Introductory Pharmacology PN 1: Medication Administration
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