Introductory Pharmacology PN 1: Medication Administration

Ann MacLeod, RN, BScN, MPH

Objectives

State the six rights of medication administration

Identify factors that influence medication doses

Identify common routes for medication administration

Identify common errors in medication administration

Common errors

Drug ordered incorrectly

Math calculations, thus improper dose

Incorrect reading of labels

Lack of knowledge of the medication being given

improper abbreviations

improper patient

failure to comply with administration policies

Understanding the Rx or Prescription

never give a medication you don't know about- look in CPS, we are expected to know about any drug we give, question if we doubt & refuse to give if we disagree

never give without an Rx

meds pt. on at home are not to be given without an order (send meds home or lock in cupboard)

Checking the Order: TRANSCRIBING

once an order is written it goes thru a process so we can give it safely

this is done by nurse (often 2) or ward clerk or pharmacy, may be a practical nurse

doctor’s order transcribed so med can be safely administered. Med order will be copied onto med record (MAR or Med card)& kardex so nurse can check med before giving. If you can’t read Rx, call MD

each facility has a process that must be followed.

Checking the Order

NAME: full name to avoid errors, pt.id #

DATE OF ORDER: may tell you when to stop drug

NAME OF DRUG: generic / trade name

DOSE: exact strength

ROUTE: how to give

TIME/ FREQUENCY : BID, od

SIGNATURE: MD, NP or midwife

Med Administration Records

MAR SHEETS (medication admin record)-med order transcribed (hand written or computerized print out) for each patient or each hour so nurse knows what meds to give

nurse signs on these sheets after giving med (some sign before but it is not best)

the recording of med administration is a legal document it keeps the team informed about what meds the pt. has had

Med Cards

MED CARDS (rarely used now) one card filled out for each pt. & med, med signed for on med sheet using cards. This med sheet is a MAR.

Electronic Patient Medical records

Electronic Medical Files

Check that medication has been given

Usually combined with prepackaged single dose delivery system

Computer flags when a dose returns to pharmacy.. Was it given?

Reduces medication errors

Practice Setting

The Administration Process-The 3 Checks

check when taking out

 when pouring

 when putting away

Administration Process The 6 rights

patient

drug

amount

time

route

documentation

E.THE SIX RIGHTS

RIGHT PATIENT- always  arm band or photo on MAR sheet, ask their name

RIGHT DRUG-check MAR sheet or kardex, do 3 checks

RIGHT DOSE (amount)- based on wt., tolerance, condition. never guess, you may have to calculate

RIGHT TIME- standard times in some places, p.o. meds while awake, I.V. meds round the clock. 30 minute rule, not with all meds

6 RIGHTS Cont’d

RIGHT ROUTE- can't change this, may be given a choice, if pt. can't tolerate contact MD

RIGHT DOCUMENTATION- chart where we should

Routes

PO - orally

Parenteral

IV - intravenous

SC - subcutaneous

IM - intramuscular

Instillation - drops gtt

Insertion - supp

Topical - percutaneous ung - transdermal

Inhalation

PREPARING THE MEDS

Meds are prepared in med room or at the pt. bedside with the cart, meds should be locked when not using , some kept in fridge

STEP 1- check MAR or med ticket with MD Rx or kardex

STEP 2- ensure order is complete & you understand it

STEP 3- prepare med (3 checks)

PREPARING THE MEDS cont’d

STEP 4- identify pt. & prepare to give (some pts. want more teaching info than others)

STEP 5- record : name, route, admin time, dose, signature, status

STEP 6- assess for adverse effects, check within hr. & record if req’d

Identifying the pt.

always compare armband with MAR sheet or med card (don’t assume you have the right pt.)

if no arm band check photo id, ask another nurse to verify or ask pt. to state their name

G. DOCUMENTATION

the medication record is a legal document –nurse name & status signed for each med given : drug, dosage, route,time, signature

the record keeps team informed

chart as soon as you give

prn's, stats may be charted in 2 places

response to med must be charted somewhere