copyright © 2015 cengage learning® chapter 7 safe medication administration
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Copyright © 2015 Cengage Learning® MAR Similarities Large column usually on left-hand side of MAR form contains: –Drug names Both scheduled and as needed (prn) –Drug dosage –Frequency of drug administration (continues) 7-3TRANSCRIPT
Copyright © 2015 Cengage Learning®
Chapter 7
Safe Medication Administration
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Medication Administration Record (MAR)
• Although some differences exist among health-care facilities, most MARs are fairly similar.
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MAR Similarities
• Large column usually on left-hand side of MAR form contains:– Drug names
• Both scheduled and as needed (prn)
– Drug dosage– Frequency of drug administration
(continues)
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MAR Similarities (cont’d)
• Usually three columns designated for documenting medication administration for day, evening, and night shifts
(continues)
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MAR Similarities (cont’d)
• Space for precautions related to administration, such as checking:– Pulse– Blood pressure– Body weight
(continues)
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MAR Similarities (cont’d)
• Column included for initials of person transcribing medication from order sheet to MAR.
• May include “start” and “stop” columns.– Indicate what day and time medication is to be started
and stopped.
(continues)
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MAR Similarities (cont’d)
• Area where all staff initials identified with full name and title
• May be one sheet (front and back) or two sheets to separate scheduled and prn medications
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Six Rights of Medication Administration
• Right drug• Right dosage• Right route• Right time• Right person• Right documentation
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Right Drug
• Check every drug three times:– When drug is located– Just before opening or pouring medication– Immediately prior to administration
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Right Dosage
• Compare to average dosages.• Metric dosages containing decimals are of
particular concern. – Ask yourself if the dosage makes sense.
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Right Route
• Oral• Sublingual
– Under tongue
• Drops– For eye, ear, and nose
• Topical
(continues)
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Right Route (cont’d)
• Transdermal• Inhalation• Creams• Suppositories
(continues)
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Right Route (cont’d)
• Parenteral routes– IV
• Most common
– Intramuscular (IM)– Subcutaneous– Intradermal
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Right Time
• Standard time.• 12:00 am for midnight to 11:59 pm for one
minute before midnight.• Times are duplicated during 24-hour period.
– Only am and pm differentiate.
(continues)
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Right Time (cont’d)
• Military time• 0001 for one minute after midnight to 2359
for one minute before midnight
(continues)
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Right Time (cont’d)
• After one o’clock in the afternoon, 12 hours added to each time until midnight– For example, 1300 = 1:00 pm, 1700 = 5:00 pm,
2200 = 10:00 pm
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Right Person
• Most important nursing intervention.• Check ID band, and read both surname and
first name and birthdate.• Do this every time medication given.
– No exceptions
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Right Documentation
• When medication is administered, must be documented immediately.
• Never record before administered medication.
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Right of Refusal
• Partner with client.• If client questions medication, consider
client correct until proven otherwise.• Client also has right to refuse medication.
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Medication Errors
• Estimated 100,000 people die each year from medication errors.
• Occur during:– Prescribing– Transcribing– Administering
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Joint Commission’s “Do Not Use” List
• U– Write “unit”
• IU– Write “International Unit”
• QD, Q.D., q.d., or qd– Write “daily”
(continues)
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Joint Commission’s “Do Not Use” List (cont’d)
• QOD, Q.O.D., q.o.d., or qod– Write “every other day”
• MS– Write “morphine sulfate”
• MSO4 or MgSO4– Write “magnesium sulfate”
(continues)
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Joint Commission’s “Do Not Use” List (cont’d)
• Omit trailing zero– For example, write X.0 mg as X mg
• Use zero before decimal number– For example, write .X mg as 0.X mg
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Actions When Medication Errors Occur
• Report as soon as discovered.• Institute necessary remedial measures
immediately.• Determine reason for error.• Prepare incident/accident report.• Institute corrective policies/procedures to
prevent recurrence, if possible.
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Medication Errors
• The major factors in nursing medication administration errors are distraction and Fatigue.• Personnel are held legally responsible if
wrong drug or dosage given regardless of source of error.
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