Calculate with Confidence5th edition

Gray Morris

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Medication Administration

Unit Three: Chapter 10

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Medication Administration: Objectives

After reviewing this chapter, you should be able to:

1. State the consequences of medication errors2. Identify the causes of medication errors3. Identify the role of the nurse in preventing

medication errors4. Identify the role of the Institute for Safe

Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors

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Medication Administration: Objectives (cont)

5. State the six “rights” of safe medication administration

6. Identify factors that influence medication dosages

7. Identify the common routes for medication administration

8. Define critical thinking9. Explain the importance of critical thinking

in medication administration

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Medication Administration: Objectives (cont)

10. Identify important critical thinking skills necessary in medication administration

11. Discuss the importance of client teaching

12. Identify special considerations relating to the elderly and medication administration

13. Identify home care considerations in relation to medication administration

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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 technology44,000 to 98,000 deaths per year estimated540,000 med errors with children per year

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Medication Errors (cont)

Causes for errorsCohen, M. (2007). Medication Errors, 2 ed.

Failure to identify client and miscommunicationLack of information about patient – allergies, medsLack of information about the drugCommunication and teamwork failuresUnclear, absent, or look-alike and sound-alike

medsUnsafe standardization, storage, distribution, and

devicesCalculation errors and failure to adhere to “rights”

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Critical Thinking and Medication Administration

Definition: A process of thinking that includes being reasonable and rationalOrganizational skills Autonomy: Willingness to challenge wrong

orders and get clarificationReasoning: selection of right tools and client

assessment

Nurse administering med is legally liable —regardless of MOST causes of error

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Factors Influencing Medication Dose & Action All must be considered

1. Route of administration2. Time of administration3. Age of client4. Nutritional status of client5. Absorption and excretion of the drug6. Health status of the client7. Sex of the client8. Ethnicity and culture of the client9. Genetics

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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

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Special Considerations for Elderly (cont’d)

Require lower doses as a rule May need

Special delivery devicesVisual aid to read labelsEasy-open lids

Allow extra time for teaching Polypharmacy and Beer’s criteria

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Six “Rights” of Medication Administration

Right MedicationCompare medication administration record

(MAR) with order

Right DoseCheck calculations and labels

Right ClientTwo unique identifiersNOT room number

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Six “Rights” of Medication Administration (cont’d) Right Route

Check orders and drug guidesSpecial considerations with feeding tubes

Right TimeTime of day and frequency

Right DocumentationAccuracy—no documentation leads to double-

dosingAvoid “Do Not Use” abbreviationsOutcomes of medications

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Figure 10-1 A, Example of a container that holds a day’s medications, stored by hour of administration. B, Container that holds a week’s medications. C, Figure 10-1 A, Example of a container that holds a day’s medications, stored by hour of administration. B, Container that holds a week’s medications. C, The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A From Ogden SG: The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A From Ogden SG: Calculation ofCalculation of drug dosages, drug dosages, ed. 8, St. Louis, 2007, ed. 8, St. Louis, 2007,

Mosby; B From Elkin MK, Perry AG, Potter PA: Mosby; B From Elkin MK, Perry AG, Potter PA: Nursing interventionsNursing interventions and clinical skills, and clinical skills, ed. 4, St. Louis, 2008, Mosby.) ed. 4, St. Louis, 2008, Mosby.)

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Other “Rights”

Right to refuseDocument and notify caregiver

Kendra’s LawPotentially dangerous mentally illCourt-ordered assisted outpatient treatment

(AOT)

Emergency Court OrdersMay give forciblyRequires Judge’s order

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Other “Rights” (cont’d)

Right to education about medication being given

Right to understand interactions with herbals

Right to medication reconciliation across continuum of care

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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

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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!

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Routes of Administration

Oral (p.o.) Sublingual (SL) Buccal Parenteral

(IV, IM, Subcut, ID)

Insertion—in cavities Instillation—body cavity, eyes, ears, nose

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Routes of Administration (cont’d) Inhalation—metered-dose inhalers,

nebulizers, spacers Intranasal Topical—lotions, ointments, pastes Percutaneous—on skin, on mucous

membranes Transdermal—patches

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Equipment for Med Administration Medicine cup (30 mL/1 oz) Soufflé cup Calibrated dropper—use only supplied

dropper Nipple—adapted for some infant meds

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Figure 10-2Figure 10-2 Medicine cup. (Modified from Brown M, Mulholland JL: Medicine cup. (Modified from Brown M, Mulholland JL: Drug calculations:Drug calculations:process and problems for clinical practice, process and problems for clinical practice, ed. 8, St. Louis, 2008, Mosby.)ed. 8, St. Louis, 2008, Mosby.)

Figure 10-3 A,Figure 10-3 A, Plastic medicine cup. B,Plastic medicine cup. B, Soufflé cup. (Courtesy of Soufflé cup. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Basic Basic

pharmacology for nurses, pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.)ed. 14, St. Louis, 2007, Mosby.) Figure 10-4Figure 10-4 Medicine dropper. (ModifiedMedicine dropper. (Modifiedfrom Clayton BD, Stock YN Harroun RD:from Clayton BD, Stock YN Harroun RD:Basic pharmacology for nurses, Basic pharmacology for nurses, ed. 14,ed. 14,

St. Louis, 2007, Mosby.)St. Louis, 2007, Mosby.)

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Figure 10-5Figure 10-5 Nipple. (From Clayton BD, Stock YN, Harroun RD:Nipple. (From Clayton BD, Stock YN, Harroun RD:Basic pharmacology for nurses, Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.)ed. 14, St. Louis, 2007, Mosby.)

Figure 10-6Figure 10-6 Oral syringes. (Courtesy of Chuck Oral syringes. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, HarrounDresner. From Clayton BD, Stock YN, Harroun

RD: RD: Basic pharmacology for nurses, Basic pharmacology for nurses, ed. 14,ed. 14,St. Louis, 2007, Mosby.)St. Louis, 2007, Mosby.)

Figure 10-7Figure 10-7 Parts of a syringe. (From Potter PA, Perry AG:Parts of a syringe. (From Potter PA, Perry AG:Fundamentals of nursing, Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)ed. 7, St. Louis, 2009, Mosby.)

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Figure 10-8Figure 10-8 Types of syringes. A,Types of syringes. A, Luer-Lok syringe marked in 0.1 mL (tenths). B,Luer-Lok syringe marked in 0.1 mL (tenths). B, TuberculinTuberculinsyringe marked in 0.01 mL (hundredths) for dosages of less than 1 mL. C,syringe marked in 0.01 mL (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked inInsulin syringe marked in

units (100). D,units (100). D, Insulin syringe marked in units (50). (From Potter PA, Perry AG: Insulin syringe marked in units (50). (From Potter PA, Perry AG: Fundamentals ofFundamentals ofnursing, nursing, ed. 7, St. Louis, 2009, Mosby.)ed. 7, St. Louis, 2009, Mosby.)

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Figure 10-9 A,Figure 10-9 A, Acceptable devices for measuring and administering oral medication to childrenAcceptable devices for measuring and administering oral medication to children(clockwise): (clockwise): measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibratedmeasuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated

dropper, hollow-handled medicine spoon. B,dropper, hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via aMedibottle used to deliver oral medication via asyringe. (A,syringe. (A, From Hockenberry MJ, Wilson D: From Hockenberry MJ, Wilson D: Wong’s nursing care of infants and children, Wong’s nursing care of infants and children, ed. 8,ed. 8,

St Louis, 2007, Mosby. B,St Louis, 2007, Mosby. B, Courtesy Paul Vincent Kuntz, Texas Children’s Hospital, Houston.)Courtesy Paul Vincent Kuntz, Texas Children’s Hospital, Houston.)