Medication Transcription, Verifying Medication Orders &

Administration

By:

Evelyn W. Stone RN.,BSN.,M.Ed.www.qprofessionalmentalhealthservice.com

Types of Drug Orders

WrittenVerbalPRNDiscontinuedSTAT

Written Order

Prescriber may write order on order form. Prescriber may call order in to pharmacy. Carefully check medication label to be

sure it agrees with the orderorder you have received.

FAXED orders are legal and acceptable.

Verbal Order

May be received in person or on the phone (only by nurses or pharmacists).

The person receiving it must prepare a written copy of the order for the prescriber’s signature.

PRN Order

Medication/treatment may be used “as needed”

Include what the medication is.Include what the treatment is.The problem being treated.Frequency of administration.

Discontinue Order

Medication/treatment is to be stopped Discontinued medications should be

immediately removed D/Cd meds can be -

1. returned to the pharmacy

2. flushed down a drain Document name of med, amount, method and

date of disposal on med disposal form

STAT Orders

Do it now

Get the med and give to client

Document in designated section on the MAR

Report to oncoming nurse of the STAT order and that it was carried out

STAT (Continued)

Use highlighter and yellow out the section of the MAR where you initialed or signed that the stat med was given.

Document in the progress notes that the medication was given.

Physician Orders

All orders, whether written or verbal, must include:

Client name Medication to be given Strength of medication Dose to be given Frequency to be given Route Length of time to be given

Medical Alerts/Allergies

Physician must be made aware of…

1. Allergies

2. Conditions

3. All other meds client is taking

which might contraindicate a specific

medication.

***Be prepared to give complete, correct information about a client’s diagnoses, allergies, and all current meds to physician.

Factors that Influence Medication Dosage

AgeWeightTimeRate ExcretedRouteDrug Combinations/InteractionsCondition of the client

Age

Pediatric and the Elderly excrete meds at different rates

Weight

Some medication dosages are calculated by the physician & based on body weight.

Time

The time is specified if it is to be given once a day.

If unsure of the time in which the med is to be given, call the pharmacist.

Call the Administrator, Director or Qualified Professional

Route

How medications are taken and absorbed by the body may affect the dosage.

Drug Combinations/Interactions

Two drugs given together may react differently than the same drugs given separately.

Condition of the Client

BehaviorSeizuresDiabetesVital Signs (history of high BP, fast

irregular heart rate)Acceptance of food, fluidsMobilityOthers

Basic Rules for Administering Medications

Be sure medications are being taken as prescribed. Be alert to changes in client’s behavior, and physical well-being. Report changes to the Administrator & Nurse.

Correct transcription of orders Knowledge of drugs being given Special administration instructions Knowledge of client’s physical condition Knowledge of client’s emotional status Climate conducive to concentration Communication of information to others Resources for medication information

Correct Transcription of Orders

Read every word on the script. Fax the script to the pharmacy. When the medication is received from the

pharmacy, check to make sure that it is the correct medication.

Write each word on the MAR that is on the medication label.

Recheck your transcription word for word to make sure that it was transcribed correctly.

Knowledge of Drugs Being Given

Name of Medication and dosage Why it was ordered What benefit should be expected Side-effects to be expected Special monitoring needed:a. Vital signsb. Stool records c. seizure records Special administration instructions: 1. crushed or chewed 2. given in food 3. need to be given on empty stomach 4. given with any liquid

Knowledge of Client’s physical condition

Medical alert – Seizures, Diabetes, HIV etc.

Physical limitations – Spinabifeda, amputee etc.

Knowledge of client’s emotional status

DisorientedHostileMute, withdrawnRefusing medicationsAssaultive behavior

Climate Conducive to Concentration

Temperature 68-82 degrees

Not too hot

Not too cold

Communication of Information to Others

Drug InformationLearn the information that comes with the

drug.Call the Pharmacist and request medication

leaflets that are suitable for lay public.Client information – Special alerts to staff.

Staff to give client education each time the meds are given to help the client recognize his meds and what they are for.

Resources for Medication Information

PharmacistPhysician/DentistRN Consultant/RN Qualified ProfessionalDrug Information SheetDrug Handbook

Common Dosage Forms

SolidsTopicalTabletCapsuleLiquidsGases

Solids

Suppository- small, solid, cone shaped, glycerin base, melt at body temperature, administered by rectum or vagina.

Refrigerate as directed Topical- applied directly to skin, lotion (external use),

paste (mixture of powders and ointments), ointment, cream (suspension of oil and water), powder (finely ground drugs), shampoo (medication in soap), patches (slowly release meds.), Aerosol sprays (suspended in gas, e.g. Desenex spray, Cruex spray).

Used for local effect

Solids (cont.)

Tablet- powdered drug compressed into small, hard disc

Capsule- powdered, liquid, or oil drug form

1. hard or soft

2. dissolves quickly in the mouth

Liquids

Solution- one or more drugs dissolved in water.

Suspension- preparation of a finely divided, undissolved drug in a liquid.

Syrup- aqueous solution of sugar.Elixir- drug mixed in an alcohol solution,

sweetened.

Gases

Inhalant- Medication carried into the respiratory tract through air, oxygen, or steam

Common Routes of Administering Medications

Medications are designed for one or two specificroutes of administration. Physicians order theroute of administration when ordering themedication. Oral Insertion Instillation Topical Inhalation Parenteral

Oral

1. By mouth

2. Buccal – between the cheek and gum

3. Sublingual – under the tongue

Insertion

“Putting in” vaginally or rectally

Instillation

Putting a drug in liquid or ointment form into ears, eyes or nose

Topical

External application of meds to the skin, nails or hair

Inhalation

Inhaling a drug into the respiratory tract.

Parenteral

By injection

** Injections are given by a licensed person.

A habilitation tech may be trained by a licensed person to give insulin injection.

Correct Preparation and Administration

General Medication administration procedures

Oral MedicationsLiquid MedicationsInserting MedicationsInstilling MedicationsTopical Medications InhalantsNebulizers

General Med Administration Procedures:

Wash handsVerify the order on the MAR by checking it

against the doctor’s order.Do the “Three Checks”

a. when selecting from the storage area

b. before pouring the medc. after pouring and prior to returning

med to storage area

(continued)

Confirm the client’s identity.Give the med by the route as ordered.Document on MAR “IMMEDIATELY” after

they are given to each client before going to the next client.

Never sign off meds prior to giving it.** Complete this process for each client

prior to going to the next client.

Administering Oral Meds

Pour the correct number of pills/capsules into the medication lid, then into the med cup.

Explain to client what meds you are giving and the purpose at client’s level of understanding.

Give with water or other fluid. Stay with client until all meds are swallowed. Sublingual meds are placed under the tongue.

Liquid Medications

Liquid meds must be measured in a calibrated medication cup.

Place the med cup on a level surface at eye level Hold the med container so that the medication flows from

the side opposite the label so it doesn’t run down the container and stain or obscure the label.

Check the med cup again to make sure you have poured the correct amount.

For small amounts less than 5cc, use a calibrated syringe to measure the medication.

Give the med with the appropriate liquid. Always do the “3” checks before giving the med.

Eye Drops

• Explain purpose and procedure• Have client assume back-lying position• Put on gloves• Instruct client to look up toward ceiling• Hold dropper 1” above eye, install drops into pocket of

the outer 1/3 of the eye• Instruct client to close eye gently and wipe excess away• Remove and discard gloves• Gather and dispose of equipment• Wash hands

Eye Ointments

Follow steps for eye drops

• Discard first bead of ointment• Squeeze small amount of ointment into

the lower eyelid from the side near the nose to the outer eye

Ear Drops

Draw proper amount of med into dropper Explain purpose of the med Put on gloves Straighten ear canal – adult pull up & back/child

pull down & back Hold the tip of the ear dropper just over the ear

canal. Client should remain on side for 5-10 minutes Remove gloves & wash hands

Nose Drops

Explain purpose of med Put on gloves Have client lie on back with head slightly hyper-extended Draw up med into dropper Push up the tip of the client’s nose slightly Hold dropper just above the nostril and direct its tip toward

the midline of the nose so the drops flow toward the back of the nasal cavity.

Instill the number of drops Have client remain in lying position for 5 minutes and breathe

through the mouth Remove the gloves Wash your hands

Topical

Explain purpose of med Put on gloves Open container and place cap or lid upside

down to prevent contamination Use a tongue blade, gauze or cotton applicator

to apply Cover the end of the tongue blade, gauze or

applicator with med Apply medication to affected area Remove the gloves Wash your hands

Aerosol Sprays

Explain purpose of medicationShake the container if indicatedHold the container 6-12 inches from the

affected areaSpray evenly

Inhalants

Explain the purpose of procedure Shake the inhaler Have client exhale completely then place the mouth

piece in mouth, close lips around it. Have client inhale slowly & deeply Repeat the procedure as necessary to give as

prescribed Client may gargle to remove medication from the mouth Clean mouth piece Return to storage place

Narcotics – Schedule II Drugs

Controlled substances Secured under “DOUBLE LOCK” system Sign out each dose each time a dose is given on

the medication sign out sheet that came with the medication from the pharmacy

Always confirm the correct count of all narcotics when oncoming and off going.

Safety Rules

Right ClientRight DrugRight DoseRight TimeRight routeRight Documentation

(Continued)

No medication should ever be given without a doctor’s order

Encourage client to take meds as prescribed

Keep an MAR on each clientFor Each medication, your MAR should

include drug name, the amount to be given & how often the drug should be taken

(Continued)

Medication should always be administered within 1 hour of the time it is prescribed

If a client refuse medication, try & find out why You can not force a client to take medication Write “R” in the block of the date it supposed to

be given & circle it Write on the back of the MAR in the designated

area about the refusal

(Continued)

Document in the progress note the refusal and the reason

Inform the AdministratorNotify the physicianNotify the team

Conclusion

1. Remember to do the “three” checks

2. Remember If there are more than “three” pills recheck the order before administering

3. Remember “6” checks

4. Remember Client education must be done each time medication is given

Other Services

Medication AdministrationSeizure ManagementBehavior ManagementClient AbuseIncidentsTen Traits of a ProfessionalBoundaries

Other Services

Mental IllnessBloodborne PathogensAutismDevelopmental DisabilitiesDevelop Procedure & Policy Manual

To Contact Instructor:

www.ewsastaffingnetwork.com

www.qprofessionalmentalhealtservice.com

1008-F Big Oak Court

Knightdale, NC 27545

(919) 266-7050