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  1. What is the nurse's role in Rx administration
    • Nurses are legally responsible for medications they administer, including knowledge of drug actions and side effects and the questioning of orders they believe are incorrect.
    • Education…knowledge deficit
    • Assess.. affordable, accessible, ability
    • Monitor and Document
    • You are the last line of defense
  2. More Pt rights of Rx admin
    • Be informed about a medication
    • Right to refuse…regardless of consequences. "Pt refused followed by education.
    • Medication of medication history
    • Consented prior to receiving investigational drugs
    • Receive drugs safely and not unnecessarily
  3. Pharmacy's role
    • Prep. and distribution
    • Asses and evaluate Rx therapy needs
    • Provide education about Rx ae to the pt.
  4. LIP's role
    • Assess and prescribe the medication
    • Computer..most accurate
    • Written
    • Telephone
    • Read BackVerbal..ONLY in Emergent Situations
    • Repeat Back
  5. 7 Essential Elements of Rx order
    • Patient Name
    • Date the drug was ordered
    • Name of the Drug
    • Dosage (time, frequency, urgency, amount, number of doses)
    • Route of administration (IV, IM, PO, etc.)
    • Time and frequency drug should be given
    • Signature of MD or LIP
  6. Standard Written
    Thesea re carried out as written or until the prescriber alters or d/c an order.

    ie give lasix 20mg iv BID for 5 days.
  7. Automatic Stop Dates
    These medication orders will need renewed after a specific period of time.  Pharmacy will notify the prescriber.
  8. STAT vs. NOW
    • STAT…emergent…high priority…obtain and administer
    • NOW…slightly lower priority…complete within an hour.
  9. Single Drug Order
    One time order. Just need it once.
  10. Standing orders and protocols
    Used to treat occurrences and they will be in the patient medical record.

    Example:Potassium Replacement Protocols.. an order set describing how to administer potassium replacement depending on the patient blood level.

    MD or LIP will just order to follow the potassium replacement protocol. 
  11. PRN
    • The Nurse will use subjective and objective data – Assessment and then document reason given and results.
    • The order will specify:
    • The condition to give the drug
    • When to give the drug
    • Route

    Example:Tylenol 650 mg po Q 4 hrs PRN Temp. >101°F.
  12. What to do when orders change
    • Orders are re-written when changes in the patient occur:
    • Surgery
    • Transfer between different services ie. the floor to the ICU
    • Transfer to another hospital or facility.

    Medication reconciliation MUST be completed
  13. Nursing process and Rx admin
    • Assessment: objective/subjective, allergies, etc.
    • Review medication order / clarify
    • Reference material
    • Education: The “six rights”
    • Perform associated interventions
    • Evaluate response
  14. Things to Assess before administration
    • Medication record (MAR)
    • Diet and fluid orders
    • Laboratory values
    • Physical Assessment
    • Ability to swallow
    • GI motility
    • Adequate muscle mass
    • Adequate venous access
    • Vital signs
    • Body system assessment
  15. Subjective Assessment prior to admin
    • Knowledge:
    • What medications are you taking?
    • What are they for?
    • Expected results?
    • Common side effects.
    • Adherence/compliance:
    • Lifestyle
    • Financial situation
    • Health insurance
    • The Right to Refuse
  16. Assessment during Rx admin
    • Understanding of the patient perception of why they are taking the medication
    • Ability to  self administer
    • Swallowing…change form, thick liquids, Speech Therapist
  17. What should a Rx order contain?
    • Correct transcription and communication
    • Accurate dose calculation and measurement
    • Correct administration
    • Correct recording
  18. The MAR
    • Drug order is written on the patient’s chart
    • Medication order is transcribed to a Medication Administration Record (MAR)
    • MAR’s contain Name, Room #, Bed #, Drug Name, Dose, and Times and Method of Administration
  19. Three check points when admin Rx
    • Three Checks
    • Before you pour
    • Check the medication label against the MAR
    • After you pour/prepare
    • Verify the label against the MAR again
    • At the bedside
    • Check the medication a third time!
  20. 6 rights of Rx admin
    • Right drug/medication
    • Right patient
    • Right dose
    • Right route
    • Right time
    • Right documentation
  21. Right med/dose
    • Double check the MD / LIP order
    • Do not borrow medication from other patients
    • Be Aware of look alike and sound alike medications, ie   diazepam vs. lorazapam
    • Does this drug @ this dose for this pt make sense?
  22. Right pt
    • Common Names->Two Identifiers
    • Confused?
    • What do you compare your 2 identifiers against?
  23. Right Route
    • Double check your route:
    • Oral (PO)
    • Topical
    • Respiratory Inhalation
    • Parenteral (IM, SQ, IV, etc)
    • Don't change route without LIP documented approval.
  24. Right Time
    • Window…30 min. before and after
    • Should the medication be taken with meals or empty stomach?
    • What if the person is NPO for a procedure?
  25. Basic Rx safety
    • Prepare medication for only one client at a time
    • Compare order with medication available
    • Calculate drug dose
  26. More Rx Safety
    • Compare prepared medication to MAR
    • Check medications at least 3 times before administering
    • Take directly to patient
    • 2 patient identifiers
    • Complete required assessment
    • Explain purpose of medication
    • Assist to sitting position
    • Medication and water to client
    • Stay with client until all medications are swallowed – DO NOT bedside
  27. Oral Dose Prep
    • Prepare medication for only one client at a time
    • Compare order with medication available
    • Calculate drug dose
    • Prepare medications
    • Keep unit dose in wrapper
    • Don’t touch pills
    • Liquids at eye level
    • Fill till bottom of meniscus is at desired mark
    • Narcotics: need 2 RNs to verify Rx.
  28. Topical Rx admin
    • Mucous membranes of the mouth – buccal;
    • sublingual – rapid systemic effects; local effects
    • Skin administration – cleanse the skin before application. Lotions, pastes, ointments->Spread the medication around
    • 3 Bears Rule – just right amount
  29. Enteral Rx (NG)
    Check placement. Sometimes tube can migrate to lung.
  30. Terms for eye drops
    OD=Right eye, OU=both eyes, OS=Left eye
  31. Vaginal admin
    • Suppositories; foams; jellies; creams
    • Body temperature liquefies and distributes medication
    • Follow Standard precautions
    • Privacy if client self-administers
  32. Parenteral Rx
    • Medications administered by injection
    • Invasive procedure:
    • requires aseptic technique
    • Proper administration – location, location, location
    • Make sure you've got right needle (gauge) and right syringe (proper volume to accurately draw)
  33. Mixing Rx
    • Medications must be compatible
    • Total dose must be within accepted limits
    • Care must be taken to not contaminate one medication vial with another medication – change needles
    • Ensure that the final dose is accurate –  Insulin
  34. Prepping insulin
    • Requires check by 2 licensed personnel – you are not licensed yet
    • What do you assess before giving or drawing up?
    • Insulin classifications
    • Regular insulin is clear and fast acting
    • Other insulin is cloudy – such as NPH
    • Order for drawing two insulin in one syringe:
    • 1) inject air into cloudy (long lasting) vial.
    • 2) inject air into clear vial (fast acting).
    • 3) Turn over and draw clear into syringe.
    • 4) Turn over and draw cloudy into syringe.
    • 5) Check total amount before administering.
  35. Mixing medications – long acting and short acting insulin
    Image Upload
  36. SubQ
    • Abbreviated SC or SubQ
    • Small amount of injectable material – usually 0.5 – 1 ml fluid
    • 25-27 Gauge needle; ¼ - 5/8 inch in length
    • 90º angle.
    •  Absorption slower than IM route
    • EBP shows no need to aspirate (unless heparin)
  37. sites for subq
    Image Upload
  38. IM injection
    • Faster absorption that SC due to increased vascularity
    • Injecting medications into the blood is a risk of this route
    • Needle ½ - 3 inches in length, dependent on amount of adipose tissue and patient size.
    • Gauge~24ish.
    • 90º angle, < 3 ml injectable amount
    • Assess integrity of muscle prior to injection
  39. Sites for im
    • Image Upload
    • Deltoid should never get more than 1mL
    • Steer clear of the glutes
  40. Z Track
    • Image Upload
    • 1)Pull skin laterally before injection-1-1.5 inches
    • 2)Inject medication
    • 3)Hold skin and keep needle in place 10 secs.
    • 4)Withdraw needle and release skin
  41. Intradermal Injections
    • Typically used for skin testing
    • Necessary to see injection sites for changes of color
    • Lightly pigmented, free of lesions, as hairless as possible
    • Decreased blood supply = increased absorption time
    • TB syringeAngle – 5º - 15º
    • Checking for induration at site
  42. Intradermal sites
    Image Upload
  43. Rx Documentation after admin
    • Name of medication
    • Dose
    • Route (site of injection)
    • Date  / Time
    • Initials / Signature
  44. Questioning Rx order
    • Any order that is ambiguous, unusual or contraindicated by the client’s condition.
    • Contact prescriber – discuss your rationale for believing medication is inappropriate
    • Use SBAR-R and state “Clarify the order..”
  45. What should I do if I commit a Rx error
    • Immediately assess the patient’s vital signs and physical status.
    • Report findings to the primary care provider.
    • Notify the nurse manager of your unit and report the event surrounding the event.
    • Check with your institution for agency-specific policy regarding incident reporting.
Card Set:
2012-07-01 13:49:24
FT3 medication administration

medication administration
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