Nursing Medication Lab Lecture PDF

Good afternoon everyone and welcome. This is a big and exciting lab lecture and lab week. This is on medication of men and so in this lab lecture we'll dive into some of the elements of this. It's a big one so a lot of the aspects that we're going to be talking about you will need to really dive int...

Good afternoon everyone and welcome. This is a big and exciting lab lecture and lab week. This is on medication of men and so in this lab lecture we'll dive into some of the elements of this. It's a big one so a lot of the aspects that we're going to be talking about you will need to really dive into the readings and really gain an understanding of this because we are only going to be touching upon the surface and this is highly foundational to many of the things that you will be doing as we move forward in your labs and your courses move and your opportunities for example giving medications out in clinical practice. That being said, let's get started. So nursing teach you one lab lecture outcomes. It's discussed the purpose and the preparation for the medication safety screen process within the Faculty of Nursing. And I will talk a little bit about that right now. This is a safety screen that is quiz that you need to take each time you go into clinical and so in 2-2-1 it is a practice screen so take that moment to do that practice quiz and in 2-2-1 you'll have as many opportunities as you want to retake it and it is also used as a diagnostic tool to identify where you are running into issues or problems and And so making sure that you, if you're running into issues, that you get seek out help from your lab instructors. In the safety screens, the medication safety screens in your clinical settings such as in 225, it will be offered near the beginning of term and you will need to have passed it in order to give medications in the clinical setting. You will need a minimum pass of 90% and so if you do not make that you will be asked to do some remediation and it will be identified by your course lead and then you will be determined whether to, you will then go ahead and type it again and hopefully that will be asked for you. The thing that I have found with students is when they haven't passed the exam, sorry the quiz, it's usually, or the safety screen, it is usually because they haven't really thoroughly gone through their gray calculations text and reviewed all the calculations because mainly the safety screen will be calculations. And so really, you have to brush up on all of those areas and become confident in it, such as in conversions, etc. And then, but also it's really important to get an understanding of medication administration in the clinical settings. So these textbooks apply, give you that application knowledge in terms of why things are important, so it's really important that you do your readings. So we will be practicing some medication calculations in lab and preparation of labs, so that is really important to take that on. And we'll also look at medication administration routes such as oral, topical, instilled, such as via suppository, and inhaled. And so we're going to talk about those in our lab lecture today, but also you will be practicing and reviewing them in lab again. You're going to be talking about the RN's responsibility in administering drugs in various routes, but a big thing for today's lab lecture will be the policies regarding medication admin, both at the Faculty of Nursing, Alberta Health Services, CRNA, et cetera. So medication reconciliation is one, independent double check, high alert medications, patient identification and co-signage. You will also discuss essential elements in relation to medication administration documentation. So these are a lot of things that we will be addressing this week. So like I said, the details will be in your readings and so it's really highly important that you understand them. So one of the things that we need to address is the medication management standards through CRNA. This is, according to these, these are the standards that must be met by nurses in our province. And so these would be also applied to students. So safety, responsible and accountable to provide safe medication management. Authority, you need to follow the current legislation standards and policies related to medication admin. For example, who is a prescriber and who is not, how do you handle certain medications such as narcotics, knowledge, regulated members are knowledgeable about the medications they administer and those that their clients are taking, whether prescribed over-the-counter or natural health products. And also an important standard is ethics. so you need to follow the codes of ethics and ethical principles in all aspects of medication management. So the other policies and standards and there are many and maybe even some that we haven't addressed here. For example a big one for students is the Faculty of Nursing Clinical Policy and Scope of class and it's under your undergraduate student resource center. So you need to make sure you review and read these very detailed policies. Specifically they will apply to all of your clinicals and going forward. So each clinical you need to go back and review. In particular for 221 it talks about certain ones but more More importantly, 225, it talks about other aspects, so what you can go ahead and give, for example, and then how you give. Another one is the patient identification policy. Do not use abbreviations, symbols, and designations. medication reconciliation policy, controlled substances, independent double check, and medication management strategies. So where you don't want to make an error or have an adverse effect is that you have not followed the policies or standards and you've done it incorrectly. So these are not in any way policies that you can work around. You need to follow them. The big one, like I said, is the Faculty of Nursing Clinical Policies and Scope of Practice. This is for undergraduate student nursing students and it indicates in the policy that you have received formal theory and lab instruction and are deemed confident by the clinical instructor to perform the skills. So the agency will allow certain skills to be performed and it indicates what they are. You can perform these under supervision, but it is the level of supervision that is important to understand. So for example, it may indicate that a certain skill is always a direct supervision. So that means you can only give it through direct. Others might be indirect supervision after you've already received first-time supervision. So this is where all skills must be supervised first time by their instructor and then direct or indirect supervision each time after and you need to know what that means and what that applies to. The activity needs to be within the scope of practice of an RN and a student so there may be a specialized procedure that an RN can do because they have specialized certification, but you will still not be able to do that. The most restrictive policy prevails, so the faculty of nursing or the agency policy, so for example you might see in the agency or that it may be communicated that the agency policy is, for example a student can give this, but the faculty of nursing policy says no. So you need to to be able to identify that. So that'll be an important document to read. So the other one that is very important that we need to attend to, and this is not in a document but it's in your readings, is the medication rights. These are the ones taken from Gray Morris and you can see there's quite a few. In your Gregory text They talk about 10 and here we have more than that. In your documents from Alberta Health Services, they talk about eight, but you need to know that some of them have been more defined. So the five really key ones are the medication, the dose, the patient, the time, the frequency. So that is six, sorry, so the time and frequency should be together, but you need to attend to all of these. So you would consider all of these are right. So if we look at the medication rights, the medication is we need to give the right medication and the other one that goes along with this is the right reason. So that is an important part of it. So we have to have a good understanding of that. The other is the right dose. So this is where calculations might come in and so you need to make sure you've achieved the right dose for the patient so that is important. Giving it to the right patient so where things could go wrong is you have missed the identification step and you are giving the medication to another patient. This is a, you know, some students wonder, well how can this occur? If you're out in a busy unit with multiple medications and multiple patients, this could occur because a step was missed. The right route. So the right route is ordered usually, the medication route, and we cannot give the medication in a different route without a new medication order. So for example, if The patient isn't able to take the medication orally, and the medication order indicates it had to be orally, and you go ahead and change the route, that would be a medication error for that patient. It also would influence the dosage, so you need to be mindful of that. Medications are ordered at a specific time, so you need to give it during the time allotted, And so we know that for time-sensitive medications, they need to be given, they can be given within the window of 30 minutes before and 30 minutes after. And so that has to be included in your planning. The frequency, so that is needing to be mindful of. So in your readings you saw that the frequency could be BID, QID, Q6 hours, all of those, so that would be in the order itself. The site, and the site is important when we get to parental medications, parental medications, so for example, if you're giving it in a certain site, an IM medication is given in a different site than a subcutaneous medication. The reason I mentioned, so the why of they are receiving this medication, the right documentation, so doing it correctly, providing education and making sure you're providing the correct education, the technique of the medication to be administered, so for example the IM technique versus the subcutaneous technique or, for example, in this case, the oral technique, giving a medication through oral versus buccal. So what is the difference? The assessment and approach, so how you approach giving the medication and also what do you need to assess for that medication. So what do you need to assess prior to giving it of your patient? What do you need to evaluate after the medication has been given? And also there is a right to refuse. So the patient might refuse the medication. And so what have you done for that? So in terms of refusal, if the patient has refused, used, you need to determine whether they need more information about the medication, what is the reason for the refusal, and if so, and they have met all of their information in terms of informed consent and they still wish to refuse, you need to then let the healthcare provider who has ordered the medication to know as well as indicate on the medication record. So, medication reconciliation is a policy with Alberta Health Services and it is about reconciling, it is about reconciling medication to ensure that between transitions that the accurate medication. So it means a structured process in which healthcare professionals partner with the patient, family, and caregivers for an accurate and complete transfer of medication information at transitions of care. The information is used to verify and validate the patient's admission, transfer, referral, or discharge medication orders to reduce medication or errors and adverse medication events at all points of care. For example, if a patient is admitted to a unit, the best possible medication history would be obtained by the prescriber or most responsible health care provider in the situation, and a medication list would be determined. The medications then during the stay may be changed depending on the course of the hospitalization. And then on discharge, the patient might be sent home on different information regarding their medication or different prescriptions. So this is an important one to become aware of and refer and see how you would be involved with it because it is important in the patient's care. So the other part of it is there's three steps. Like I said, you generate the most responsible health care provider, generates a best possible medication history, they reconcile the best possible medication or history at care transitions, and document and communicate the information. So it is completely outlined in the policy, so you need to make sure that you review the policy and also, if possible, find out how it's done on your unit and how you can be a part of it. So, the other is there is the components of the medication order, and so when you get the medication order, it is ordered and it is transcribed onto the MARA, and it needs to include all of these orders. So, before when you're looking at it in reading the medication order, it has to have the patient's full name and identification number, the date and time the order is written, the medication name, so you know that it could be either the generic name or the trade name and ideally it would be the generic name, the dose, the route, time and frequency of administration, and the signature of the prescriber. If any of these elements are missing, you need to go back to the health care provider who wrote the order and have it clarified. Sometimes, though, when you are looking at the order, you also need to look at it to see that it is complete. So ensuring that it is complete and it makes sense. So if you know the medication and you know the dosage, if it is an unusual dosage or route or timing, you need to then verify and ensure that this is in fact is the case. and also that might give you the reason. So, medication orders, there are many ways or aspects of them, and so they could be routine, so when the medication should be given would be indicated, so it could be routinely given at a certain time. So, for example, oral antibiotics or IV antibiotics might be given every six hours it could be PRN so and then it would indicate how often so PRN every four hours so if that is the case then it can't be given more within within earlier than four hours. One time only doses stat doses such as immediately and doses that the order might be for now. And that would mean that it would be given as soon as possible. It's not as urgent as a stat. You also, whenever you're managing medications for a patient, you need to make sure throughout the day that you are understanding when the medications have to be given and you're checking read eerily on to for any kind of medication changes so that you want to capture them in case something has changed such as the dosage or medication has been discontinued or the medication has been in the timing has changed. One of the things that we need to also be mindful of is the abbreviations symbols and dosages. And so there is a policy related to this that you need to read from Early Health Services. And basically what you are doing are using only agreed-upon abbreviations. And here, these are the ones that are not allowed to be used. And the reason is, is they have found that they are symbols that tend to create a a lot of errors. So making sure that you're not using them. And for example, the U is instead you need to use unit because the U if it is handwritten might inadvertently look like an O and also it could be misunderstood even if it was typed as an O. So you want to make sure that you have clarity and to avoid any medication errors. So quick question, what is this and what is missing from this medication order? And so I'm just going to give you a brief moment to identify what is missing. And I'm just going to pause the screen. So it is for this one, the missing aspect is the route. So this is missing and it is very important that the route be included it is for example likely you know maybe if we notice that is 250 milligrams QID we've got the timing and it could be PO and so what the route then would be for example a tablet every four times a day QID of 250 milligrams. So it's interesting because when you've been on a unit and you might assume something you might want to your mind might fill in the blanks and you might go ahead and just do it. What in this case what you have to do is you have to contact the prescriber Dr. Bright and get them to indicate the route and then you would indicate that in the order or they have to redo the order. have to redo the order. Okay, quick question, what is missing from this or what is incorrect? what is incorrect? So give you a moment. So here we have the name of the patient, the lifetime identifier, the date and the time, the medication, so coding, and what we don't have is the dosage, so two tablets every three to four hours peer in. Now the other thing that we are not seeing is, so we need to have this indicated, so the dosage of this. This is just indicating tablets, this does not indicate the dosage and coding could come in several forms. So we want to make sure that we have the correct amount of medication. So that would have to be clarified. But the other thing that is wrong here or incorrect is it's saying three to four hours PRN. No, it should indicate the number of hours PRN. There would be for. So that has to be given, so an exact time. So here's another order. If you could correct the following, keeping in mind our incorrect or in abbreviations that we're not allowed to use. So in this case, look at this, we have an incorrect here in 0. that we have a So if it was incorrectly read, one might incorrectly assume it's 50 and also we have a U here and one could also have two zeros. So we want to make sure that there's no information after this. If you need to, what you could, if it was a partial dose, it would be, for example, there might be a zero ahead with this point. But this is not the case in giving this kind of medication. You would just say five and then you'd write out the word units of Toronto insulin to be given QD or daily or once every morning if blood glucose level is greater than four. And then again, here we have another error in that we're using a greater than and lesser than sign, which is very confusing, especially for certain people who might not remember what that means. So it should be written out in full. So here it is, five units of Toronto insulin sub-cute before breakfast if the patient's blood glucose level is greater than four. and so this is what we would want to see as being more clear. So the high alert medications are extremely important for you and here is a link to the high alert medication list through the Institute for Safe Medications practice and this is going to be highly highly important for you as you're out in clinical and And also it is really aligned with your faculty of nursing policies. High alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. So the question is, what do you think, can you name two high alert medications? So if you can look into this and click into this, find two high alert medications. So the thing too is that it's a really good idea is to actually have a hard copy of this near your study space for when you're researching your medications or your drugs so that you are alert to what could potentially go wrong and know that there are certain steps that have to be taken. For example, in these situations, these are the drugs that likely have an independent double check and also co-signatures for students as well and even RNs. So what you might have indicated or found out, so anticoagulants, so the category of anticoagulants such as Caprin, Coumadin, those are high alerts, insulin, narcotics, just to name a few. So make sure you've reviewed the list and you're aware of what they occur, where they occur. So the other thing that we will include in our practice when we are giving medications is we will know that prior to ministering any and all medications there are three checks and ten rights. So we talked about the ten rights in as mentioned Gregory it was ten rights and in gray it's 15. The three checks are very important in terms of strategy you need to use when you're pouring your medications and that is you when you are have your MAR and you compare it to the medication order to ensure that the MAR is written out and complete and it is clear then you compare as you're taking the medication out of the container or out of the drawer you're looking at the medication label with the MAR as you remove it from the storage area. Then as you are preparing the drug, so as you're pouring the drug into a medication cup or if you are using the full medication with the label on it, then you can use that. And then as you are putting it back to wherever it goes, you compare it with the mar. Also at the bedside, you patient identifiers to the MAR as well at the patient's bedside before administering the drug. So that could be even a fourth step as well. So you need to make sure that you are always involved with checking every step. The independent double check policy is a really important one. This one is where you will have a high alert drug or medication that requires an independent double check and this is a policy that you need to read. And it is where two health professionals, regulated health professionals, a student would be a third if they're involved in this process, shall independently verify with the are the most current order. The patient's relevant lab values are diagnostic results. Medication dosage calculations if required. So they would each independently calculate the dosage, the rights, and they will not communicate with each other. And they will then go ahead and do this work. And then at the end once they've determined it, they will go ahead and confer. So then they will determine what each of their results are. They will not do this until they've gone through all the steps and to avoid any kind of bias or influence. So it has to be, and that's the policy for independent double checks. So if, for example, you are helping with that, you can be the third person, but you cannot be one of the two people. So it has to be two health professionals. The thing that is also required is documentation that this step was taken and that you've all indicated that you've done the independent double check. However, on the electronic record, it only indicates room for one person. You need to indicate who the other person was, too. And also you can put that on the narrative record that this occurred. So again, where do I need to do this? So this would be required, for example, in a calculation of medications with a narcotic or any high alert drugs, these are required as part of your practice. The other one that's really important, and it's also highly important that you know when you need a co-signature is you will require co-signatures from regulated health care professionals. Student would be one and then the regulated health care professionals is second. So medications requiring co-signatures or direct observation of preparation and initial direct observation include all IV medications, controlled substances, high alert medications, pediatric fractional doses, all routes, and all other medications as determined by the local unit or policy. This is actually from your, you need to review your faculty of nursing policies on this. So make sure you go back and do that. The other is that you will, if you are in a situation where you are working with a narcotic for example, the narcotics will require, you have to do wastage. You need to have also an independent double check to verify the amount that you need to draw up, but also they need to observe of your wastage. So you need to ensure that two feet you are getting your wastage witnessed. The other is that because narcotics are so controlled they are in a lock cabinet and you need to carry us the healthcare professional on the unit will be carrying the keys and you will never as a student be allowed to carry the keys nor pick up narcotics from the pharmacy. So just be aware of that. But you may be involved with doing the end of shift count. So there's an inventory count at the end of shift to ensure that there's the amount that was used during the shift aligns with the amount of medication present or a narcotic medication present, and that can be done then. It has to be done before the nurses leave the unit. The other is distribution systems, and you've read about that. I'm not gonna get into a lot of detail, but you will notice it may be different on the units that you're working. So on the long-term care unit, you might notice the way they are accessing and distributing the medications on a unit such as an acute care unit. You might see this kind of cart and it's an automatic dispensing cart. So on your unit, you'll be orientated to the way you can access the MARR document and also how you can access the medications. It comes with very, it depends on the unit that you're working on and the area that you're working on. So one of the other policies that you need to be clear on is the patient identification policy. And so this is where you will, once you have poured or drawn up your medication, you then are going to the bedside and now you need to have two or more patient identifiers to confirm the patient's identity. You know this already, we need to do this for other things. It's included in other healthcare services, such as before you go ahead and do a dressing, or for example, we practiced that while we were doing the feeding and making sure we had the right patient nutrition tray. So this is very much an important part of your practice here, and if you skip this, it can be very detrimental. So you need to do this, and these are the lists and the policy of what you can use for an identifier. And so if you have a patient who is able, you can ask for the patient's first and last name, and it would be considered one. They could then, you can compare to the, you could also use their ID barcode, and so that would be with the barcode scanner. And you could, so in other settings, for example, in long-term care, they might use facial recognition. So they might have a patient picture on the MARR or the medication records so that you can use that. So there's multiple ways but you can never get around it. It has to be two. So make sure you get that into your process and it will never and it's always done. So now we're at the routes of medication have been and the ones that are going to be addressed in 221 are oral topical installation so that That might be nasal, eye, ear, vaginal, or rectal and rectal, and inhalation. So these are the ones we're going to practice and attend to this week, coming up or during this week. The thing that you need to identify is that they, with each of these routes, there is different way to in a way you need to you need to provide them and you cannot change the order for example like I said previously for example if the patient you go to the patient and they're not able to take it orally but you want to give it let's say through a vaginal suppository you need an order to make that change. It is also might affect the dosage, so they come in different doses, dosages, and different ways. So it has to make sense. And it also has to be right for the patient. So that is with the order. So if it's not something happens and you need to change it, you need to go ahead and contact the most route, it's easiest and most desirable way to administer. It comes in many forms like liquids, tablets, capsules, sustained release, bucol, sublingual, just to name a few. And with each of those forms comes a different way to provide it to the patient. So you need to know how to, for example, bucol, what does that mean, and sublingual. And so sustained release, for example, is very important to know. So what form does it come in? With each form and medication comes specific instructions, as I just mentioned. You cannot crush certain capsules or sustained release or intent to tear-coated medications. And also patients It's not that we're oral, for example, they must be able to swallow well. So if your patient has dysphasia, they need to, you need to reevaluate the order or get them to look at it. You have to have no contraindications. So for example, the patient cannot be NPO or nothing by mouth in order to give it. And if it is allowed, for example, if they're going to the OR, maybe you know that they're going to be NPO, you may need to clarify if it's still being ordered orally. Proper technique and handling, so for example, aseptic technique. Hand hygiene, accurate pouring, and hand hygiene after as well, so after handling it. Ideally, you wouldn't handle the medication and touch it, you directly pour it into the cup or hand it to the patient and they can give it to themselves. Follow directions, for example, one of the directions after bucol and sublingual is no fluid intake after because it has to be absorbed in the oral cavity and so that would interfere with that. You need to stay at the bedside and watch them consume the medication. You never ever ever can leave a medication unattended as another patient might take it or you cannot be sure that they've actually consumed the medication. You need to evaluate for therapeutic effects and adverse effects. So how are they, is Is it giving the response that you expect or are they having any difficulties with it? So for example, in adverse effect, you would want to also let others know that this is what's happened and documented. So topical medications are applied to intact skin or mucous membranes. They come in many forms such as paste, lotions, ointments, and patches. And interesting, this is, sorry, I went ahead one slide. What you need to be aware of and what can happen out on clinical, especially if you're not allowed to give it is sometimes a topical medication might be at the bedside and the, you might inadvertently give it thinking it's just a benign lotion, but it's actually a Medicated lotion so that could cause a medication error if you are not allowed to give it So make sure that you know the Anything that you are applying to the patient So it can be local or systemic in effect. So for example nitro a nitroglycerin patch is Systemic in nature and maybe even time released so that is important to notice must carefully follow the directions, for example, cleansing the error prior to application and know where to apply it. So there will be indications on the medication on where it's suitable to be applied, but also you need to know where you can apply it on the patient. For example, on the patient, you might be taking off an old patch, Is it best to find another location for the new patch so that might be what you have to consider and use your critical thinking skills? You should use hand hygiene, wear gloves, and use of applicators where required. When you're documenting, you need to note the area that the topical medication was applied or and also where the old patch was removed. So it's very important that you look for the old patch before you when you are applying the new patch and never leave it in place. As I mentioned some of the medications might be time released and so you might be adding another patch to another patch. So For example, nasal sprays, drops, or tampons might be applied, eyes, drops, ointments, ears, drops, vaginal suppositories, foam jellies, creams, and maybe even tampons, medicated tampons, rectal suppositories, and enemas. So there's specific instructions and procedures for each. There will be positioning required of the patient, but also a lot of medication teaching. So this is important for all of the medications we're talking about, but it's really important because we are getting into a very personal, in an invasive way here. And so it's important that we explain what we're doing, why we're doing it this way, and how we're going to be doing it. So you will have an opportunity to chat more about this in practice here in the labs. Inhalation, this is an important one, especially for oxygen administration. When we talk about that in our next lab, inhalation medications are inhaled and penetrate the lungs airways. they're usually rapidly absorbed and they may be a metered dose inhaler or dry powdered inhaler or still slow steam inhaler so sorry slow stream inhaler. They could also be a nebulizer so that's where oxygen or air is applied and makes a steam type of mist and the patient breeze sat in for a period of time. Ensure the directions are followed well and also you really need to know for all of the medications that you give, no matter what route, is you need to know the directions but also how. So for example, there would be specific instructions, for example, in relation to ordering. If you are giving one type of medication and you have to give another type, so for example two medications of the same type, is it allowed to be given at the same time or is an order required? Is it one has to be given before the other? A lot of times too, there is dexterity required for the patient to do this on their own and they need to be taught how to do this. So they may be using a spacer device because of the issue with dexterity and the pumping action. So knowing how to use that. Documentation is really an important part of this. And you can imagine if it's not documented, there's the saying, if it's not documented, it's not done. And maybe it would be not seen as given. So we want to make sure that you document as soon as possible after you've given the medications on a dedicated form in a timely and accurate manner. So this is where that timely and accurate comes in. So on the MARS sheet, it will have the patient's name and ID number, the order written out in full with the dose, route, and frequency, the prescriber's name, and the date and start and stop. you will be providing the time administered and your signature. Now some of these documentation forms might be only requiring your initials but when you're doing it longhand it might also include your full signature in many cases. The other is, for example, the location of where the patch is applied or where the IM medication was given. And also, you need to think about what needs to be also documented on the progress notes. For example, the reason for the pain, teaching, given, effectiveness, all of these aspects. Questions asked and answered by or that the patient may have or any kind of discharge worries that they might have. So here might be an example of a MARR record where you would then sign in this and you are giving the date and time of the medication. So question, J. Myers is an RN, Jane Myers administered her patient's medication Prednisone 5 mg PO at 1700 hours and when it was finished her shift at 1900 hours. The next nurse is reviewing the medications to be given later in the evening and notice that the Prednisone medication was not signed off at 1700 and does not see it signed off at all. What should the nurse do? So if you could look at these options and see what you would choose. So the correct answer would be B, so you could verify if it was missed or if it was given, and so that if it was indeed given, so you were able to contact Nurse Myers, you found out that it was indeed given at 1700, you would indicate that as a phone that you verified this medication and that it was via phone and that was in fact given. And so then after you know that, you can then go ahead and safely give it later when it's next you. Here are some additional questions for you. 50 milligrams of medication is to be given orally. The medication comes in dose strength of 25 milligrams in two mils. 25 milligrams in two mils. How many mils will you give? will you give? So the correct answer is four mils because you need to give 50 milligrams. So that was the dosage calculations that you learned how to do in your Gray Morris's calculation text. calculation text. And so this one's a fairly easy one. Make sure you practice the harder ones. So medication reconciliation is done in which of the following situations? of the following situations? Name all. So it's actually all ABC and ABC. So it would be indicated that, oh sorry, it does, it's not when they go for an x- ray that is incorrect, it is B and C so that is the correct one. for an x-ray that is incorrect, it is B and C so that is the correct one. So which of the following oral forms of medication can be crushed? of the following oral forms of medication can be crushed? And so the only one here that can be crushed is C, a tablet, not capsules, not sustained release and not enter coded so this would be a tablet and also if it the tablet in order to be let's say give part of the tablet it has to have a score so it has to have that marking and so it what we call a scored mark and so that it allows us to split the tab so you need to be mindful of that as well. So these are just match the terms explanations so I will leave that to you so you can take a look at it you can pause this video and try and see what you can do and here are the answers if you need to go back. you need to go back. So this is the end of our medication administration lab lecture today. I apologize for my dog barking and I'm having to pause and I hope if you bring any that if you have any questions you'll bring it to your lab instructor or you can get in touch with me. Thank you very much for your time. Have a great day!