National Kidney & Transplant Institute Institute of Advanced Nursing and Allied Health Professions

National Kidney & Transplant InstituteInstitute of Advanced Nursing and Allied Health ProfessionsMEDICATION ADMINISTRATION(Oral, IV Push & Incorporation)OVERVIEWWe take medications to diagnose, treat, or prevent illness. Drugs are potentially dangerous, even if they are meant to improve our health.Medications need to be safe and effective. Medication error due to the wrong drug, the wrong dose, the wrong timing of administration, or the wrong route of administration accounts for 1.3 million injuries each year in the United States, according to the Food and Drug Administration (FDA, 2009)

2nd -Doctors, nurses, nurse practitioners and a few other professionals are trained in how to safely give you a medication.2OVERVIEWMedication administration is not just giving a medication to a patient. It also involves observation of what happens afterward.The Nurses first responsibility is to ensure the safety of the patient.Nurse is responsible for what, how, when & how much is given. Nurse also must question orders that seem incorrect or inappropriate.

2nd-Professionals are trained to know how medications move through the body, what the effect of the medication is, and what adverse effects may occur.

3OUTLINEI. Oral medications administrationII. Giving intravenous push through: a. Y-connector b. Heparin lock or rubber in stopper c. Multi-flow adaptor/Three-way stopcockIII. Incorporation of medicine through: a. IV fluid b. Volumetric Chamber

OBJECTIVESIdentify the 11 Golden Rules in Administering MedicationsRecall on how to administer oral and intravenous medications.Demonstrate proper administration of medication thru oral and intravenous

Oral Medication AdministrationSteps:Observed 11 Golden Rules in Administering MedicinesAscertained medication order by verifying/comparing order written on the standing order sheet with the medication sheet and validating with the Physicians Order Sheet.Explained procedure to patient and his significant others. Secured informed consent as necessary.

Oral Medication Administration4. Reviewed drug references for indication, contraindications, side effects, adverse reactions and nursing responsibilities prior to administration.5. Observed hand hygiene before and after preparing and administering medicines.6. Observed infection control practices as necessary.Oral Medication Administration7. Prepared necessary equipment and supplies.8. Computed for the required dose.9. Provided privacy as needed.10. Observed health care waste management protocol in disposing materials used.11. Endorsed omitted, unavailable medicine, reason, intervention and referral done.Oral Medication Administration12. Reported adverse drug reaction and accomplish necessary form.13. Reported medication variance and accomplish necessary form. Oral Medication PreparationSteps:Observed general considerations.Checked medicine three times before administering. When taking medicines from storage area before placing medicine into the medicine cup. Re-checked before placing medicine bottle/pack into storage area.Oral MedicationContRe-checked before administering to patient.3. If in fluid form, pour medicine from the pack to the lid of the container and then into the medicine cup.4. When pouring liquid, placed medicine cup in a firm surface and read fluid level at the lowest point of the meniscus.Oral Medication5. Re-checked medicine label again to ensure correct drug and dosage.6. Placed medicine/medicine cup on a tray.7. If multi-dose vial/pack, return to the storage area.8. Placed patient on a sitting position if not contraindicated by his condition.Oral Medication9. Assisted patient in taking medicine and gave fresh glass of water, or other liquid to aid swallowing.10. Made sure patients swallows medicine.SubligualSteps:Observe general considerationsSpecial instructions: explain that the patient must not swallow the drug or drink any liquid until drug is completely absorbed.Ask patient to place drug under his tongue or to hold tongue up so that you can place medication under the tongue.Intravenous PushThrough the Y-connectorSteps:Observe the general considerations.Countercheck standing order sheet against physicians order.Explain the procedure.Check I.V site.Check for skin test result of medicine for I.V. push , drug-drug, drug-I.V, fluid incompatibility, dosage.4. If infiltrated , if there are signs of phlebitis, do not give the drug.15Intravenous PushThrough the Y-connector8. Flush I.V. tubing after medicine administration with I.V fluid (aspirate I.V. fluid using same syringe and push I.V. fluid slowly).9. Regulate rate of I.V. fluids as ordered.10. Observe for signs and symptoms of adverse drug reaction and refer accordingly.

Intravenous PushThrough the Y-connector6. Disinfect injection port of diluent (if in vial) and medicine. Aspirate amount of diluent and dilute medicine (if medicine needs to be diluted).7. Aspirate right dose , disinfect Y-connection port of I.V administration set; pierce through the bulls eye rubber port ; kink tubing; push I.V medicine slowly as ordered or as per manufacturers instructions. Observe precautionary measure during drug administration.

Intravenous PushHeparin Lock or rubber in-stopperSteps:Observe the general considerations.Countercheck standing order sheet with physicians order sheet.Gather equipment such as I.V tray, heparin solution, normal saline diluents and 3 pieces 2.5 cc syringes.

Intravenous PushHeparin Lock or rubber in-stopper4. Prepare medicine to be administered.5. Fill tuberculin syringe with heparin solution (0.10 cc Heparin plus 0.90 cc normal saline)6. Check patency of IV line.7. Disinfect port.8. Administer as follows: 2 cc normal saline, the ordered medicine, 2 cc normal saline and heparin solution.

Intravenous PushMulti-Flow Adaptor/Three-Way StopcockSteps:1.Observe general consideration.2.Countercheck standing order sheet with the Physicians order sheet.3. Check for sensitivity testing for I.V. antibiotics.4.Rotate stopcock so that the line going to the patient is closed. Remove cover of the injection port aseptically and keep the sterility of the cover.

Intravenous Push5.Swab injection port with alcohol.6.Check patency of I.V. line.7.Open port going to the patient.8.Flush with 2cc saline.9. Administer prescribed medicine.10.Flush with 2cc saline.11.Close port from the injection site and retract syringe.12.Regulate I.V. as prescribed.

Incorporation of medicine into IV FluidSteps:Observe general considerations.Countercheck standing order sheet with the physicians order.Check for sensitivity testing for I.V. antibiotics.Remove cap of the airway of the I.V. administration set, maintain the sterility and incorporate prepared medicine into the airway. Recap airway after.Incorporation of medicine into IV Fluid5. If the I.V administration set has no airway, put down the I.V fluid, kink I.V tubing ; remove I.V administration set from the I.V fluid; return I.V administration set to IV fluid aseptically; invert bottle twice to mix medicine with the I.V fluid and regulate flow rate as prescribed.

Incorporation of medicine into volumetric chamberSteps:Observe general considerations.Countercheck standing order sheet with physicians order sheet.Aspirate prepared medicine.Check present I.V fluid label, level and incorporated medicine in the volumetric chamber or I.V. fluid. If with incorporated medicine, check for drug-drug incompatibility.Incorporation of medicine into volumetric chamber5. If the ongoing I.V. fluid in the volumetric chamber is to be consumed in 6-8 hours, ask from the physician an order for I.V fluid to be used solely for drug administration and keep set sterile for succeeding doses.6. Add desired I.V fluid or diluent into volumetric chamber and incorporate medicine. Mix gently.Incorporation of medicine into volumetric chamber7. Open clamp of the airway of the volumetric chamber.8. Regulate flow rate of I.V. infusion as prescribed.9. Place I.V. label on volumetric chamber as follows: patients name, medicine , date and time of start and end of infusion.