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Medication Administration. Dewi Baririet Baroroh FIKES UMM. Pretest. Name the five rights Name the three types of injections we will talk about today. Must answer both correct to receive one point. No partial credit. If I can’t read it  no points. . Overview. - PowerPoint PPT Presentation

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Medication Administration

Medication AdministrationDewi Baririet BarorohFIKES UMMPretest Name the five rightsName the three types of injections we will talk about today.

Must answer both correct to receive one point. No partial credit. If I cant read it no points. OverviewMedication errors is a serious problem:

8th leading cause of death in the US7,000 deaths annually44% of errors occur during administration of medication

Rich, V. (2005) How We Think About Medication Errors. American Journal of Nursing,supplement. Pg. 10. 3Although a large portion of your time as a nurse is spent administering medications, it should never be taken haphazardly. Medication AdministrationMedical OrderTranscriptionWhat drug information is neededPlanning/ PreparationMedication Preparation Medication AdministrationPost Medication Administration7 Components of a Medication OrderTammie Fae MR # 1974758

3/15/07 Toradol 15mg IM prn pain0815 ----------------------------------------- Dr. SeussFrequencyRoutine: administer as ordered until discontinued (BID, TID, QD)One time only: administer one dose and then discontinueStat: administer immediatelyPRN: as needed within the time interval given. Needs to have an indication stated in order.

TranscriptionTranscribed from the medical record to the MAR Unit clerkNurse

Role of the RN: Check MAR against medication order in chart to assure accuracy. Once completed, the nurse puts the date, time and initials on the order. ** Note allergies against new med order.

Planning/ PreparationDrug information Action Indication Normal dosage range and routeAdverse effects ContraindicationDrug interactionsNursing Considerations

Planning/ PreparationAssessment information B/P (HTN med)Pulse (cardiac drugs like Digoxin)Pain rating (pain med)Temp (antipyretic)Time ManagementPlan to administer within hour of scheduled administration timeAdministration times are set by individual facility policies.

Planning/ Preparation LabsDrug levelsDigoxinDilantin TheophyllineElectrolytesLasix- check K+ levelsAdministering electrolytes, know level before administration Other dataBlood glucose before insulin or oral hypoglycemicWhere do I look for my meds?? Supply of MedicationsCassettes/Drawers for each patientAutomated medication-dispensing systems (Pyxis)Floor Stock Controlled substancesopioidsantiseizure medications (phenobarbitol)Anti-anxiety medications

Controlled SubstancesMedications that have a high abuse potential. There are laws and regulations to monitor the use of these medications.

Locked with limited access.Inventory done by 2 nurses at set intervals. Medication counted before removal and tally kept on separate document.Waste of medications must be witnessed and documented by another nurse.

Medication PreparationWash handsAssemble the medications in the medication room. Remove the meds from the drawerCheck for drug expiration dateCheck for the five rights against the MAR

**Check drawers at the beginning of your shift in case any medications are missing, you can order them from pharmacy. NEVER borrow medications from other patients supply.

5 RightsRight DRUGRight DOSERight ROUTERight TIMERight PATIENT

15Right patient: check arm band and MR #5 RightsRight DRUG: Compare drug to MAR three timesTaking out of cassette, in med room and at bedside Note expiration dateKnow indication and nursing considerations5 RightsRight DOSE: Validate calculations of divided doses with another nurseCheck heparin, insulin and digoxin with another nurseKnow the usual dose and question any dose outside of safe range5 RightsRight ROUTE:Right route or method of administrationIf a change in route is needed, request new order from physicianEx: Tylenol 650mg suppository can not be changed to PO route without a new order.

5 RightsRight TIME: Medication given 30 minutes before or 30 minutes after time ordered is acceptable. Refer to policy and procedure manual.**Standard administration times are set by each facility.Ex: QD dose 1000 BID dose 0900, 2100Know the last time of administration for any PRN drug

5 RightsRight PATIENT: Identify the patient by asking patient to state name and/or DOB and check armband. Compare name and medical record number on MAR with information on armband.Miscellaneous rightsRight Documentation: document the name of the drug, the dose, route, and time administered. Also document the patients reaction. Right to Know: Patients have the right to know about the medication he or she is being given. Right to refuse: the patient has to the right to refuse treatment, but must be notified of the risks of their actions as well as the doctor should be notified. Medication PreparationCalculate drug dosagePrepare one medication at a timeLeave medications in packages if possible. Use appropriate measuring devices to prepare medications.Check 5 Rights again before leaving medication room**If possible, calculate night before clinicalMedication AdministrationBring MAR and medications to patient room. IPIE Check 5 RightsCompare wristband to MAR Ask patient about allergiesOpen packages at patient bedside while performing patient education Ex: Here is your atenolol 25mg, it is to help control your blood pressure. Always tell patient: Name of medicationDosageIndication for use

Administer Medications

Post AdministrationDocument on MARAs soon as possible AFTER administration Document time administered InitialsMake sure signature/initials are in signature section of MARDocument client responseNarrative noteFlowsheetEspecially document for PRN medications and first time a new medication is administeredPost AdministrationDocument if refused or heldCircle timeInitialReason not administeredMonitor patient for therapeutic effects.

RoutesOral EnteralBuccalSublingualTopicalTransdermalInhalantOphthalmic

NasalOticRectal VaginalIntradermalSubcutaneousIntramuscularIntravenous

Oral MedicationsNEVER crush sustained release, controlled release or enteric coated pills.Capsules can not be splitMore than 3 to = dose Place into plastic/paper administration cup without touching the med.May use pudding or applesauce for patients with difficulty swallowingStay with patient until all medications are taken.

Oral Medication ModuleLearning exercise-not testing Instruction sheetComplete 2 patients by Medication Administration testing dayIdentify errorsIdentify reason patient is taking medication Identify nursing considerationsIdentify common side effectsHave Skills lab instructors sign your form once answers are checkedPracticeFurosemide (lasix)Identify any errors between medical order and MAR. Identify why the patient is taking this medication Dosage rangeIdentify nursing considerationsIdentify common side effectsLook for ErrorsPhysicians OrderPt NameAllergies

Lasix 20mg PO QD-----Jia Lu, NP------MARPt NameAllergies

Medication name, dose, frequencyTimeLasix 2mgPO QD0900LasixIndication: edemaDosage: WNLNursing considerations: Monitor electrolytes especially check potassium level and s/s hypokalemia, monitor fluid volume status, monitor BP (antihypertensive effects), give in am Side effects: loss of hearing, Low K, Mg, Cl, Ca, Na, High glucose, uric acid; metabolic alkalosis, increased urine output, glycosuria, skin changes (rash, itch, purpura)TopicalMake sure previous dose is removed, before applying new dose.Apply patches to nonhairy areas of the bodyTake care not to touch topical medications with ungloved hands

Opthalmic ApplicationsInstruct patient to look toward ceilingMake a pouch in the lower lid by pulling skin downward over the bony orbitInstill in conjunctival pouchClean/dry from inner to outer canthus

Inhalant RouteMDI: Metered dose inhalerSpacer: chamber attached to the end of an inhaler that assists the patient in receiving a higher % of drug with each inhalationNebulizer: Aerosolized medication either given by a hand held device or by a face mask (peace pipe)**MDI instructions page 545 SDMEnteral Tube AdministrationUse liquid form if possibleCrush pills individually and mix with 15-30 mL of warm water. If medication should be given on empty stomach-stop medication for 15-30 minutes before and after med administration Placement, Flush with water, administer medication, flush with water, administer medication, flush with water

Parenteral MedicationsIntradermalSubcutaneousIntramuscular

Equipment Needed

Equipment NeededSyringes Different sizes (1ml, 3ml, 5ml)Tuberculin syringeInsulin syringe NeedlesShaft (length of the needle)Gauge (diameter)

40Gloves are not needed to prepare parenteral medication, but are needed to administer it. Equipment NeededSize The smaller the number, the larger the diameterExample: 18 gauge big 25 gauge smallSafetyOne handed Scoop technique Safety needles

41Gloves are not needed to prepare parenteral medication, but are needed to administer it. Opening packagesWhat needs to stay sterile? How do I recap? How do I change needlesBlunt needles? Filter needles?Safety vs. Nonsafety?Drug Preparation: AmpouleTap the top of the ampouleUse gauze or an alcohol swab to protect your fingers.Break the neck of the ampoule away from your body.Use a filter needle if availableInsert your needle into the solutionInvert the ampoule (or leave on surface)With your needle in the solution, pull back on the plunger to the appropriate dose.

43Ampules are glass. Filter needles should be used if available to prevent injecting glass particles into your patient. Article in Journal of Advanced Nursing Nov 2004 (Vol 48, Issue 3, p. 266) Glass contamination in parenterally administered meds. Preston, S.T., Hegadorn, K FOUND: larger g

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