Medication: Removing From An Ampule PDF

558 SKILL 103 ACTION RATIONALE 26. Perform hand hygiene. Hand hygiene deters the spread of microorganisms. 27. Proceed with administration, See appropriate skill for pre- based on prescribed route....

558 SKILL 103 ACTION RATIONALE 26. Perform hand hygiene. Hand hygiene deters the spread of microorganisms. 27. Proceed with administration, See appropriate skill for pre- based on prescribed route. scribed route. EVALUATION Medication is withdrawn into a syringe in a sterile manner, and the proper dose is prepared. DOCUMENTATION It is not necessary to record the removal of the medication from the ampule. Prompt recording of administration of the medication is required immediately after it is administered.  ͕͔͗        An ampule is a glass flask that contains a single dose of medication for parenteral administration. Because there is no way to prevent contamination of any unused portion of medication after the ampule is opened, discard any remaining medication if not all the medication is used for the prescribed dose. You must break the thin neck of the ampule to remove the medication. DELEGATION CONSIDERATIONS The preparation of medication from an ampule is not delegated to nurs- ing assistive personnel (NAP) or to unlicensed assistive personnel (UAP). Depending on the state’s nurse practice act and the organization’s policies and procedures, the preparation of medication from an ampule may be del- egated to a licensed practical/vocational nurse (LPN/LVN). The decision to delegate must be based on careful analysis of the patient’s needs and circumstances, as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. EQUIPMENT Sterile syringe and filter Computer-generated Medica- needle tion Administration Record Ampule of medication (CMAR) or Medication Small gauze pad Administration Record (MAR)  ‡†‹ ƒ–‹‘ǣ‡‘˜‹‰ˆ”‘ƒ’—Ž‡ 559 ASSESSMENT Assess the medication in the ampule for any particles or discolora- tion. Assess the ampule for any cracks or chips. Check expiration date before administering the medication. Verify patient name, dose, route, and time of administration. Assess the appropriateness of the drug for the patient. Review assessment and laboratory data that may influence drug administration. NURSING DIAGNOSIS Risk for Infection Deficient Knowledge Risk for Injury OUTCOME IDENTIFICATION AND PLANNING Medication will be removed in a sterile manner. Medication will be free from glass shards. Proper dose will be prepared. IMPLEMENTATION ACTION RATIONALE 1. Gather equipment. Check the This comparison helps to identify medication order against the errors that may have occurred original order in the medical when orders were transcribed. record, according to facility The primary care provider’s policy. Clarify any inconsis- order is the legal record of medi- tencies. Check the patient’s cation orders for each facility. chart for allergies. 2. Know the actions, special This knowledge aids the nurse nursing considerations, safe in evaluating the therapeutic dose ranges, purpose of effect of the medication in rela- administration, and adverse tion to the patient’s disorder and effects of the medications to can also be used to educate the be administered. Consider patient about the medication. the appropriateness of the medication for this patient. 3. Perform hand hygiene. Hand hygiene prevents the spread of microorganisms. 4. Move the medication cart to Organization facilitates error-free the outside of the patient’s administration and saves time. 560 SKILL 103 ACTION RATIONALE room or prepare for admin- istration in the medication area. 5. Unlock the medication cart Locking the cart or drawer safe- or drawer. Enter pass code guards each patient’s medication and scan employee identifi- supply. Hospital accrediting cation, if required. organizations require medica- tion carts to be locked when not in use. Entering pass code and scanning ID allows only autho- rized users into the computer system and identifies the user for documentation by the computer. 6. Prepare medications for This prevents errors in medica- one patient at a time. tion administration. 7. Read the CMAR/MAR and This is the first check of the select the proper medica- label. tion from unit stock or the patient’s medication drawer. 8. Compare the label with the This is the second check of the CMAR/MAR. Check expira- label. Verify calculations with tion dates and perform cal- another nurse to ensure safety, if culations, if necessary. Scan necessary. the bar code on the package, if required. 9. Tap the stem of the ampule This facilitates movement of or twist your wrist quickly medication in the stem to the while holding the ampule body of the ampule. vertically. 10. Wrap a small gauze pad This will protect your fingers around the neck of the from the glass as the ampule is ampule. broken. 11. Use a snapping motion to This protects your face and break off the top of the fingers from any shattered glass ampule along the scored line fragments. at its neck. Always break away from your body. 12. Attach filter needle to Use of a filter needle prevents syringe. Remove the cap the accidental withdrawing of from the filter needle by small glass particles with the pulling it straight off. medication. Pulling the cap off in a straight manner prevents acci- dental needlestick.  ‡†‹ ƒ–‹‘ǣ‡‘˜‹‰ˆ”‘ƒ’—Ž‡ 561 ACTION RATIONALE 13. Withdraw medication in the By withdrawing an additional amount ordered plus a small small amount of medication, any amount more (approximately air bubbles in the syringe can 30% more). Do not inject be displaced once the syringe is air into the solution. While removed while allowing ample inserting the filter needle medication to remain in the into the ampule, be careful syringe. The contents of the not to touch the rim. Use ampule are not under pressure; either of the following therefore, air is unnecessary and methods to withdraw the will cause the contents to over- medication: flow. The rim of the ampule is considered contaminated. a. Insert the tip of the needle Handling the plunger only at the into the ampule, which is knob will keep the shaft of the upright on a flat surface, plunger sterile. and withdraw fluid into the syringe. Touch the plunger only at the knob. b. Insert the tip of the needle Surface tension holds the fluids into the ampule and invert in the ampule when inverted. If the ampule. Keep the the needle touches the sides or needle centered and not is removed and then reinserted touching the sides of the into the ampule, surface tension ampule. Withdraw fluid is broken, and fluid runs out. into syringe. Touch the Handling the plunger only at the plunger only at the knob. knob will keep the shaft of the plunger sterile. 14. Wait until the needle has Ejecting air into the solution been withdrawn to tap the increases pressure in the ampule syringe and expel the air and can force the medication carefully by pushing on the to spill out over the ampule. plunger. Check the amount Ampules may have overfill. of medication in the syringe Careful measurement ensures with the medication dose that the correct dose is with- and discard any surplus, drawn. according to facility policy. 15. Depending on facility This third check ensures accu- policy, the third check of racy and helps to prevent errors. the label may occur at this Note: Many facilities require the point. If so, when all medi- third check to occur at the bed- cations for one patient have side, after identifying the patient been prepared, recheck and before administration. the labels with the CMAR/ MAR before taking the medications to the patient. 562 SKILL 103 ACTION RATIONALE 16. Engage safety guard on fil- The filter needle used to draw up ter needle and remove the medication should not be used to needle. Discard the filter administer the medication. This needle in a suitable con- will prevent any glass shards tainer. Attach appropriate from entering the patient during administration device to administration. syringe. 17. Discard the ampule in a suit- Any medication that has not been able container. removed from the ampule must be discarded because sterility of contents cannot be maintained in an opened ampule. 18. Lock the medication cart Locking the cart or drawer safe- before leaving it. guards the patient’s medication supply. Hospital accrediting organizations require medica- tion carts to be locked when not in use. 19. Perform hand hygiene. Hand hygiene deters the spread of microorganisms. 20. Proceed with administration, See appropriate skill for pre- based on prescribed route. scribed route. EVALUATION Medication is removed from the ampule in a sterile manner, is free from glass shards, and the proper dose is prepared. DOCUMENTATION It is not necessary to record the removal of the medication from the ampule. Prompt recording of administration of the medication is required immediately after it is administered.