MEDICATION ADMINISTRATION By MS.Rajathurai Jeya,RN
Administration of Medications• Medicine may be defined as a substance used to promote health , to prevent, to diagnose , to alleviate or cure diseases.• The safe and accurate administration of medication is one of the major responsibility of a nurse.• The nurse must have through knowledge of drugs that is administered by her “A FUNDAMENTAL RULE OF SAFE DRUG ADMINISTRATION IS: “NEVER ADMINISTER AN UNFAMILIAR MEDICATION” 2
• Nurses must know generic and trade names of drugs to be administered, classification, average dose, route of administration, use, side and adverse effects, contraindications, and nursing implications in administration.• Essential parts of Medication order.• Abbreviations and symbols used in writing medication order as per hospital policies.• Preparation of solutions and fractional doses• Storing of medicines• Factors of safety in the administration of medicines• Rules for the administration of medicines• Ethical and legal aspects• Nurse’s role in the administration of medicines.
Drug Knowledge1.Names of Drugs:All the drugs will have at least two names1. Generic Name2. Trade name(e.g. )Ceftriaxone - Generic nameMesporin, Samixon, Rocephin –Trade name2.Classification of drugs:Drugs are classified in several ways, according to their action, composition , their purposes and uses etc.(e.g.) Analgesics, antipyretics, etc.3.Preparation of drugs:Medications are available in different types of preparation.The preparations may determine the method of administration(e.g.)Capsule , Ointment , Powder, Suppository etc.
4.Dosage:The dose is the amount of drug administered at one time.Information about the dosage and route is crucial to protectagainst medication error5.Effects of drug on the body:Therapeutic effects: It is the effect which is desired or the reason adrug prescribed .Local and systemic effects: Local effects of a drugs are expectedwhen they are applied topically to the skin or mucus membrane.A drug used for systemic effect must be absorbed into the bloodstream to produce the desired effect in the various systems and partsof the body.Toxic effects: May develop after prolonged intake or when amedicine accumulates in the blood because of impaired metabolism orexcretion, or excessive amount taken•Toxic levels of opioids can cause respiratory depression•Antidotes available to reverse effects
Side and Adverse EffectsSide effects are non-therapeutic reactions to a drug.• Unintended secondary effects a medication predictably will cause• May be harmless or serious• If side effects are serious enough to negate the beneficial effect of meds therapeutic action, it may be discontinued• People may stop taking medications because of the side effects(An example of side effect is Drowsiness , Whichoccurs with antihistamines)• Adverse Drug Reaction: Any reaction to a drug that is undesirable, unexpected, and occurs at doses normally used for the prevention, diagnosis, or treatment of disease .• All adverse medication reactions or suspected medication reactions are reported to the Physician, Nurse Manager/Charge Nurse and Pharmacist. An adverse reaction is reported to the Pharmacy by filling out the Adverse Drug Reaction Notification Form .
Nursing process in administering drugs:• Assessment: The first step of nursing process is the systematic organized collection of data about the patient.• Nursing diagnosis: Once the data have been collected, the nurse must organize and analyze that information to arrive at a nursing diagnosis.• Intervention :The assessment and nursing diagnosis of the patient’s situation will direct specific nursing intervention.• Evaluation: it is a part of continual process of patient care that leads to changes in assessment, diagnosis, intervention. The patient is continually evaluated for therapeutic response.
Essentials of medication order• The drug order, written by the physician, it has 7 essential parts for administration of drugs safely. the nurse should know how to read a drug order.• It should have the following components: 1- Patients full name. 2- Date and time. 3- Drug name. 4- Dosage. 5- Route of administration. 6- Time and frequency of administration. 7- Signature of physician.
Types of Medication Orders• STAT order: needed immediately• Single order: given only once• PRN order: given as needed• Routine orders: given within 2 hours of being written and carried out on schedule• Standing order: written in advance carried out under specific circumstances.
TIME OF ABBREVIATION MEANINIG TIME ac Before Meals 7:30am, 12:30pm, 7:30pm pc After Meals 10am, 2pm, 10pm tid –with meals Three times a daily with 8am, 1pm, 8pm meals bid Twice a day 8am,8pm(IV)- 10am, 10pm (oral) tid Three times a day 10am,6pm,2am q6h Every six hours (Four 6am, 12nn, 6pm, 12am times a day) 6am, 10am,2pm,6pm,10pm,2am q4h Every four hours (six times a day) q3h Every Three hours(8times 6am, 9am,12nn, 3pm, 6pm, 9pm, 12am, 3am a day) q2h Every two hours twelve 6am,8am,10am,12nn,2pm,4pm,6pm, 8pm, times a day) 10pm, 12am, 2am,4am
Basic principles (Safety) in medication administration3 checks and 7 Rights: obtaining the container removing the med replacing the container• Right patient• Right dose• Right drug• Right route• Right time• Right Frequency• Right Documentation
Right Drug• Read the physician’s orders to study the correct name of the drug• If the order is not clear consult the physician• Make sure the drug copied correctly on the Medication chart, on the nurses record• Select the right drug from the cupboard. Read the label of the medicine container and the name of the medicine in the medication chart thrice• Look for the colour, odour and consistency of the drug . Unusual characteristics of the drug should be questioned.• Administer medicine only from a clearly labeled container.• Avoid conversations during preparation of medicines.
Right Dose• Read the physician’s orders to know the correct dose.• Consider the age and weight of the patient. This may help to find an error in physician’s orders.• Know the minimum and maximum dose of the medicine administered. Calculate the fraction dosage correctly.• Have the medicine card or written order before you preparing drug.• Know the abbreviations and symbols used• Help the patient to take all the medicines that is ordered for him.
Right patient• An important step in administering medication safely is being sure the medication is given to the right client.• Read the physician’s orders to make sure for whom the medicine is ordered.• To identify the client correctly:• The nurse check the medication administration Form against the client’s identification bracelet and ask the client to state his or her name to ensure the client’s identification bracelet has the correct information.
Right Route• Read the Physician’s orders to determine the route of administration• Dilute the drug if indicated• Know right method of giving drugs ,e.g. oral, parenterally etc..• Know the abbreviations used to designate the route of administration e.g. I.V, IM. P.O, etc.• Review the available forms of drug to make sure the drug can be given according to the order.• Make sure the patient is able to take the drug by the route indicated or ordered.
Common routesORAL( P.O) •It is the most a. Inappropriate if client cannot swallow common route and if GIT has reduced •Most motility convenient b. Inappropriate for client with nausea and route vomiting •The easiest and c. Drug may have most desirable unpleasant taste d. Drug may discolor way to the teeth administer e. Drug may irritate medication the gastric mucosa f. Drug may be •Usually less aspirated by seriously expensive ill patient.
Nurses responsibility in administration of oral drugs• Check the physician’s orders ,Check the diagnosis and age of the patient• Check the purpose of medication• Check the nurses record for the time of last dose given.• Check for any contraindications present (nausea ,Vomiting, delirium, unconsciousness, etc)• Check the form of drug available• Break the tablets only if it is scored.• Explain the procedure to the patient , discuss the need of medications.• Assist the patient sitting position if possible• Stay with the patient until swallow medicine
Sublingual •A drug that is placed •Same as oral under the tongue, • Drug is rapidly where it dissolves. absorbed in the •When the medication bloodstream is in capsule and Disadvantages ordered sublingually, •If swallowed, drug the fluid must be may be inactivated by aspirated from the gastric juices. capsule and placed • Drug must remain under the tongue. under the tongue until • A medication given dissolved and by the sublingual absorbed route should not be swallowed, or desire effects will not be achieved
Buccal a. A medication is held in • Same as oral the mouth against the mucous membranes of • Drug can be the cheek until the drug administered for dissolves. local effect b. The medication should not be chewed, • Ensures greater swallowed, or placed potency because under the tongue (e.g drug directly sustained release nitroglycerine, opiates, enters the blood antiemetic, tranquilizer, and bypass the sedatives) liver c. Client should be taught to alternate the cheeks •If swallowed, with each subsequent drug may be dose to avoid mucosal inactivated by irritation gastric juice
Topical AdministrationSkin applications Nasal Instillation Eye Instillation•Use of gloves or •Drops, ointments, disks •Assessment of •Assessment of eyesapplicators•Preparation of skin nares •Asepsis•Thickness of application •Client instruction •Positioning and self- administrationEar Instillation Vaginal Instillation Rectal Instillation •Suppositories•Assessment of ear •Suppositories, •Use of glovescanal foams, creams •Client positioning, comfort,•Warming of solution •Use of gloves and and hygiene•Straightening of applicator Inhalationcanal for children •Client positioning, The patient inhales the fumesand adults comfort, and hygiene in to the lungs to have local or systemic effects
Parenteral administration of medicine• Parenteral tharapy means giving of therapeutic agent including food outside the alimentary tract.• Types of parenteral routes: Intra dermal, subcutaneous, Intra Muscular, Intravenous, etc)Purposes:• To get rapid and systemic effect of the drug• To provide needed effect when the patient unconscious, unable to swallow due to neurological or surgical alterations.• To give nourishment when it cannot taken by mouth
Intra DermalRoute• Intra Dermal: Medicine when introduced in the dermis(under the epidermis)• 10 – 15-degree angle• 0.5 ml or less of medication• injection into the Dermis• form a bleb or wheal• common site: forearm, upper back, upper dorsal aspect of the arm, and upper chest• many nerves are in the dermis – painful, burning sensation,• TB and allergy testing most common• 27g needle most common• Slowly inject medication until wheal forms on skin• Avoid scarred, blemished, hairy areas
Subcutaneous• Medicine introduced in to the subcutaneous tissue• 45-90degree angle• adipose tissue• tissue does not have as many blood vessels as muscle so medication is absorbed slower• 1mL max.• common sites: posterior arm, abdomen and anterior aspects of the thigh• 23 – 25-gauge needles• rotate injection sites• “give slowly”
IntramuscularDeltoid• Expose upper arm and shoulder• Relax arm, flex elbow to find triangle-shaped deltoid muscle• Injection site in center of triangle• 1–2 inches below acromion process.
IntramuscularDorsogluteal, Ventrogluteal, Vastus Lateralis,• Dorsogluteal: is composed of the thick gluteal muscles of the buttocks.(Extreme caution: sciatic nerve and major blood vessels• Never used for kids less than 2 years old or small children with small body mass/muscle• Divide in fourths, upper/lateral divide in fourths again, outside top edgePosition: The patient may be prone or side lying .
Intramuscular• Vastus Lateralis: The vastus lateralis is the major muscle in the anterolateral thigh and is used most often for intramuscular injections in infants. By school-age and adolescence, this site may be more painful than others because of the development of the musculature.• To administer: Locate the area between the greater trochanter of the femur and the knee. Divide this area into thirds. Give the injection into the middle third, grasping the thigh and compressing the muscle as shown. The needle should be directed on a front-to-back course.
Intramuscular• Ventrogluteal Muscles: The ventrogluteal muscles make up the other preferred site for IM injections in infants, although this is a useful site for other age-groups as well. These muscles contain no important nerves or vessels and are accessible when the child is in a variety of positions.• To administer: on the anterior superior iliac spine and your middle finger at the iliac crest. Inject the medication just below the iliac crest using a 90˚ angle.
Intramuscular• Gluteal Region: The gluteal muscles are very small and poorly developed in the infant and young toddler. It is not recommended as an injection site until the child has been walking for at least one year since locomotion helps to develop the gluteal musculature.• Place the child supine and encourage a “toe- in” position as this position will help relax the muscle. Palpate the posterior superior iliac spine and the head of the greater trochanter of the femur. Give the injection superior and lateral to imaginary line between these landmarks. Direct the needle in a straight front-to-back course.
Nurses responsibility in administration of parenteralmedications• Check the physician’s orders for the type of injections , dosage, and the route of administration• Check the diagnosis and age of the patients• Check the purpose of injections• Check the necessity for giving test dose.• Check the form of the medication available and the correct method of administration.• The nurse must have the knowledge of anatomy and physiology of the body is essential and safe administration of medication parenteral route.
Right Time & Right Frequency• Administered the drug as per physician’s orders• The nurse must know why a medication is ordered for certain times of the day and whether the time schedule can be altered• Medication that must act at certain times are given priority (e.g. insulin should be given at a precise interval before a meal )• Know the common approved abbreviation in administering drugs as per intuitional policy.• Give the medicine as ordered in relation to the food intake (a.c(before meals), p.c( after meals))• Give the medicines according to the action expected . e.g. Sleeping pills are given at bed time, the diuretics are given in the morning hours .
Right Documentation• Documentation is an important part of safe medication administration• The documentation for the medication should clearly reflect the client’s name, the name of the ordered medication, the time, dose, route and frequency.• Sign medication sheet immediately after administration of the drug.• Use the standard abbreviations in recording the medications.• Record only that medicine which you have administered.• Never record a medication before it is giving to the patient.• Record the effects observed.• Record the medications that are vomited by the patient, refused by the patient and those drugs that are not administered to the patient and the reason for not giving the medication.
Rules of administration of medicationWhile preparing the drugs:• Read the physician’s orders before preparing the drug. No medicine should be prepared without the doctors orders. Verbal orders are carried out only in emergency.• Check medicine card against the physician’s orders. Be sure the medicine is copied correctly on the medicine card and in the nurse’s record.• Avoid conversation during the preparation of medicine.• Calculate the drug dosage accurately if doubt consult other Supervisor or physician.• Give medication only from clearly labeled container.• Read the label of the medicine and compare it with the medicine card thrice:- Before the medicine container taken from the shelf- Before pouring the drugs- Before replacing the container in shelf- Check the expiry date of the drugs along with the 3 checks
Cont’d• Make sure the medicine glasses are clean and dry before the medicine is taken• When taking tablets and capsules do not touch them with hand. Drop the tablets from the container to its lid and then in to the medicine cup to be taken to the bedside.• Once the medicine is poured out of bottle , it should not be poured back in the bottle to prevent contamination of whole medicine.• Do not use the medicine differ in colour , taste, odour and consistency.• Prepare the drug just before the time of administration of medicine. Never leave the medicine tray without proper identification.
Cont’dDuring Administration:• Observe the seven rights and three checks.• Observe for the symptoms of over dosage of the drugs before it is administered.• Identify the patient correctly.• Give the drugs one by one• Stay with the patient until he has taken the medicine completely• Always give the medicine prepared by yourself.• Do not leave the medicine with the patient.• Medication errors must be reported according to the policy of the hospital
Monitoring first dose of medicationBefore administering the drugs:• Ask if patient has taken medication before• Ask for patient allergies• Review concomitant medicines, herbs and foods• Review concomitant disease states• Review lab values• Know right medications , dose, patient, route, time, and reason• Explain to patient, medication’s name , purpose and potential adverse effects.
During & after administration• Observe for changes in clinical status, adverse reactions and allergic reactions.• When present, involve the family in monitoring the patient.• Monitor for acute changes in clinical status, patient’s subjective and objective response.• Adverse reactions and allergic reactions• If adverse reaction are present follow the hospital policy and procedure of reporting adverse reaction of drugs .
Ethical and legal aspects in drug administrationA moral as well as legal dimension is involved in the administration of medications. “Nurses are responsible for their actions”• Under the law nurses are responsible for their own actions regardless of a written order. It is expected to know all nurses the minimum and the maximum dose of every medicine that she administer. If a nurse gives an Inj.pethadine 500mg to a patient instead 50mg , the nurse is responsible for the harm, she cannot justify her deed spite of a written order for the same dosage.• The nurses responsibility includes to monitor medication errors by observing seven rights of giving medication.• The nurse must follow the own institutional policy(leaving medicine in the bedside strictly prohibited)
CLIENT’S RIGHT RELATED TO MEDICATIONADMINISTRATION• The patient has the right to considerate and respectful care, and the right to refuse the medication,• To be informed of the medication’s name, purpose, action, and potential undesired effects,• To refuse a medication regardless of the consequences• To have a qualified nurses or physicians assess medication history, including allergies• To be properly advised of the experimental nature of medication therapy and to give written consent for its use• To receive appropriate supportive therapy in relation to medication therapy• To not receive unnecessary medications
Medication safety guidelines• Medications are not given without physician’s written orders.• Do not administer a drug about which any doubt exists, check further with the physician.• Labels must be clear if not return to pharmacy.• A nurse not to pour medication to one bottle to another, not to put a medicine back into bottle, Nurses are not authorized to re-label medication bottles, Medication which loses its label or which lacks a legible label shall be return to the pharmacy.
• Nurse who administer the medications are responsible for their own action. Question any order that you considered incorrect (may be unclear or inappropriate)• Be knowledgeable about the medication that you administer• Keep the Narcotics in locked place.• Use only medications that are in clearly labeled containers.• Return liquid that are cloudy in color to the pharmacy• Before administering medication, identify the client correctly• The nurse who prepares the drug administers it.. Only the nurse prepares the drug knows what the drug is. Do not accept endorsement of medication.• If the client vomits after taking the medication, report this to the nurse in-charge or physician.
• Preoperative medications are usually discontinued during the postoperative period unless ordered to be continued.• When a medication is omitted for any reason, record the fact together with the reason.• When the medication error is made, report it immediately to the nurse in-charge or physician. To implement necessary measures immediately. This may prevent any adverse effects of the drug.• Each nurse should know the common dose, maximum dose, how to compute dosage if necessary.
• Do not leave the medication at the bedside. Stay with the client until he takes the medications.• Prepare medications for one patient at a time.• Do not label the medicine by patient room number or bed number .
• Know and follow institutional policy and procedures• Look up what you do not know• Chart carefully• Listen to the patient “I never took that before’’ and the like• Check ,Double – check when a dose seems high• The unit dose cart should be moved up to door of the patient room with drawer side towards the room during administration .• Narcotics are to be checked by every shift, and the narcotic cabinet must be locked.• Follow the universal safeguards in administration of medications.• Always check patient ID before administering medications.• Chart the medication after administration, if it is not charted , it is not done.• Chart if any nursing action done before administering( apical heart rate, B.P, )• Check for the expected effect(therapeutic) of the drug. Did side effects or adverse effects occur perform indicated nursing actions . Record observations.
Patient & Family Education• Name dose and action of the drug.• Time of administration• Special storage and preparation of the drug• Specific OTC drugs and alternate• Special comfort and safety reasons• Specific points about drug toxicity• Specific warning about drug discontinuation.