Medication Administration: Rights and Procedures

Medication Administration: Key Rights and Procedures

• Always verify patient allergies and medication expiration dates
• Confirm the correct drug through three checks
  • When taking the drug from its storage
  • While comparing the drug to the Medication Administration Record (MAR)
  • At the bedside, right before administration
• Ensure correct dosage, verify calculations, and appropriateness for the patient; a second nurse can verify the dosage
• Administer medication within the appropriate time frame, from 30 minutes before to 30 minutes after the scheduled time
• Use military time to prevent day/night errors
• The right route: medications administered ONLY via prescribed routes, such as oral (PO), sublingual (SL), buccal, Parenteral (injection or infusion), rectal (PR), vaginal, topical, transdermal, subcutaneous, intramuscular (IM), intradermal, intravenous (IV), or inhalation
• Confirm the right patient by using barcode scanning or two patient identifiers (full name and date of birth)
  • Never use the patient’s room number or physical location
• Document only after administering medications, including refusals, withholdings, accuracy, completeness, and any adverse reactions or side effects

Safety Checks and High-Risk Situations

• Three safety checks are neccessary when administering medication
  • First check: Upon removal, compare the label of the medication against the MAR, determine if the dosage is correct, and check the expiration date
  • Second check: During preparation check the medication label against the MAR
  • Third Check: At the bedside, recheck the label against the MAR before giving the medication to the client
• Common errors: administering drugs with similar names, administering medications that the nurse didn't prepare, incorrectly identifying medications, or ignoring patient reports that the medication looks different
• Risk of incorrect dosage can be present if needing multiple tablets/capsules, large prescribed dosage change, or if the pharmacy-supplied dose does not match the prescribed dose
• Risks include ignoring patient statements about different doses, using unstandardized measuring devices, and crushing non-scored tablets
• Other risks include incorrect dose calculations, inaccurate med information or lacking required assessment data
• Right Time risks include administering medications at convenient times rather than most effective times, not meeting specific needs, skipping doses, or incorrect PRN frequency
• Risks for incorrect route administration include not knowing/looking up correct route or preparing non-designated parenteral doses
• The risks related to the right patient include identifying a patient with similar names, relying on memory, or using an unsafe identifier

Patient Rights and Medication Administration Rules

• Patients have the right to be informed, refuse medication, have accurate medication history, and receive medication following the six rights of administration
• Unlicensed assistive personnel (UAP) cannot administer medications; nurses should never administer medications they didn't prepare
• The medication administration process includes identifying and informing the patient, administering the drug after completing three checks, intervening and documenting drug administered, and evaluating drug response
• Rules includes never administering medications you did not draw up and checking airways for med reactions
• Gave wrong meds: check patient first, alert charge nurse, PCP, safety report and reconcile meds at admission, transfer, and discharge
• Give meds on time unless refused and chart it
• Never leave meds unattended
• Check heart rate, blood pressure, respiratory rate if needed
• Always assess patient and allergies before giving medications
• Always have order from Dr if pt brings their own meds from home

Medication Routes and Topical/Transdermal Medications

• Routes: oral medications, testing swallowing ability, avoiding crushing enteric-coated/sustained-release tablets
• Sublingual, buccal, and NG tube administration. For NG tubes, verify placement before administration
• Topical: ointments, creams, lotions, powders, and aerosol sprays
  • Cleanse skin with warm water and soap before applying, and wear gloves to avoid absorption
• Transdermal: absorbed through skin

Inhaled, Nasal, and Otic Medications

• Inhaled: rapid administration through the respiratory tract. Always use a spacer if patient have difficulty
  • Rinse mouth after prevent thrush
• Nasal: using drops or sprays
  • Drops: patient must blow nose, tilt head back, and avoid touching the applicator tip
  • Sprays: patient should tilt head down and aim the spray tip in the eyes direction
• Otic: position the auditory canal based on patient age
  • Warm medication containers, straighten the auditory canal, and have the patient remain in a side-lying position for 10-15 minutes

Ophthalmic, Suppositories/Enemas and Parenteral Medications

• Ophthalmic: use liquid or ointment forms, have the patient look toward the ceiling, and use a dry sterile absorbent sponge.
  • Expose the lower conjunctival sac, avoid touching the dropper or tube tip, and press firmly on the nasolacrimal duct
• Suppositories/Enemas: patients is in a left lateral or left recumbent position with upper leg flexed, lubricate with glove and ask patient to retain for 5-10 minutes
• Vaginal: lay on back with knees (dorsal recumbent position) fully insert using a rolling motion, going downward and backward
• Parenteral: administered by injection
  • Intradermal, subcutaneous, and intramuscular methods

Injections

• Intradermal injections: shallow injections into the dermal layer, using a 1 mL syringe and a 25-27 G needle at a 5-15 degree angle, with a maximum dose of 0.1 mL
  • Sites: inner forearm, upper arm, and across the scapula
  • Example: TB test or allergy test
• Subcutaneous injections: injection into the subcutaneous tissue with slow absoption
  • Max: 1ml
  • Syringe: 0.5 - 3ml
  • Needle: 25-31 G, 3/8 – 5/8 inch
  • Angle: 45 - 90 degrees
  • Sites: abdomen, lateral aspects of the upper arm and thigh, scapular area of the back and upper ventrodorsal gluteal area
  • Examples: insulin, heparin, narcotics, blood thinners, fertility drugs
• Intramuscular injections: injection into a muscle of adequate size, using the Z-track method.
  • Syringe: 1 - 5 mL (adults)
  • Needle: 19- 25 G, 1 – 3 inch
  • Angle: 90 degrees
  • Sites: Ventrogluteal, Vastus lateralis, and deltoid

Med Administration Methods

• Use standard sizes: 1 mL, 3 mL, 5 mL, and 10 mL
• Use filter needles when glass is involved
• The Z-track method is used for irritating medications by pulling the skin to the side before injection
• Clean skin with circular motion, inner to outer
• Quickest to Slowest Action: IV, IM, Subcutaneous, PO
• Give IV flush with saline, meds, flush with normal saline
• Drug side effects = expected and treated
• Allergic reactions = unpredictable
• Anaphylactic reactions = severe allergic reaction
• Drug toxicity = harmful effects from medications

Medication Elements

• Chemical name is the medications molecular structure
• Generic name is not capitalized and often contains a prefix or suffix that helps identify
• Official name is the generic name
• Trade (brand) name is a registered name by the drug manufacture
• Prescription medications order must have: date, time, patient's name, drug name, dosage, route, frequency, and signature

Verbal Orders

• Verbal orders: ONLY GIVEN TO RN – repeat & read back to confirm, then write it, signed by nurse, then signed by doctor later
• Interpreting medication orders: Order must be clearly written or entered correctly in the electronic system Clinical judgment: evaluate amount prescribed, and the route are safe for the patient to take
• Nurse must understand the purpose of medication
• Nurses must assume all legal responsibility for all medications they administer
• Assess patient for any adverse reactions to the medication and notify prescriber

Key Documentation

• Key components include patients full name, administration time, dose, route, frequency, site, nurses initial and signature
• Shows previous meds administered and by whom along with PRN meds.
• Documentation is needed when a medication is NOT administered

Pharmacodynamics and Pain Management:

• Pharmacodynamics: onset of action, Half-life, Peak plasma level, Trough
• Pain is very subjective: has physical and emotional components
• Pain is whatever the person says it is
• Cognitive, affective, behavioral, and sensory factors can influence pain

Assessing Pain

• Acute: Pain lasting less than 3-6 months and example is trauma, surgery, labor
• Chronic pain: lasts longer than 6 months with example being arthritis, fibromyalgia, neuropathy
• Nociceptive pain: from visceral and somatic locations in the body (sharp, burning, aching, cramping, stabbing)
• Unrelieved pain: results from healthcare team and patient failures

Pain Scales

• SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating, Severity and OLDCARTS: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity PQRST
• FLACC: facial expressions, leg movement, activity, cry, consolability
• Acute pain shows acute elevated pulse and BP values
• Nonpharmacological pain relief: Positioning, splinting, massage, distraction, meditation
• Multimodal analgesia

Health Literacy and End of Life

• Health literacy: the ability of a patient to understand and integrate health.
• Roles of health literacy in nursing and patient education: Nurse's responsibility. Patient education includes preventing diseases, promoting health, treatment instructions, and coping with limitations
• End of life: know that everybody in different cultures, ethnicities and religions, act differently to loss
• Types of grief: complicated, chronic, delayed, disenfranchised, etc.
• Hospice is comfort care while palliative helps to improve quality of life
• Impending death: Decreased urine output, cold, changes in vital signs, changes in breathing patterns, absence of a heartbeat, respiration, involuntary release, drop in body temp
• Advanced directives = legal documents that can inform health care providers about a patient's goal of care
• A nurse needs to recognize a potential situation in which a pt may be a organ donar