Medication Administration Safety

Exam Details

• The exam consists of 50 questions.
• Questions are multiple choice, select all, and ordering types.
• The time limit for the exam is 1 hour and 15 minutes.

Medication Administration Safety Guidelines

• Minimize distractions during medication preparation using No Interruption Zones (NIZs).
• Know the medication's purpose, how the patient receives it, expiration date, and how to check for effectiveness and adverse effects.
• Verify patient identity using two identifiers and check against the MAR (Medication Administration Record).
• Perform a triple check for accuracy: when retrieving, during preparation, and at the bedside.
• Clarify unclear orders with peers, pharmacists, or providers.
• Use available technology such as bar scanning and eMARs.
• Use strict aseptic technique when preparing and administering parenteral medications.
• Educate patients and caregivers about the medication's purpose, dose, side effects, and when to report concerns.
• Medication administration is typically non-delegable and follow state nurse practice acts and agency policies
• Prevent needlestick injuries by using safety devices and properly disposing of sharps.

Administration of Oral Medication Procedure

• Verify the medication order against the MAR and confirm the 7 rights (patient, medication, dose, route, time, documentation, reason).
• Check for food/fluid restrictions, swallowing difficulties, potential drug interactions, or special instructions.
• Explain the purpose and possible side effects of the medication to the patient.
• Provide an appropriate amount of water or other permitted fluid for medication intake.
• Stay with the patient and observe them take the entire dose to ensure it is swallowed completely.
• Offer additional water or food if allowed, after the medication is swallowed.
• Document the date, time, medication name, dosage, route, and observations of patient response.

Administration of Oral Medication Safety

• Positively identify the patient using at least two identifiers.
• Don't crush or split medications unless allowed.
• Never leave oral medications unattended at the bedside.
• Monitor for choking, difficulty swallowing, or adverse reactions.
• Provide education on the medication's purpose, side effects, and precautions.
• Ensure the patient can swallow safely before giving oral medications.
• Check for potential drug-food/fluid interactions.
• Follow standard precautions and proper hand hygiene.

Types of Oral Medications

• Enteric-coated tablets are taken orally and shouldn't be crushed.
• Scored tablets are taken orally and can be split or scored.
• Buccal tablets are placed between the cheek and gum.
• Sublingual tablets are placed under the tongue.
• Orally dissolving tablets (ODT) are placed on top of the tongue.

Administration of Injected Medication Procedure

• Verify order, patient, drug, dose, route, and expiration.
• Explain the procedure and obtain consent.
• Aseptically prepare the medication using a sterile technique.
• Select the appropriate needle, syringe, and injection site.
• Clean the injection site with an antiseptic swab.
• Administer slowly at the recommended rate, angle, and location.
• Activate the safety device on the needle.
• Apply pressure to the injection site, but do not massage.
• Properly dispose of sharps.
• Monitor for adverse reactions.
• Document date, time, medication, dose, route, site, and patient response.

Administration of Injected Medication Safety

• Needleless devices prevent needlestick injuries and exposure to bloodborne diseases.
• The Needlestick Safety and Prevention Act requires the use of safety devices, like safety syringes with a needle guard.
• Use needleless systems or SESIP devices when available, do not recap needles.
• Plan safe needle disposal in puncture-proof containers and immediately dispose of needles and sharps in appropriate containers.
• Keep a sharps injury log and report injuries quickly while participating in training and following safety protocols.

Injection Sites and Angles

• Intradermal injections are administered at a 5-15 degree angle into the inner forearm or upper back.
• Subcutaneous injections are administered at a 45-90 degree angle into the abdomen, outer thigh, or upper arm.
• Intramuscular injections are given at a 90-degree angle into the deltoid, ventrogluteal, or vastus lateralis muscles.
• Intravenous injections are administered at a 10-30 degree angle into hand veins or the forearm.

Administration of Topical Medication Procedure

• Perform hand hygiene and gather needed supplies.
• Identify the patient and explain the procedure.
• Inspect the application area and remove previous patches or residual medication.
• Cleanse the skin thoroughly and then allow it to fully dry.
• Apply gloves and shake/mix the topical medication before use.
• Evenly apply medication over the affected area using a sterile technique for open wounds, rotating application sites for patches.
• Allow the medication to dry completely before applying dressings.
• Properly discard used supplies and remove gloves.
• Perform hand hygiene.
• Document medication administration, site condition, and patient response.

Administration of Topical Medication Safety

• Verify medication order, patient allergies, and contraindications.
• Follow specific application instructions depending on the medication form.
• Assess skin condition and avoid applying to broken skin unless specifically ordered.
• Check for and remove any previous patches before applying a new one.
• Use personal protective equipment like gloves to avoid absorption.
• Monitor for adverse reactions such as skin irritation or systemic effects.
• Educate patients on proper use, precautions, site rotation for patches, and when to seek medical attention.
• Store medications per manufacturer's recommendations.

Administering Ophthalmic Medications (Eye Drops) Procedure

• Perform hand hygiene and gather supplies, including medication, clean gloves, and tissues.
• Identify the patient and explain the procedure.
• Have the patient tilt their head back and look up at the ceiling.
• Use your non-dominant hand to gently pull down the lower eyelid, forming a pocket.
• Use your dominant hand to instill the prescribed number of eye drops into the pocket, avoiding contact with the eye or eyelashes.
• Instruct the patient to gently close their eyes for 2-3 minutes without blinking.
• Apply gentle pressure to the inner canthus for 1 minute to prevent systemic absorption.
• Use a clean tissue to wipe away excess solution from the cheek area.
• Wait 5 minutes between administering multiple eye drops.
• Discard used supplies properly and perform hand hygiene.
• Document administration, patient response, and any concerns.

Administering Ophthalmic Medications (Eye Drops) Safety

• Verify the medication order, expiration date, and absence of patient allergies.
• Check for particulate matter or discoloration before use.
• Avoid touching the dropper to any surface to prevent contamination.
• Instruct the patient not to squeeze the bottle during instillation.
• Ensure proper administration technique and sequence if multiple drops are ordered.
• Monitor for adverse effects, such as stinging, redness, or vision changes.
• Educate the patient on proper administration, storage, and side effect monitoring.

Administering Ear Medication Procedure

• Perform hand hygiene and gather supplies including medication and cotton balls/pledgets.
• Identify the patient and explain the procedure.
• Position the patient with the affected ear facing upwards.
• For adults, gently pull the pinna up and back. For children under 3, pull the pinna down and back.
• Instill the prescribed number of drops into the ear canal, avoiding contact with the ear.
• Keep the ear tilted for 2-3 minutes to allow the medication to disperse.
• Gently massage the area in front of the ear to aid distribution.
• Use a clean cotton ball to wipe away any excess solution.
• Discard used supplies properly and perform hand hygiene.
• Document administration, ear condition, and patient response.

Administering Ear Medication Safety

• Verify the medication order, expiration date, and patient allergies.
• Allow refrigerated medications to reach room temperature before instilling.
• Inspect the medication for discoloration, cloudiness, or particulates.
• Avoid touching the dropper to any surface to prevent contamination.
• Monitor for adverse effects like vertigo, tinnitus, or ear pain.
• Educate the patient on proper administration, head positioning, and side effect monitoring.
• Do not forcefully insert cotton into the ear canal.

Side Effects

• Side effects are predictable reactions to a medication at the usual dose.
• Side effects can range from mild, like drowsiness or nausea, to more serious, causing harm.

Adverse Effects

• Unusual and can include Toxic effects or Idiosyncratic reactions
• Toxic effects happen when a medication accumulates in the body and may lead to dangerous reactions, and can be reversed
• Idiosyncratic reactions are unexpected, where a patient either overreacts or underreacts, and are hard to predict

Allergic Reactions

• Allergic reactions to medications are unpredictable and occur when the body becomes overly sensitive.
• Symptoms vary by person and medication, and anaphylaxis is life-threatening requiring immediate care.
• Patients with drug allergies should avoid those medications and wear an ID bracelet.
• Mild reactions include urticaria (hives), rash (small, raised vesicles), pruritus (itching), and rhinitis (inflammation of mucous membranes).

Medication Errors

• Medication errors cause 1.5 million adverse events and cost billions annually
• Errors reduction can be using by Computerized Provider Order Entry (CPOE) for prescribing and Bar-code Medication Administration (BCMA) for matching medications to patients.
• Prevention is a team effort of vigilance, medication list reviews, electronic records, barcode systems, and medication reconciliation.
• Address concerns, like addiction fears, and prevent nonadherence with education.
• Remind always the 7 rights to prevent errors

Procedure for Wasted Medication

• Always count opioids when dispensing and immediately correct any discrepancies.
• Maintain special inventory records, often electronic, to track opioid usage, waste, and remaining amounts.
• Document the patient's name, date and time of administration, medication name, and dosage.
• If only a partial dose of a controlled substance is administered, a second nurse must witness the disposal, and both nurses must sign the form.
• Adhere to the agency's policy for proper opioid disposal, and never dispose of wasted medication in sharps containers.

Pain

• Acute (transient), sudden due injuries illnesses of surgeries, which prompt medical action and providers aggressively manage to support recovery.
• Chronic (persistent), lasting beyond 3 to 6 months because of arthritis, fibromyalgia related, and impact emotional and psychological state
• Acute pain serves a protective role, while chronic pain doesn't

Pain Assessment

• Pain is a subjective experience, so pain assessment must be thorough.
• The elements include location, intensity using scales, quality, onset and duration, alleviating and aggravating factors, and impact on function and quality of life.
• Routine Clinical Approach to Pain Assessment and Management: ABCDE (Ask, Believe, Choose, Deliver, Empower)
• Tools are; Numeric Pain Scale (NPS), Wong-Baker FACES Scale and FLACC Scale
• Pain must be assess regularly to aid accurate management of treatment

Pain Management

• Pharmacologic management involves medications
• Use Non-Opioid Analgesics for mild to moderate pain
• Opioid Analgesics are used for moderate to severe pain and come with a risk of respiratory disrrssion
• Multimodal Analgesia target different sites in the peripheral or central pain pathways.
• Nonpharmacologic methods addressing pain include physical, cognitive, and emotional approaches.
• Cognitive and Behavioral Techniques include distraction, relaxation and music therapy

Patient Controlled Analgesia (PCA) Safety Guidelines

• Patient safety is role of a professional nurse by using clinical judgment and the best evidence to ensure safe patient-centered care.
• Only the patient should press the PCA button.
• Monitor the patient for signs of oversedation and respiratory depression.
• Administering Medication and Check the Order, medication, medical history
• Assess Pain and IV Line
• Following the "Seven Rights" and ensure Patient Comfort
• Check Pain Level, side effects to monitor.
• When Stopping PCA; Verify Doctor's Order and document usage

Range of Motion (ROM) Exercises

• ROM exercises maintain or improve joint mobility, prevent contractures, and promote circulation.
• Passive ROM is performed by a nurse or caregiver and Active ROM is performed by the patient which has risks
• Active-Assistive ROM is performed with assistance by the patient and suitable for patients recovering from injury/surgery.
• Monitor for pain, swelling, or discomfort to avoid injury

Mobility Devices

• Devices help patients maintain independence and prevent falls while proper education can ensure safety

Common Mobility

• Canes provide balance and stability
• Walkers provide maximum stability and have intact rubber tips, stepping forward is required
• Crutches are often used for temporary limitations with correct positoning

Safety And Fall Prevention

• Preventing falls is a critical aspect especially for elderly or high-risk patients
• Strategies for Fall Prevention are bed alarms, clear walkways, and assistive devices
• Conduct a fall risk assessment using tools such as the Morse Fall Scale
• Also you must evaluate patient mobility and proper transfer protocols

Hygiene

• Practies promotes comfort, prevents infection, and enhances self-esteem throught baths,
• Oral and Perineal Care
• Pay attentiom to Age Related Considerations on skin, health and mobility

Skin Impairment Assessment

• The tool inspects all pressure points for signs; edema, pain and consistency in the skin
• Prevention is repositioning the surface, keeping the skin clean and provide help with incontinence
• Pressure Injuries, Venous Ulcers, Arterial Ulcers- Ischemic and Diabetic Ulcers

Pressure Ulcers Stages

• Stage 1: Non-blanchable erythema of in skin
• Stage 2: Partial thickness skin loss in epidermis/dermis
• Stage 3: Full thickness tissue loss through subcutaneous tissue
• Stage 4: Full thickness with exposed bone, tendon or muscle
• the wound is obscured from healing due to slough/eschar tissues
• Treatment depends on relief, barrier, debride, dressings or surgery etc

Respiratory Assessment

• Rate, breath depth using the neck muscles to breathe or with stethoscope
• Abnormal sounds like wheezing, crackles, and monitor oxygen levels
• Atelectasis refers to collapsed lung tissue signs are fever, cough, shortness of breath
• To prevent, use incentive spirometer, deep breathing exercies
• Suctioning clears mucus while explaining the procedure, extra O2 and catheter
• Complications; prevent pneumonia and atelectasis, thin secretions, smoking
• Hupoxia is low oxygen level sign of discoloration, confusion and treat blockage

Arterial Blood Gas(ABG)

• It's a a blood test relating to Acid Base with main main thing Oxygen
• This test shows CO2 level, acidity, oxygen level problems in kidneys
• We can help monitor COPD, pneumonia, etc

Intake and Output

• Measurement and insight with hydration, fluid electrolyte function in body
• Input includes Oral, Tube and IV fluids and output vomitus or key indicator
• Measuring all liquid with graduated tools to ensure you compare them after 24 hr assessment

Fluid Replacement Therapy

• Aims to correct fluid imbalance depended on patients by Isotonic (dehydration and vomit), Hypotonic is haponatremia is used or hypertonic to expand volume

Electrolytes

• Assess them for electrolyte levels and look for key signs
• Hyponatremia is low sodium where muscle cells swell, cramping confusion
• Hypernatremia is high sodium where extreme thirst, dry and confusion takes hold
• Hypokalemia (low potassium) weakens the muscles, causing flattened waves
• Hyperkalemia (high potassium) can cause nausea, ECG changes and even heart failure
• Identify early signs or vitas to prevent life threatening complications