Medication Admin Prep Sheet DEMO PDF

Medication Administration Prep Sheet THIS IS A WORKSHEET TO ASSIST WITH MEDICATION ADMINISRTRATION DEMO Medication administration is one of the most important and dangerous areas of practices nurses participate in. Medication Reconciliation Depending on the policy most institutions will have nur...

Medication Administration Prep Sheet THIS IS A WORKSHEET TO ASSIST WITH MEDICATION ADMINISRTRATION DEMO Medication administration is one of the most important and dangerous areas of practices nurses participate in. Medication Reconciliation Depending on the policy most institutions will have nurses check the original orders daily. This generally occurs on a designated shift. At DSON our policy states that we MUST check the original order prior to administration of any medication. Thus when checking the original order one must go to the original order and check against the Medication Reconciliation Record (MAR). It may be: Paper to computer; Paper to paper or Computer to computer. What do you check? (Eleven Rights) 1. Right patient 2. Right Medication 3. Right Dose 4. Right Route 5. Right Time 6. Right Documentation 7. Right Reason 8. Right Response 9. Right Education 10. Right to Refuse 11. Right Assessment This needs to be done in this order for each and every medication. Once the original order is checked then the original can be put away. Would if you find an error when checking? What would you do? - Stop Administration Process - Verify the Error - Identify the Type of Error - Notify the Prescriber Inform the Pharmacy - Document the Error - Monitor the Patient - Follow Institutional Policy  - Communicate with the Patient What is the nurse’s responsibility prior to giving any medication? - Verify the Medication Order - Perform the Eleven Rights Check - Assess the Patient - Prepare the Medication Safety - Educate the patient - confirm patient consent What medications are time Limited? AND what does that mean? - Ex. Antibiotics, Opioids, Corticosteroids, Anticoagulants, Sedatives and Hypnotics; Time-limited medications are prescriptions that have a specific duration for use, typically defined in the order by the prescriber. These medications are only administered for a set period, after which the order must be reviewed, renewed, or discontinued What are Adverse Reactions? - Adverse reactions are unintended, harmful, or unpleasant effects that occur after the administration of a medication or treatment at normal doses. These reactions can range from mild to severe and may require medical intervention, adjustment of the medication, or discontinuation. What is the DEA schedule? - Classification system for controlled substances I. Schedule I (CI) à High potential for abuse; no accepted medical use in the U.S.; lack of accepted safety for use under medical supervision. II. Schedule I (CI)à High potential for abuse; no accepted medical use in the U.S.; lack of accepted safety for use under medical supervision. III. Schedule I (CI)à High potential for abuse; no accepted medical use in the U.S.; lack of accepted safety for use under medical supervision. IV. Schedule I (CI)à High potential for abuse; no accepted medical use in the U.S.; lack of accepted safety for use under medical supervision. V. Schedule I (CI)à High potential for abuse; no accepted medical use in the U.S.; lack of accepted safety for use under medical supervision. What are the pregnancy categories and what do they mean?  - classify medications based on their potential risks to the fetus when taken during pregnancy A. Category A Controlled studies in pregnant women show no risk to the fetus in any trimester. B. Category B Animal studies show no risk, but there are no well-controlled studies in pregnant women, or animal studies show risk that hasn’t been confirmed in humans C. Category C Animal studies show adverse effects, and there are no adequate human studies, but potential benefits may justify the risk D. Category D There is positive evidence of human fetal risk, but potential benefits may outweigh the risks in serious or life-threatening situations. E. Category X Studies in animals or humans show fetal abnormalities, or evidence of fetal risk, and the risks clearly outweigh any potential benefits. What type of medications CAN NOT be Crushed or cut? - Enteric Coated, Extended-Release (ER, XR, XL) / Sustained-Release (SR) / Controlled-Release (CR) Medications, Modified-Release (MR) or Delayed-Release (DR) Medications, sublingual (SL) or Buccal Medications, Film-Coated Tablets, Hazardous Medications, Medications with Special Coatings for Taste or Stability What is your first step for prepping medications? - Verify What is a red zone? - designated period or physical area where healthcare professionals focus solely on medication preparation and administration to minimize distractions and reduce the risk of errors. Administration of PO medication How many times do you check the medication prior to leaving the medication room? - 3 times: before you leave the room, when leaving and before administering What do you need to observe on the packaging? - Expiration date, lot number, medication name, dosage, Route of adimistration, special instructions When do you open the package?  - At time of administration, and before leaving the medication room What do you do if it falls on the floor? - Do not administer, dispose of it properly, document the incident When administering the PO medication what position should the patient be in? - sitting upright (at least at a 45 to 90-degree angle) What do you need to make sure the patient does? - Ensure that the patient actually swallows the medication, not just holds it in their mouth If the patient does not want to take the medication or is in the bathroom can you leave it on the bedside table? - NO you cannot If you need to waste a medication what is the proper procedure? - Controlled Substances: If you need to waste a controlled substance (e.g., opioids), the procedure is more stringent. - Two Nurses: A second nurse, who is authorized to handle controlled substances, should observe and verify the waste. - Documentation: Both nurses must document the amount of medication wasted, the reason for wasting it, and the identity of the nurses involved. - Proper Disposal: Dispose of the medication in a safe and secure manner as per institutional policy (usually in a designated medication disposal container). - Non-Controlled Medications: For non-controlled medications, document the wasted medication and follow institutional guidelines for disposal. SQ Administration: What does it mean to give a SQ injection? - SQ Injection refers to the administration of medication into the subcutaneous tissue, which is the layer of fat and connective tissue just below the skin. Medications given via this route are typically absorbed slowly and are used for insulin, anticoagulants, and certain vaccines What is the maximum amount of ml can you administer SQ? - Upper arm (back of the upper arm, outer aspect) - Abdomen (at least 2 inches away from the navel) - Thigh (outer aspect) - Upper buttocks (optional, less commonly used) Where can you administer a SQ injection? - Typically, the maximum volume for a subcutaneous injection is 1 mL. If larger volumes are needed, it is usually given in divided doses or at different sites. What is the gauge of the needle? - The needle gauge for subcutaneous injections is generally between 25 and 31 gauge. The smaller the number, the larger the diameter of the needle. - Insulin needles: Often 28-31 gauge. - Other medications: 25-27 gauge. What is the length of the needle? - The needle for a subcutaneous injection typically ranges from 3/8 inch to 5/8 inch in length. What are the types of syringes you can choose from? - 1 mL syringe: Often used for insulin - 3 mL syringe: Common for larger doses, but used less frequently for SQ injections as the volume is typically smaller. - Insulin syringes: These have finer markings for smaller volumes and are specifically calibrated for insulin doses (usually 0.3 mL to 1 mL syringes). Should you where gloves when giving a SQ injection? - Yes, gloves should be worn when giving a subcutaneous injection. This helps maintain standard precautions to prevent contamination and reduce the risk of exposure to blood or other potentially infectious materials. What is the correct procedure for SQ administration? - Preparation: - Verify the medication, patient, and dose using the Five Rights. - Wash hands and wear gloves. - Clean the vial or ampule, if needed. - Draw up the correct dose of medication using an appropriate syringe and needle. - Expel any air bubbles from the syringe. - Site Selection: - Choose an appropriate site (e.g., upper arm, abdomen, thigh). - Rotate sites if needed to avoid irritation or tissue damage. - Injection Technique: - Pinch the skin to lift the subcutaneous tissue. - Insert the needle at a 45° to 90° angle, depending on the patient’s body fat. Typically, a 45° angle is used for thinner patients, and 90° is used for patients with more subcutaneous fat.  - Inject the medication slowly and steadily. - After Injection: - Withdraw the needle quickly. - Massage the injection site gently if required (for some medications). - Dispose of the needle and syringe in a sharps container immediately. Where should the needle and syringe go after the injection is give? - Following safe injection practices the nurse knows the rule of ONE Insulin Pens Infection Control: When getting an insulin pen ready should you wear gloves? - Yes Are insulin pens “Patient specific”? - Yes, insulin pens are patient-specific. The pen should not be shared between patients because it can carry the risk of cross-contamination or infection. Can you EVER share insulin pens with other patients if using a different needle? - No, insulin pens should never be shared with other patients, even if a different needle is used. Insulin pens are designed for individual use only, and sharing can lead to infection or inaccurate dosing. What should you do if you accidently puncture yourself with a new needle from an insulin pen? - Immediately wash the area with soap and water. - Report the incident to your supervisor and follow the facility's post-exposure protocols. This may include reporting the injury, completing an incident report, and possibly receiving a blood test or receiving post-exposure prophylaxis (PEP) depending on the situation. Can you just replace the needle and use the insulin pen? Explain - Yes, you can replace the needle and use the insulin pen, as long as you are still using it for the same patient. After replacing the needle, ensure the pen is primed properly before administering the dose. What is the procedure when using an insulin pen? Please include attaching the needle, priming the pen & How long do hold the pen in place? - Attaching the Needle:  - Remove the cap from the insulin pen and the protective cover from the new needle. Attach the needle firmly to the pen. - Priming the Pen: - Dial up 2 units (or as recommended by your facility) to prime the pen. This ensures that the needle is clear of air and ready for injection. - Administration: - Choose an appropriate site (e.g., abdomen or thigh), pinch the skin, and insert the needle at a 90-degree angle. - Press the button to deliver the insulin and hold the pen in place for about 5 to 10 seconds to ensure complete medication delivery. What do you do with the needle and insulin pen after? - Dispose of the needle in a sharps container immediately after use. - The insulin pen should be stored as per the manufacturer’s instructions (typically in a cool, dry place, and with the cap on). Heparin/Anticoagulants Where does Taylor state that these medications should be administered SQ? - Heparin and other anticoagulants are typically administered subcutaneously (SQ) in areas of fatty tissue, such as the abdomen or outer thigh. Always refer to institutional policies for specific sites. Should you aspirate? Explain - No, do not aspirate when administering heparin or other anticoagulants. Aspirating (pulling back the plunger) can cause tissue damage and is generally not necessary for SQ injections, as you are injecting into fatty tissue. Ampules How should you open an ampule? - Break the ampule by snapping the neck. Hold the top of the ampule with a gauze pad or alcohol swab to avoid cutting yourself. Break it away from you to minimize the risk of glass shards. What type of needle should be used to remove the medication? - Use a filter needle when drawing medication from an ampule to avoid drawing up any glass shards. Once the medication is drawn, replace the filter needle with an appropriate needle for injection. What should be done after removing the medication? - Replace the filter needle with an appropriate needle for the route of administration (e.g., SQ or IM). - Check the medication for any air bubbles and remove them. Where should the ampule be discarded? - The ampule should be discarded in a sharps container, as the broken glass poses a risk for injury. IM Injections: What are the landmarks? 1. Vastus lateralis (thigh): Located on the outer aspect of the upper leg. 2. Deltoid (upper arm): Located just below the shoulder. 3. Gluteus medius (buttocks): Located in the upper, outer quadrant of the buttock. 4. Dorsogluteal (buttocks): In the upper outer quadrant of the buttock, but this site should be avoided due to the risk of nerve damage. a. Which landmark should be avoided because of nerve damage and obesity Which Landmark should be avoided because of nerve damage and obesity? - Dorsogluteal site should be avoided because it carries a higher risk of nerve damage, especially in patients who are obese. Which landmark is best for newborns? What is the maximum amount that can be given? Explain - Vastus lateralis is the best site for newborns and infants. The maximum amount that can be safely administered is generally 0.5 mL for infants, depending on the size and specific policies. When using the Deltoid what is the maximum amount that can be given? Should you EVER use the Deltoid for newborns and infants? Explain - The Deltoid site can accommodate a maximum of 1 mL for adults. For newborns and infants, the Deltoid should never be used due to underdeveloped muscle mass in that area. What is the best site for adults? - The Vastus lateralis (thigh) or Gluteus medius (upper outer buttock) is the best site for adults, with the Gluteus medius being preferred for larger volumes or more viscous medications. What is the proper procedure to administer an IM Injection?  - Prepare the Medication: Verify the medication, dosage, and patient. - Select the Site: Choose an appropriate site (e.g., vastus lateralis, deltoid, or gluteus medius). - Clean the Site: Use an alcohol swab to clean the injection site. - Insert the Needle: Insert the needle at a 90-degree angle to the skin. Ensure the needle is long enough for deep muscle tissue (usually 1 to 1.5 inches). - Aspirate (for some medications): For some injections, you may aspirate to check for blood return, though this is not required for all injections. - Inject the Medication: Inject the medication slowly. - Withdraw the Needle: Withdraw the needle quickly and apply gentle pressure. - Dispose of Needle: Immediately dispose of the needle and syringe in a sharps container. What is a Z-Track? When would you use it? Explain. - is a technique used to ensure the medication does not leak back out of the injection site, particularly for irritating medications (e.g., iron injections). What do you do with the needle and syringe after administration? - Dispose of the needle and syringe immediately in a sharps container. Never recap needles. Here are detailed notes about medication administration from the provided sources: Medication Errors and Patient Safety Adverse drug effects are a serious issue, leading to a million emergency department visits and hospitalizations annually. A majority of American adults (82%) take at least one medication, and a significant percentage (29%) take five or more. This, along with an aging population and increasing chronic illnesses, raises concerns about medication safety and age-related drug responses. Common causes of medication errors include issues at various stages, such as transcription, prescribing, and documentation. Failure to adhere to medication rights, the use of trailing zeros, omitting leading zeros before decimals, confusing drug names, inappropriate abbreviations, and distractions like poor lighting and interruptions also contribute to these errors. Safe Medication Administration Practices Safe medication administration involves understanding various aspects of a drug, including its generic and trade names, DEA schedule, pregnancy/lactation category, dosage safety, mechanism of action, side effects, excretion route, interactions with other medications, and relevant nursing considerations such as lab values.  Nurses have a legal responsibility for the medications they administer and are accountable for following safe drug administration standards. If a nurse suspects an error, they must question the order. Nurses need to be familiar with the policies and procedures for safe medication handling and administration at their facility. Medications can only be given with a prescription from a licensed practitioner. Nurses should only follow written, typed, or electronic orders. Verbal orders are only acceptable in emergencies and should be given to a registered nurse or pharmacist, never a student nurse. Verbal orders have legal implications, and nurses must adhere to their institution's policy for them. Medication reconciliation is essential to ensure an accurate and up-to-date list of a patient's medications. The "Three Checks" and the "Eleven Rights" of medication administration are crucial for patient safety. Three Checks The medication label should be checked three times: ○ When reaching for the medication ○ After retrieving it and comparing it with the medication administration record (MAR) ○ Before giving it to the patient Eleven Rights of Medication Administration Right Patient: Use the patient's full name, ask them to state their name and birth date, compare this information with their ID bracelet and the MAR, verify allergies and their specific reactions, and be aware of potential order entry errors. Right Medication: Triple-check the medication label, know the brand and generic names, be aware of similar-sounding names, familiarize yourself with the medication, never administer medication prepared by someone else, and never give unlabeled or tampered medication. Right Dose: Check the medication concentration, compare the dose with the order, triple-check calculations, and ensure the dosage is within a safe and therapeutic range for the patient. Right Route: Confirm the route with the order, ensure you are using the route specified, and select appropriate administration tools. Right Time: Verify the medication schedule, including the start and stop dates, time of administration, frequency, and last dose given. Adhere to the prescribed time and facility policy. Evaluate the patient within 30 minutes or as per policy. Right Reason: Understand the rationale for the medication, consider the patient's history, and why they are taking it. Re-evaluate the reasons for long-term medication use.  Right Assessment: Assess the patient to ensure the medication is safe and appropriate. Notify the provider immediately if it's not. Document and report if the medication was not given. Right Documentation: Document administration immediately after giving the medication, following facility policy. Document and report any relevant signs and symptoms to the provider. Right Response: Monitor the patient, detect and prevent complications, evaluate health changes, assess lab values, document the patient's response to the medication, and provide patient education. Right to Education: Determine the patient's knowledge level and educate them on dosage, administration times, side effects, and contraindications. Right to Refuse: The patient or their legal representative has the right to refuse medication. Inform them of the consequences, ensure they understand, notify the provider, and document the refusal and their understanding of the consequences. Additional Considerations for Safe Medication Administration Do not administer outdated, expired, or chemically altered medications. Only administer correctly labeled medications. Report all medication errors and near misses. Never conceal an error. Prioritize the patient's immediate care. Use errors to identify system issues and enhance patient safety. Withhold medications if the order is incomplete, unsigned, the patient has abnormal physical findings, any of the 11 rights are missing, the patient refuses, or any questions about the order remain unanswered. Infection control is vital: ○ Wash hands thoroughly ○ Scrub the hub for 15-30 seconds ○ Adhere to the "one needle, one syringe, one patient" rule ○ Use a new sterile needle and syringe for each vial access ○ Avoid using multi-dose vials whenever possible Minimize distractions. Follow facility policy for medication co-signing. Never pre-pour medications. Document immediately after administration. Perform the "Three Checks" and ensure all "Eleven Rights" are met. Always double-check allergies. Never leave medication at the bedside. Elevate the patient's head, confirm they swallowed their medication, consider any oral motor concerns, and ensure proper landmarking for injections. Reconcile medications as needed and per facility policy. Monitor patients for signs of delirium (confusion and disorientation).  Recognize that chronic illness and infection can affect medication metabolism and absorption. Pharmacokinetics Absorption: The drug moves from the site of entry into the bloodstream. Distribution: The drug is transported throughout the body. Metabolism: The drug is broken down into an inactive form. Excretion: The drug is eliminated from the body. Drug Preparations Oral: Capsules, pills, tablets, extended-release formulations, elixirs, suspensions, and syrups. Topical: Liniments, lotions, ointments, suppositories, and transdermal patches. Injectable: Various routes of administration, including subcutaneous, intramuscular, intradermal, intravenous, intraarterial, intracardial, intraperitoneal, and intraspinal. Administering Injections Read the medication label and compare it with the order when removing it from the supply. Calculate the dosage and select the appropriate equipment based on the route of administration, viscosity, quantity, patient size, and type of medication. Prepare the medication from ampules, vials, or prefilled cartridges. Choose the correct syringe (standard, tuberculin, insulin, or Tubex) and needle (considering length and gauge). Recheck the medication label. Withdraw the medication using sterile technique: ○ Draw up the correct amount of air into the syringe ○ Cleanse the vial top ○ Inject air into the vial's airspace ○ Withdraw the medication ○ Remove air bubbles ○ Cap the needle For insulin, follow facility policy for mixing. Clean the medication room, identify the patient, compare their information with the MAR and ID band, inform them about the medication, provide privacy, and position them appropriately. Palpate the injection site for landmarks, rotate sites for repeated injections, and assess for any abnormalities. Apply clean gloves, clean the injection site with an alcohol wipe from the center outward, and let it dry.  Hold the skin taut (for IM) or pinch it (for SC). Insert the needle quickly at the correct angle: ○ 90 degrees for intramuscular injections ○ 45 degrees for subcutaneous injections Stabilize the needle, inject the medication slowly and smoothly, observe the patient's facial expression, and remove the needle quickly using counter-pressure. Dispose of the syringe in the sharps container without recapping the needle. Reposition the patient, wash hands, document the medication, and assess and document the patient's response. Non-Injectable and Non-Oral Medications Topical medications: ○ Apply to the skin, avoiding open cuts ○ Be aware of decreased absorption on hardened skin (soles and palms) and increased absorption on inner limbs and trunk ○ Wear gloves Patches/Transdermal: ○ Remove the old patch before applying a new one ○ Cleanse the skin ○ Monitor for irritation ○ Apply to the recommended site and rotate sites ○ Mark the patch with the date and time if required ○ Wash hands Nasal medications: ○ Use water-soluble medications to prevent pneumonitis ○ Maintain hand hygiene and wear gloves Nose drops: ○ Position the patient supine and tilt their head back ○ Position the dropper above the nostril and direct it toward the midline ○ Administer the drops and have the patient keep their head back for 5 minutes ○ Clean and flush the dropper Nasal sprays: ○ Position the patient upright with their head tilted back slightly ○ Occlude one nostril and insert the tip into the open nostril ○ Instruct the patient to inhale while squeezing the atomizer ○ Repeat for the other nostril ○ Clean the atomizer tip and wash hands Eye drops: ○ Wash hands, wear gloves, and offer tissues ○ Clean the eye, eyelids, and eyelashes ○ Tilt the patient's head back ○ Hold the dropper close to the eye without touching it  ○ Administer the drops into the conjunctival sac ○ Apply gentle pressure to the inner canthus Eye ointments: ○ Wash hands, wear gloves, and clean the eye, eyelids, and eyelashes ○ Tilt the patient's head back and apply downward pressure to expose the lower eyelid ○ Apply the ointment along the conjunctival sac ○ Instruct the patient to close their eyes gently Ear drops: ○ Wash hands and wear gloves ○ Position the patient with the affected ear up ○ Clean any drainage ○ Stabilize the dropper to avoid ear canal damage ○ Pull the ear up and back (for adults) or down and back (for children under 3) ○ Allow the patient to remain in position for 5-10 minutes Respiratory medications: ○ Are rapidly absorbed due to high vascularity ○ Must be water-soluble to prevent pneumonitis Metered-dose inhalers: ○ Wash hands and explain the steps to the patient ○ Assemble the unit and remove the mouthpiece cover ○ Have the patient exhale fully and shake the inhaler ○ Place the mouthpiece in front of or in the patient's mouth ○ Instruct the patient to inhale slowly and deeply while depressing the canister ○ Have the patient hold their breath for 10 seconds or as long as possible, then exhale through pursed lips ○ Wait 5 minutes between puffs or as directed ○ Use sequential inhalers according to the physician's order ○ Rinse the mouthpiece and wash hands Rectal medications: ○ Often used for nausea, vomiting, unconsciousness, or if a medication has a foul odor or taste ○ Use a lubricant and insert past the sphincter ○ Hold the buttocks closed if the patient has poor sphincter control ○ Be aware of potential vagal stimulation ○ Wear gloves Vaginal medications: ○ Usually require an applicator ○ Keep the patient supine ○ Wear gloves Patient Teaching Review medication administration techniques.  Emphasize taking medication as prescribed and for the prescribed duration. Advise against altering dosages without consulting a physician. Caution the patient against sharing medications.