Medication Administration

PRINCIPLES

As with all nursing activities, the nursing process governs the principals of medication administration

Medication administration is an important role within nursing

When administering any medication, there is certain information you should have

Before administering any medication you should know

The dose, route, and frequency are within the therapeutic range for that drug

This expectation is governed by safe practice standards

The drug will be safe for the client

Important information

How should it be administered - is this route appropriate for this client?

Drug group or category - is it appropriate for the condition (links to your understanding of the client's condition)

Indications for clinical use - understand the client's condition (anatomy, physiology, and pathophysiology), why it is being used

Usual dose - is this within recommended dose, range, and frequency.

Common adverse effects and possible toxicity (signs and symptoms to observe for)

Contraindications and precautions - is there a reason it should not be given, are there special or specific observations you should perform?

Nursing/administration considerations that may be specific to that medication, i.e. needs to be given with food.

RIGHTS OF MEDICATION ADMINSITRATION

Depending on the literature you read or the facility policy where you are working, the number of rights may vary.

There were originally 5 rights of medication administration, however this has increased as an attempt to have a standard that continues to reduce the risk of error with medication administration

The rights of medication administration are the recommended guide used in clinical practice when administering medication

If you do not have this knowledge, you should not administer any medication

So for every drug you administer, you are legally responsible for knowing the information outlined in the previous slides

8 RIGHTS OF MEDICATION ADMINISTRATION

Right expiration date

Right dose

Right medication

Right documentation

Right route

Right time

Right person

Right to refuse

A drug order is written for a specific medication

It is your responsibility to obtain, prepare, and correctly administer the medication

To provide the right drug, requires an accurate interpretation of the doctor's orders and checking it against a clearly labelled drug container.

Never try to decipher an illegible drug order, and never give a drug order if you're not sure why it was prescribed

Check that the information on the medication order, drug name (preferrably generic) dose, route, frequency, time dues, and when the drug was last given, are all legible at this point.

Ensure that the label on the drug package is checked carefully against the drug order (3 times in the administration process) and if there are any doubts about the name of the drug, or the drug appears inappropriate for the client's health condition, then the prescribing doctor should be questioned.

If you are unfamiliar with the drug that has been prescribed, then you must check with an appropriate reference (MIMS, Havards) or other senior health care professionals such as an RN, pharmacists, or the prescribing doctor.

Match the drug label against the order in the NIMC three times

Again before removing the dose from the packaging

Before returning the drug to the drawer or discarding it.

Once when removing the packaged drug from the patient's drug drawer

Double check the dosage with a colleague if available. Always double check injectable medications and when pfacility policy directs. This is best practice of standards.

Accurate drug calculation is required by one or two nurses

Upon making the correct calculations, the nurse must also be able to determine whether the dose is appropriate for the age, size, and condition of the client.

The nurse needs to ensure that they are able to accurately interpret measurements and abbreviations. In order to do this, the nurse must be able to perform correct drug calculations.

General dosing amounts can be found in MIMS. They may also be found in the drug handbook or Havards guide to drugs.

If unclear, contact the prescriber

If the dose needs to be measured, use appropriate equipment

Never assume what dose of the drug will be administered

Measurement should be done with care and accuracy

The dose is the amount of medication that is administered at one time

The routes include

Double check that you are using the correct route

This is how the medication will be administered

Ensure that the route of administration is clearly written on the drug chart

The drug itself may also be labelled with the preferred route of administration

In order to ensure the right route is being used, the nurse must have an understanding of the correct technique for administration. All medications must be given by the prescribed method and also the required method for that drug.

Generally, oral dosages of a given drug are greater than injected dosages, so a serious overdose may occur if a dose intended for oral administration is given by injection instead

Some medications can come in many forms and therefore the prescribed method must be adhered to.

NOTE

Different medication forms and routes have different dose ranges

Obtaining the right dose is contingent on confirming the right route

Check the right route before checking the right dose

Topical, otic, ophthalmic, inhalant

IM, SC

Rectal, vaginal

Oral, sublingual, buccal

Double check the frequency to prevent missing a dose or giving an extra dose.

Timing of doses can be critical to maintain a specific blooddrug level or to ensure accurate laboratory test values, or avoid interactions with other drugs.

Usually a dose should be given within 30 minutes before or after the time specified in the order, in accordance with facility protocols.

Missing a dose decreases the drug's therapeutic blood level, reducing its effectiveness.

The NIMC has standard recommended times for administration but you should always check your facility policy.

Giving more doses than ordered, increases the drug's blood level, increasing the risk for toxicity.

If frequency is not recorded, do not assume when a medication should be administered, refer to the prescribing Dr.

Giving your client's their medications at the correct time is not always easy, particularly when you have a number of client within your care. Therefore, time management is essential in doing the best that you can.

This is recorded on the MEdication Administration record (MAR) or National inpatient medication chart (NIMC)

It is important to prioritise which drugs are required for which patients, taking note of their current medical status.

Frequency is the number of times the medication dose is administered

It is also important to document the therapeutic and/or adverse reactions of the drug on the observation chart or progress notes, especially if the reaction is of significance, or intended to resolve a specific problem.

After giving a drug, always document that it was administered - never before.

This is imperative to ensure that the client does not miss a crucial drug administration or receive an overdose of the prescribed drug.

If a patient refuses a medication, report this to the prescriber and record refusal on both the NIMC and in the patient's record.

Administering medications does not end with the physical administration of the drug. It also involves the careful and accurate documentation pertaining to the administration of the drug in the appropriate charts and client records. Always ensure that you have signed off on the drug, in the drug chart, at the time of administration.

Use only accepted abbreviations and avoid those that could be misread or misinterpreted.

The right documentation will be able to tell you

SPECIAL REQUIREMENTS

Using the right documentation ensure the right patient/client receives the correct dose of the right medication at the right time by the prescribed route

How much of the drug is to be administered

At what time and how often the drug is to be administered

What drug is to be administered

What route is to be used when administering the drug

Who the patient/client is

All medications have their own legal requirements for storage and documentation

By law, facilities must track the use of controlled substances and maintain an accurate count of their supply.

The right documentation includes correctly recording the use of controlled substances such as narcotics, which are schedule 8 medications

All S8 medications must be kept in a secure area, seperate from ward stock.

S8 medications are often referred to an DD's meaning dangerous drugs

There is a special DD or S8 drugs register where all the drugs are stored in the drug cabinet will be accounted for. They will be counted and recorded on the change of each shift by two registered nurses, one each from the on-coming shift and from the off-going shift.

CONTROLLED DRUGS S8

Check to see that the count is correct

Remove the correct medication as identified by the medication order

Unlock the DD cupboard

Write how many doses are left int he column under the specific drug name

Ensure there is a second checker in attendance throughout the procedure

RECORDING CONTROLLED DRUGS

Preparation for medication administration of an S8

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