Medication Administration

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<ul><li> 1. Calculate with Confidence 5 thedition Gray Morris Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.</li></ul> <p> 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 </p> <ul><li>After reviewing this chapter, you should be able to: </li></ul> <ul><li><ul><li>State the consequences of medication errors </li></ul></li></ul> <ul><li><ul><li>Identify the causes of medication errors </li></ul></li></ul> <ul><li><ul><li>Identify the role of the nurse in preventing medication errors </li></ul></li></ul> <ul><li><ul><li>Identify the role of the Institute for Safe Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors </li></ul></li></ul> <p> 4. Medication Administration: Objectives(cont) </p> <ul><li>State the six rights of safe medication administration </li></ul> <ul><li>Identify factors that influence medication dosages </li></ul> <ul><li>Identify the common routes for medication administration </li></ul> <ul><li>Definecritical thinking </li></ul> <ul><li>Explain the importance of critical thinking in medication administration </li></ul> <p> 5. Medication Administration: Objectives(cont) </p> <ul><li>Identify important critical thinking skills necessary in medication administration </li></ul> <ul><li>Discuss the importance of client teaching </li></ul> <ul><li>Identify special considerations relating to the elderly and medication administration </li></ul> <ul><li>Identify home care considerations in relation to medication administration </li></ul> <p> 6. Medication Errors </p> <ul><li>Meds administered incorrectly can be harmful or fatal </li></ul> <ul><li>Result in emotional and legal consequences for the nurse </li></ul> <ul><li>Most common cause of client injury despite advances in technology </li></ul> <ul><li><ul><li>44,000 to 98,000 deaths per year estimated </li></ul></li></ul> <ul><li><ul><li>540,000 med errors with children per year </li></ul></li></ul> <p> 7. Medication Errors(cont) </p> <ul><li>Causes for errors </li></ul> <ul><li><ul><li>Cohen, M. (2007).Medication Errors,2 ed. </li></ul></li></ul> <ul><li><ul><li>Failure to identify client and miscommunication </li></ul></li></ul> <ul><li><ul><li>Lack of information about patient allergies, meds </li></ul></li></ul> <ul><li><ul><li>Lack of information about the drug </li></ul></li></ul> <ul><li><ul><li>Communication and teamwork failures </li></ul></li></ul> <ul><li><ul><li>Unclear, absent, or look-alike and sound-alike meds </li></ul></li></ul> <ul><li><ul><li>Unsafe standardization, storage, distribution, and devices </li></ul></li></ul> <ul><li><ul><li>Calculation errors and failure to adhere to rights </li></ul></li></ul> <p> 8. Critical Thinking andMedication Administration </p> <ul><li>Definition: A process of thinking that includes being reasonable and rational </li></ul> <ul><li><ul><li>Organizational skills</li></ul></li></ul> <ul><li><ul><li>Autonomy: Willingness to challenge wrong orders and get clarification </li></ul></li></ul> <ul><li><ul><li>Reasoning: selection of right tools and client assessment </li></ul></li></ul> <ul><li>Nurse administering med is legally liable regardless of MOST causes of error </li></ul> <p> 9. Factors InfluencingMedication Dose &amp; Action </p> <ul><li>All must be considered </li></ul> <ul><li><ul><li>Route of administration </li></ul></li></ul> <ul><li><ul><li>Time of administration </li></ul></li></ul> <ul><li><ul><li>Age of client </li></ul></li></ul> <ul><li><ul><li>Nutritional status of client </li></ul></li></ul> <ul><li><ul><li>Absorption and excretion of the drug </li></ul></li></ul> <ul><li><ul><li>Health status of the client </li></ul></li></ul> <ul><li><ul><li>Sex of the client </li></ul></li></ul> <ul><li><ul><li>Ethnicity and culture of the client </li></ul></li></ul> <ul><li><ul><li>Genetics </li></ul></li></ul> <p> 10. Special Considerations for Elderly </p> <ul><li>Two thirds use Rx and OTC meds </li></ul> <ul><li>Most scripts are for older adults </li></ul> <ul><li>Number in population will double by 2030 </li></ul> <ul><li>Physiologic changes slow function </li></ul> <ul><li><ul><li>Changes in circulation, absorption, metabolism, excretion, and stress response </li></ul></li></ul> <ul><li><ul><li>Lowered body mass, change in mental status </li></ul></li></ul> <p> 11. Special Considerations for Elderly (contd) </p> <ul><li>Require lower doses as a rule </li></ul> <ul><li>May need </li></ul> <ul><li><ul><li>Special delivery devices </li></ul></li></ul> <ul><li><ul><li>Visual aid to read labels </li></ul></li></ul> <ul><li><ul><li>Easy-open lids </li></ul></li></ul> <ul><li>Allow extra time for teaching </li></ul> <ul><li>Polypharmacy and Beers criteria </li></ul> <p> 12. Six Rights of Medication Administration </p> <ul><li>Right Medication </li></ul> <ul><li><ul><li>Compare medication administration record (MAR) with order </li></ul></li></ul> <ul><li>Right Dose </li></ul> <ul><li><ul><li>Check calculations and labels </li></ul></li></ul> <ul><li>Right Client </li></ul> <ul><li><ul><li>Two unique identifiers </li></ul></li></ul> <ul><li><ul><li>NOT room number </li></ul></li></ul> <p> 13. Six Rights of Medication Administration (contd) </p> <ul><li>Right Route </li></ul> <ul><li><ul><li>Check orders and drug guides </li></ul></li></ul> <ul><li><ul><li>Special considerations with feeding tubes </li></ul></li></ul> <ul><li>Right Time </li></ul> <ul><li><ul><li>Time of day and frequency </li></ul></li></ul> <ul><li>Right Documentation </li></ul> <ul><li><ul><li>Accuracyno documentation leads to double-dosing </li></ul></li></ul> <ul><li><ul><li>Avoid Do Not Use abbreviations </li></ul></li></ul> <ul><li><ul><li>Outcomes of medications </li></ul></li></ul> <p> 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 </p> <ul><li>Right to refuse </li></ul> <ul><li><ul><li>Document and notify caregiver </li></ul></li></ul> <ul><li>Kendras Law </li></ul> <ul><li><ul><li>Potentially dangerous mentally ill </li></ul></li></ul> <ul><li><ul><li>Court-ordered assisted outpatient treatment (AOT) </li></ul></li></ul> <ul><li>Emergency Court Orders </li></ul> <ul><li><ul><li>May give forcibly </li></ul></li></ul> <ul><li><ul><li>Requires Judges order </li></ul></li></ul> <p> 16. Other Rights (contd) </p> <ul><li>Right to education about medication being given </li></ul> <ul><li>Right to understand interactions with herbals </li></ul> <ul><li>Right to medication reconciliation across continuum of care </li></ul> <p> 17. Teaching Clients About Meds </p> <ul><li>Imperative for preventing errors </li></ul> <ul><li>Helps prevent adverse reactions </li></ul> <ul><li>Improves adherence </li></ul> <ul><li>Include the following:</li></ul> <ul><li><ul><li>Brand and generic names, explanation of amount, explanation of timing for dose, measuring devices, and route </li></ul></li></ul> <ul><li>Follow up on teaching </li></ul> <p> 18. Home Care Considerations </p> <ul><li>Home health care is increasing with increased population and early discharges </li></ul> <ul><li>Special considerations for home setting </li></ul> <ul><li>Practice requires more autonomy </li></ul> <ul><li>Teaching focuses on devices from local pharmacies and calibrated home devices </li></ul> <ul><li>Communication is critical! </li></ul> <p> 19. Routes of Administration </p> <ul><li>Oral (p.o.) </li></ul> <ul><li>Sublingual (SL) </li></ul> <ul><li>Buccal </li></ul> <ul><li>Parenteral</li></ul> <ul><li><ul><li>(IV, IM, Subcut, ID) </li></ul></li></ul> <ul><li>Insertionin cavities </li></ul> <ul><li>Instillationbody cavity, eyes, ears, nose </li></ul> <p> 20. Routes of Administration (contd) </p> <ul><li>Inhalationmetered-dose inhalers, nebulizers, spacers </li></ul> <ul><li>Intranasal </li></ul> <ul><li>Topicallotions, ointments, pastes </li></ul> <ul><li>Percutaneouson skin, on mucous membranes </li></ul> <ul><li>Transdermalpatches </li></ul> <p> 21. Equipment for Med Administration </p> <ul><li>Medicine cup (30 mL/1 oz) </li></ul> <ul><li>Souffl cup </li></ul> <ul><li>Calibrated dropperuse only supplied dropper </li></ul> <ul><li>Nippleadapted for some infant meds </li></ul> <p> 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:Fundamentals of nursing,ed. 7, St. Louis, 2009, Mosby.) 25. Figure 10-9 A, Acceptable devices for measuring and administering oral medication to children (clockwise):measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated dropper, hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via a syringe. (A, From Hockenberry MJ, Wilson D:Wongs nursing care of infants and children,ed. 8, St Louis, 2007, Mosby. B, Courtesy Paul Vincent Kuntz, Texas Childrens Hospital, Houston.) </p>


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