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Medication Administration

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Medication Administration Unit VI Part 3 (lab 2) Keith Rischer, RN, MA, CEN, CCRN * WHAT IF PT COMMENTS THAT MED SEEMS UNUSUAL IN ANY WAY NURSE SHOULD HOLD UNTIL ... – PowerPoint PPT presentation

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Title: Medication Administration


1
Medication Administration
  • Unit VI
  • Part 3 (lab 2)
  • Keith Rischer, RN, MA, CEN, CCRN

2
Todays Objectives
  • Differentiate the roles of various health team
    members in medication preparation and
    administration.
  • State the essential parts of a drug order.
  • Describe nursing actions which maintain physical
    safety of clients receiving medications.
  • Discuss factors that determine appropriate routes
    for drug administration.
  • Demonstrate preparation, administration, and
    charting of medications.
  • Identify the most common medication errors made
    by nurses and what can be done to decrease errors
    in the clinical setting.

3
Roles of Health Team Members
  • Physicians
  • Advanced practice nurses
  • Pharmacists
  • Unit Secretaries
  • Registered nurses
  • LPN
  • Medical technicians

4
Medication Order Components
  • Full name of client
  • Date and time order is written
  • Name of the drug to be given
  • Dosage of the drug
  • Route of administration
  • Frequency of administration
  • Reason for medication (PRN meds)
  • Signature and licensure of the person writing the
    order
  • Atenolol 50mg po daily Nathan Bowler, MD
  • 9/3/2010, 1500

5
Types of Orders
  • Based on frequency/urgency of order
  • Standing orders
  • PRN orders
  • One time orders
  • Stat orders
  • Now orders
  • Prescriptions

6
Nursing Actions r/t Med Administration
  • Review medical history
  • Check the MAR
  • Assess for poly-pharmacy
  • Check for allergies
  • Know normal dose ranges
  • Critical lab values
  • K (3.5-5.0)
  • Mg (1.8-2.6)
  • AST, ALT, (lt50) albumin (3.1-5)
  • Creatinine (0.6-1.4)

7
Nursing Actions r/t Med Administration
  • Assess
  • ability to swallow
  • GI motility
  • muscle mass (for injection)
  • venous access (for IV)
  • vital signs
  • BP, HR, O2 sats
  • Evaluate response

8
Patient Medication Education
  • Name-dose-action
  • When to take?
  • With/without meals
  • Coping with expected/most common SE
  • Warnings of toxic effects

9
The Six Rights
  • Right medication
  • Avoid verbal orders
  • Does drug make sense with pts history?
  • Right dose
  • Double check all drug calculations
  • Right time
  • Timing of critical meds

10
The Six Rights
  • Right route
  • Best route considering needs
  • Right client
  • 2 identifiers
  • Check for allergies
  • Drug-drug interactions
  • Right documentation
  • Always AFTER med given

11
Practice Guidelines
  • These guidelines are necessary for the safe
    administration of all medications
  • Patient assessment (HR-BP-LOC)
  • 6 rights
  • 3 checks before administration
  • 1 - Check with MAR as pull drugs
  • 2 -Recheck drugs to be administered with MAR
  • 3 - Recheck drugs to be administered with MAR at
    bedside
  • Verify Pt ID
  • Verify MAR with patient at bedside

12
Practice Guidelines
  • Give medications one at a time
  • Keep in unit dose wrapper til given
  • Educate on meds while giving
  • do you know why you are taking_______?
  • If knowledge deficit apparent incorporate in plan
    of care that day
  • Why taking what it doesat their level
  • Most common side effects
  • With food?
  • When to take and how often

13
What to do if
  • Your patient is lethargic and confused after
    receiving a prn dose of Morphine
  • Patient drops a tablet on the floor
  • Drops his HR from 72 to 52 after Atenolol
  • Develops a red raised rash with itching after a
    first dose of Ampicillin
  • Refuses his medication that is ordered by the
    physician

14
Medication Safety Tips
  • Nursing responsibilities
  • Follow the 6 rights of med administration
  • Read med labels comparing with MAR 3 times
  • Use 2 client identifiers
  • Name, DOB or MR
  • Avoid interruptions during the med admin process
  • Clarify illegible handwriting with prescriber
  • Question unusually large or small doses

15
Medication Safety Tips
  • Nursing responsibilities
  • Double check all calculations verify with
    another RN as needed
  • When you have made an error, reflect on what went
    wrong and how it could have been prevented.
  • Follow extra care and safeguards around High
    Alert meds these have a high potential for
    error and adverse effects.
  • Heparin
  • Insulin

16
What Influences Med Errors
  • Nurses lt5 yrs or gt20 yrs highest error
  • Shift with most med errors?
  • Average amount of med errors annually by RNs?
  • 1-2/year
  • Which violation of the 5 rights most common?
  • Wrong time
  • Wrong dosage
  • Interruptions during med pass
  • Each interruption increased liklihood of error
    12.7

17
Are These med Errors???
  • Crushing tablets that should not be crushed.
  • Use of discontinued or out-of-date medications.
  • Pushing an IV medication too rapidly or undiluted
    (when it should be diluted for patient safety).
  • Giving a patient (with a K 5.2) the prescribed
    KCL 20 meq po daily.
  • Administering Furosemide 40 mg po to a patient
    with a BP of 84/40.
  • Not documenting the site of an intramuscular
    injection

18
Would you ? these orders
  • Tamsulin (Flomax) 0.4 mg po now
  • 54 yr old female with current kidney stone
  • Hydromorphone (Dilaudid) 12 mg IV now
  • 28 yr male-pain with sickle cell disease 9/10
  • Morphine 10 mg IV now
  • 32 yr female with acute abd pain 10/10

19
What can Be Done to Decrease
  • No interruptions during med pass
  • Critical thinking questioning
  • Healthy collaborative physician relationships
  • EMR computerized MD order entry

20
What if Med Error made???
  • Assess pt. response/safety
  • Contact physician
  • Document in chart just the facts
  • Do not mention a safety report was filled out
  • Document in facilities Safety Report (incident
    report)
  • Risk management reviews
  • Manager provides follow up/remediation
  • If severe incident, notify nurse manager or
    supervisor ASAP

21
Cognitive Skills Required
  • Basic knowledge of pharmacology
  • Drug name
  • Types of preparation
  • Types of orders
  • Drug classification and action
  • Side effects/adverse effects
  • Drug dose calculations
  • Knowledge of how to prepare and administer drugs
    safely

22
Technical skills
  • Ability to implement techniques for safe and
    effective preparation and administration of meds

23
Interpersonal skills
  • Ability to communicate clearly and effectively
  • Ability to establish trusting relationships as a
    basis for teaching and counseling
  • The student nurse is also an EDUCATOR

24
Ethical/legal Skills
  • Commitment to safety and quality strong sense of
    responsibility and accountability
  • Knowledge of institutional policy and procedure
    manual related to administration of meds
  • Commitment to report medication errors and to
    follow agency policy for working to prevent their
    recurrence
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