1. Medication administration is a core nursing function that requires knowledge of drug names, classifications, effects and factors that influence drug action. 2. Nurses must have a valid medication order from a licensed practitioner before administering any drug and should verify that orders contain all required information. 3. Common types of medication orders include standing orders, PRN orders, single doses and stat doses. 4. To safely administer medications, nurses must follow the 5 rights (right patient, drug, dose, route and time) and perform 3 medication label checks. Documentation of administration is also important.

1. NU 101
Foundations of Nursing
Practice
Introduction to Medicines
Administration

2. Medication Administration
 Medication administration is a basic nursing
function that involves skilful technique and
consideration of the patient’s development,
health status, and safety.
 The nurse administering medications needs a
knowledge base about drugs, including drug
names, preparations, classifications, adverse
effects and physiologic factors that affect drug
action.

3. Medication Orders
 NO medication may be given to a patient
without a medication order from a licensed
practitioner
 A medication order is required for all
medications administered in a healthcare
facility
 The physician should use a specifically
designed form for the order

4. Medication Orders
 Types of orders:
 A standing order: carried out as specified until a
stated period of time is passed then the order is
cancelled.
 p.r.n (as needed): commonly used for treatment
of symptoms
 Single or “once off”: the order is carried out only
once at a time specified by the prescriber.
 Stat order: also a single order by is carried out
immediately

5. Medication Orders
Parts of a medication order should include 7 parts:
1. Patients name
2. Date and time the order is written
3. Name of drug to be administered
4. Dosage of the drug
5. Route by which the drug is to be administered
6. Frequency of administration of the drug
7. Signature of person writing the order

7. Checking the Medication Order
 In many institutions the doctor’s order is
copied onto the patient’s medication record,
often called the MAR (Medication
Administration Record). The nurse is
responsible for checking that the medication
order was transcribed correctly by comparing it
with the original order. The nurse is also
responsible for double-checking the dosage
and appropriateness of the medication.

8. Criteria for Clarification of
Medication Orders
 Order is illegible
 Order is incomplete
 Incorrect route or dosage is prescribed
 Medication is not expected for patient’s current
diagnosis

9. Preventing Medication Errors
 Is an event that results in a patient receiving
inappropriate or failed medication therapy
 In the event of a drug error you should assess
the patient for any adverse effects and notify
the doctor right away!
 Always follow the 5 rights and 3 checks –
when you don’t that’s when mistakes happen!!

10. Preventing Medication Errors
 Any drug order suspected to be in error should
be questioned. The nurse should ask:
 Do the patient’s condition, symptoms, and health
status warrant receiving this medication?
 Does it make sense for the patient to have this
medication?
 Is the correct dose and preparation ordered?

11. Preventing Medication Errors
 If you don’t understand why the medication
has been ordered, you should ask how the
order relates to the patient’s plan of care!
 Remember…. Nurses have the right to refuse
to administer any medication that, based on
their knowledge and experience, may be
harmful to the patient!
 If you are unsure always check before
administering medication
 Patient safety is the priority!

12. Documentation
 Accurate documentation is very important for
patient safety!
 Obtain patient information necessary to establish
a medication history.
 Use the nursing process to establish a medication
history for a patient.
 The nurse must document on the medication
record (name of the medication, dosage, route of
administration, time given, nurse’s initials, omitted
drugs, refused drugs, medication errors).

13. Three Checks of Medication
Administration
 Determining that you have the right drug
involves checking the medication label against
the MAR (Medication Administration Record)
at least three times before you administer the
drug
Medication label check #1
 Compare the medication label to the
MAR as you remove the drug from the
storage area

14. Three Checks of Medication
Administration
Medication label check #2
 Compare the medication label to the
MAR as you prepare each drug

15. Three Checks of Medication
Administration
Medication label check #3
 Compare the medication label to the
MAR at the patient’s bedside before
administering each drug

16. Five rights of medication
administration
 Following the five rights ensure safety and
accuracy when administering medications
The right drug
 Is this the medication the physician
ordered?
 Does the medication label match the
MAR?
 Verify the drug’s expiration date
 If the drug is unfamiliar, consult a
drug guide or a pharmacist

17. Five rights of medication
administration
The right dose
 Is this the dose the physician
ordered?
 Perform any necessary conversions
or calculations
 If you need to cut or crush the
medication, check with a pharmacist
or drug guide first

18. Five rights of medication
administration
The right route
 Can this medication be given by the
route ordered?
 If giving an injection, verify that the
preparation is for parenteral use

19. Five rights of medication
administration
The right time
 Is it time for you to give the
medication?

20. Five rights of medication
administration
The right patient
 Was the medication ordered for this
patient?
 Use two identifiers to confirm that
you have the right patient.

21. Patient Identification- always use 2
identifiers!

22. Knowledge Needed to Administer
Drugs Safely
 Drug name, preparations, and classifications
 Mode of action and purpose of medication
 Side effects and contraindications for medication
 Antagonist of medication
 Safe dosage range for medication
 Interactions with other medication
 Precautions to take before administrating
medication
 Proper administration technique

23. Nursing Responsibilities for
Administering Drugs
 Assessing the patient and understanding the need for
medication
 Ensuring the 5 rights and 3 checks of medication
administration
 Preparing the medication to be administered using
accurate dosage calculations at the prescribed dose
as per the prescriber’s directions
 Administering medication and documenting it is given
 Monitoring patient response and pharmacological
effects
 Educating patients regarding their medication regimen
and the pharmacological effects

24. Administering Oral Medications
 Most commonly used route of administration
 Usually most convenient and comfortable
route for the patient
 Intended for absorption in the stomach and
small intestine
 Drug action has slower onset and a more
prolonged, but less potent effect than other
routes

25. Home Care Considerations for Oral
Medications
 Encourage patient to discard outdated
prescription medications
 Discuss safe storage when children and pets
are in the home
 Encourage patients to carry a card listing all
medications, dosage, and frequency in case of
emergency
 Discuss importance of using an appropriate
measuring device for liquid medications
 Health teaching

26. Group Activities: Discussion
Questions
 As a class, discuss how you would respond in the
following situations:
 A patient with a high blood pressure reading
refuses to take the ordered antihypertensive
medication because he doesn’t like the way the
medicine makes him feel.
 Another student tells you that she inadvertently
gave medications to the wrong patient but is afraid
to tell your instructor.
 You just realized that you forgot to bring a patient
a medication that she was supposed to get 3
hours ago.

27. Group Activities: Discussion
Questions
 You suspect that a patient may be having a
negative reaction to an antibiotic you
administered.
 An elderly woman whom you are preparing for
discharge tells you that she has no idea how she
will ever be able to keep all her pills straight once
she gets home.
 As a nurse, a fellow nurse on your shift hands you
medication to administer to the patient in Room
417, bed 2. How might this situation be handled?

28. Group Activities
 Now lets take a look at the case studies…..

29. Adverse Drug Effects: Allergic
Reactions
 Allergic effect: an immune system response that
occurs when the body interprets the administered
drug as a foreign substance and forms antibodies
around the drug.
 The reaction can occur immediately or be delayed for
hours to days. Symptoms may become more severe
each time the drug is introduced to the body.
 Signs and symptoms: rash, urticaria, fever, diarrhea,
nausea and vomiting – but an adverse drug effect can
cause any sign or symptom!!!
 Nursing interventions: administer O2 therapy, stop any
infusions and call for help.

31. Adverse Drug Effects: Anaphylaxis
Reaction
 The most serious allergic effect is called an anaphylaxis reaction.
 Anaphylaxis is a severe, life-threatening, generalized or systemic
hypersensitivity reaction.
 The reaction is usually unexpected. The patient will feel and look
unwell.
 Anaphylaxis is likely when all of the following 3 criteria are met:
 • Sudden onset and rapid progression of symptoms
 • Life-threatening Airway and/or Breathing and/or Circulation
problems
 • Skin and/or mucosal changes (flushing, urticaria, facial oedema)
 The following supports the diagnosis:
 • Exposure to a known allergen for the patient
 Call for help right away!
 Lets take a look at the video….

33. Summary
 Can anyone summarize the main points from
today’s session?

34. Reference
 Big Taylor book chapter 29: Medications