Administration of medication

 

ADMINISTRATION OF MEDICATION

Clients with acute or chronic alteration in their health may have to use a variety of medications.

The role of nurse in the administration of medication has become increasingly complex & diversified.

Administration of correct medication and dosage by the specified route, using proper technique and taking appropriate precautions were once all that was expected of a nurse.

Today there increasing demand for a broader level of knowledge and skills from a nurse. Besides administering medication, a nurse has to observe and interpret the client’s response to therapy, so as to recognize possible incompatibilities and interaction of medication.

Administration of medication is a basic nursing function that involves knowledge and skill. The safe and accurate administration of medication is one of the most important responsibilities of a nurse. Improper administration of medication can cause harmful effects. The nurse administering medication should have the basic knowledge regarding drug.

(A)  GENERAL PRINCIPLES/CONSIDERATIONS:

1.      Purpose of Medications:

   All of us have taken medications at one time or another at some point in our lives. Medications were given to us, or we tool them ourselves for various reasons.

 

1.      Medication are used to make us feel better by reducing fever, pain or symptoms of a disease.

2.      Medications are supposed to carry benefits for us but they can also carry many risks that may not make us feel better, they can also carry many risks that may not make us feel better, they may even cause injury to us.

3.      Risks can be serious, or they may be mild and cause something minor like a stomach upset.  When the benefits outweigh the risk that the medication has associated with it, we will usually take the medication.

4.      Medication have risks that may not be known to us, but all medications that are approved for use by the U.S food and Drug Administration.

5.      They should also include any warning about known risks to certain consumer groups.

6.      In order to minimize the risks those taking medications should read the labels on the medications carefully and should has the doctor prescribing the medication or the pharmacist dispensing the medication any questions that we have about the medication before we take it for the first time.

7.      Some medications can have an adverse reaction when taking along with other medications, while pregnant or while nursing a baby , so read all medication labels regarding these and other warning before taking them.

 

2.      Principles : Rights, special Considerations, prescriptions Safety in Administering Medications and Medication Errors :

(a)   Rights :  Three checks and five right:

The nurse observes the three checks and five rights when administrating medications.

The label on medication container should be checked three times during medication preparation.

The Label Should be read :

1.      When the nurse  reaches to the container to the drawer or shelf or before giving the unit dose to the patient.

 

The five rights helps to ensure accuracy when administering medication.

1.      Right medication : Drug (the nurse should know the drug order written by the physician).

2.      Right patient :  (The nurse should read the patient’s name on the patient’s chart and on the medicine card. call the patient by name and ask him to repeat).

3.      Right dose : (A dose is the amount of drug administered at one time).

4.      Right route : (The nurse should know the method of giving drugs e.g. orally, parenterally, rectally etc.)

5.      Right time : (The time of administration is highly important. The nurse should know the time intervals between the administration of drugs.)

 

Check Three times for Safe Medication Administration :

        I.            First Check :Read the medication administration record(MAR) and remove the medication(s) from the client’s drawer. Verify that the client’s name and room number match the MAR

·       Compare the label of the medication against the MAR.

·       If the doage doe not match the MAR, Determine if you need to do a math calculation.

·       Check the expiration date of the medication.

      II.            Second Check

·       While preparing the medication (e.g., pouring, Drawing up, or Placing unopened Package in a medication cup), look at the medication label and check against the  MAR.

    III.            Third Check :

·       Recheck the label on the container (e.g. vial, bottle, or unused unit-dose medications)before returning to its storage place.

                                             or

·       Check the label on the medication against the MAR before opening the package at the bedside.

Ten “Right” of medication administration:

a)      Right Medication :

·       The medication given was the medication ordered.

b)      Right Dose :

·       The dose ordered is appropriate for the Clint.

·       Given special attention if the calculation indicated multiple pills/tablets or a large quantity of a liquid medication. This can be a “cue” that the math calculation may be incorrect.

·       Double-check calculations that appear questionable.

·       Know the usual dosage rang of the medication.

·       Question a dose outside of the usual dosage range 

c)      Right Time

·       Give the medication at the right frequency and at the time ordered according to agency policy.

·       Medications given within 30 minute before or after the scheduled time are considered to meet the right time standard.

d)      Right Route :

·       Give the medication by the ordered route.

·       Make certain that the route is safe and appropriate for the client.

e)      Right Client :

·       Medication is given to the intended client.

·       Check the client’s identification band with each administration of a medication.

·       Know the agency’s name alert procedure when clients with the same o similar last names are on the nursing unit.

f)       Right Client Education :

·       Explain information about the medication to the client (e.g. while receiving ,what to expect any precautions).

g)      Right Documentation :

·       Document medication administration after giving it, not before.

·       If time of administration differs from prescribed time, note the time on the MAR and explain reason and follow-through activities (e.g. Pharmacy states medication will be available in 2 hours ) in nursing notes.

·       If a medication is not given, follow the agency’s policy for documenting the reason why ?

h)      Right to refuse :

·       Adult clients have the right to refuse any medication.

·       The nurse role is to ensure that the client is full informed of the potential consequence of refusal and to communicate the client’s  refusal to the health care provider.

i)        Right Assessment “

·       Some medication require specific assessment prior to administration (e.g apical pulse, blood pressure, lab results).

·       Medication order may include specific parameters for administration (e.g., do not given if pulse less than 100).

j)        Right evaluation :

·       Conduct appropriate follow-up (e.g., was the desired effect achieved or not ? Did the client experience any side effect or adverse reactions).

Abbreviation	Term
H(hr)	Hour
H2O	Water
I&O	Intake and output
IV	Intravenou
LMP	Last menstrual period
(L)	Left
meds	Medication
mL(ml)	Milliliter
Mod	Moderate
neg	Negative
Ø	None
#	Number or pounds
NPO(NBM)	Nothing by mouth
NS(N/S)	Normal saline
O2	Oxygen

Commonly used Abbreviations

Abbreviation	Term
Abd	Abdomen
ABO	The main blood group system
ac	Before meals
ADL	Activities of daily living
Ad lib	As desired
Adm	Admitted or admission
AM	Morning
amb	Ambulatory
amt	Amount
approx	Approximately
bid	Tice daily
BM(bm)	Bowel movement
BP	Blood pressure
BRP	Bathroom privileges
¯c	With
C	Celsius (centigrade)
CBC	Complete blood count
c/o	Complains of
DAT	Diet as tolerated
drsg	Dressing
Dx	Dianosis
ECG(EKG)	Electrocardiogram
F	Fahrenheit
fld	Fluid
GI	Gastrointestinal
gtt	Drop
qid	Four times a day
(R)	Right
¯s	Without
Start	At once, immediately
tid	Three times a day
To	Telephone order
TPR	Temperature,pulse,respirations
VO	Verbal order
VS	Vital signs
WNL	Within normal limits
wt	Weight

OD	Right eye or overdose
OOB	Out of bed
OS	Left eye
pc	After meals
PE(PX)	Physical examination
per	By or through
PM	Afternoon
Po	By mouth
Postop	Postoperatively
preop	Preoperatively
prep	Preparation
Pm	When necessary

 

 

 

 

 

 

 

 

 

 

(b)   Special Considerations : Nurses must know the range of safe medication dosages for infants and children.

1.Infants :

·       Oral medication can be effectively administered in several ways :

·       A syringe or dropper.

·       Allow infant to suck medication place in nipple.

·       Mixed in small amounts of food.

·       Never mix medication into foods that are essential, since the infant may associated the food with an unpleasant taste and refuse  that food in the future. Neve mix medications with formula.

·       Place a small amount of liquid medication along the inside of the baby’s cheek and wait for the infant to swallow before giving more to prevent aspiration or spitting out.

·       When using a spoon, retrieve and referred medication that I thrust outward by the infant’s tongue.

2.      Children :

·       Whenever possible, give children a choice between the use  of a spoon, dropper, or syringe.

·       Dilute the oral medication, if indicated, with a small amount of water. Many oral medications are readily swallowed if they are diluted with a small amount of water .

·       Oral medications for children are usually prepared in sweetened liquid form to make them more palatable.

·       Administer the medication slowly with a measuring spoon, plastic syringe, or medicine cup.

·       To prevent nausea, pour a carbonated beverage over finely crushed ice and give it before  or immediately after the medication is administered.

·       Follow medication with a drink of water, juice, a soft drink ,or a popsicle or frozen juice bar. This removes  any pleasant aftertaste.

·       For children who take sweetened medications on a long –term basis, follow the medication administration with oral hygiene. These children are at high risk for dental caries.

  3.Elders :

·       The physiologic changes associated with ageing influence medication administration and effectiveness. examples include altered memory, less acute vision decrease in renal function, less complete and slower absorption from the gastrointestinal tract, and  decreased liver function.

·       Elders usually require smaller dosages of drugs, especially sedatives and other central nervous system depressants.

·       Elders are mature adults capable of reasoning. The nurse, therefore, needs to explain the reasons for and the effects of the client’s medications.

·       Socioeconomic factors such a lack of transportation and decreased finances may influence   obtaining medications when needed

·       An increase in marketing and availability of vitamins, herbs, and supplements alerts the nurse to include this information in a medication history .

(c)    Prescription/medication :

The medication orders are written on form designed specially for physician’s order which is part of patient’s permanent record.

Safe practice dictates that nurse should follow only a written order, because a written order by physician is least likely to result in misunderstanding the errors.

Under certain circumstances, such as emergency, a verbal order from the physician may be given to the registered nurse .in most of the setting student nurses are not allowed to carry verbal orders.

Types of order :

·       There are several types of order that a physician may write .

·       A standing order is carried out as specified until it is cancelled by another order.

·       Many physicians whose practices are limited to a particular clinical area have a specified set of written order for all their hospitalized patients. These are also referred as standing orders.

·       The physician may write p.r.n. order (as needed ) for medication. The patient receives medication when it is requested or needed.

·       Another type of order is called a single order; that  is the directive is carried out only once, at a time specified by the physician.

·       Medication to be administered immediately before surgery is an example of a single order.

·       A stat order also is a single order but it is carried out immediately .

·       A stat order for epinephrine would be carried out immediately for a patient who I experiencing an anaphylactic drug reaction.

Parts of the Medication order :

The medication order consists of seven parts :

1.      Patient’s  name .

2.      Date and time of the order written.

3.      Name of the drug to be  administered .

4.      Dosage of the drug.

5.      Route by which drug to be administered.

6.      Frequency of administration of the drug.

7.      Signature of physician writing the order

 

(d)   Safety in Administering medications :

1.Regarding label :

1. Give medication only from clear labeled container.

2. Poisonous drug should label as “poison” in red ink.

3. Select the right drug from the cupboard. Follow three checks.

4.Pour liquid medication from the bottle from the opposite side of the label.

5. Never administer medications from unmarked bottle/ container.

 

2. Regarding measuring medicines :

1. Hold medicine bottle in right hand and open the cork or lid with left hand.

2. Always use a calibrated measure in order to measure the accurate dose.

3.Avoid conversation or any thing that prevents or diverts the concentration on the task in hand.

4. Shake the fluid medication before pouring in to the ounce glass.

5. hold ounce glass on the eye level and place thumb nail of the hand holding the glass at the high on the glass to which medicine is to be poured.

6.wipe the mouth of bottle before recapping the bottle.

 

3.Regarding administration :

1. Observe five Rights.

2. Give medicine if there is written and signed order only.

3.Verbal orders should be accepted only in emergency.

4.Do ‘no use’ drugs that differ in color, odor or consistency,

5. Never give more than one drug at a time unless they are ordered.

6. Know minimum and maximum dos for the medication being given.

7. Always identify the right patient before giving medication by calling patient with his name.

8. Stay with patient unless he has taken the medication. The drug should not be left with patient.

9.An error with medication should be reported immediately to the nurse in charge.

10. Never give medication in dark or dim light.

11.Never allow one patient to carry medication to anther patient.

 

4.Regarding recording the drug :

1.Record if an ordered medication is refused or if it cannot be administered.

2.Record each dose of medication soon after it is administrated.

3.use standard abbreviation in recording medications.

4.Record only those medicines which you have administered.

5. Record effects, usually any unusual effects.

6. Never record any medication as “given” before it has been given to the patient.

 

5.Abbreviation used in medication :

·       OD –once in a day.

·       BD-Twice in a day

·       TID-Tree time in a day.

·       QID-Four time in a day.

·       Q4h-Every 4 hourly

·       Q8H-Evry 8 hourly.

·       Q12H-Every 12 hours.

 

(e)   Medication Errors : A medication error is “a failure in the treatment process that leads to, or has the potential to leads to, harm to the patient”

 

It is the administration of drug :

·       Which is given not according to the order.

·       Is administered as per the order but is unsafe or inappropriate for the client.

·       When documentation a client’s chart does not reflect that a medication was administered as ordered.

·       Medication was given ,but no charted.

·       Administering of I.V. medication at the wrong rate

·       Administrating   medication in wrong dose.

·       Administering medication at the wrong time.

·       Administering the wrong medication

·       Charting medication that was not given

·       Administering substitution medication.

·       Failure of given a medication within the prescribed time interval

·       Giving a medication by the wrong route.

·       Incorrect preparation of drug by a incorrect route.

·       Administering medication to the wrong  client.

·       Giving a drug that has deteriorated.

  When a medication error occurs, it must be documented exactly as it has occurred.

3.      DRUGS FORMS : Drug are available in many forms or preparations.

The following are the list of pharmaceutical preparation of drugs:

1.Oral preparations :

     Capsule         :    Powdered drugs or liquids within a gelatic  container.

     Elixir              :   Solution containing alcohol, sugar and water may or may not have active

  Emulsion         :  Suspension with oil base.

Lozengs (tache)  :   Tablet held in mouth to b dissolved and its combination of drugs and some sugar or                           

                        soothing material  which relieves  the tingling sensation at the back of throat and stop a   

                          cough.        

 Powder          :   A finally grinded drug or drugs frequently mixed with liquid before administration.  

Spansule         : A drug made in capsule in such a way that there is a slow release of its contents and

                              provided effect over a long period      

Suspensions  : Medication in liquid form which must be shaken before administration because it separates.

                                  Syrup

Syrup              :  An aqueous solution of  sugar often used to disguise unpleasant taste of drugs and smooth i

                             irritated membrane.

Tablet             :  Compressed hard disk of powdered medication, may be scarred for easy breaking. This may

                           Be scarred for easy breaking. This may be sugar coated or have fine coting as cohesion.

Tincture        :  Alcoholic or hydro alcoholic solution prepared from the drugs derived from plants.

Aqueous solution : One or more drugs dissolved in water.

Extract                     :  Concentrated preparation of drug from vegetables or animal generally used to

                                    preserve a drug for using a medication.

Pill                            : single dose units made by mixing the powder drugs with a liquid such as syrup and

                                  rolling the mixture into round or oval shape. It is replaced today by tablets and capsules.

 

2.      Topical preparations :

Cream       : Non –greasy, semisolid preparations for topical applications.

Gel/Jelly   : clear semisolid, substance that liquefies when applied to skin.

Lotion       : Emollient liquid may be clear solutions or suspensions which are applied to the skin

Ointment : Drug combined with oil base or drug in petroleum(Vaseline).

Paste         : Preparation like an ointment for external use, frequently thick a stiff, penetrates the

                      skin less than ointments.

Suppository  : Medicines contained within a gelatinous base, when dissolved at body temperature slowly release the drug.

Spirits            : A concentrated alcohol solutions of a volatile substance also known as essence.

Waters           :  Saturated solution of volatile oils.

Plaster           : Solid preparation used as a counter irritant or as an adhesive used externally.

Transdermal patch : Medicine in a patch, when applied to the skin, permits gradually, control absorption.