Medication Administration and
Drug Calculations
Contents
• Review of key terms
• Routes of drug administration
• Legal & ethical aspects
• Role & responsibility of nurses...
Pharmacology
• Pharmacology is the study of drugs, their properties, actions
and effects on the living system.
• Pharmacok...
Pharmacology
 Pharmacodynamics - impact of drugs on body:
◦ Dose-response relationship
◦ Drug receptor interaction
◦ Drug...
Key terms
 What is a Drug?
◦ A drug is any natural or synthetic substance
that alters the physiological function or state...
Key terms
• Why do drugs have different names?
o Chemical name describes the constituents that
make up its molecular struc...
Routes of drug
administration
• Enteral - Oral, Sublingual,
Buccal, Nasogastric tube,
Orogastric tube,
Gastrostomy tube,
J...
Legal & Ethical aspects
Laws
• Poisons Act 1964
• Drugs and Poisons and Controlled Substances
Regulations Act 1981.
• Ther...
Legal & Ethical
Aspects
Three key legal principles:
1. Accountability
2. Duty of care
3. Negligence
Legal & Ethical
Aspects
Ethical issues
• Rules and principles for right conduct
• Standards of ethical practice and conduc...
Role &
Responsibilities
 Prescriber: medical doctor responsible
for diagnosing, charting and initiation of therapy
 Phar...
Over-the-Counter
Medicines (OTC)
• Can buy them for self-treatment from
pharmacies, supermarkets, health food
stores and o...
Schedules of medicines
& poisons
National classification system:
• Schedule 1 Not currently in use
• Schedule 2 Pharmacy M...
Prescription Medicines
• You require a doctor's prescription to
buy prescription medicines from a
pharmacist.
• Only autho...
Role & responsibility of nurses
 Check medication orders
◦ Medication chart details
◦ Standing orders confirmed
◦ Emergen...
Role & responsibility
of nurses
 Storage of medications
◦ Bedside drug locker
◦ Pharmacy cupboard
◦ Imprest or medication...
Rights of medication
administration
1. Right patient
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Rig...
Medication
administration
• Procedure for safe drug administration
o Patient ID
o Preparation- pharmacy/drug room/ bed sid...
ID Band
X a
The Australian Commission for Safety and Quality in
Health Care has developed a national standard for
patient ...
Medication Errors
• Accountability, Reporting & Acting on drug
errors
o Report to physician
o Monitor client for adverse e...
Negative Effects
• Assess patient before and after medication
administration and report all adverse effects:
o Side effect...
Medication Errors
• Defined as “deviations from a physician’s order”
(Mayo & Duncan, 2004)
• Common sources of medication ...
Medication Errors
• Common causes for drug errors by
nurses
o Orders are not clear
o Order is misread
o Nurses are distrac...
Drug calculations
• Tablets
Number of tablets
= Required / Prescribed dose
Stock dose
• Liquids
Volume
= Required / Prescr...
Drug calculations
• Intravenous orders
Rate/hour = Prescribed / Required Volume
Hours
Drops per Minute = Prescribed / Requ...
Documentation
• Drug chart
• IV orders
• Narcotic/PCA orders
• Patient history
• Fluid balance chart
• Additional Hospital...
Drug Levels
Gentamicin Levels
• Specimens should be collected as one of the following
combinations:
o Level 1 (GENT1) - im...
Review
• It is the role and responsibility of nurses to
administer medications safely and competently.
• Drug administrati...
References &
Resources
• Australian Nursing and Midwifery Council 2008. Code of Professional Conduct.
Australian Nurses Co...
IHNA offers qualifications in
aged care, disability and
nursing. Go to
http://www.ihna.edu.au to kick
start your health ca...
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Medication Administration and Calculation for Nurses Returning to Practice

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This presentation outlines the responsibility and role of nurses in administrating medication and calculation of medication in Australia. This presentation was compiled by Gulzar Malik, an experienced and qualified Nursing Educator at IHNA. For more information about IHNA's return to nursing programs, please call 1800 22 52 83.

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Medication Administration and Calculation for Nurses Returning to Practice

  1. 1. Medication Administration and Drug Calculations
  2. 2. Contents • Review of key terms • Routes of drug administration • Legal & ethical aspects • Role & responsibility of nurses • Medication errors • Medication administration documentation • Review
  3. 3. Pharmacology • Pharmacology is the study of drugs, their properties, actions and effects on the living system. • Pharmacokinetics - The way drugs move through the body systems. ABSORPTION BODY METABOLISM EXCRETION DISTRIBUTION Chemical & Physiological factors affect Factors affect Effectiveness in functions of excretion sites affect Sites of metabolism & factors affect
  4. 4. Pharmacology  Pharmacodynamics - impact of drugs on body: ◦ Dose-response relationship ◦ Drug receptor interaction ◦ Drug receptor relationship - selectivity, affinity of chemical, agonists, antagonists ◦ Drug interactions
  5. 5. Key terms  What is a Drug? ◦ A drug is any natural or synthetic substance that alters the physiological function or state of a living organism. ◦ Two main groups  Medicinal (chemical)  Non-medicinal (vitamins, herbal)  What is medication? ◦ A drug administered for therapeutic effects.
  6. 6. Key terms • Why do drugs have different names? o Chemical name describes the constituents that make up its molecular structure o Generic name given by manufacturer when fist developed, simpler then chemical name o Trade name brand name under which manufacturer markets drug • How do they work? o Chemical interaction between drug and body’s cells interact with cell membrane, cell enzymes, or certain components of cell
  7. 7. Routes of drug administration • Enteral - Oral, Sublingual, Buccal, Nasogastric tube, Orogastric tube, Gastrostomy tube, Jejunostomy tube, Rectal. • Topical- skin preparations, transdermal patches, mucous membranes (eye drops, throat swabs, rectal & vaginal, bladder irrigation, nasal & throat sprays). • Inhalations – aerosol therapy, metered dose inhalers. • Parenteral – Intradermal, Subcutaneous, Intramuscular, Intravenous. • Other routes - Intrathecal, Epidural, Intraperitoneal, Intrapleural, Intraosseous.
  8. 8. Legal & Ethical aspects Laws • Poisons Act 1964 • Drugs and Poisons and Controlled Substances Regulations Act 1981. • Therapeutic Goods Act 1989 sets out the legal requirements for the import, export, manufacture and supply of therapeutic goods in Australia (advertising, labelling, product appearance and appeal guidelines). • Therapeutic Goods Administration (TGA)- regulatory agency. • Scheduling of substances and the safe storage of therapeutic goods, are covered by the relevant State or Territory legislation.
  9. 9. Legal & Ethical Aspects Three key legal principles: 1. Accountability 2. Duty of care 3. Negligence
  10. 10. Legal & Ethical Aspects Ethical issues • Rules and principles for right conduct • Standards of ethical practice and conduct set by the profession
  11. 11. Role & Responsibilities  Prescriber: medical doctor responsible for diagnosing, charting and initiation of therapy  Pharmacist: supply, distribution, preparation, and resource of drug information  Registered Nurse: administers medications
  12. 12. Over-the-Counter Medicines (OTC) • Can buy them for self-treatment from pharmacies, supermarkets, health food stores and other retailers. • Examples include cough and cold remedies, anti-fungal treatments, sunscreens, non-prescription analgesics such as aspirin and paracetamol.
  13. 13. Schedules of medicines & poisons National classification system: • Schedule 1 Not currently in use • Schedule 2 Pharmacy Medicine • Schedule 3 Pharmacist Only Medicine • Schedule 4 Prescription Only Medicine OR Prescription Animal Remedy • Schedule 5 Caution • Schedule 6 Poison • Schedule 7 Dangerous Poison • Schedule 8 Controlled Drug** • Schedule 9 Prohibited Substance
  14. 14. Prescription Medicines • You require a doctor's prescription to buy prescription medicines from a pharmacist. • Only authorised health care professionals can supply them, such as in a hospital setting. • Examples include contraceptive pills, antibiotics and strong painkillers.
  15. 15. Role & responsibility of nurses  Check medication orders ◦ Medication chart details ◦ Standing orders confirmed ◦ Emergency or telephone order APP documented ◦ Nurse initiated medications documented ◦ Record of medication administration  Ensuring safe practice ◦ Check orders ◦ Check drug labels ◦ Check patient ID ◦ Store as packed
  16. 16. Role & responsibility of nurses  Storage of medications ◦ Bedside drug locker ◦ Pharmacy cupboard ◦ Imprest or medications cupboard ◦ DD cupboard ◦ Medication trolley ◦ Drug fridge
  17. 17. Rights of medication administration 1. Right patient 2. Right medication 3. Right dose 4. Right time 5. Right route 6. Right documentation + Right to refuse
  18. 18. Medication administration • Procedure for safe drug administration o Patient ID o Preparation- pharmacy/drug room/ bed side o Information o Administration o Safety o Completion o Documentation (drug chart, IV, FBC, Pt’s progress notes)
  19. 19. ID Band X a The Australian Commission for Safety and Quality in Health Care has developed a national standard for patient identification bands. This standard will become a part of accreditation standards.
  20. 20. Medication Errors • Accountability, Reporting & Acting on drug errors o Report to physician o Monitor client for adverse effects o Document in chart, client history o Report to shift in-charge o Adverse incident form o Education to avoid future errors
  21. 21. Negative Effects • Assess patient before and after medication administration and report all adverse effects: o Side effect o Adverse reaction o Allergic reaction o Anaphylactic shock o Medication error
  22. 22. Medication Errors • Defined as “deviations from a physician’s order” (Mayo & Duncan, 2004) • Common sources of medication errors o Illegibly written orders o Dispensing errors o Administration errors • Withholding medications o Document clearly with rationale o Incident report if wrongly withheld
  23. 23. Medication Errors • Common causes for drug errors by nurses o Orders are not clear o Order is misread o Nurses are distracted or interrupted o Nurses are tired or exhausted o Lack of adequate knowledge
  24. 24. Drug calculations • Tablets Number of tablets = Required / Prescribed dose Stock dose • Liquids Volume = Required / Prescribed strength x Stock Volume Stock strength
  25. 25. Drug calculations • Intravenous orders Rate/hour = Prescribed / Required Volume Hours Drops per Minute = Prescribed / Required Volume x Drip factor of giving set Time (in Minutes) The drip factor of standard giving set is 20
  26. 26. Documentation • Drug chart • IV orders • Narcotic/PCA orders • Patient history • Fluid balance chart • Additional Hospital requirements • Specific drug administration protocol charts
  27. 27. Drug Levels Gentamicin Levels • Specimens should be collected as one of the following combinations: o Level 1 (GENT1) - immediately post dose, and Level 2 (GENT2) - 6 to 8 hours post dose, or o A spot test (GENT), or o Pre (GENTPR) - immediately before the dose, and post dose (GENTPO) - 30mins post dose for IV, or 1 to 1.5 hours post dose for IM. Record dose, exact times of collection and start/finish times of infusion.
  28. 28. Review • It is the role and responsibility of nurses to administer medications safely and competently. • Drug administration is guided by codes of practice under legal and ethical frameworks in Australia. • The fundamental rule of medication administration is o Do it right the first time, no second chances o Follow medication administration polices and guidelines o Take time to check and check again
  29. 29. References & Resources • Australian Nursing and Midwifery Council 2008. Code of Professional Conduct. Australian Nurses Council Inc. Canberra. ACT. • Byrant, B., Knights, K., Salerno, E. 2007, 2nd Ed., Pharmacology for Professionals, Australia : Mosby. • The Pharmacy Guild of Australia, March 2009,Australia’s unique medication scheduling system. Retrieved January 8, 2011 from www.guild.org.au • Nurses & Midwives Board of Western Australia June 2010. Medication Management Guidelines for Nurses and Midwives. Retrieved June 24, 2010 from Nurses & Midwives Board of Western Australia. • Nurses & Midwives Board of Western Australia June 2010. Medication Management Guidelines for Nurses and Midwives. Retrieved January 4, 2012 from Nurses & Midwives Board of Western Australia. • Cohen, H., Robinson, E.S., Mandrack, M. 2003,Getting to the Root of Medication, Volume 33, Number 9 (36-45), Nursing, Commonwealth Standard, Drugs, Poisons and Controlled Substances Regulations 2006. • Drugs and Poisons regulation Group (DPRG) January 2008, Department of Human Services (DHS), Key Requirements for Nurses Providing Acute Care (Other than Nurse Practitioners), www.health.vic.gov.au/dpu • Mayo, A.M. 7 Duncan, D. 2004, Nurse Perceptions of medication Errors: What We Need to Know for Patient safety, Journal of Nursing Care Quality, July/September, Volume 19, number 3 (209-217), Lippincott Williams & Wilkins, Inc.
  30. 30. IHNA offers qualifications in aged care, disability and nursing. Go to http://www.ihna.edu.au to kick start your health career. Thank you for viewing this presentation!

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