Medication Administration

Medication Administration

• Key objectives post review include being able to state consequences and identify causes of medication errors
• You should be able to identify the role of a nurse in preventing medication errors
• You should be able to identify the roles of the Institute for Safe Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors
• You should be able to state the base six "rights" of safe medication administration and identify factors that influence medication dosages
• You should be able to identify the common routes for medication
• Key objectives post review include being able to define critical thinking and explain it's importance in medication administration
• You should be able to identify important critical thinking skills necessary in medication administration
• You should be able to discuss the importance of client teaching and identify the special considerations relating to the elderly and medication administration
• You should be able to identify home care considerations in relation to medication administration

Medication Errors

• The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) defines medication error as any preventable event that may cause inappropriate medication use or patient harm while the medication is controlled by a health care professional, patient, or consumer

Consequences of Medication Error

• Acute or chronic disability
• Death
• Increased hospital stay or healthcare costs
• Legal consequences
• Loss of nursing license or position
• Medication errors are the most common cause of injury despite advances in technology

Causes of Medication Error

• Lack of medication or client information
• Confusing medication names
• Miscalculation of dosages, or incomplete orders
• Failure to observe "rights", identify a client, or educate clients
• Miscommunication of orders
• Administration of medications without critical thought
• Failure to comply with required policy or procedure
• Shortage of nursing personnel
• Distractions and interruptions

Organizations Involved in Medication Error Prevention

• Institute for Safe Medication Practices (ISMP)
• United States Pharmacopeia (USP)
• The Joint Commission (TJC)
• United States Food and Drug Administration (FDA)
• Quality and Safety Education for Nurses (QSEN)
• National Quality Forum (NQF)

Critical Thinking

• Critical thinking is a process of thinking that includes being reasonable and rational
• It includes organizational skills
• Includes autonomy and one should be willing to challenge incorrect orders and get clarification
• Includes being able to distinguish relevant from irrelevant information
• Includes being able to use reasoning, such as the selection of the right tools and client assessment
• A nurse who administers medication is legally liable for medication error regardless of the reason for the error

Factors Influencing Medication Dose and Action

• Route and time of administration
• Age and nutritional status of client
• Absorption and excretion of the drug
• Health Status and gender of the client
• Ethnicity, culture, and genetics of the client

Special Considerations for Elderly

• Two-thirds use prescription and over-the-counter medications
• Americans who are 65 years or older are expected to be 21.7% of the population by 2040
• Physiological changes include slower function and can cause unexpected medication reactions
• Elderly persons are often more sensitive to the effects of medications
• Physiological changes include changes in circulation, absorption, metabolism, excretion, and stress response
• Other physiological changes include lowered body weight and change in mental status
• Requiring lower doses and possibly special delivery devices, visual aids to read labels, and easy-open lids may be needed
• Allowing extra time for teaching and asking clients to demonstrate what was taught is important

Six "Rights" of Medication Administration

• Right client confirmed by two unique identifiers (e.g., name and DOB), but NOT room number
• Right medication by comparing the medication administration record (MAR) with the order
• Check 3 times before administration
• Right dose confirmed by checking calculations and labels
• Right route by how medication is administered (i.e. by mouth, injection, etc.)
• Check orders and drug guides, and assess any special considerations with feeding tubes
• Right time by checking time of day, frequency, and noting the "30-minute rule"
• Right documentation to avoid double-dosing
• Avoid "Do Not Use" abbreviations
• Outcomes of medications should also be documented

Other "Rights"

• The right indication includes understanding the reason for a medication to know when to hold
• The right to know so clients can be educated regarding medications
• The right to refuse by documenting and notifying the caregiver
• Right response by ensuring the medication has the intended effect

Medication Reconciliation

• The process of comparing medications the client has been taking before admission with the medications the organization will provide
• On admission, nurses need to get a thorough history of medication being taken to prevent medication interactions that may cause harm or death
• Errors of transcription, omission, duplication of therapy, and medication interaction are to be avoided

Patient/Client Education

• It is imperative for preventing errors, helps prevent adverse reactions, and improves adherence
• Education should include brand and generic names, explanation of amount, explanation of timing for dose, measuring devices, and route.
• Follow up on teaching is important

Home Care Considerations

• Home health care is increasing with increased population and early discharges
• There are special considerations for home setting
• Practice requires more autonomy
• The six rights should be used as guidelines
• Teaching should focus on devices from local pharmacies and calibrated home devices
• Most important, communication is critical

Nurse's Role in Medication Error Prevention

• Open communication between nurses and clients, including teaching and listening, may prevent medication errors
• Report medication errors per organization's policy
• Always adhere to safety standards and use technology to help prevent medication errors and identify safety risks

Routes of Administration

• Oral (p.o.) - Swallowed tablets, capsules, or liquid solutions
• Sublingual (SL) - Placed under tongue
• Buccal - Placed in mouth against cheek
• Enteric-coated - Dissolves in the small intestine
• Parenteral - IV, IM, Subcut, or ID
• Insertion - Placed into body cavity such as rectal or vaginal suppositories
• Instillation - Placed in the eye, nose, or ear
• Inhalation (INH) - Administered into respiratory track, such as metered-dose inhalers, nebulizers, spacers
• Intranasal - Solution instilled into the nostrils
• Topical - Applied to skin (lotions, ointments, pastes)
• Percutaneous - Applied to skin or mucous membranes
• Transdermal - Topically applied medicated patches or discs

Equipment for Medication Administration

• Medicine cup (30 mL/1 oz/2 Tbs)
  • Used for liquid medication 5-30 mL
• Soufflé cup

  • Used for solids such as tablets or capsules
    

• Calibrated dropper -Used to administer small amounts of liquid medication
• Nipple -Adapted for some infant meds
• Oral syringe -To administer liquid medications orally
• Parenteral syringe -Used for IM, Subcut, ID, IV meds -Barrel marked in mL or units -Needle attached to tip -Plunger pushes medication through needle