Module C- Administering Medications

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Module C- Administering Medications

• By Brenda D. Rigsby, MSN, RN, CRNP

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Safety Issues

• Standard Precautions
• Equipment disposal
• Needleless systems
• Personal protection equipment
• Reporting needle sticks
• Reporting medication errors
• Behaviors to avoid during medication
  administration

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Standard Precautions

• Guidelines recommended by the Centers for Disease
  Control and Prevention to reduce the risk of the
  spread of infection in hospitals.

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Standard Precautions, cont.

• These Precautions (e.g., handwashing, and wearing
  personal protective equipment such as gloves,
  mask, eye protections, gown) apply to blood, all
  body fluids, secretions, excretions (except
  sweat), nonintact skin, and mucous membranes of
  all pts. And are the primary strategy for
  successful nosocomial infection control.

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Personal protection equipment

• Protective equipment, including personal
  protective equipment for eyes, face, head, and
  extremities, protective clothing, respiratory
  devices, and protective shields and barriers,
  shall be provided, used, and maintained in a
  sanitary and reliable condition wherever it is
  necessary by reason of hazards of processes or
  environment, chemical hazards, radiological
  hazards, or mechanical irritants encountered in a
  manner capable of causing injury or impairment in
  the function of any part of the body through
  absorption, inhalation or physical contact.

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Equipment disposal

• Put the syringe and needle into the sharps
  container
• Needless system

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Reporting needle sticks

• What are the steps involved in reporting a needle
  stick?

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Elements leading to Medication Errors

• Misinterpretation
• Miscalculations
• Misadministration
• Difficulty in interpretation handwritten orders

• Misunderstanding of verbal orders
• Drug name confusion
• Lack of employee/patient knowledge

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Reporting medication errors

• What steps should be taken when a medication
  error has occurred?
• USPMERP- United States Pharmacopeia Medication
  Errors Reporting Program- healthcare professions
  report
• MedWatch- public reports
• Institute for Safe Medication Practices (ISMP)
• JCAHO

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Medication Orders

• Reading and interpreting medication orders
• Parts of a medication order
• Types

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Essential Order Components

• Client name
• Date/Time
• Medication name
• Dose
• Route
• Time Frequency
• Signature

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Medication administration record example
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Medication orders documentation
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Reading and interpreting medication orders

• See the provided handout.

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Types

• STAT
• Routine
• Standing
• PRN
• One time dosing
• Written vs. Verbal/phone

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Reading and interpreting labels

• Common abbreviations
• No longer approved abbreviations

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Drug packaging

• Mix-O-Vials
• Cartridges/Tubex
• Dose Packs
• Vials
• Ampules
• Pre-filled syringes

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Drug Administration

• equipment/adaptive equipment
• Systems of distribution
• Computerized system
• Unit Dose
• Stock
• Narcotic Control Systems

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Reconstitution of medications

• Diluent
• Labeling

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Calculating dosages

• Use of approved formulas
• Compare order to safe dose

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Preparing dosages for administration

• Read physicians orders accurately
• Compare to medication administration record
• Check medication at least 3 times
• Check expiration date on medication
• Accurately measure medication dose
• Check for patient allergies Check for patient
  allergies
• Review nursing implications

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Behaviors to avoid during medication
administration

• What are some behaviors to avoid during
  medication administration?

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Drug information preparation

• Classification
• Mechanism of action
• Side effects
• Adverse/toxic reactions
• Contraindications/cautions
• Drug/food interactions
• Nursing implications

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Routes for administering medications

• Enteral
• Parenteral
• Intradermal
• Subcutaneous
• Intramuscular
• Z-track
• IV
• Percutaneous

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Enteral Medication Route

• The enteral route refers to those drugs
  administered directly into the GI tract by oral,
  rectal, or nasogastric routes.
• Dosage forms
• - capsules -
  elixirs
• - lozenges or troches - emulsions
• - pills -
  suspensions
• - tablets -
  syrups

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Dosage Forms

• Capsules- small, cylindrical gelatin containers
  that hold dry powder or liquid medicinal agents.
  Convenient way of administering drugs with an
  unpleasant odor or taste.
• - Time-released capsules- provide a gradual
  but continuous release of drug b/c the granules
  w/in the cap. Dissolves at a different rate. It
  reduces the of doses/day.
• Lozenges- are flat disks containing a medicinal
  agent in a suitably flavored base. They are held
  in the mouth to dissolve slowly.
• Tablets- are dried, powdered drugs that have been
  compressed into small disks. Scored tablets- the
  indentation maybe used to divide the dose.
  Enteric-coated tablets- has a special coating
  that resists dissolution in the acidic pH of the
  stomach but is dissolved in the alkaline pH of
  the intestines.
• Elixirs- clear liquids made up of drugs dissolved
  in alcohol and H2O. They are primarily used when
  the drug will not dissolve in water alone.

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Tablets
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Dosage Forms

• Emulsions- are dispersions of small droplets of
  water-in-oil or oil-in-water. They are used to
  mask bitter tastes or provide better solubility
  to certain drugs.
• Suspensions- are liquid dose forms that contain
  solid, insoluble drug particles dispersed in a
  liquid base. They should be all shaken well
  before administration to ensure thorough mixing
  of the particles.
• Syrups- contain medicinal agents dissolved in a
  concentrated solution of sugar, usually sucrose.
  They are effective in masking the bitterness of
  the drug and for use in pediatrics b/c they tend
  to prefer the taste.

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Equipment

• Unit Dose or Single Dose
• Soufflé Cup
• Medicine Cup
• Medicine Dropper
• Teaspoon
• Oral Syringe
• Nipple

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Enteral Administration

• Administering oral medications liquid
• - Adult or child-
• -Give the most important drug 1st.
• -Never dilute a liquid med. Unless
  specifically ordered.
• - Always remain w/ the pt while the med is
  taken. Never leave meds at BS, unless orders
  state this.
• - Infant
• - Check the I.D. bracelet
• - assess alertness
• - position with head slightly elevated
• - Administer using oral syringe or dropper or
  nipple.

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Enteral Administration

• Administering medications via nasogastric tube
• Liquid forms of drug should be utilized whenever
  possible for NG administration.
• When using tablets(crush) and capsules(pull
  apart) and mix w/ 30cc of H20. Not enteric
  coated or sustained release caps.
• When more than one drug is used flush w/ 5-10 cc
  of H2O.

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Enteral Administration

• Administering rectal suppositories
• Administering disposable enemas
• See textbook

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Parenteral Administration

• Preparing parenteral medications
• - Syringes
• Syringe has several functions
• Device for transfer of medication
• From storage container
• To administration container
• To patient
• System for maintenance of sterility
• System for measuring medication
• System for delivering medication
• System for prevention of needle sticks

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Syringe parts
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Syringe

• (Syringe has 3 parts)
• 1. barrel
• Main body of syringe
• Acts as receptacle for medication
• Has measuring scale on side
• 2. plunger
• Used to pull or push medication into or out
  of barrel
• 3.tip
• Provides connecting site for needle
• Syringe calibration
• 1. Metric Scale- measures in mL (cc)
  fractions of ccs
• 2. Apothecary Scale- measures in minims
  ( 15 minims 1ml),
• 3.Insulin scale- measures in units
  (U-100 Insulin 100 U 1cc)
• 4. Tuberculin scale- measures in
  1/100th of a ml (cc)

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Syringe

• Factors Affecting Syringe Choice
• Volume of Medication
• 1cc or less ID SQ IM
  IV
• 1 3cc
  IM IV
• gt3cc
  IV

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Needle parts
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Needles- has several parts

• Hub
• Provides attachment device to
  syringe tip
• Shaft
• Length
• Varies from 3/8 to 3
• Diameter
• Expressed as Gauge (ga.
  or )
• Bevel
• Provides sharp point and cutting edge
• Varies from short(very dull) to
  long(more sharp

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Needles

• Factors Affecting Needle Choice
• General Principle
• Use smallest gauge of appropriate length
• Goal is to deliver to target
  tissue with least trauma
• Viscosity of Medication
• Thicker meds need bigger needle (lower
  gauge)
• Target Tissue
• Intradermal and Subcutaneous
• 3/8- 5/8, 25 ga- 30 g
• Intramuscular
• 1 1 ½ , 20 ga- 22 ga

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Giving an Intramuscular Injection
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Parenteral Administration

• Preparing injections from ampule
• Glass with hour glass neck
• Must break the neck to access med
• Single dose
• Preparing injections from vial
• Glass or plastic with rubber cap protected
  by metal or plastic cover
• Rubber cap must be pierced to access
  medication
• Maybe liquid or powder (must be diluted)
• Maybe single or multidose
• Preparing injections in one syringe by mixing two
  vials

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Parenteral Administration
Route Volume Gauge Length
Intradermal 0.01- 0.1ml 26-29ga 3/8 ½
Subcutaneous 0.5 2ml 25-27ga 3/8-5/8
Intramuscular 0.5- 3ml-adult 1-2ml-child 18-23 ga-adult 25-27ga-child 1-11/2-adult ½ - 1-child 5/8 - newborn
Intravenous 1- 2000ml 20-22ga(sol) 15- 19 ga(bld) ½ -1¼ (butterfly) ½ - 2 (reg needle
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IM injection needle length selection
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Parenteral Administration

• Administering intradermal (ID) injections
• are made into the dermal layer of the skin
  just below the epidermis. Usually 0.1ml, are
  injected to produce a wheal.
• Route of choice- for allergy sensitivity tests,
  desensitization injections, local anesthetics,
  and vaccinations

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Intradermal injection technique
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Parenteral Administration

• Subcutaneous (SC) injections
• are made into the loose connective tissue
  btw the dermis and muscle layer. No more than 2ml
  can ordinarily be deposited at a SC site.
• Route of choice for drugs such as insulin
  heparin. Do not aspirate

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Giving the SC injection

• Prepare medication, gather supplies, wash hands,
  don gloves, talk to Pt.
• Select site(mark site with non-dominant hand)
• Cleanse site (circular motion, center-gtout, using
  dominant hand
• Put cleansing swab btw 3rd 4th fingers of
  non-dominant hand

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Giving the SC injection

• Grasp skin to make site firm (non-dominant hand
• Hold syringe as if it is a pencil
• Insert needle quickly and smoothly at appropriate
  angle
• 45 degrees- thin people (emaciated)
• 90 degrees- larger people
• Transfer non-dominant hand to hold hub of syringe
  stable
• Inject medication slowly but purposefully
• W/d needle slowly but purposefully
• Apply gentle pressure w/swab (do not massage)

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SC injections common sites
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Subcutaneous injection technique
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Intramuscular(IM) injection

• SITES Max. Volume
• Vastus Lateralis Muscle- vol. up to 2cc
• Rectus Femoris Muscle- vol. up to 2cc
• Gluteal Area- up to 4cc
• Ventrogluteal area
• Dorsogluteal area
• 4. Deltoid Muscle vol up to 2cc

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Intramuscular injection technique
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Supplies

• Medicine
• Doctors Orders
• Drug Card
• MAR
• Alcohol pads
• Gloves
• Patient chart

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Getting Ready

• Wash your hands with soap and water
• Gather your needed supplies

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Drawing up the medication

• Check the label on the medicine
• Check the expiration date
• Inspect for discoloration of the medication

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• Remove the cap from the medicine bottle
• Clean the top of the bottle each time with an
  alcohol pad.
• Do not touch the top of the bottle after it is
  cleaned with alcohol

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• Attach and / or tighten the needle onto the
  syringe
• Take the needle cap off the needle and place the
  cap in the boat
• Pull back on the end of the plunger
• Draw air into the syringe equal to the amount of
  medicine

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• Place the bottle on the table
• Insert the needle into the rubber stopper on top
  of the bottle
• Invert bottle with the syringe attached
• Pull the plunger down allowing the medication to
  fill the syringe
• Stop at the desired amount

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• Check for bubbles in the syringe
• Remove the bubbles
• Pull down the syringe again and fill the syringe
  with the correct amount of medicine
• Check again for air bubbles if present repeat the
  step above

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• Remove the needle from the bottle
• Carefully replace the needle cap
• Change the needle

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Selecting The Site

• Carefully select the site for the injection so
  major blood vessels and nerves are avoided
• Use different sites to prevent repeated
  injections in the same area
• Change sites with each injection
• Do not use areas that are bruised, tender,
  scarred from surgeries or injury, or swollen

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Lets Take A Break!!!!!!!!!!!
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Routes for administering medications

• Instillations
• Eye
• Ear
• Nose
• Rectal
• Vaginal
• Topical
• Inhalation

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Percutaneous Administration

• Instilling ophthalmic medications
• - Administering ointment
• - Instilling eye drops
• Refer to the textbook

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Percutaneous Administration

• Administering ear drops

Refer to the textbook
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Percutaneous Administration

• Administering nasal drops and spray
• Refer to the textbook

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Percutaneous Administration

• Administering vaginal medications
• Refer to the textbook

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Administering medications via metered-dose
inhalers

• Administering medications via transdermal drug
  delivery system

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Intranasal Medications in the Prehospital Setting
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Insulin administration

• Syringes
• Sliding scale
• Types of insulin
• Validation of dose by another licensed nurse
• Sites
• Lab data
• Mixing insulins

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12.0 Heparin administration

• Special technique for injection
• Sites
• Validation of dose by another licensed nurse
• Lab data

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The six rights of Medication Administration

• Patient
• Medication
• Dose
• Route
• Time
• Documentation

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Client/family teaching

• Drug information
• Discharge planning
• Return demonstrations as required

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Properly Handling and Disposing of Medication
Administration Supplies

• Recapping Needles
• Biohazard Containers
• Wasting medications

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Documenting medication administration

• School or hospital protocol
• Adjunct assessment data
• Evaluation of patients response to drug

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Clean Up The Supplies

• Do not recap the needle
• Dispose of other supplies in the trash
• Record date time and site of injection and how
  the patient tolerated

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• Wash your hands

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The End

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