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  • 1. Calculate with Confidence 5 thedition Gray Morris Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Medication Administration Unit Three: Chapter 10 Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. 3. Medication Administration: Objectives

  • After reviewing this chapter, you should be able to:
    • State the consequences of medication errors
    • Identify the causes of medication errors
    • Identify the role of the nurse in preventing medication errors
    • Identify the role of the Institute for Safe Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors

4. Medication Administration: Objectives(cont)

  • State the six rights of safe medication administration
  • Identify factors that influence medication dosages
  • Identify the common routes for medication administration
  • Definecritical thinking
  • Explain the importance of critical thinking in medication administration

5. Medication Administration: Objectives(cont)

  • Identify important critical thinking skills necessary in medication administration
  • Discuss the importance of client teaching
  • Identify special considerations relating to the elderly and medication administration
  • Identify home care considerations in relation to medication administration

6. Medication Errors

  • Meds administered incorrectly can be harmful or fatal
  • Result in emotional and legal consequences for the nurse
  • Most common cause of client injury despite advances in technology
    • 44,000 to 98,000 deaths per year estimated
    • 540,000 med errors with children per year

7. Medication Errors(cont)

  • Causes for errors
    • Cohen, M. (2007).Medication Errors,2 ed.
    • Failure to identify client and miscommunication
    • Lack of information about patient allergies, meds
    • Lack of information about the drug
    • Communication and teamwork failures
    • Unclear, absent, or look-alike and sound-alike meds
    • Unsafe standardization, storage, distribution, and devices
    • Calculation errors and failure to adhere to rights

8. Critical Thinking andMedication Administration

  • Definition: A process of thinking that includes being reasonable and rational
    • Organizational skills
    • Autonomy: Willingness to challenge wrong orders and get clarification
    • Reasoning: selection of right tools and client assessment
  • Nurse administering med is legally liable regardless of MOST causes of error

9. Factors InfluencingMedication Dose & Action

  • All must be considered
    • Route of administration
    • Time of administration
    • Age of client
    • Nutritional status of client
    • Absorption and excretion of the drug
    • Health status of the client
    • Sex of the client
    • Ethnicity and culture of the client
    • Genetics

10. Special Considerations for Elderly

  • Two thirds use Rx and OTC meds
  • Most scripts are for older adults
  • Number in population will double by 2030
  • Physiologic changes slow function
    • Changes in circulation, absorption, metabolism, excretion, and stress response
    • Lowered body mass, change in mental status

11. Special Considerations for Elderly (contd)

  • Require lower doses as a rule
  • May need
    • Special delivery devices
    • Visual aid to read labels
    • Easy-open lids
  • Allow extra time for teaching
  • Polypharmacy and Beers criteria

12. Six Rights of Medication Administration

  • Right Medication
    • Compare medication administration record (MAR) with order
  • Right Dose
    • Check calculations and labels
  • Right Client
    • Two unique identifiers
    • NOT room number

13. Six Rights of Medication Administration (contd)

  • Right Route
    • Check orders and drug guides
    • Special considerations with feeding tubes
  • Right Time
    • Time of day and frequency
  • Right Documentation
    • Accuracyno documentation leads to double-dosing
    • Avoid Do Not Use abbreviations
    • Outcomes of medications

14. Figure 10-1 A, Example of a container that holds a days medications, stored by hour of administration. B, Container that holds a weeks medications. C, The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A From Ogden SG:Calculation of drug dosages,ed. 8, St. Louis, 2007, Mosby; B From Elkin MK, Perry AG, Potter PA:Nursing interventions and clinical skills,ed. 4, St. Louis, 2008, Mosby.) 15. Other Rights

  • Right to refuse
    • Document and notify caregiver
  • Kendras Law
    • Potentially dangerous mentally ill
    • Court-ordered assisted outpatient treatment (AOT)
  • Emergency Court Orders
    • May give forcibly
    • Requires Judges order

16. Other Rights (contd)

  • Right to education about medication being given
  • Right to understand interactions with herbals
  • Right to medication reconciliation across continuum of care

17. Teaching Clients About Meds

  • Imperative for preventing errors
  • Helps prevent adverse reactions
  • Improves adherence
  • Include the following:
    • Brand and generic names, explanation of amount, explanation of timing for dose, measuring devices, and route
  • Follow up on teaching

18. Home Care Considerations

  • Home health care is increasing with increased population and early discharges
  • Special considerations for home setting
  • Practice requires more autonomy
  • Teaching focuses on devices from local pharmacies and calibrated home devices
  • Communication is critical!

19. Routes of Administration

  • Oral (p.o.)
  • Sublingual (SL)
  • Buccal
  • Parenteral
    • (IV, IM, Subcut, ID)
  • Insertionin cavities
  • Instillationbody cavity, eyes, ears, nose

20. Routes of Administration (contd)

  • Inhalationmetered-dose inhalers, nebulizers, spacers
  • Intranasal
  • Topicallotions, ointments, pastes
  • Percutaneouson skin, on mucous membranes
  • Transdermalpatches

21. Equipment for Med Administration

  • Medicine cup (30 mL/1 oz)
  • Souffl cup
  • Calibrated dropperuse only supplied dropper
  • Nippleadapted for some infant meds

22. Figure 10-2 Medicine cup. (Modified from Brown M, Mulholland JL:Drug calculations: process and problems for clinical practice,ed. 8, St. Louis, 2008, Mosby.) Figure 10-3 A, Plastic medicine cup. B, Souffl cup. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD:Basic pharmacology for nurses,ed. 14, St. Louis, 2007, Mosby.) Figure 10-4 Medicine dropper. (Modified from Clayton BD, Stock YN Harroun RD: Basic pharmacology for nurses,ed. 14, St. Louis, 2007, Mosby.) 23. Figure 10-5 Nipple. (From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses,ed. 14, St. Louis, 2007, Mosby.) Figure 10-6 Oral syringes. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD:Basic pharmacology for nurses,ed. 14, St. Louis, 2007, Mosby.) Figure 10-7 Parts of a syringe. (From Potter PA, Perry AG: Fundamentals of nursing,ed. 7, St. Louis, 2009, Mosby.) 24. Figure 10-8 Types of syringes. A, Luer-Lok syringe marked in 0.1 mL (tenths). B, Tuberculin syringe marked in 0.01 mL (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked in units (100). D, Insulin syringe marked in units (50). (From Potter PA, Perry AG:Fundamen

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