medication administration

CHAPTER

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53Medication

Administration



53-2

53.1 Describe rules and responsibilities regarding drug administration and the initial

preparation for the drug administration.

53.2 List the rights of drug administration.

53.3 Recognize the correct equipment to use for administering medications.

Learning Outcomes



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53.4 Carry out the procedures for administering oral medications.

53.5 Carry out procedures for administering parenteral medications.

53.6 Carry out procedures for administering parenteral medications by other routes.

Learning Outcomes



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53.7 Relate special considerations required for medication administration to pediatric,

geriatric, and pregnant patients.

53.8 Outline patient education information related to medications.

53.9 Implement accurate and complete documentation of medications.

Learning Outcomes



53-5

Introduction

• Drug administration – Given correctly ~ restores health

– Given incorrectly ~ condition can worsen

• Medical assistant must– Understand fundamentals

of drug administration

– Know your scope of practice



53-6

Preparing to Administer a Drug

• For common drugs know – Uses– Contraindications– Interactions– Adverse effects

• Be alert to any change in patient’s condition that could affect drug therapy



53-7

Preparing to Administer a Drug (cont.)

• Drug and drug allergies– Keep an accurate medication list in the patient

record

– Ask about drug allergies at every appointment



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• Administration site– Check site of administration

– Be sure there are no contradictions to using the site



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• Patient condition– Assess overall condition– Review drug list – Be sure dose is appropriate

• Patient consent form– Answer questions– Have signed before administering injection



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General Rules for Drug Administration

• Give only drugs the doctor orders

• Wash your hands– Prepare in a

well-lit area

– Focus on task

– Avoid distractions



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General Rules for Drug Administration

• Triple check medicationWhen taken from storage container and matched to MAR

When prepared

Before administration



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General Rules for Drug Administration (cont.)

• Calculate the dose carefully

• Do not leave a prepared drug unattended

• Do not administer a drug you did not prepare

• Verify patient identity



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• The physician must be in the office

• Have patient remain in office

• Instruct patient



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• If patient refuses the medication– Discard properly– Document

• Report medication errors

• Document after administering medication



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Apply Your KnowledgeWhat does “triple check” include?ANSWER: The medication needs to be checked 3 times:

1st check – when you remove it from the storage area and match it to the MAR

2nd check – when you prepare it

3rd check – before you close the storage container or just before you administer the medication to the patient



53-16

Rights of Medication Administration

• Basic rights– Right patient– Right drug– Right dose– Right route– Right time– Right

documentation

• Additional rights– Right reason– Right to know– Right to refuse– Right technique



53-17

Rights of Medication Administration (cont.)

• Right Patient– Ask patient for name and date of birth– Check against record

• Right Drug– Check ordered drug name against label– Check expiration date– Look up drug if unfamiliar– Perform a triple check



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• Right dose – Read label – Calculate accurately

• Right route – Matches route ordered– Can be administered by route ordered



53-19


• Right time

• Right documentation– Immediately following administration

– Correct information



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• Right reason

• Right to know – patient education

• Right to refuse– Report to physician– Document

• Right technique – know the correct technique



53-21

Apply Your Knowledge

How do you properly identify the patient before administering a drug?

ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.



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• You must be able to give drugs safely by any route

• In the medical office – Buccal or sublingual medications

– Other routes based on scope of practice

– Demonstrate use of inhalers

– Topical drugs

Drug Routes and Equipment



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Medications by Mouth

• Oral administration– Slower absorption

– Tablets, scored tablets, capsules, lozenges, and liquids

– Contraindications • Nausea• Comatose• Unable to swallow

– Patient education



53-24

Medications by Mouth

• Buccal or sublingual administration– Buccal – placed between the cheek and gum

– Sublingual – placed under the tongue

– Faster absorption; bypasses GI tract



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Gold star Answer!

Apply Your Knowledge1. Why is it important to be able to administer

medications by a variety of methods?

ANSWER: You may be asked to administer drugs by any of an number of different routes.

2. Why is absorption faster when drugs are administered sublingually or buccally?

ANSWER: The drug is absorbed directly into the bloodstream bypassing the GI tract.



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Medications by Injection

• Parenteral administration– Any route other than through the GI tract

– Rapid drug action

– Safety risks• Rapid administration• Exposure to blood-borne

pathogens



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Medications by Injection (cont.)

• Needles– Parts

– Gauge

– Length ~ select for• Type of injection• Patient size• Amount of fatty tissue• Injection site



53-28

Medications by Injection(cont.)

• Syringes– Barrel ~ calibrated cylinder

– Plunger ~ forces drug through barrel

– Needlestick prevention safety device

Needle

Needlestick prevention safety device

Syringe hub

Barrel

Plunger

Trailing ring

Leading ring



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Forms of Packaging for Parenteral Drugs

• Cartridge

• Ampule

• Vial

– Liquid or powder ~ reconstitute with diluent

– Single or multiple doses



53-30


• Intradermal (ID)– Into upper layer of skin– Used for skin tests

• Subcutaneous (subcut)– Provides slow, sustained release

and longer duration of action– 1 mL or less– Rotate sites To diagram



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Epidermis and dermis

Subcutaneous tissue

MuscleMedication

Z-track Method


• Intramuscular (IM) – More rapid absorption– Less irritation of tissue – Z-track method

To diagram



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• IM injections – choose sites carefully

VentroglutealIliac Crest

Deltoid

muscle

Clavicle Vastus lateralis (mid-portion)




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• Intravenous (IV)

– Directly into vein

– Given by IV infusion• Drug is dissolved into a solution• Slow drip into a vein

– Rapid onset of action

– Sudden adverse reactions possibleTo diagram



53-35

Apply Your Knowledge___ prevents drug from leaking into subcutaneous tissue___ used to administer skin tests___ small bottle with rubber diaphragm ___ can administer a larger amount of medication___ provides a slow, sustained release inside diameter of needle provides an almost immediate effect

ANSWER:MatchingA.Intramuscular injectionB.GaugeC.Subcutaneous injectionD.Intradermal injectionE.VialF.IV injectionG.Z-track method

G

DE

A

C

BF



53-36

Other Medication Routes

• Inhalation – Administered through the mouth

or nose – Read package insert

• Topical – Direct application of a drug on the skin – Some forms ~ creams, lotions, ointments– Transdermal system



53-37

Other Medication Routes

• Urethral administration – local effect

• Vaginal – Local effect – Suppositories most common form

– Douches ~ administer liquid medications

• Rectal – suppositories or enemas



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List parenteral routes other than an injection.

ANSWER: Other parenteral routes include:Inhalation TopicalUrethral VaginalRectal

Great job!



53-39

Special Considerations

• Pediatric patients – Drug effects are less predictable

– Require dosage adjustments and careful measurements of doses



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Special Considerations (cont.)

• Pediatric patients – Observe pediatric patients closely for adverse

effects and interactions

– Administration sites and techniques differ

– Patient education ~ parents vs. child



53-41


• Pediatric patients – Oral medications ~ use calibrated dropper or

spoon

– Injections• Sites

• Restraining methods



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• Pregnant patients – check drug references for safety during pregnancy

• Patients who are breast-feeding– Check drug references for safety during

lactation– May need to supplement with formula



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Why are drug effects less predictable in children?

ANSWER: Drugs are absorbed, distributed, metabolized, and excreted differently in children than adults.

Fantastic!



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Patient Education about Medications

• Over-the-counter drugs– May not produce therapeutic effect– May be dangerous in combination with other

substances– May mask or aggravate

symptoms– May have more than

one active ingredient



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Patient Education about Medications (cont.)

• Prescription drugs– When and how to take the medication

– Drug safety precautions

– How to read a prescription label• Special instruction• Warnings



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• Drug-drug interactions– Types

• Effects may be increased• Effects may be decreased• One drug may be increased by another• Lead to adverse reactions

– Check patient drug use

– Patient education



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• Food-drug interactions– Alter the therapeutic effect

– Interfere with body’s use of nutrients

– Patient education• Be specific about foods to avoid and when• Explain what to expect if interaction occurs• Describe what to do



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• Adverse effects– May be mild to life-threatening

– Elderly or patient with kidney and liver disease ~ more susceptible

– Patient education• Take as instructed• Recognition of significant adverse effects• Report to physician



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• Complete medication list– Prescription and OTC drugs

– Supplements and herbals

– Past and present use of recreational drugs and alcohol

– Patient education• Tell all of their doctors about their medications• Keep an up-to-date list with dosages



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• Patient compliance – patient education– How and when to take each drug

– How long to take each drug

– How to identify possible adverse effects



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• Patient compliance – patient education

– What to do with old medication

– How to store drugs

– When to call the doctor



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What should you instruct the patient about regarding drug administration?

ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly.

Bravo!



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Charting Medications

• Entries – accurate

• Be consistent with charting methods used

• Tips – Have the right chart, document in right place– Chart directly from physician’s order– Be specific– Do not leave gaps or skip lines



53-54

Charting Medications (cont.)

• Tips (cont.)

– Correct errors in proper manner

– Do not use ditto marks

– Write neatly; enter carefully in EHR

– Use approved abbreviations and symbols

– If unsure, ask supervisor



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When charting that you gave the patient a subcutaneous injection, you wrote intravenously by mistake. What should you do?

ANSWER: If you make an error, do not erase it. Draw a line through intravenously. The mistake should still be visible, so do not black it out. Initial it and then chart “subcut”.

IMPRESSIVE!



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In Summary

53.1 Before administering a medication, you should check the patient for allergies and also evaluate any drug-drug interactions.

You should check all injection sites for abnormalities.

Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary.

53.2 The rights of drug administration include the right patient, right drug, right dose, right route, right time, right documentation, right reason, right to know, right to refuse, and right technique.



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In Summary (cont.)

53.3 Drugs may be administered for either local or systemic effects. Table 53-2 outlines the many drug administration routes.

53.4 Oral medications typically are swallowed and absorbed through the digestive tract. Sublingual medications go under the tongue, and buccal medications go between the cheek and gum.

53.5 The three most common injection routes are ID, subcut, and IM. IV is less frequently used in a

medical office. All injections are given using aseptic technique.



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In Summary (cont.)

53.6 Other medication routes include inhalants (respiratory), topical (including transdermal), urethral, vaginal, and rectal.53.7 Certain special considerations must be made when

caring for pediatric, pregnant, and breastfeeding patients. Pediatric patients require extreme care when

calculating doses. Checking medications given to pregnant and

breastfeeding patients for possible adverse effects is essential.



53-59

In Summary (cont.)

53.8 Patients should be educated about why, when, and how they should take medications.

This includes instruction to ensure patient compliance.

Patients should also be instructed about the dangers of medication combinations, the importance of reporting an adverse effect, and maintaining a complete medication list.

53.9 Documentation of medication administered should occur immediately after the given and should include the name, date, time, medication administered, dose, route, location, lot #, and how the patient tolerated it.



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End of Chapter 53

Words are the most powerful drug used by mankind.~Rudyard Kipling

medication administration

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