1. Applying the Nursing Process to
Drug administration
Responsibilities of a nurse in d
Administration
F.CHIPHANGWI
2. Learning objectives
Review the nursing process
Discuss the steps in nursing process as
applied to drug administration
Discuss the responsibilities of a nurse in drug
administration
3. Definition of the nursing process
The nursing process is a plan that is used to
identify patients problems, develop and
implement a plan of action, then evaluate the
results of nursing activities.
The nursing process becomes an integral
part of drug therapy as the process is applied
to assess the needs of clients when
medications have been prescribed.
4. Nursing process ct.
Assessment, problem identification, planning,
intervention, and evaluation, all components
of the nursing process, are important steps in
determining if clients need medication.
5. Assessment of Client
Involves collectives of subjective data and
objective data
The assessment phase is very important in
the administration of drugs because data
obtained may influence nursing decision
made during the planning, implementation
and evaluation phases.
Also is necessary to plan appropriate client
teaching to promote compliance with
therapy.
6. Assessment of the client cont.
To administer medications safely to any
client, information must be collected during
initial assessment. In addition to these
baseline data, a medication specific
assessment should be part of the ongoing
nursing assessment to determine medication
effectiveness and promptly identify adverse
affects.
7. Assessment of the client cont.
Collect Subjective & Objective data:
Client, Drug & Environment.
Use current Drug handbook/text reference/
licensed pharmacist
Complete a drug history
Perform a Nursing Physical Assessment
Create a medication profile
8. Assessing Drug History of Client
OTC meds (e.g. aspirin, vitamins, dietary
supplements,antacids, minerals, )
Prescription Medications (e.g. birth control
pills
Street drugs (e.g. marijuana, cocaine)
9. Drug History (continued)
Herbals
Problems with drug therapy in the past (e.g.,
allergies, adverse effects, diseases or
injuries, organ pathology)
10. The Interview Process
Establish a therapeutic relationship with client
Use open ended questions (avoid “yes” or “No”
answers)
Questions/content of questions should include:
Oral intake of client: how does client tolerate fluids
swallow problems
Laboratory/diagnostic test value e.g. renal, liver
panels, hgb/hct., protein, albumin levels.
11. Interview process/Med eval
Consider client’s experience with meds/health care
system, previous hosp.
Check vital signs (establish baseline)
List meds client is taking /how taken/when
List new meds ordered
Use holistic framework- identify emotional, physical,
cognitive, cultural & socioeconomic factors impacting
drug therapy
12. Interview Process/med eval (cont.)
Check drugs adverse effects &
contraindications, routes of administration,
toxicity
Drug action
How does the cultural origin & racial/ethnic
group of client influence the drug therapy
13. Medication Orders
Orders must contain six elements:
Client’s name
Date & time order was written
Name of the medication
Dosage (includes size, frequency & number
of doses)
Route of delivery
Signature of prescriber
14. Researching the medication ordered
Use current text/handbook
Review:
classification, mechanism of action
doses, routes, side effects, contraindications,
drug incompatibilities
interactions, precautions & nursing
implications
15. Analysis of Data: developing a nursing
diagnosis
Base diagnosis on conclusion about risk factors,
actual client needs or problems based on knowledge
base.
E.g. nursing diagnosis include:
Deficient knowledge; risk for injury; noncompliance
Diagnosis based on side effects or risk factors e.g.:.
fatigue, constipation, impaired tissue perfusion,
sexual dysfunction, sleep disturbance, urinary
retention
16. Planning care: identifying goals &
outcome criteria
Prioritize the nursing diagnosis
Specify objective, measurable, realistic goals
Establish a time period for achievement of
outcomes
If order is in question- do not give- call
physician for clarification/further instructions.
Document all information obtained!!
17. Implementation
This is the carrying out of plan of action.
In pharmacology, implementation refers to the
preparation and administration of one /more drugs to
specific patients.
A view of the subjective and objective data obtained
is crucial before administration of a drug, thus
decisions on whether or not to administer a drug is
based on this data.
It involves administering the drugs, carrying out the
interventions to promote therapeutic response and
minimize adverse effects of the drug, nurse
18. Implementation cont.
interventions, monitoring side effects,
documenting medical and patient teaching,
nurse care to help move the patient toward
the desired goal and optimal wellness
Requires constant communication&
collaboration with client & health care team
19. Implementation cont.
Follow the “six rights”:
Right drug
Right dose
Right time
Right route
Right client
Right documentation
20. Client/patient’s rights with regards to
medication
Right to a “double check”
Right to proper storage/documentation
Right to accurate calculation& preparation
Right to careful checking of transcription of
orders
Client safety- use of correct administration
procedures
Right to accurate routes of administration
21. Client/patient rights –cont’d
Right to close consideration of special situations
e.g.: difficulty with swallowing, client with NG tube or
who is unconscious
Right to having all measures taken to prevent and
report med errors if they occur
Right to individualized /complete client teaching
Right of accurate/cautious monitoring
Right to accurate documentation
22. Evaluation of drug therapy: an ongoing
part of the nursing process
This is the fifth phase of the nursing process.
Monitor client responses to the drug
Monitor expected and unexpected responses
Monitor therapeutic (intended effects), side
effects , adverse effects & toxic effects
Document !! Very important!!
23. Nurses responsibilites in drug
admininstration
Medications must be kept in an orderly
manner in a place where they are not freely
accessible to patients or to the public and
where they are protected from air, moisture &
light.
Only medicines that are properly labeled
must be retained. Instructions regarding
storage, refrigeration & expiration dates
should be carefully observed.
24. Responsibilities cont’d.
Controlled substances (narcotics) should be
kept under lock and keys and appropriate
records should be kept regarding their use.
No medications should be given without a
proper medical order from a physician clearly
indication the medication, dose, route and
schedule.
25. Responsibilities cont.
A medication card is filled out for each drug
indicating the date, the patients room
number, drug name, dose, route schedule,
and duration of administration.
The nurse who transcribes the order to the
medication card would initial it. The identity
of the medication should be carefully
checked when it is taken from the storage,
when it is prepared and when the container
is returned to the shelf.
26. Responsibilities cont’d.
Medication in the solution or suspension
should be shaken well to ensure
homogeneity before a quantity is removed
from the container in filling a drug order.
Care should be taken to wipe the rim of
container in taking solutions.
27. Responsibilities cont’d.
Know the drug to be given in terms of nature,
action, usual dosage, indication and
contraindications, mode of action, side
effects, physical characteristics and why it is
particularly given to the patient.
Be careful with the same sound. Know
abbreviations of the drug.
Gather all necessary equipment before
starting preparation of medication
28. Responsibilities cont’d.
Do not converse with anyone (as much as
possible) while preparing the medication.
Allow no interruptions.
Read and check label on medication three
times.
– Before taking from the shelf.
– Before pouring or measuring.
– Before returning to the shelf.
.
29. . Responsibilities cont’d.
Avoid touching medications especially tablets
or pills.
Do not return excess medicine to the bottle to
avoid contamination
Always keep medicine card and medicine
tray together.
Arrange prepared medications according to
dispensing and other factors
30. Responsibilities cont’d.
Never leave medicine cupboard or shelf
unlocked.
When preparing the medications, do not use
the following:
– Medications from unmarked container with
illegible labels.
– Medications that are cloudy or have changed of
color.
– Medications that have sediment at the bottom
unless the medication requires shaking before
31. Responsibilities cont’d.
Identify the patient carefully using all
precautions.
Check the bed cards; look at the
identification bands, call the patient by name
or ask the patient to state his name.
Remember the five rights of medications,
right dose, right patient, right time, and right
route of administration.
32. . Responsibilities cont’d.
With rare exceptions, patients have the right
to know the name and action of the drug they
are taking, and they have the right to refuse
a medication, medications that are refused
must be changed and the reason for refusal
must be recorded.
Provide the correct adjunctive nursing
measure.
33. Responsibilities cont’d.
Give medications within 30 minutes of the
time ordered except for preoperative
medications, which must be given exact time
ordered or medications that are ordered to
be given hourly or every 2 hours (e.g. eye
medication, prior to surgery).
34. If a patient vomits after taking an oral
medication report the fact to the responsible
nurse and state the names of all
medications.
With-hold the medication. Often the physician
re-orders the same drug by a different route,
for example subcutaneously or
intramuscularly
35. Responsibilities cont’d.
Special precautions must be observed for
certain drugs. Most agencies requires that
two qualified nurse double-check the
dosages of anticoagulants, insulin, digitalis
preparations and certain IV medications.
Check agency policies
36. . Responsibilities cont’d.
.
After medication has been administered,
record it on the patient’s chat. The recording
should include the time, the name of the
drug, the dosage, the method of
administration and any related data.
37. Responsibilities cont’d.
Some agencies require that the method of
administration be specified if it is other than
oral, the oral route is usually not specified in
the record.
Evaluate the effectiveness of a medication of
suitable time after its administration. For
example, the effectiveness of an
intramuscularly injected analgesic can be
evaluated 10-20 minutes after administration.
38. Medicaton errors
Medication errors fall into several categories,
such as :
Ommitting the dose
Administering the wrong dose
Administering an extra dose
Administering the unordered drug
Administering by the wrong route
Misinterpretation
The way the amounts are expressed
39. Preventing Medication errors
Know and follow institutional policies and
procedures for medication administration
Know where to obtain resources for drug
information
Verify orders as much as possible before
giving medications
Inspect for expiration, defects
40. Preventing medication Errors
Verify patients ID
Take labeled medications right to the
bedside
Observe for adverse reaction
If calculations are necessary, it is wise to
check with another person.
Be familiar with administration devices
before using them
41. Responsibilities cont’d.
When medications are intentionally omitted;
e.g. before surgery or a diagnostic test,
record the omission and the reason on the
patient’s chart. It may also be necessary to
notify the prescriber.
Medication error sometimes occurs. When
an error is made, report it immediately to the
responsible person so that corrective
42. Responsibilities cont’d.
measure can be implemented promptly. Errors
are usually documented on an unusual
incident form that becomes a part of the
agency’s file.
The nurse who prepared the medicine should
be the one to administer and record. Never
allow a patient to carry or bring medicine to
another.
43. Responsibilities cont’d.
Medications are usually discontinued before
surgery, and the physician writes new orders
after the surgery. New orders are generally
given drugs to a newly admitted patient,
takes at home or when a patient is
transferred to another service within an
agency. Check agency policies.
