods <ul><li>Stock Method </li></ul><ul><ul><li>Drugs are stored on unit and dispersed to all clients from the same container. </li></ul></ul><ul><ul><li>Always available, cost-efficiency of large quantities. </li></ul></ul><ul><ul><li>Drug errors are more prevalent with multiple ‘pourers.’ </li></ul></ul><ul><ul><li>More risk of abuse by health care workers. </li></ul></ul>
  18. 18. Drug Distribution Methods <ul><li>Stock Method </li></ul><ul><ul><li>Less accountability for amount used; unable to track usage. </li></ul></ul><ul><ul><li>Increased opportunity for contamination. </li></ul></ul>
  19. 19. Drug Distribution Methods <ul><li>Unit Dose Method </li></ul><ul><ul><li>Drugs are individually wrapped and labeled for single doses for 24 h use. </li></ul></ul><ul><ul><li>Eliminated many drug dosage errors. </li></ul></ul><ul><ul><li>Saves time (no dose calculation necessary). </li></ul></ul><ul><ul><li>Client is billed for specific doses. </li></ul></ul>
  20. 20. Drug Distribution Methods <ul><li>Unit Dose Method </li></ul><ul><ul><li>More accountability. </li></ul></ul><ul><ul><li>Less chance for contamination and error. </li></ul></ul><ul><ul><li>Potential delay in receiving drug. </li></ul></ul><ul><ul><li>Not immediately replaceable if contaminated. </li></ul></ul><ul><ul><li>More expensive. </li></ul></ul>
  21. 21. Right Time <ul><li>Time at which the prescribed dose should be administered. </li></ul><ul><li>Doses are given to maintain the plasma level of the drug. </li></ul><ul><li>Military time has the advantages of reducing administration errors and decreasing documentation. </li></ul>
  22. 22. Right Time <ul><li>Drugs may be given 30 mins before or after the prescribed time if the administration time is > 2 h. </li></ul><ul><li>Drugs that are affected by food intake should be given on an empty stomach. </li></ul><ul><li>Drugs that irritate the gastric mucosa should be given with food. </li></ul>
  23. 23. Right Time <ul><li>Drug administration may be adjusted to fit the client’s lifestyle, activities, tolerances, or preferences. </li></ul><ul><li>Check if the client is scheduled for any diagnostic or therapeutic procedures that contraindicate the administration of medications. </li></ul>
  24. 24. Right Time <ul><li>Check drug expiration dates. </li></ul><ul><li>Administer antibiotics at even intervals to maintain therapeutic blood levels. </li></ul>
  25. 25. Right Route <ul><li>Necessary for adequate or appropriate absorption. </li></ul><ul><li>Common routes are as follows: oral, sublingual, per feeding tube, topical, inhalation, instillation, suppository, intradermal, subcutaneous, intramuscular, and intravenous. </li></ul>
  26. 26. Right Route <ul><li>The client should be able to swallow adequately before oral medications are given. </li></ul><ul><li>Do not mix medications with other substances before consultation with a pharmacist. </li></ul>
  27. 27. Right Route <ul><li>Use aseptic technique when administering drugs. </li></ul><ul><li>Stay with the client until oral drugs are swallowed. </li></ul><ul><li>If it is necessary to combine a medication with another substance, this should be explained to the patient. </li></ul>
  28. 28. Five + Five Rights <ul><li>Five additional rights essential to professional nursing practice: </li></ul><ul><ul><li>Right assessment </li></ul></ul><ul><ul><li>Right documentation </li></ul></ul><ul><ul><li>Patient’s right to education </li></ul></ul><ul><ul><li>Right evaluation </li></ul></ul><ul><ul><li>Patient’s right to refuse </li></ul></ul>
  29. 29. Right Assessment <ul><li>Some drugs require monitoring or examination prior to administration. </li></ul>
  30. 30. Right Documentation <ul><li>Appropriate information regarding the administered drug should be immediately recorded. </li></ul><ul><li>This includes the name, dose, route, date/time, and the nurse’s initials or signature </li></ul>
  31. 31. Right Documentation <ul><li>Client response should be documented after the administration of narcotics, nonnarcotic analgesics, sedatives, antiemetics, and adverse reactions to the medications. </li></ul><ul><li>Do not commit items to memory! </li></ul>
  32. 32. Right to Education <ul><li>The client should receive accurate and thorough information about the medication and how it relates to his or her particular situation. </li></ul><ul><li>Client teaching also includes therapeutic purpose, possible side effects, diet restrictions or requirements, skill of administration, and laboratory monitoring. </li></ul>
  33. 33. Right Evaluation <ul><li>The effectiveness of the medication is determined by the client’s response to the medication. </li></ul><ul><li>Determine the extent of any side effects or adverse reactions as well. </li></ul>
  34. 34. Right to Refuse <ul><li>If a patient refuses a treatment, the nurse should determine the reason for the refusal, when possible and take reasonable measures to facilitate carrying out the treatment plan. </li></ul><ul><li>In order to decide whether to accept or refuse a treatment, the patient should be given necessary knowledge. </li></ul>
  35. 35. Informed Consent <ul><li>Involves full disclosure. </li></ul><ul><li>The participant must comprehend the information (written in common language). </li></ul><ul><li>Literacy level of the participant should be determined and recorded. </li></ul><ul><li>Must be mentally competent to make the decision. </li></ul>
  36. 36. Right to Refuse <ul><li>The client must know the risks of refusing the medication and reinforce the reason for the medication. </li></ul><ul><li>If refusal is resolute, it must be documented immediately and the superior or other health care providers should be informed. </li></ul>
  37. 37. Assignment <ul><li>Read, understand, and rehearse pages 29 to 39 of your main textbook. </li></ul><ul><li>It is possible that it will be included in the exam. </li></ul>

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