Medication Administration and Safety Week 3, Winter 2025 PDF

Medication Administration and Safety Week 3 Winter 2025  REQUIRED READING: Required reading: Potter, P. A., Perry, A. G., et al (2019). Chapter 34: Pages 727-730; 730-731; Page 734; Page 736-738; Page 739 Prescriber’s role; Page 743 Nurse’s role;...

Medication Administration and Safety Week 3 Winter 2025  REQUIRED READING: Required reading: Potter, P. A., Perry, A. G., et al (2019). Chapter 34: Pages 727-730; 730-731; Page 734; Page 736-738; Page 739 Prescriber’s role; Page 743 Nurse’s role; Pages 746-749 Standards (10 rights); Page 757-763  Examine the nurse’s role and responsibilities regarding medication administration. Discuss methods of educating a patient about the prescribed medication. Implement nursing actions to prevent medication errors. Describe factors to consider in choosing routes of medication administration. Discuss factors to consider in assessing a patient’s needs for and response to medication therapy. Explain the rights of medication administration. Prepare and administer oral medication Calculate a prescribed medication dose. Nurse’s Roles The nursing process provides a framework for medication administration. Administration of medication must be safe Determining whether the correct medication was ordered Determining correct time, administration route, and evaluation of effects Clinical calculations must be handled without error. Conversions in and between systems Dose calculations Assessing the patient’s ability to self-administer medication Patient and family education This Photo by Unknown Author is licensed under CC BY Systems of Medication Measurement Requires the ability to compute medication doses accurately and correctly Metric system: Weight: milligrams (mg) Solution: milliliters (mL) Household system: Teaspoon (tsp): 5 ml Tablespoon (tbsp): 15 ml Metric System Grams (g), milligrams (mg), kilograms (kg) Litres (L), millilitres (mL) Units of mass per unit of volume (g/mL or mg/mL) Systems of Medication Measurement Requires the ability to compute medication doses accurately and correctly Metric system: Weight: milligrams (mg) Solution: milliliters (mL) Household system: Teaspoon (tsp): 5 ml Tablespoon (tbsp): 15 ml Household Units of Measurement Metric Equivalent Measurement 1 teaspoon (t s p) 5 milliliters 1 tablespoon (T b s) 15 milliliters 1 ounce (o z) 30 milliliters Glass (6 o z) 180 milliliters (8 o z) 240 milliliters Cup (6 o z) 180 milliliters (8 o z) 240 milliliters  Metric System Grams (g), milligrams (mg), kilograms (kg) Litres (L), millilitres (mL) Units of mass per unit of volume (g/mL or mg/mL) Practice The nurse has an order to give 1 teaspoon of a drug. The nurse measure 15 milliliters of medication to administer. Is this the correct amount? Ten Rights 1. The right patient 2. The right medication 3. The right dose 4. The right time and frequency 5. The right route 6. The right reason 7. The right patient education 8. The right to refuse 9. The right documentation 10. The right evaluation  Name: Aisha Mohammed HC: 01234567 DOB: 21/03/1958 Age: 65 years Sex: Female Allergies: None 1- The right patient Weight 80 kg Must use 2 patient identifier Check the MAR against Pt.’s ID Ask Pt. to stat his/her full name & DOB 2- The right medication Acetaminophen 1000 mg q6h PO for fever 1. Medication preparation safety Verify each medication with the MAR 3 times 1. Before removing the container 2. When the medication is removed 3. Before returning it to the storage Storage and Expiration Date The drug label contains: information for mixing/storing expiration date of the drug or the mixed drug Practice Brand name Generic name Total amount Dosage Strength Expiration date Route of administration 2. Medication administration safety (3 checks) 1. When medication initially selected (preparation safety) 2. After preparation of dosage (Cup & MAR) 3. At the bedside before administering (Cup, MAR & Pt.) 3- The right dose Acetaminophen 1000 mg q6h PO for pain How many tablets should the nurse administer? Every calculation begins with the medication order and label on the medication.  4- The right time and frequency Acetaminophen 1000 mg q6h PO for fever Examples: PC: after meal (within 30 mins after meal) STAT: immediately PRN: as needed Routine orders: 30 mins before or after of the time Sensitive (i.e., antibiotic, insulin): at precise interval 5-The right route  Routes of Administration 1. Enteral Routes A. Per Oral (PO): The easiest and most used Given by mouth Slower onset of action More prolonged effect Nasogastric tube /feeding tube) B. Sublingual (SL) Placed under the tongue to dissolve Quick absorption Should not have liquid after administration C. Buccal (BUC) Placed inside the cheeks Oral Administration Contraindications Presence of gastrointestinal alterations Inability to swallow and risk for aspiration See Box 34-18 in how to protect your pt. Positioning  Forms of medication by oral Tablet Scored vs. not scored Orally Disintegrating Tablets (ODT) Capsule Liquid Medication that cannot be crushed/cut Enteric coated Sustained-release/Slow release (SR) & Extended release (XR), Long acting (LA) 6- The right reason Who is responsible to know the rationale for ordered medication What if you don’t know it Look it up! Make sure you know the nursing implications When should we call doctor for verification? Contraindicated with the pt.’s medical history or current condition Dose is more than recommended limits Order route is contraindicated for the pt. 7- The right patient education To be informed of the medication’s name, purpose, action, and potential undesired effects Teaching patients about their medications and possible adverse drug events How to take the medication! Family of certain patients should be included in the education 8- The right to refuse Patient has right to refuse a medication, regardless of the consequences However, they need to be fully informed about the potential consequences of their decision Patient Rights To receive labelled medications safely, without discomfort, in accordance with the 10 rights of medication administration Patient has right to refuse a medication, regardless of the consequences To have qualified nurses or physicians assess a medication history, including allergies and use of herbal therapies To be informed whether medications are part of a research study To be informed of the medication’s name, purpose, action, and potential undesired effects To receive appropriate supportive therapy in relation to medication therapy To not receive unnecessary medications  Why? 9- The right Communication to other healthcare providers documentation How/What? Pt.’s full name Full name of the medication Dose Time and frequency Route Relevant preassessment for some medication Patient’s condition at the time of medication administration All required post-assessment When? Right After Administration  10-The right evaluation/assessment Remember Nursing process Before administration Functional, cognitive, physical limitation After administration Monitoring the effects (desirable and not desirable) of the medication Adverse effects Any signs of medication interactions Critical thinking What would be the next step if the medication is ineffective? Additional follow up will be necessary Medication orders: Topical/parenteral L/ Nasogastric Week 4 Medication orders & Topical medication administration Routes of Administration 2. Parenteral (involves injection) A. Intradermal (ID) B. Subcutaneous (SC)(subcu) C. Intramuscular (IM) D. Intravenous (IV)  Routes of Administration 3. Topical (skin and mucous membranes) A. Skin: (cream, ointment, patch) B. Membranes Direct Apply (Ophtalmic, Otic, Nasal, Inhalation, irrigation) Placing in a body cavity (Vaginal, Rectal) Transdermal Skin application May cause systemic or local effects Nurse should → gloves + use applicator Sterile technique if open wound Clean site before application: Washing skin gently with water and soap; Soaking an involved site or; Locally debriding tissue (if knowledge/certified/authorized) Apply according to directions (see packaging or drug book) Spread lightly unless specified otherwise (rubbing may cause irritation) Transdermal Transdermal patch: Patch may be opaque or transparent (Check and remove) Guidelines: Document area where the patch was applied Ask patient whether he or she has an existing patch Do not assume patch as fallen out, inspect and assess skin thoroughly Ask any new patient if they are using topical medication (reconciliation) If difficult to see, use noticeable label when applying patch Document removal of patch Potter p.761 from institute for safe medication practice, 2007 nasal instillation Spray, drops or tampons Most common spray Drops: Position patient For all nasal instillation: Blow nose Position accordingly Breath through mouth Stay 5 minutes in position after meds See Potter et al. (2019). Box 34-20 p. 763  Nasal spray Self-administration is easier (synchronize with inhalation) May also cause systemic effect in children Procedure: High fowler’s position or sitting position Administer with head upright Offer tissue to blot a runny nose but not blowing the nose for several minutes  Eye instillation: If more than 1 treatment, wait 5 minutes before next medication to avoid interaction. Ophthalmic medication. The cornea of the eye is richly supplied with pain fibres and is therefore very sensitive to anything applied to it. The nurse should avoid instilling any form of eye medication directly onto the cornea. OINTMENT: DROPS: Inner edge of 1-2 cm the lower above the eyelid. conjunctival From the inner sac canthus to the outer canthus. See Potter et al. (2019). Skill 34-2 p.764 https://coursewareobjects.elsevier.com/objects/elr/Canada/Potter/fundamentals6e/videos/Chapter034.html# Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All right reserved. Nursing observation Safer to write → Right eye; left eye; or both eyes Possible Abbreviations: OD: Oculus Dexter → Right eye OS: Oculus Sinister → Left eye OU: Oculus Uterque → Both eyes Use only for affected eye High risk of transmission between one eye to the other! AVOID TOUCHING eye structures Never use another patient’s eye medication. Intraocular administration: Resemble contact lens Place into conjunctival sac May remain in place up until 1 week (See specific recommendations)  Ear instillation Otic medications ALWAYS ROOM TEMPERATURE: Internal ear structures very sensitive to temperature; may cause vertigo (extreme dizziness) or nausea. ALWAYS STERILE DROPS: In case eardrums is ruptured NEVER OCCLUDE EAR CANAL: With the dropper or irrigation syringe Forcing medication creates pressure and may cause injury to eardrum See Potter et al. (2019). Box 34-21 p. 769  medication administration by inhalation Inhalations To respiratory tract: Given by inhalers, nebulizers Forms: Aerosol spray Mist Powder Devices: Metered-dose inhalers (mdis) Dry powder inhalers Slow-stream inhalers Alveolocapillary network absorbs rapidly: Mainly local effect Some can cause systemic effect Meter-dose inhalers (MDIs) Chemical propellants pushes a measured dose of drug with each push of the canister Important: Prime canister prior to first use (spray 2 to 4 puffs on the side) Spray test the inhalers if not used for more than a week  Using MDI 1. Insert canister in older 2. Remove mouthpiece cover 3. Shake inhaler 5-6 times 4. Breathe out, away from inhaler 5. Bring inhaler close to mouth (2 fingers) / or / past teeth above tongue, seal lips around. 6. Position head slightly tilted back 7. Start to inhale slowly (3-5 sec) while depressing canister once 8. Keep inhaling slowly until full breath 9. Hold your breath for 10 seconds or as long as you can 10. Remove inhaler from mouth and exhale through pursed lips Wait at least 20-30 seconds between inhalations of medications If same medication, reshake before repeat https://www.youtube.com/watch?v=Zb2DFfHlQrY See Potter et al. (2019). Skill 34-3 p. 772 Meter-dose inhalers (MDIs) MDIs Can be used with a spacer Facilitate breathing + medication release Helpful if lack of coordination (inhaling) Cleaning the device: Every day: inhaler and covering cap Rinse with warm water Ensure completely dry prior to use Twice a week: L-shaped plastic mouthpiece Wash with mild soap and warm water Rinse and dry See Potter et al. (2019). Skill 34-3 p. 772  Dry Powder Inhaler (DPI) Activated by inhalation No need for coordination of inhalation and delivery Delivers a fine powder directly into the bronchial tree See Potter et al. (2019). Skill 34-3 p. 772 SLOW- STREAM INHALERS Slow- stream inhalers Vaporize a liquid medication into fine mist Patient inhales the mist Often with a face mask Flow (L/min) will deliver the mist Need to stay upright Vaginal instillation Forms: Suppositories Foam Jellies Creams Applicator may be used Body fluid precaution Often patient prefer self administration After insertion: body temperature causes to melt, absorb and distribute See Potter et al. (2019). Box 34-22 p. 770 Rectal instillation Forms: Suppositories Rounded end prevent anal trauma during insertion Often suppository kept in fridge Body fluid precaution Insert past the internal anal sphincter and against the rectal mucosa If not, suppository may be expelled After insertion, body temperature melt the suppository Distribution and absorption of the medication See Potter et al. (2019). Box 34-23 p. 771 Nursing Process Nursing Process Assessment Medical history History of allergies Medication data Diet history Patient’s perceptual or coordination problems Patient’s current condition Patient’s attitude toward medication use Patient’s knowledge and understanding of medication therapy Patient’s learning needs Nursing Process Diagnoses: Anxiety Deficient knowledge of medications Nonadherence to prescribed medications Impaired swallowing Nursing Process Planning Organize care activities to ensure the safe administration of medications Goals and outcomes Setting priorities Nursing Process Implementation Health promotion Acute care Receiving medication orders Correct transcription and communication of orders Accurate dose calculation and measurement Correct administration Recording medication administration Nursing Process Evaluation The effects of the medications Monitor patient responses to medications on an ongoing basis. Need the knowledge of the desired effect, the therapeutic action, and the common adverse effects. A change in a patient’s condition can be physiologically related to health status, medications, or both. MUST KNOW Are all required equipment and supplies at bedside e.g., cup, water…? Never leave the medication at bedside Make sure the patient taking the medication (follow the prescribed information) Never give a medication that you have not prepared yourself Never document for a medication that you did not administrate yourself Quick question If a nurse experiences a problem reading a prescriber’s medication order, what would be the most appropriate action? A. Call the prescriber to verify the order. B. Call the pharmacist to verify the order. C. Consult with other nursing staff to verify the order. D. Withhold the medication until the prescriber makes rounds. Quick question If a nurse experiences a problem reading a prescriber’s medication order, what would be the most appropriate action? A. Call the prescriber to verify the order. B. Call the pharmacist to verify the order. C. Consult with other nursing staff to verify the order. D. Withhold the medication until the prescriber makes rounds.  Pt. information Medication name Dosage Form Time & Frequency  Medication Errors Any event that could cause, directly or indirectly administration of inappropriate medication therapy failure to administer appropriate medication therapy Can cause or lead to inappropriate medication use or patient harm Common errors: Omission Improper dose Wrong time Wrong patient Medication Errors Possible contributing factors: Procedures and systems (labelling & distribution) Culture of safety Examples include “near miss” reporting Incident or occurrence reports used to track incident patterns and quality improvement Accountability is an important professional responsibility! Incident Report Written account of incident (usually within 24 hours) Includes the patient identification information; the location and time of the incident; an accurate, factual description of what occurred and what was done; and the nurse’s signature Used to track incident patterns and to address quality improvement and risk management issues as necessary Disclosure to patients or family members: important Quick Quiz! Nurses are legally required to document medications that are administered to patients. What, specifically, are they are mandated to document? A. The rationale for administration B. The medications before administration C. The medications after administration D. The prescriber’s rationale for prescription  Legislation and Standards Qatar Council for Healthcare Practitioners (QCHP) Nursing Regulations in the State of Qatar (pg.14-21) How do you see our today’s topic is related to these standards? Qatar regulations for Health Care workers Some important regulation in the state of Qatar for health care workers (nurses): 1.3.1 Practices in accordance with agreed policies and procedures that guide nursing practice 2.1.8 Administer medications and therapies in a safe, timely and effective manner 2.1.11 Applies best available knowledge from credible sources to support clinical reasoning, decision-making and safe practice Qatar Council for Healthcare Practitioners (QCHP) References Holland, L. N., Adams, M.P., Brice, J.L. (2015). Core concepts in pharmacology (5th ed). Pearson Prentice Hall Potter, P.A., Perry, A. G., Stockert, P., Hall, A. (2019). Canadian fundamentals of nursing (6th Can ed.). (Astle, B.J. Duggleby, W. Eds.). Elsevier Qatar Council for Healthcare Practitioners (QCHP). Nursing Regulations in the State of Qatar Vallerand, A.H. & Sanoski, C.A. (2020). Davis’s drug guide for nurses (17th ed.). F.A. Davis. Giddens, J. F. (2019). Concepts for Nursing Practice E-Book. Elsevier Health Sciences. All pictures without citation are from google images labeled for noncommercial reuse