Drug Classifications, Routes & Med Errors PDF

Dallas Hengstler Fall 2022  Identify commonly used drug classification systems in Canada. Identify various classes of medications used to treat specific disorders/illness. Explain the principles of medication Learning a...

Dallas Hengstler Fall 2022  Identify commonly used drug classification systems in Canada. Identify various classes of medications used to treat specific disorders/illness. Explain the principles of medication Learning administration. Describe the routes of medication administration. Objectives Apply the nursing process as it relates to medication administration. Describe the most encountered medication errors. Develop a framework for professional nursing practice for prevention of medication errors.  Drug classifications are a way to organize drugs into categories. Various ways to Classify drugs Drug Classification Classifying drugs by chemical similarities is useful because drugs that are chemically similar often have similar impacts and risks.  Therapeutic class Physical change Drug Pharmacological classification Classification Main physiological change induced by drug  Anti-Alzheimer’s Antineoplastics Antiretrovirals Antianemetics Antiulcer agents Antihypertensive Antianginals Antidiabetics Antianxiety Antiparkinson Antirheumatics Antiarrhythmics Antivirals Therapeutic Antiasthmatics Antidiarrheals Anticholinergics Antiplatelet class Anticoagulants Anticonvulsants agents Antiemetics Antiinfectives Antipsychotics Antifungals Antitubercular Antipyretics Antidepressants Antihistamines  Calcium channel blocker Angiotensin converting enzyme inhibitors (ACE Pharmacological inhibitors) Classification Beta blockers or beta-adrenergic blockers Bronchodilators Cholinergic blocking drugs (anticholinergics)  Drugs names can be used to classify drugs as well: Chemical Drug Names Brand/Trade Generic  Let's watch a quick video describing drug classifications to further your understanding Video Categorizing Drugs: Classes, Names, and Schedules: https://youtu.be/FPLzzuwZyMo  9 Principles of Drug Administration  Check the “six” rights Depending on province or territory, there may be other “rights” as well (see Chapter 1 in the textbook). Preparing for Standard precautions: Perform hand hygiene! Double check if unsure about anything. Drug Be punctual. Administration Check for drug allergies. Prepare drugs for one patient at a time. Check label three times. Use verified medication record. 10  Check expiration dates and compatibility. Assess patient as required. Check patient’s identification; two identifiers required. Preparing for Bar code system use. Drug Give medications on time. Explain medications to the patient. Administration Open medications at the bedside. Try not to touch the medications. Document medications given on the MAR before going to the next patient. 11  Preparing for Drug Administration Follow policy if patient refuses a drug. Discard any medications that fall to the floor or become contaminated. Stay with the patient while the patient takes the drugs. Do not leave the drugs in the patient’s room to take at another time. Assess and document the patient’s response to the drug(s) administered. 12  Discuss the recommended ways to identify patients before giving medications in the hospital and long- term care setting Think Pair Share  Drugs Classified by Route Enteral Oral Parenteral Sublingual Intravenous Buccal Intramuscular Rectal Subcutaneous Intradermal Topical  Administering Enteral Drugs Oral medications Sublingual or buccal medications Liquid medications Oral medications to infants and children Drugs given through a nasogastric or gastrostomy tube Rectal drugs 15  Oral Medications Oral medications Assess for dysphagia. Crushing pills Aspiration precautions Age-related considerations Fluid-restriction considerations Remain with the patient until all medications have been swallowed. Document medication administration and patient response. 16 Sublingual and Buccal Medications Sublingual and buccal medications Sublingual tablets are placed under the tongue. Buccal tablets are placed between the upper or lower molar teeth and the cheek. These drug forms are not taken with fluids. Instruct the patient not to drink anything until the tablet has dissolved completely. When using the buccal route, alternate sides with each dose to reduce risk of oral mucosa irritation. Document medication administration and patient response. 17  Oral Liquid Medications Liquid medications Ensure proper dose. When pouring from a container, shake gently to mix the contents. Discard excess medication in the sink. Use of calibrated oral syringes Document medication administration and patient response. Special considerations for infants and children 18 NG and Gastrostomy Drug Administration Administering drugs through a nasogastric or gastrostomy tube 19 Administering Rectal Medications Administering rectal drugs Hand hygiene, standard precautions, gloves Assess patient for active rectal bleeding or diarrhea. Position patient on left side unless contraindicated (Sims’ position). Do not insert suppository into stool. Follow insertion procedure, at least 2.5 cm beyond anal sphincter. Have the patient remain lying on his or her left side for 15 to 20 minutes to allow absorption of the medication. Age-related considerations 20 Vaginal Medications Vaginal medications Creams, foams, gels Suppositories or tablets 21  Parenteral Drugs Never recap a used needle! May recap an unused needle with the “scoop method” Prevention of needlesticks “Needleless” systems Filter needles 22  Needle angles for various injections Intramuscular (IM) Injections Subcutaneous (subcut) Intradermal (ID) 23 Subcutaneous Injections 24 Intramuscular Injections Sites Ventrogluteal site (preferred) Vastus lateralis site Deltoid site Dorsogluteal site (not recommended) Z-track technique 25  Intravenous Medications Most rapid onset compared to other routes Needleless systems Compatibility issues Expiration dates Age-related considerations Infusion of intravenous piggyback (IVPB) medications Labelling intravenous (IV) infusion bags when adding medications 26 Intravenous Medications Adding medications to a primary infusion bag IVPB medications (secondary line) IV push medications (bolus) Through an IV lock Through an existing IV infusion Directly into the vein 27 Intravenous Medications Volume-controlled administration set Using electronic infusion pumps Patient-controlled analgesia (PCA) pumps 28 Eye and Ear Medications Eye medications Drops Ointments Age-related considerations Ear drops Adults Infant or child younger than 3 years of age 29 Administering Ear Drops 30 Administering Nasal Medications 31 Inhaled Medications Inhaled drugs Metered-dose inhalers (MDIs) Dry powder inhalers Small-volume nebulizers 32 Inhaled Medications: Nebulizer Treatment 33  Skin Medications Administering medications to the skin Lotions, creams, ointments, powders Transdermal patches Age-related considerations 34  Medication Administration After administration of any medication, chart the medication given on the medication administration record (MAR). Monitor the patient for a therapeutic response and adverse reactions. Provide instructions on administration for the patient or caregiver. 35 Audience Response System Question 1 The nurse’s instructions to a patient who is to take a sublingual tablet would include what statement? A. “Place the tablet on the tongue and let it dissolve there.” B. “After it starts dissolving, chew the medication.” C. “Place the tablet under your tongue and then take a sip of water.” D. “Don’t drink anything until this tablet is fully dissolved.” 36 Audience Response System Question 2 A patient is ordered to receive two different types of insulin. The nurse will draw each insulin into an insulin syringe and administer two injections. draw the cloudy insulin into the insulin syringe first and then the clear insulin into the same syringe. call the prescriber to question the order. draw the clear insulin into the insulin syringe and then the cloudy insulin into the same syringe. 37 Audience Response System Question 3 A patient is to receive a 0.5-mL injection of iron dextran, which can be very irritating to the body’s tissues. The proper technique for administration of this drug would be a(n) A. IM injection using the Z-track technique. B. IM injection into the deltoid muscle. C. subcut injection into the abdomen. D. ID injection into the forearm. 38 Audience Response System Question 4 Which is the safest site for administration of an IM injection to an adult? A. Deltoid B. Dorsogluteal C. Vastus lateralis D. Ventrogluteal 39 Audience Response System Question 5 When administering eye drops, where will the nurse place the drop? On the pupil On the sclera In the conjunctival sac In the inner canthus 40  Medication Errors: Preventing and Responding Adverse Drug Event General term Encompasses all types of clinical problems resulting from medication us Medication errors Adverse drug reactions (ADRs) Allergic reaction Idiosyncratic reaction Medication Errors Preventable Common cause of adverse health care outcomes Drugs commonly involved in severe medication errors: central nervous system drugs anticoagulants, chemotherapeutic drugs  Medication Errors More potential for harm with “high-alert” medications SALAD (sound-alike, look-alike drugs) LASA (look-alike, sound-alike) TALLman lettering cycloSPORIN vinRIStine vinBLAStine  Issues Contributing to Errors Errors can occur during any step of medication process Procuring Prescribing Transcribing Dispensing Administering Monitoring  Issues Contributing to Errors Organizational issues Educational system issues Sociological factors Use of abbreviations Small Group Activity Review the list of error-prone abbreviations, symbols, and dose designations Using the Institute for Safe Medication Practices Canada’s “Do Not Use” list (available at https://www.ismp- canada.org/download/ISMPCanadaListOf DangerousAbbreviations.pdf)  Types of Medication Errors Near miss Did not reach the patient Results in no harm No harm event Reaches patient Results in no harm Medication Error Causes harm Critical Incident Results in serious harm Preventing Medication Errors Multiple systems of checks and balances should be implemented to prevent medication errors. Prescribers must write legible orders that contain correct information, or orders should be entered electronically. Authoritative resources such as pharmacists or current (within the past 3 to 5 years) drug references or literature must be consulted. Preventing Medication Errors Nurses need to always check the medication order three times before giving the drug. Faculty members should not be the student’s research source regarding medications. The rights of medication administration should be used consistently. Case Study During your busy clinical day as a student nurse the staff nurse assigned to your patient comes to you and says, “would you like to give this injection? We have a “now” order for octreotide acetate 200 mcg subcutaneously. I've already drawn it up, 200 mcg equals 2 mL, and it needs to be given as soon as possible so I drew it up to save time” she hands you the syringe that has 2 mL of a clear fluid in it and the patient's medication administration record MAR. Go to page 84 of your textbook and answer the questions to the case study  Preventing Medication Errors Assessment Two patient identifiers Do not administer if you did not draw up or prepare yourself. Minimize verbal or telephone orders. Repeat order to prescriber. Spell drug name aloud. Speak slowly and clearly. List indication next to each order.  Preventing Medication Errors Avoid abbreviations. Never assume anything about items not specified in a drug order (e.g., route). Do not hesitate to question a medication order for any reason when in doubt. Do not try to decipher illegibly written orders; contact the prescriber for clarification.  Preventing Medication Errors Never use a “trailing zero” with medication orders. Do not use 1.0 mg; use 1 mg. 1.0 mg could be misread as 10 mg, resulting in a 10-fold dose increase.  Preventing Medication Errors Always use a “leading zero” for decimal dosages. Do not use.25 mg; use 0.25 mg..25 mg may be misread as 25 mg.  Preventing Medication Errors Take time to learn special administration techniques of certain dosage forms. Always verify new medication administration records.  Preventing Medication Errors Always listen to and honour any concerns expressed by patients regarding medications. Check patient allergies and identification. Audience Response System Question The nurse is administering a drug that has been ordered as follows: “Give 10 mg on odd- numbered days and 5 mg on even-numbered days.” When the date changes from May 31 to June 1, what should the nurse do? A. Give 10 mg because June 1 is an odd-numbered day. B. Hold the dose until the next odd-numbered day. C. Change the order to read: “Give 10 mg on even-numbered days and 5 mg on odd- numbered days.” D. Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd or even numbered Audience Response System Question The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient’s blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first? A. Notify the patient’s physician. B. Notify the clinical faculty or preceptor. C. Take the patient’s blood pressure. D. Continue to monitor the patient.