Introduction to Medication Principles (Part I) PDF

Introduction to Medication Principles (part I) [Kushto-Reese] - We are going to discuss medication principles and medication administration, but one thing I want you to remember, because giving medications is a huge responsibility. It's a big part of what we do as nurses, and it's exciting but chal...

Introduction to Medication Principles (part I) [Kushto-Reese] - We are going to discuss medication principles and medication administration, but one thing I want you to remember, because giving medications is a huge responsibility. It's a big part of what we do as nurses, and it's exciting but challenging. So please remember that you, the nurse, have the right and the responsibility to decline administering a medication if you believe it may jeopardize patient safety. So kind of the buck stops at you. You're the last opportunity to report an error and to provide the safest environment for the patient, and that's a lot of responsibility, but it's something that we know that we do, and we're good at as nurses. So when we're discussing responsibilities and safe administration, one of the things we need to know is the five rights and more. So we're going to talk about the five rights a little bit later on in class. So keep that in the back of your mind. We also need to understand how to access information that we might need. Medications are changing all the time, so you have to keep up, and you can't be expected to know it all. So look it up. Use your sources of information. As you work on your particular unit, you will learn the standard medications that are given on that unit. You also learn the medication standards, like what are some of the protocols and policies in the hospital where you work and on the unit where you work. Patient related variables is a huge factor when giving medications. No two patients are alike. Patients have histories, and different histories. They have issues that can cause a reaction to medications, and they may have other medications that interact. So it's important to look at all patient related variables and clarifying orders. We have electronic recordkeeping and orders, but we still need to clarify and question any order that you think does not sound right. Kind of trust your intuition and question something if you're concerned. Adverse drug events are huge. They're the second most common source of death in patients in hospitals. There are lots of sources of medication error. There's a whole list here. So we have to look at how drugs are transcribed and how they're labeled and make sure that that's accurate and we're reading them correctly. We have to identify the client, and we'll do that when we talk about the five rights. We have to make sure that the patient takes the medication. We have to be sure we verify orders, as I said earlier. You want to always question if it doesn't sound correct. And we want to use our resources. Sometimes when things are really busy in the hospital is when medication errors are made, and sometimes that's not within our control. So we have to use the time and take the time to be safe with medication administration and delivery. © 2020 Johns Hopkins School of Nursing. All rights reserved. There are new safety measures in place. Institute of Medicine and the Joint Commission of National Patient Safety Goals has taken a look at some of the reasons for medication errors and improved medication error reporting. The electronic health record and the newly designed delivery systems ensure a safer way to administer medications today. Unit-Dose system is a prepackaged, pre-labeled individual dose for the patient. It's the safest, it's the most cost effective, because there is no waste. Patients will receive their medications in these forms. It could be powder, it could be tablet, it could be liquid, it could be suppository, it could be IV medication, eye drops, all of the things that you see here, ear drops, ointments, they're all prepackaged and labeled with a patient's name. So safety is enhanced, and cost is lowered because of the effectiveness of this type of administration. There are automated medication dispensing systems that involve a code and a fingerprint to ensure the validity of the user. All of our controlled substances are kept in these Pyxis machines, and oftentimes medications as well. We enhance medical patient safety by use of the barcode scanner. So the patient wears a bracelet, and the nurse scans the barcode to ensure it's the correct patient, drug, dose, route, and time and documentation. These are the five rights that I mentioned earlier. We also ask the patient to identify their name and date of birth verbally. Here are some pictures of barcode scanners and how they are implemented when checking the medication before giving to a patient. The nurse in this picture is actually scanning the pump for the IV medication she is about to deliver using the IV pump. Again, this ensures safety and accuracy with medication administration delivery. When we're taking a patient's history, we should be sure to ask which nonprescription medications they are taking. For example, an over the counter medication like Tylenol. We want to make sure that they're using FDA approved medications. We also want to find out what their prescription medications are, so that we can look and see if there are any interactions and what their levels may be. Sometimes patients will bring their prescription medications from home, and that way we can look at them, and if need be, the pharmacy may take those medications in case the patient needs those dispensed directly if they're not available at the hospital. We definitely want to be sure to ask about herbs and botanicals, things like echinacea. We think of these substances as natural substances, which they are, however, they're very potent, and so many times if a patient is using other prescription medications, herbs and botanicals may not be safe because there may be some drug interactions. So we always want to make sure to ask about those. Let's look at the components of a medication order. First, we will look at medication names. There is a brand or trade name. There is a generic name. On the labels to the right, the generic name is Luminal and the trade name is phenobarbital. A lot of these medications look alike and sound alike. So we use tall man lettering to differentiate them. The first medication, phenobarbital, is a medication that we give for seizures. So we use this tall man lettering to denote the fact that it is phenobarbital, not the medication on the bottom, pentobarbital. Pentobarbital is a medication given prior to surgery to sedate a patient. So they're two separate medications, but they may look alike, their names look alike, in this example. They may be packaged alike. So we always want to point out the differences to keep medications from being confused and errors being made. There are lots of medications with different names. © 2020 Johns Hopkins School of Nursing. All rights reserved. There is a medication called cefazolin. Its generic name is, or sorry, brand name is Ancef, but there are other medications that have similar names, cefotaxime, Ceftin, ceftazidime, ceftriaxone. So you always have to be sure that you know both the brand name and the generic name. Or if you don't know them, look them up. A second component to the medication label is the medication dosage. You're learning about that right now in dosage calc. Hopefully you're practicing lots of problems, and you're going to know whether or not it's a metric dose, an apothecary, or a household dose. You want to know the frequency and the strength. You remember from dosage calc that when you have a decimal, you always put a zero before the decimal so that that number is not misrepresented. And if you have a whole number, you do not add trailing zeros. These are the causes of many medication errors that we want to avoid. The next component is the route of administration of a medication. So we want to know, how are we giving this medication? Is it given orally, by mouth, which is PO? Is it given intramuscularly, which is, IM, intravenously, which is IV, intradermally, which is ID, or subcutaneously, which is SC? And there are other routes of administration for medications that we will discuss in the upcoming slides. The next component is the purpose that the patient is receiving the medication. So is the medication for pain, is it for fever? One example that we give both for pain and for fever is the drug Tylenol, or acetaminophen. However, if the order is written for acetaminophen or Tylenol to be given, PRN, every four hours, for pain, and the patient has a fever, we cannot give it for fever, even though we know Tylenol can be effective against a fever. The order has to be specifically written for the purpose for which it's given. So if you need Tylenol or acetaminophen for the patient's fever, you have to have a new order. So we can't interchange medication, it has to be written specifically for that reason. So the fifth component is the provider signature. So they need to sign the medication order. And then we have the final order, which includes OxyContin, the drug name, 20 milligrams, the drug dose, PO, the drug route, q. 12, which is frequency of the drugs, every 12 hours, for moderate to severe pain. So the reason or the purpose is also given. So this is a complete medication order. © 2020 Johns Hopkins School of Nursing. All rights reserved.