Nursing responsibilities medication administration

1. MEDICATION
ADMINISTRATION

2. OBJECTIVES
 Define the key terms used.
 Discuss the important concepts related to the safe and effective administration of
medication.
 Describe various factors that affect the action of drugs in individual clients.
 Discuss the legal implications connected with medication administration.
 List the common abbreviation used in relation to administration of medication.
 Understand the calculation of drug.
 Develop knowledge regarding medication assessment

3. INTRODUCTION
Administration of medication is a basic nursing function that involves knowledge and skill. The safe
and accurate administration is the most important responsibility of nurse. Improper administration
can cause harmful effects.
Some basic points regarding drugs:
 Name of the drug
 Classification
 Route and time of administration
 Principles of drug action
 Dosage
 Medication standards
 Types and forms of drugs

4.  Sources of information about medication
 System of medication distribution
 Medication order
 Prescription and non prescription medication
 Weights and measures used
 Preparation of solution and calculation
 Storing of medication
 Factors affecting safety
 Abbreviation and symbols used
 Rules of administration
 Legal aspects, nurse practice acts, clients rights
 Institutional policies
 Nurses role

5. MEDICATION
A Drug is any substance that alters physiologic function, with the potential of affecting health.
A Medication is a substance used in the diagnosis, treatment, cure, relief, or prevention of
health alteration.

6. NAME OF THE DRUGS
Drugs may be known as several name.
1. Chemical Name: which is known to chemist; it indicates the ingredient of the drug. Identify
the molecular structure. E.g. ibuprofen (anti-inflammatory)2- 4(isobutyl phenyl)Propionic acid.
2. Generic Name: It is assigned by the manufacturer who first developed the drug and is
assigned by the United States Adopted Names Council. It is derived form chemical name. E.g.
Morphine Sulphate ibuprofen etc.

7. 3. Official Name: It is assigned by the food and drug administration after approval. It is often
same as generic name.
4. Trade Name: it is assigned by the manufacturer and is copyrighted. One drug may be
manufactured by several companies. For E.g. Paracetamol such as Crocin, Calpol, Ifimol,
Metacin etc.

8. CLASSIFICATION OF DRUGS
According to action:
 Analgesics: Drugs used to relieve pain.
 Anesthetics: Drugs which causes loss of sensation.
 Anthelmintic: Drugs which destroy and expel worms.
 Antipyretics: Drugs which reduce fever.
 Antidotes: Used to Counteract the effect of poison.
 Anti-infective: Act either to inhibit, kill the micro organism.
 Anti-inflammatory: To reduce Inflammation.
 Anti-coagulants: Inhibit or decrease the blood clotting process.
 Anti-histamines: used to prevent of relieve allergy.
 Antacids: react with HCL to decrease activity of stomach secretions.
 Anti convulsants: used to prevent of treat convulsions

9.  Antibiotics: Ability to destroy or inhibit the growth of micro-organism.
 Anti-diarrhetics: used to treat diarrhea.
 Antitussives: drugs inhibit the cough reflex (CNS).
 Anti-asthmatics: Drugs which provides relief for asthmatic attack by relaxing the smooth
muscles of bronchioles.
 Antiseptic: Inhibits the growth of bacteria.
 Antifungal: drugs which prevent the growth of fungi.
 Antispasmodic: relieves the spasmodic pains or spasm of muscles.
 Antiemetics: relieves or prevents nausea and vomiting.
 Anti-tubercular: used to treat tuberculosis.
 Coagulants: helps in the coagulation of blood.
 Carminatives: Drugs which cause expulsion of gas from stomach and intestines.

10.  Diaphoresis: Increase the action of sweat glands.
 Diuretics: Which increase the flow of urine.
 Detergents: A cleansing agent.
 Digestants: An agent that promotes digestion.
 Emetics: drug that produce vomiting.
 Ecbolics or Oxytocics: Drugs that stimulates uterine contractions.
 Expectorants: Increase the bronchial secretions and aid in the expulsion of the mucus.
 Emollient: Substances that smoothen, soften and protect the skin.
 Galactogogue: Substance that increase the flow of milk.
 Hypnotics: Drugs that produce sleep.
 Hemostatics: An agent to check hemorrhage.
 Hypotensive: any substance capable of lowering BP.
 Hypoglycemic: Drugs that lower the blood sugar level.
 Haematinics: an agent which tends to increase Hb content of blood.

11.  Mydriatics: Dilate the pupils of eye.
 Nasal decongestant: Drugs which relieve the nasal congestion.
 Narcotics: Drugs that produces stupor or complete insensibility.
 Scabicides: Used in the treatment of scabies.
 Sedatives: Substances which lessen the body activity.
 Stimulants: Increase functional activity of an organ or system.
 Vesicants: A blistering agent.
 Vasodilators: Drugs which dilate the blood vessels and lowering BP.
 Vasoconstrictors: Drugs which constrict the blood vessels and raising the BP.

12. Classification of Drugs
(To promote the client's functional health
pattern)
Health Pattern Class of Drugs
Activity and Exercise Antihypertensive
Antiarrythmatics
Antianginal
Anticoagulants
Bronchodilators
Nutrition and Metabolism Antibiotics
Antiemetics
Antacids
Insulin
Corticosteroids

13. Elimination Laxatives
Antidiarrhoeals
Diuretics
Sleep, Rest, Cognition and Perception Sedatives
Hypnotics
Analgesics
Antipsychotics
Coping and stress tolerance Anti-anxiety agent
Anti-depressant agent
Sexuality and reproduction Ovarian hormones

14. Sources of Information about medications
A fundamental rule of safe administration of a drug is “Never administer an unfamiliar
medication”.
Printed Material: Books are written and published. Detailed sources available from sources
such as American Hospital Formulary Service Drug information, physician desk reference,
pharmacopoeia.
People: Physician who prescribe the particular drugs and other experienced nurses,
pharmacists and pharmaceutical sales representatives.
Computer Based Resources: Resources which are based on computers are also available for
drug reference.

15. SYSTEM OF MEDICATION DISTRIBUTION
Four types of system are used:
1. The stock supply: large quantity medication are stored in locked cupboard in a storage
room.
2. The unit dose supply: Packing of the individual clients dose and gives on time of
administration.
3. The automated medication dispensing system: By this method nurses obtain desired
medication from menu. This system helps to keep and account of all medication used for
billing and controlled substance for record keeping.
4. The self administered supply: Each medication is supplied in a separate container and is
used only for one client medication. It can be stored at the client's bedside, so as to enable
self administration.

16. Prescription medication:
A Prescription is a legal order for the
preparation and administration of
medication. Medication require
medical supervision because of
dangerous side effects.
Non Prescription Medication:
Many medication are available
without specific written orders
from a health care provider.
They are considered safe when
used as directed and it is
dangerous if it is misused,
since it may cause, serious
side effects.

17. Medication order
The prescription of a medication conveys an order which has the following components:
✓Clients name
✓ Identification or medical number
✓ Medication's name
✓ Amount and dosage
✓ Routes of administration
✓ Signature of Health care provider
✓ Use of abbreviations

18. Some important abbreviations
Abbreviations
a.c.
p.c.
a.m.
p.m.
Alt. die
o.m.
o.d.
H.S
p.r.n
s.o.s.
b.D (B.i.d)
t.i.d (t.d.s)
Stat
o.n.
Derivation
Ante cibum
Post cibum
Ante meridiem
Post meridiem
Alternis diebus
Omni name
Omni die
Hora somni
Pro re nata
Si opus sit
Bis in die
Ter in the die
Statim
Omni note
Meaning
Before meal
After meal
Before noon
After noon
Alternate day
Each morning
Daily (once a day)
Bed time
When required
When necessary in emergency
Twice a day
Three times in a day
At once
Each night

19. Types of order
 Standing orders
 PRN orders E.g. Pain killers
 One time or single order E.g. preoperative medications
 Stat order E.g. Inj. Lasix 40 mg iv stat
 Telephone, verbal and Fax orders

20. PRINCIPLES OF DRUG ACTION
Pharmacokinetics: It is defined as what body does to the drug.
It has four steps-
i. Absorption
ii. Distribution
iii. Metabolism
iv. Excretion
Pharmacodynamics: It is defined as what a drug does in the body

21. EFFECTS OF DRUGS ON THE BODY
1. Therapeutic Effects: It is the effect which is desired or the reason of drug is prescribed.
Therapeutic effects are the medication's desired and intentional effects.
The drugs are administered for the following purposes:
 To promote health E.g. Vitamins
 To prevent diseases E.g. Vaccines or anti toxins
 To diagnose diseases E.g. Barium x-ray
 To alleviate diseases E.g. Analgesics
 To treat or cure a disease E.g. malaria, T.b etc
2. Local or systemic Effects: Local effects of a drug are expected when they are applied topically to
the skin. A drugs used for systemic effect must be absorbed into the blood stream to produce the
desired effect in the various systems and parts of the body.

22. 3. Adverse effect: Adverse effect is any effect other than the therapeutic effect. Some adverse
effects are minor, whereas some other may cause very serious health problems.
4. Side effects: Side effects are the minor adverse effects. Side effects can be harmful or
harmless. Some side effects are like allergic reactions. Skin rashes, nausea, vomiting,
Hypotension, hypertension, anorexia, abdominal pain, nephrotoxicity, hepatotoxicity etc.

23. Routes of Administration
Drugs are administered according to the preparation of the drug administered and the effect
desired.
The different routes of administration of medication are described as follows:
a. Oral administration E.g. tablets
b. Sublingual administration Tab. NTG
c. Inhalation Eg. Chlorofom, ether to for anesthetic effects
d. Topical application E.g. Ointments
e. Instillation E.g. Eye, ear drops
f. Insertion E.g. Suppository
g. Insufflation E.g. Powder, vapour
h. Implantation: Putting solid drugs in to the bod tissues.

24. i. Parenteral administration: Parenteral Means giving of therapeutic agents outside the
alimentary canal. It is accomplished by a needle.
 Intramuscular: In to muscle
 Subcutaneous: In to sc tissues
 Intradermal: under the epidermis and in to dermis
 Intravenous: In to vein
 Intra Arterial: In to arteries
 Intrathoracic: Into Cardiac muscles
 Intrathecal or intra spinal: In to spinal cavity
 Intraosseous: In to the bone marrow
 Intraperitoneal: In to the peritoneal cavity

25. Medication assessment
Medication assessment is important in order to:
- Administer medication safely.
- Determine effectiveness of the medication.
- Identify any adverse effects of the medication
- Plan appropriate teaching plan to patient.
- Promote compliance with therapy.
The important information to be obtained during initial assessment:
 History of medication: Name, dosage, time and purpose.
 Allergies: name of medication and associate signs and symptoms.
 Medical History: renal, cardiac, respiratory dysfunction.
 Pregnancy and lactation status: avoid using teratogenic drugs

26. Assessment before medication
administration
1. Medication Record medication sheet and order
2. Diet or fluid order (IF NBM)
3. Laboratory values
4. Physical assessment:
 Ability to swallow
 Gastrointestinal motility
 Adequate muscular mass for sc or im injections
 Adequate venous access
 Vital signs
 Body system assessment

27. MEDICATION ERROR
It is the administration of drug:
 Which is not given according to the order.
 Is administered as per the order, but is unsafe or inappropriate for the client.
 When documentation in a client's chart does not reflect that a medication was administered
as ordered.
 Medication was given, but not charted.
 Administration of I.V. medication at wrong rate.
 Administering medication at wrong dose.
 Administering medication at wrong time.
 Administering the wrong medication.
 Charting medication was not given.

28.  Administering substitution medication.
 Failure to give a medication within the prescribed time interval.
 Giving a medication by wrong route.
 Incorrect preparation of a drug by an incorrect route.
 Administering medication to a client with known allergy to that medication.
 Improper technique when administering a drug.
 Administering medication to the wrong client.
When a medication error occurs, it must be documented exactly as it has occurred.

29. DRUG CALCULATION
Methods of Calculation
■ Basic Formula
■ Ratio and Proportion
■ Fractional Equation

42. SAFETY MEASURES
The rights ensures safety of giving drugs:
➡ Right client
➡ Right drug
➡ Right dose
➡ Right route
➡ Right time
➡Right Documentation
➡Right to refusal

43. 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.

44. 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.

45. 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.

46. 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.

47. 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 time

48. 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.

49. Rules of administration of medication
While 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

50. https://nurseslabs.com/10-rs-rights-of-
drug-administration/
 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.

51. During 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

52. Monitoring first dose of medication
Before 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.

53. 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.