Medication Administration

Legal Aspects Before you can legally administer a med:

o Prescriber and nurse must be licensedo Is the medication order valid?

Pharmacist validates (double checks)o Know purpose, action, side effects, and teaching related to medication

You are responsible for your actionso Question & clarify incomplete, incorrect, inappropriate, or invalid orderso Ask or look it up

Controlled substances (2 nurse check if wasting narcotic meds) Lewis Blackman Act= badges must be labelled w/ attending, resident, student, etc.

o Attending= person responsible for patient’s careo Resident= under umbrella of attending, also see patient but ultimately, attending

is still responsibleo Anytime patient requests attending, the nurse must pass along concern to

attendingo Mechanism must be available for patient to get prompt assistance if necessary

(patient advocate) Pharmacist is collaborative expert within hospital.

Variables Affecting Drug Action Development factors

o Infant: smaller doss Immature liver, kidneys, digestive system, increased body water,

decreased body fato Older adult: smaller doses

Decreased/impaired renal and liver function, decreased motility (time it takes from mouth to excretion) so meds stay in system longer, decreased muscle mass, decreased body water, increased body fat

Pregnancy: some meds can interfere with fetal developmento Watch for meds that are contraindicated in breastfeeding

Body weighto Increased body mass= larger doses

Gendero Hormone levels can affect toleration of medso Research done on men, but may affect women differently

Genetic & cultural factorso African Americans- certain HTN meds don’t work as well as others (beta

blockers)o Herbal remedies can affect metabolism of other meds

Diet

o Vitamin K- avoid on Coumadin bc they can reverse affecto Grapefruit can intensify meds

Environmento Temperature- cold vasoconstriction (esp. if taking meds that are supposed to

do this, might not work as well) Psychological state

o Placebo affect Illness & disease Time of administration

o Some have to be given AM, some PM, some AC, etc.

Recommended Guidelines for Administration Route depends on desired effect and patient’s condition Enteral- via GI tract:

o Oral (PO)- by mouth (swallow) Easiest, least expensive Safest, as long as they can swallow (not breaking skin or at risk of

infection like with IV)o Sublingual (SL)- under tongue and dissolves

Avoid food or drink bc this washes away Capillaries/vascular system under tongue quick absorption into

bloodstream Can swallow, but won’t work as well

o Buccal- against check Rotate side bc it can eat away/irritate cheek

o NGT/PEG- via tube (PT is NPO) Flush before, after, and between meds & check placement before Can put meds in for a temporary amount of time Patient NPO most of the time (probably reason they have tube in) Can’t crush EC or XR (call doctor & see if there is a different form)

Topical- via skin or mucous membraneso Skin

Transdermal Patches, creams, ointments Deliver meds over 12 or 24 hours Pain patches, one for memory/dementia Never cut a patch When applying, write date & time so others know when patch

was applied Look for skin irritation, maybe put in a place they can’t pick at Use gloves with creams, ointments, and patches (can get into your

skin too) Instillations & irrigations

Otic/ophthalmic/nasal Vaginal/rectal

Inhalants Nebulizer treatment Probably will be respiratory therapist in hospital, but nurse in

long-term care setting Parenteral- via needle injection

o Intradermal (ID)- below dermis (right up under skin) PPD

o Subcutaneous (SubQ)- into subcutaneous tissue (a little deeper than ID) Insulin, heparin

o Intramuscular (IM)- into muscle Flu shot, antibiotics (rosefarin)

o Intravenous (IV)- into vein Steroid injections, fluids

Parenteral Considerations Aseptic technique

o Use new, capped needle every timeo Use good techniqueo When openingo Clean skin w/ alcohol

Syringe, needle, angle dependent on patient, route, type of med (oil vs. water based)o Size of patient is important

The larger the gauge number- the smaller to diameter of needle shafto Same with IVso 18/18= large bolus of fluid/blood product in emergencyo 23= IV fluid maintenance

intradermal: 25-27 gaugeo ¼ to 5/8” needleo 5-15 degreeso small and shorto almost parallel with skin

subcutaneous- 25-30 gaugeo 3/8 to 5/8” needleo 45-90 degrees depending on how much SubQ fat patient haso sometimes pinch up skin so you can get into fat (behind arm, love handle area,

etc.) intramuscular- 21-25 gauge

o 1-1.5” needleo 90 degreeso needle needs to be longer and larger & go in at 90 degrees to get past dermis

and SubQ to get into muscle

never re-cap a needle after injection dispose via sharps container:

o needleso blades and lancetso razorso broken glass (ampules)o any sharp instrument!!

Whenever drawing up meds w/ needle, you can’t walk around with exposed needle, so you can recap (just can’t recap after it has been in patient)

Ampule: glass containero Must be broken- CAUTION!!o Use filter needle to withdraw med from ampule in case there is broken glasso Wear gloves & break ampule away from you at weak point

Vial: glass or plastic container with rubber seal for closed systemo Can have single use vials or multi use vials

Airlock method: air injected behind medication to prevent tracking into SubQ tissueo Seals medication into tissue

Z-track method: for irritating medso Pull back top layer of skin, so that when injected into muscle it won’t leak out

Medication Orders Stat order (give immediately, one time order)

o Should still go through pharmacy first to verifyo Code order= exception

Singe order (one time dose)o Maybe contrast before test or pre-surgery

Standing ordero Protocol in placeo Give Tylenol for temp. greater than 101 degreeso Gives nurse authority to write order w/o calling doctor

o No definite time frame PRN order (as needed)

o If someone is nauseated, then you can give them thiso Discretion of nurse, not patient

Essential components of medication ordero Patient’s full nameo Dateo Name of drugo Dosageo Route of administrationo Frequencyo Signature

Patient Assessment Obtain on admission: (part of medication reconciliation)

o Medication history Including herbal supplements Why they take medications When they take medications

o Allergies Is it a true allergy? Could be side effect of medication, not actual allergy

o Medical history Surgical history

o Pregnant? Or lactating? Some meds are contraindicated in pregnancy Someone might not look pregnant, but if in childbearing years, this is

importanto Not if patient uses drugs or alcohol (could be withdrawing)

Before administration:o Check medication administration record (MAR)o Diet & fluid orders

Might be NPO except medicationso Laboratory values

Look at INR levels before administering Coumadino Physical assessment

Ability to swallow Gastrointestinal motility

Output Adequate muscle mass Adequate venous access Vital signs Body system assessment

Administering medications:o Stay with patient until completely swallowedo Never leave medication unattendedo Don’t touch medication with bare handso Never administer med that falls on floor/sinko Introduce selfo Identify patient (2 identifiers)

Name and date of birtho Hand hygieneo Inform patient

What med is and what it doeso Administer drug

Recent changes in 30-minute policyo Document administrationo Evaluate response

If medication worked or not

Seven Rights of Drug Administration Right patient Right drug Right dose Right route Right time Right documentation Right to refuse

Avoiding Errors Medication checks- triple check Only give meds you pull or draw up Be sure med has drug label Know generic/trade name Reason patient is getting med? Assessment parameters for administration? Listen to patient!!

o If patient says something doesn’t look or sound right, look into this!