1. Medication administration
Presented by:
Mrs. Ghada Ahmed Aloliyani
Surgical Clinical instructor.
Date & time of the presentation : 05.10.2022 1-2 Pm
Nursing Education & Training Department
2. Out lines
• Purpose of lecture
• responsibilities:
• policies:
• seven rights.
• standard medication administration times:
• ward stock policy.
• medication administration procedure.
• route of administration.
• Drug calculation
3. PURPOSE:
• To ensure safe and competent administration of medications.
• To prevent medication errors.
• To implement the "Ministry of health rules and regulations related to
Controlled and Narcotic Substances“
• To provide uniform guidelines for documentation in the Electronic Patient
Record (EPR).
• To ensure patient's safety by monitoring adverse effect of post medication
administration
5. Seven Rights
• Right Patient
• Right Drug.
• Right Dose
• Right Route
• Right Time of administration
• Right Frequency
• Right Documentation
6. POLICIES
• Nurses who administer medications are defined by job description.
• competencies and privilege are allowed to administer medications including
but not limited: Anesthesiologists, anesthesia technicians, radiologists.
• independent double checking must be done to all medications by another
nurse
• Guidelines for safe IV Push medication shall be made available and
implemented in patient care areas .
7. Policy Cont.
• check the medication order entered by the Physician in HIS
• All high alert medication shall be independently double checked before
administration
• All medications shall be kept secure. The medication cart will not be left
open and unattended.
• Check for contraindications to patient receiving the medication (i.e.
allergies)
8. Policy cont
• Near expire drugs shall be separated and given priority for administration.
FEFO (First Expired, First Out)
• NPO Status: If the Physician writes " NPO " on the Physician's order the
Nurse or authorized clinical staff shall clarify with the Physician about route
of administration.
9. Narcotic policy
• Narcotics must be checked every shift, the Head Nurse / Charge Nurse is
responsible for the narcotic key and change to the Pharmacy Dept
• All Narcotics and Controlled Drugs will be kept under double-lock system
refer to Narcotic and Controlled Medication Policy
• Disposal and documentation of unused portion narcotics and controlled
medications according to Narcotic and Controlled Medication Policy.
10. Policy cont
• Medication preparation area should be clean, have good lighting, and
located in a closed area to avoid distraction.
• . Medications are not to be left on trays, bedside tables.
• . The Nurse or authorized clinical staff should not administer medication
prepared by other nurse unless double check done on the preparation by
other nurse.
11. • Nurses authorized clinical staff are not authorized to re-label medication
bottles or containers
• Medications which loses its label or which lacks a legible label must never
be administered to the patients. In all circumstances when medication is
withheld for the above reasons, the Head Nurse / designee must inform the
Pharmacy and secure the medication until sent to pharmacy for a
replacement
12. • each nurse and authorized clinical staff should know the common dose,
maximum dose, and how to compute dosage. drug information resource
and the hospital formulary are available on the mch shared points. if
uncertain, the nurse or authorized clinical staff can consult pharmacy
department
• all medications requiring refrigeration should be identified by the
pharmacy department and placed in the medication refrigerator
13. Policy cont
• At the patient's bedside, verify the patient's name and medical record
number on the Medication order through Hospital Inter-system (HIS) and
the ID band. Advise the patient about potential clinical adverse reactions,
or other concerns when administering a new medication and discuss any
significant concerns about the medication.
14. Standard Medication Administration Times
Administration time
Frequency
10: 00
Every Other Days
12: 00
Once A Day/ Once Daily
10:00 - 14:00 - 22:00
Three times daily
06:00 - 14:00 - 22:00
Every 8 hours
10:00 - 14:00 - 18:00 - 22:00
Four times daily
00:00 - 06:00 - 12:00 - 18:00
Every 6 hours
22:00
Once A Day At Bed Time
15. Policy cont
First dose of parenteral medication (I.V. / antibiotics, etc.) ordered round the
clock must be given within 3 hours after the order has been written.
Stat" orders will be given immediately upon receipt of the medication on the
unit (within 15 minutes). The allowance of 30 minutes is given from the time
the order has been written to the preparation and delivery of the medication to
the ward.
16. Policy cont
Medication must be given within an hour from the scheduled time
according to established Medication Administration Time.
Following standard frequency according to HIS in
administering medications ordered by medical staff.
17. Ploicy cont
• At the time of receiving medication from the Pharmacy, the Nurse or
authorized clinical staff is responsible to assure that all drugs received
match the original request form.
• Head Nurses will ensure that their area is not overstocked, but if this event
occurs, he/she will contact the Pharmacy to coordinate the overstock
return to the Pharmacy.
• Medications will be stored and labeled in a manner which ensures security
18. Policy cont
• following pharmaceutical categories must be separated from each other when
being stored:
• External
• Injection
• Ear Preparation
• Disinfectants
• Oral Preparation
• Eye Preparation
19. policy cont
• Single-dose vials / ampoules shall be discarded immediately after puncturing
/ draw.
• Multiple- Dose vials shall be dated/timed with staff and refrigerated when
they are opened unless otherwise specified by the manufacturer:
20. Policy cont
• Discard when:
• the manufacturer's expiration date is reached and when suspected or
visible contamination occurs.
• If expiration dating is not referenced on the packaging insert or
reconstitution and stability guidelines of injectable medication.
• Discard when empty EXCEPT narcotic and controlled
21. Policy cont
• Opened multiple- dose oral, eye, ear, nose drops, creams, ointments,
nebulization solution, except antibiotics) should be properly labelled and
kept in dry a liquids should be properly labelled and kept in cool dry area
with an expiry date. one month from date of opening.
• Medication refrigerators will not be used for storing foods, specimens or
blood for transfusion
22. Policy cont
• Each unit / clinic is responsible to maintain a clean and functioning
refrigerator.
• Each unit /clinic must monitor and record the temperature daily in log
sheet. If temperature falls outside the range of 2- 8 °C notify Maintenance
for repair within 30 minutes.
23. Medication Administration Procedure
• Review Medication administration record through Hospital Inter-system
(HIS) at the beginning of each shift and frequently for changes during the
shift. Check for:
• Day /Month /Year and time order was written.
• Assess medical history, patient’s allergies and medication history.
• Automatic Stop Order
• Patient’s 3 names & Medical Record Number
24. Medication Administration Procedure
• The 7 Rights of Medication Administration must be followed before
medication administration
Explain procedure to the patient, if applicable.
• Check medication label against medication record through Hospital Inter-
system (HIS) for:
• Correct Medication
• Correct Dose
• Expiration Date and verify the medication stability based on visual
examination for particulates or discoloration
25. Medication Administration Procedure
• Wash hands before medication administration follow Infection Policies &
Procedure While preparing medications, check again the label for the
medication’s name and dose.
• Take the medication and Medication administration record through Hospital
Inter- System.
• Medications are taken to the patient’s room and opened at the bedside.
26. Medication Administration Procedure
• Medications that needs preparation are prepared in the medication room.
• Patient identification is checked by patient name and medical record
number through the ID Band.
• Administer the medication after independent double checking done by 2
Nurses. Medications must be prepared for one patient at a time
27. Medication Preparation
• Oral Medication:. Tablet / Capsule Preparation:
• To prepare unit dose tablets or capsules, place packaged required number of
tablet or capsule directly into medicine cup without touching the tablets.
• If patient has difficulty swallowing to inform the physician and follow the
order.
28. Medication Preparation
• Liquid Preparation:
• Gently shake syrup / suspension Solution, if necessary. Hold bottle with
label against palm of hand while pouring. Hold medication cup at eye
level, and fill to desired level on scale.
• If patient is unable to hold the medications, place medication cup to
his/her lips and gently introduce each drug into mouth, one at the time. Do
not rush
29. Medication Preparation
Remain with the patient:
• After giving the medication until the medicine is actually swallowed.
• If patient refused to take medication, return unopened medication on the
cassette.
• If the medication was opened and refused, waste in sink and have another
Nurse witness and document on Medication Record through Hospital Inter-
system (HIS) document by changing administration status to " patient refuse"
on Medication administration record through Hospital Inter-system (HIS).
30. Intravenous (IV) Push Medications:
• Check for patient’s intravenous cannulation site for signs of inflammation,
displacement of needle or phlebitis and patient's body weight
• Patient condition for any contraindication for intravenous injection
example muscle atrophy decreased blood flow, circulatory shock
31. Intravenous (IV) Push Medications:
• Administering Medication into an existing Intravenous Line:
• Clean injection port with antiseptic swab. Allow to dry.
• Connect syringe to IV line insert needleless blunt cannula tip syringe or a
small gauge needle containing drug through center of port.
• Occlude IV line by pinching tubing just above injection port gently on
syringe's plunger to aspirate for blood return.
32. Intravenous (IV) Push Medications:
• Inject the medication slowly into the IV port at the prescribed rate. Use a
watch to time administration rate.
• If IV medication and IV solution in tubing are incompatible, flush line
with normal solution while occluding catheter above port. Administer
medication at prescribed rate, re-flush with10ml of sterile normal saline
solution, and release occlusion.
• After injecting medication, withdraw syringe and re-check fluid infusion
rate
33. Intravenous (IV) Push Medications:
• Intravenous push (Intravenous lock):
• Don gloves, prepare pre-filled syringes of normal saline (0.9%).
• Administer medication:
• Clean lock's injection port with antiseptic swab.
• Insert syringe with normal saline 0.9% through injection port of IV lock.
34. Intravenous (IV) Push Medications:
• Pull back gently on syringe plunger, and check for blood return.
• Flush IV site with normal saline by pushing slowly on plunger.
• Clean lock's injection port with antiseptic swab.
• Inject medication within the specified time.
• After administering the medication clean locks of the injection site with
antiseptic swab.
35. Intravenous (IV) Push Medications:
• Attach syringe with 1 to 3 ml of Normal Saline into injection port and
flush the port with saline.
• Dispose of used syringes properly and wash hands.
• Evaluate the patient’s response to medication therapy
36. Administering Medication by Metered Dose Inhaler
• Explain the procedure and its purpose to the patient.
• Assist the patient to sitting or standing position. Perform the second
medication check of the seven rights.
• Asked the patients to breathe out through his or her mouth
• Position the mouth piece 1 to 2 inches from the patient open mouth.
Instruct the patient to breathe in slowly through the mouth. As the patient
starts inhaling, press the canister down to release one dose of the
medication
38. Inhalation administration
• Instruct the patient to hold his or her breath for 10 seconds (if possible).
• Wait at least 1 minutes before administration of a second dose or inhalation of
different medication by metered dose inhaler. Administer bronchodilators by
metered dose inhaler before medication..
• Reassess of breathing, respiratory rate, accessory muscle use, and breath
sounds.
39.
40. Ampoule Preparation:
• Tap top of ampoule lightly and quickly with finger until fluid moves from
neck of ampoule.
• Place small gauze pad, unopened alcohol swab around neck of ampoule or
with the ampoule cutter, if available.
• Snap neck of ampoule quickly and firmly away from hands.
• Draw-up medication quickly, use long needle enough to reach the bottom of
the ampoule.
41. Ampoule Preparation cont
• Aspirate medication into syringe by gently pulling the plunger.
• Expel excess air bubbles, remove needle from ampoule. Hold syringe with
needle pointing up. Tap side of syringe to cause bubbles to rise toward
needle. Draw back slightly on the plunger upward to eject air.
42.
43. Vial Preparation
• Containing Solution:
• Remove the protective metal cap and clean the rubber cap with alcohol
swab, and allow to dry.
• Remove the cap from the needle then draw up into the syringe the amount of
air equal to the volume of the medication to be withdrawn
• Mix solution, if necessary by rotating the vial between the palms of the hand
not by shaking.
• Insert needle into upright vial and inject air into vacant area of vial, keeping
needle bevel above surface of medication.
44. Vial Preparation
• Recheck amount of medication in syringe, turn vial upright and remove
needle.
• Replace needle guard using the scoop method.. Recheck medication label
and dosage against medication order and any dose calculation. Confirm
calculation with another nurse
• Dispose of or replace equipment appropriately.
• For multi-dose vial, make label that includes date /time of opening or
mixing, date/time of expiration and concentration of drug per ml
45. Vial Containing Powder
• Remove cap covering vial of powdered medication and cap covering vial of
proper diluents.
• Clean Rubber seal with alcohol swab & let it dry and withdraw the amount
of air into the syringe equivalent to volume of diluents to be aspirated from
the vial.
• Insert needle through the rubber stopper.
• Inject air into vial's airspace and hold plunger with firm pressure.
• Invert the vial and withdraw the desired volume of diluents. Make sure that
the needle is in the solution to be withdrawn.
46.
47. • Remove needle from vial by pulling back on barrel of syringe
• Hold syringe at a 90-degree angle at eye level and expel any air bubbles.
Clean Rubber seal with alcohol swab let it dry.
• Insert tip of needle through center of rubber seal of powdered medication.
Inject diluents into vial. Remove needle. Mix medication thoroughly by
rolling vial in palms back and forth, do not shake. Withdraw medication
following steps for a vial containing a solution
48. After medication adminstration
• Dispose of soiled supplies. Place broken used vials and used needles in
sharp container
• For high alert medication, narcotic and control drug refer to Improve the
Safety of High Alert Medications Policy (& Narcotic and Controlled
Medication Policy
49. Documentation of Medications (HIS
• The Medication order administration record through Hospital Inter-system
(HIS) shall reflect the correct Physicians' order for medication. The Nurse
or authorized clinical staff who administers the medication shall document
the time on the administration record through Hospital Inter-system (HIS)
as soon as possible following administration.
50. Missed-Dose:
• When a medication was not administered on the correct time (after one
hour delayed) / missed dose the nurse or authorized clinical staff must
document this in Medication Administration record by changing
administration status to “not administered “and write a Medication Error
Form and refer to Medication Errors, including Near Misses & Hazardous
Conditions Reporting Policy
51. Withholding Medications
• The physician will be responsible to hold the medication in his Medication
order through Hospital Inter- system (HIS
• The Nurse shall follow the order and document in the Nurse's Notes the
reason the drug was not given. In addition to changing administration
status to “Withhold “in Medication Administration Record
52. Withholding Medications:
• Discontinued Medication = When a drug is discontinued the Nurse or
authorized clinical staff shall: Ensure the Physician change order status to
“discontinued” through Hospital Inter- system (HIS
53. PRN Medications:
• PRN medications shall be documented on the Medication administration
record through Hospital Inter-system (HIS) with the date, time, nurse's
name.
• The patient's response to PRN medications is written in the Nurse's Notes
through Hospital Inter-System (HIS).
• Document in Nurses Note and medication administration record through
HIS.
54. Adverse reaction
• Record patient’s response to PRN medications & reaction must be
reported to the Physician and Adverse Drug Reaction Form completed and
sent to the Pharmacy.
57. • Cephalexin (Keflex) 750 mg P.O. every 12 hours is ordered. The pharmacy
stocks 250 mg tablets. How many tablets should be administered per dose?
58. • Intravenous (IV) Dose
• An order for digoxin 0.5 mg IV daily is placed. Digoxin 0.25 mg/mL is
available from the pharmacy. How many mL will you need to administer a
0.5 mg dose?
59. • Subcutaneous Dose
• Heparin 7500 units subcutaneous every 12 hours is ordered. The pharmacy
provides a heparin vial with a concentration of 5000 units/mL. How many
mL will you need to administer 7500 units?
