chapter 35: medication administration

44
Chapter 35: Chapter 35: Medication Medication Administration Administration Bonnie M. Wivell, MS, RN, Bonnie M. Wivell, MS, RN, CNS CNS

Upload: doria

Post on 12-Jan-2016

172 views

Category:

Documents


4 download

DESCRIPTION

Chapter 35: Medication Administration. Bonnie M. Wivell, MS, RN, CNS. Introduction. Medication is a substance used in the Diagnosis Treatment Cure Relief Prevention of health alterations The nurse is responsible for the following in regard to medications: Preparation Administration - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Chapter 35: Medication Administration

Chapter 35: Medication Chapter 35: Medication AdministrationAdministration

Bonnie M. Wivell, MS, RN, CNSBonnie M. Wivell, MS, RN, CNS

Page 2: Chapter 35: Medication Administration

IntroductionIntroduction• Medication is a substance used in the

– Diagnosis– Treatment– Cure– Relief– Prevention of health alterations

• The nurse is responsible for the following in regard to medications:– Preparation– Administration– Teaching– Evaluating response

Page 3: Chapter 35: Medication Administration

Medication Legislation and Medication Legislation and StandardsStandards

• The role of the U.S. government in regulation of the pharmaceutical industry is to protect the health of the people by ensuring that medications are safe and effective.

• First law was passed in 1906– Pure Food and Drug Act: requires all meds to be free

of impure products• Other federal medication laws

– Control medication sales and distribution– Medical testing– Naming and labeling– Regulate controlled substances

Page 4: Chapter 35: Medication Administration

Medication Legislation and Medication Legislation and Standards Cont’d.Standards Cont’d.

• FDA = enforces laws, and ensures all meds on the market undergo vigorous testing before being sold to the public

• MedWatch program = initiated in 1993 by FDA; a voluntary program that encourages nurses and other health care professions to report when a medication, product, or medical event causes serious harm to a client

• State laws control substances not regulated by the federal government.

• Local government regulates the use of alcohol and tobacco

Page 5: Chapter 35: Medication Administration

Medication Legislation and Medication Legislation and Standards Cont’d.Standards Cont’d.

• An institution is concerned primarily with preventing poor health outcomes resulting from medication use

• Medication Regulations and Nursing Practice are governed by individual state Nurse Practice Acts (NPAs)

• NPAs have the most influence over nursing practice by defining the scope of a nurse’s professional functions and responsibilities

• NPAs are broad in scope and nature so as not to limit the nurse’s functional ability

• Health care agencies interpret the NPAs

Page 6: Chapter 35: Medication Administration

Controlled SubstancesControlled Substances

• Controlled substances (AKA narcotics) are carefully controlled through federal and state guidelines.

• Violation of the Controlled Substances Act is punishable by fines, imprisonment, and loss of nurse licensure.

• See Box 35-1

Page 7: Chapter 35: Medication Administration

Patient SafetyPatient Safety

• Patient Safety• To err is Human

7

Page 8: Chapter 35: Medication Administration

Clinical Effectiveness of Safe Practices

Intervention Results

Physician computer order entry 81% reduction of medication errors

Pharmacist rounding with team 66% reduction of preventable adverse drug events; 78% reduction of preventable adverse drug events

Rapid response teams Cardiac arrests decreased by 15%

Team training in labor and delivery 50% reduction in adverse outcomes in preterm deliveries

Reconciling medication practices upon hospital discharge

90% reduction in medication errors

Ventilator bundle protocol Ventilator-associated pneumonias

decreased by 62%

Page 9: Chapter 35: Medication Administration

Pharmacological ConceptsPharmacological Concepts• Drug Names

– Generic: becomes the official name listed in publications and is the name generally used throughout the drug’s use

– Chemical: chemicals that make up drug– Brand/Trade: the name under which a manufacturer

markets a med; usually short and easy to remember• Many companies produce the same med so

similarities in trade names are often confusing

• Example: – Brand: Hydrochlorothiazide– Trade: Esidrix and HydroDiuril

Page 10: Chapter 35: Medication Administration

Pharmacological Concepts Cont’d.Pharmacological Concepts Cont’d.• Classification

– The effect of the medication on a body system– The symptoms the medication relieves– The medication’s desired effect– Some medications are part of more than one class

• Medication Forms– The form of the medication determines its route of

administration– The composition of a medication enhances its

absorption and metabolism– Many meds come in several forms: Tablets,

Capsules, Elixirs, Suppositories

Page 11: Chapter 35: Medication Administration

PharmacokineticsPharmacokinetics• Pharmacokinetics = the study of how

meds enter the body, reach their site of action, metabolize, and exit the body

• Absorption = passage of med into blood– Route of administration– Ability of med to dissolve– Blood flow to site of administration– BSA– Lipid solubility of a med

Page 12: Chapter 35: Medication Administration

DistributionDistribution• After absorption, distribution occurs within the body

to tissues, organs, and to specific sites of action via blood stream.

• Distribution depends on:– Circulation: limited blood flow can inhibit distribution– Membrane permeability

• Blood brain barrier and Placenta

– Protein Binding: most meds bind to albumin to some extent

• Meds bound to proteins can’t do what they are supposed to• “Free” or unbound medication is the active form of the med• Decreased albumin due to disease process → more active

medication → med toxicity

Page 13: Chapter 35: Medication Administration

MetabolismMetabolism

• Medications are metabolized into a less potent or an inactive form.

• Biotransformation occurs under the influence of enzymes that detoxify, degrade, and remove active chemicals.

• Most biotransformation occurs in the liver

• Other sites for metabolism: lungs, kidneys, blood, intestines

Page 14: Chapter 35: Medication Administration

ExcretionExcretion

• Medications are excreted through: –Kidney–Liver–Bowel–Lungs–Exocrine glands

Page 15: Chapter 35: Medication Administration

Types of Medication ActionTypes of Medication Action

Therapeutic effect:Therapeutic effect:Expected or predictableExpected or predictable

Side effect:Side effect:Predictable and often Predictable and often unavoidableunavoidable

Adverse effect:Adverse effect:Unintended, undesirable, Unintended, undesirable, and often unpredictable and often unpredictable severe responsesevere response

Toxic effect:Toxic effect:Medication Medication accumulates in the accumulates in the blood streamblood stream

Idiosyncratic reaction:Idiosyncratic reaction:Over- or under-reaction to Over- or under-reaction to a medicationa medication

Allergic reaction:Allergic reaction:Unpredictable response Unpredictable response to a medicationto a medication

Page 16: Chapter 35: Medication Administration

Medication InteractionsMedication Interactions• Occur when one medication modifies the

action of another

• A synergistic effect occurs when the combined effect of two medications is greater than the effect of the medications given separately.– Can be beneficial: Tylenol and Codeine

– ETOH and antihistimines, antidepressants, or narcotics (all CNS depressants)

– HTN may be treated with diuretic and vasodilator

Page 17: Chapter 35: Medication Administration

Medication Dose ResponsesMedication Dose ResponsesSerum half-life:Serum half-life:Time for serum medication Time for serum medication concentration to be halvedconcentration to be halved

Onset:Onset:Time it takes for a Time it takes for a medication to produce a medication to produce a responseresponse

Peak:Peak:Time at which a medication Time at which a medication reaches its highest effective reaches its highest effective concentrationconcentration

Trough:Trough:Time at which drug is at its Time at which drug is at its lowest amount in the serumlowest amount in the serum

Duration:Duration:Time medication takes to Time medication takes to produce a responseproduce a response

Plateau:Plateau:Blood serum concentration is Blood serum concentration is reached and maintainedreached and maintained

Page 18: Chapter 35: Medication Administration

Routes of AdministrationRoutes of Administration

OralOralSwallow, Sublingual, BuccalSwallow, Sublingual, Buccal

ParenteralParenteralID, Sub-Q, IM, IVID, Sub-Q, IM, IV

OtherOtherEpidural, Intrathecal, Epidural, Intrathecal, Intraosseous, Intraosseous, Intraperitoneal, Intrapleural, Intraperitoneal, Intrapleural, IntraarterialIntraarterial

TopicalTopicalSkinSkin

Transdermal patchTransdermal patch

Instillation or irrigationInstillation or irrigation

InhalationInhalationNasal passages, oral Nasal passages, oral passage, ET or trachpassage, ET or trach

IntraocularIntraocularInsertion of disk containing Insertion of disk containing med; dropsmed; drops

Page 19: Chapter 35: Medication Administration
Page 20: Chapter 35: Medication Administration
Page 21: Chapter 35: Medication Administration
Page 22: Chapter 35: Medication Administration
Page 23: Chapter 35: Medication Administration
Page 24: Chapter 35: Medication Administration

Effects of Nutrition on DrugsEffects of Nutrition on DrugsGrapefruit Can cause toxicity when taken

with cisapride, carbamazepine, diazepam, verapamil, amiodarone, lovastatin

Vitamin K Decrease effectiveness of warfarin

Tyramine (found in cheese, beer, dried sausage, sauerkraut)

In combination with MAOI meds (Nardil, Parnate, Marplan) creates increase in epinephrine HA, ↑ P, ↑ BP death

Milk Interferes with absorption of tetracycline antibiotics

Page 25: Chapter 35: Medication Administration

Systems of Medication Systems of Medication MeasurementMeasurement

• Requires the ability to compute medication doses accurately and correctly

• Metric system: organized in units of 10

• Apothecaries: older than metric

• Household system: least accurate

• Solution

Page 26: Chapter 35: Medication Administration

Nursing Knowledge BaseNursing Knowledge Base• Safe administration is imperative

• Nursing process provides a framework for medication administration

• Clinical calculations must be handled without error– Conversions in and between systems

– Dose calculations

– Pediatric and elderly calculations

– ALWAYS double-check calculation and medication with a second nurse on high alert meds (insulin, heparin)

Page 27: Chapter 35: Medication Administration

Prescriber’s Role Prescriber’s Role • Prescriber can be physician, nurse practitioner,

or physician’s assistant.• Prescribers must document the diagnosis,

condition, or need for each medication.• Orders can be written, computer generated,

verbal, or by telephone.• DO NOT use abbreviations on pages 701-703

when documenting med orders or other information about meds

Page 28: Chapter 35: Medication Administration

Types of Orders in Acute Care Types of Orders in Acute Care AgenciesAgencies

• Standing or Routine Medication Orders

• PRN Orders: as needed

• Single (one-time) Orders

• STAT Orders: within 15 mins

• Now Orders: up to 90 mins to administer

• Prescriptions: taken outside the hospital

Page 29: Chapter 35: Medication Administration

Communication of Medication OrderCommunication of Medication Order

• Order is written on client’s chart– By provider or RN receiving TO or VO

• Order copied to Medication Administration Record (MAR)

• MAR contains: name, room, bed, drug name, dose, route, times, allergies

• Video

Page 30: Chapter 35: Medication Administration

Components of Medication OrdersComponents of Medication Orders

• Client’s full name• Date and time that the order is written• Medication name• Dose• Route• Time and frequency of administration• PRN orders must have a reason• Signature

Page 31: Chapter 35: Medication Administration

31

Page 32: Chapter 35: Medication Administration

Medication AdministrationMedication Administration• Pharmacist’s role

• Distribution system

• Medication errors (near miss)

• Medication Reconciliation– Verify– Clarify– Reconcile– Transmit

• Nurse’s role

32

Page 33: Chapter 35: Medication Administration

The Six Rights of Medication The Six Rights of Medication AdministrationAdministration

• Right medication

• Right dose

• Right patient

• Right route

• Right time

• Right documentation

• Right to refuse

Page 34: Chapter 35: Medication Administration

Where Do Drugs Come From in the Where Do Drugs Come From in the Hospital?Hospital?

• Pyxis/Omnicell– Machine on the nursing unit where a stock supply of

meds are stored• Commonly used meds• Narcotics

• Packaged in the pharmacy and delivered to the nursing unit

• Unit dose system: drugs are packaged individually• Liquids can be unit dose or bottles

– Medication in bottles will be measured in Milliliters, teaspoons, ounces, etc.

Page 35: Chapter 35: Medication Administration
Page 36: Chapter 35: Medication Administration

Potential Medication ErrorPotential Medication Error

Page 37: Chapter 35: Medication Administration

Critical ThinkingCritical Thinking

• Knowledge: understand why you are giving a med; if you don’t know, look it up

• Experience: skills become more refined

• Attitudes: take adequate time to prepare and administer

• Standards: ensure safe practice– 6 Rights

Page 38: Chapter 35: Medication Administration

The Nursing Process and Med The Nursing Process and Med AdministrationAdministration

• Assessment– Medical history– Allergies– Medication data– Diet history– Client’s perceptual or coordination problems– Client’s current condition– Client’s attitude about medication use– Client’s knowledge and understanding of medication

therapy– Client’s learning needs

Page 39: Chapter 35: Medication Administration

Nursing DiagnosisNursing Diagnosis• Anxiety• Ineffective health maintenance• Health-seeking behaviors• Deficient knowledge (medications)• Noncompliance (medications)• Disturbed visual sensory perception• Impaired swallowing• Effective therapeutic regimen management• Ineffective therapeutic regimen management

Page 40: Chapter 35: Medication Administration

PlanningPlanning

• Minimize distractions or interruptions when preparing and administering meds

• This will limit errors

• Prioritize care when administering meds

• Collaboration– Prescriber– Pharmacist– Case manager/social worker

Page 41: Chapter 35: Medication Administration

ImplementationImplementation• Health promotion

– Client and family teaching• Acute care

– Receiving med orders (write it down and read it back)– Correct transcription and communication of orders– Accurate dose calculation and measurement– Correct administration– Recording med administration

• NEVER chart a med before administering it

• Restorative care: med administration varies across care settings

Page 42: Chapter 35: Medication Administration

Special ConsiderationsSpecial Considerations• Infants and children

– Vary in age, weight, surface area and the ability to absorb, metabolize, and excrete meds

– Lower doses; special calculations– Alternative forms, such as liquids or elixirs

Psychological prep

• Older adults– Simplify– Assess swallowing– Some have greater sensitivity

• Polypharmacy

Page 43: Chapter 35: Medication Administration

EvaluationEvaluation• You must monitor a client’s response to

meds on an on-going basis• The goal of safe and effective med

administration involves the client’s response to therapy and ability to assume responsibility for self-care

• You will evaluate the effectiveness of nursing interventions when you assess whether the client has met goals/outcomes

Page 44: Chapter 35: Medication Administration

• Will cover actual administration and other issues surrounding administration during tomorrow’s class

• QUESTIONS?