Medication Transcription, Verifying Medication Orders

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Medication Transcription, Verifying Medication
Orders Administration

• By
• Evelyn W. Stone RN.,BSN.,M.Ed.
• www.qprofessionalmentalhealthservice.com

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Types of Drug Orders

• Written
• Verbal
• PRN
• Discontinued
• STAT

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Written Order

• Prescriber may write order on order form.
• Prescriber may call order in to pharmacy.
• Carefully check medication label to be sure it
  agrees with the order you have received.
• FAXED orders are legal and acceptable.

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Verbal Order

• May be received in person or on the phone (only
  by nurses or pharmacists).
• The person receiving it must prepare a written
  copy of the order for the prescribers signature.

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PRN Order

• Medication/treatment may be used as needed
• Include what the medication is.
• Include what the treatment is.
• The problem being treated.
• Frequency of administration.

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Discontinue Order

• Medication/treatment is to be stopped
• Discontinued medications should be immediately
  removed
• D/Cd meds can be -
• returned to the pharmacy
• flushed down a drain
• Document name of med, amount, method and date of
  disposal on med disposal form

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STAT Orders

• Do it now
• Get the med and give to client
• Document in designated section on the MAR
• Report to oncoming nurse of the STAT order and
  that it was carried out

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STAT (Continued)

• Use highlighter and yellow out the section of the
  MAR where you initialed or signed that the stat
  med was given.
• Document in the progress notes that the
  medication was given.

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Physician Orders

• All orders, whether written or verbal, must
  include
• Client name
• Medication to be given
• Strength of medication
• Dose to be given
• Frequency to be given
• Route
• Length of time to be given

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Medical Alerts/Allergies

• Physician must be made aware of
• Allergies
• Conditions
• All other meds client is taking
• which might contraindicate a specific
• medication.
• Be prepared to give complete, correct
  information about a clients diagnoses,
  allergies, and all current meds to physician.

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Factors that Influence Medication Dosage

• Age
• Weight
• Time
• Rate Excreted
• Route
• Drug Combinations/Interactions
• Condition of the client

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Age

• Pediatric and the Elderly excrete meds at
  different rates

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Weight

• Some medication dosages are calculated by the
  physician based on body weight.

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Time

• The time is specified if it is to be given once a
  day.
• If unsure of the time in which the med is to be
  given, call the pharmacist.
• Call the Administrator, Director or Qualified
  Professional

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Route

• How medications are taken and absorbed by the
  body may affect the dosage.

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Drug Combinations/Interactions

• Two drugs given together may react differently
  than the same drugs given separately.

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Condition of the Client

• Behavior
• Seizures
• Diabetes
• Vital Signs (history of high BP, fast irregular
  heart rate)
• Acceptance of food, fluids
• Mobility
• Others

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Basic Rules for Administering Medications

• Be sure medications are being taken as
  prescribed. Be alert to changes in clients
  behavior, and physical well-being. Report changes
  to the Administrator Nurse.
• Correct transcription of orders
• Knowledge of drugs being given
• Special administration instructions
• Knowledge of clients physical condition
• Knowledge of clients emotional status
• Climate conducive to concentration
• Communication of information to others
• Resources for medication information

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Correct Transcription of Orders

• Read every word on the script.
• Fax the script to the pharmacy.
• When the medication is received from the
  pharmacy, check to make sure that it is the
  correct medication.
• Write each word on the MAR that is on the
  medication label.
• Recheck your transcription word for word to make
  sure that it was transcribed correctly.

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Knowledge of Drugs Being Given

• Name of Medication and dosage
• Why it was ordered
• What benefit should be expected
• Side-effects to be expected
• Special monitoring needed
• Vital signs
• Stool records c. seizure records
• Special administration instructions
• 1. crushed or chewed
• 2. given in food
• 3. need to be given on empty stomach
• 4. given with any liquid

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Knowledge of Clients physical condition

• Medical alert Seizures, Diabetes, HIV etc.
• Physical limitations Spinabifeda, amputee etc.

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Knowledge of clients emotional status

• Disoriented
• Hostile
• Mute, withdrawn
• Refusing medications
• Assaultive behavior

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Climate Conducive to Concentration

• Temperature 68-82 degrees
• Not too hot
• Not too cold

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Communication of Information to Others

• Drug Information
• Learn the information that comes with the drug.
• Call the Pharmacist and request medication
  leaflets that are suitable for lay public.
• Client information Special alerts to staff.
  Staff to give client education each time the meds
  are given to help the client recognize his meds
  and what they are for.

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Resources for Medication Information

• Pharmacist
• Physician/Dentist
• RN Consultant/RN Qualified Professional
• Drug Information Sheet
• Drug Handbook

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Common Dosage Forms

• Solids
• Topical
• Tablet
• Capsule
• Liquids
• Gases

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Solids

• Suppository- small, solid, cone shaped, glycerin
  base, melt at body temperature, administered by
  rectum or vagina.
• Refrigerate as directed
• Topical- applied directly to skin, lotion
  (external use), paste (mixture of powders and
  ointments), ointment, cream (suspension of oil
  and water), powder (finely ground drugs), shampoo
  (medication in soap), patches (slowly release
  meds.), Aerosol sprays (suspended in gas, e.g.
  Desenex spray, Cruex spray).
• Used for local effect

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Solids (cont.)

• Tablet- powdered drug compressed into small, hard
  disc
• Capsule- powdered, liquid, or oil drug form
• hard or soft
• dissolves quickly in the mouth

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Liquids

• Solution- one or more drugs dissolved in water.
• Suspension- preparation of a finely divided,
  undissolved drug in a liquid.
• Syrup- aqueous solution of sugar.
• Elixir- drug mixed in an alcohol solution,
  sweetened.

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Gases

• Inhalant- Medication carried into the respiratory
  tract through air, oxygen, or steam

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Common Routes of Administering Medications

• Medications are designed for one or two specific
• routes of administration. Physicians order the
• route of administration when ordering the
• medication.
• Oral
• Insertion
• Instillation
• Topical
• Inhalation
• Parenteral

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Oral

• By mouth
• Buccal between the cheek and gum
• Sublingual under the tongue

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Insertion

• Putting in vaginally or rectally

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Instillation

• Putting a drug in liquid or ointment form into
  ears, eyes or nose

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Topical

• External application of meds to the skin, nails
  or hair

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Inhalation

• Inhaling a drug into the respiratory tract.

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Parenteral

• By injection
• Injections are given by a licensed person.
• A habilitation tech may be trained by a licensed
  person to give insulin injection.

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Correct Preparation and Administration

• General Medication administration procedures
• Oral Medications
• Liquid Medications
• Inserting Medications
• Instilling Medications
• Topical Medications
• Inhalants
• Nebulizers

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General Med Administration Procedures

• Wash hands
• Verify the order on the MAR by checking it
  against the doctors order.
• Do the Three Checks
• a. when selecting from the storage
  area
• b. before pouring the med
• c. after pouring and prior to returning med to
  storage area

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(continued)

• Confirm the clients identity.
• Give the med by the route as ordered.
• Document on MAR IMMEDIATELY after they are
  given to each client before going to the next
  client.
• Never sign off meds prior to giving it.
• Complete this process for each client prior to
  going to the next client.

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Administering Oral Meds

• Pour the correct number of pills/capsules into
  the medication lid, then into the med cup.
• Explain to client what meds you are giving and
  the purpose at clients level of understanding.
• Give with water or other fluid.
• Stay with client until all meds are swallowed.
• Sublingual meds are placed under the tongue.

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Liquid Medications

• Liquid meds must be measured in a calibrated
  medication cup.
• Place the med cup on a level surface at eye level
• Hold the med container so that the medication
  flows from the side opposite the label so it
  doesnt run down the container and stain or
  obscure the label.
• Check the med cup again to make sure you have
  poured the correct amount.
• For small amounts less than 5cc, use a calibrated
  syringe to measure the medication.
• Give the med with the appropriate liquid.
• Always do the 3 checks before giving the med.

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Eye Drops

• Explain purpose and procedure
• Have client assume back-lying position
• Put on gloves
• Instruct client to look up toward ceiling
• Hold dropper 1 above eye, install drops into
  pocket of the outer 1/3 of the eye
• Instruct client to close eye gently and wipe
  excess away
• Remove and discard gloves
• Gather and dispose of equipment
• Wash hands

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Eye Ointments

• Follow steps for eye drops
• Discard first bead of ointment
• Squeeze small amount of ointment into the lower
  eyelid from the side near the nose to the outer
  eye

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Ear Drops

• Draw proper amount of med into dropper
• Explain purpose of the med
• Put on gloves
• Straighten ear canal adult pull up back/child
  pull down back
• Hold the tip of the ear dropper just over the ear
  canal.
• Client should remain on side for 5-10 minutes
• Remove gloves wash hands

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Nose Drops

• Explain purpose of med
• Put on gloves
• Have client lie on back with head slightly
  hyper-extended
• Draw up med into dropper
• Push up the tip of the clients nose slightly
• Hold dropper just above the nostril and direct
  its tip toward the midline of the nose so the
  drops flow toward the back of the nasal cavity.
• Instill the number of drops
• Have client remain in lying position for 5
  minutes and breathe through the mouth
• Remove the gloves
• Wash your hands

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Topical

• Explain purpose of med
• Put on gloves
• Open container and place cap or lid upside down
  to prevent contamination
• Use a tongue blade, gauze or cotton applicator to
  apply
• Cover the end of the tongue blade, gauze or
  applicator with med
• Apply medication to affected area
• Remove the gloves
• Wash your hands

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Aerosol Sprays

• Explain purpose of medication
• Shake the container if indicated
• Hold the container 6-12 inches from the affected
  area
• Spray evenly

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Inhalants

• Explain the purpose of procedure
• Shake the inhaler
• Have client exhale completely then place the
  mouth piece in mouth, close lips around it.
• Have client inhale slowly deeply
• Repeat the procedure as necessary to give as
  prescribed
• Client may gargle to remove medication from the
  mouth
• Clean mouth piece
• Return to storage place

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Narcotics Schedule II Drugs

• Controlled substances
• Secured under DOUBLE LOCK system
• Sign out each dose each time a dose is given on
  the medication sign out sheet that came with the
  medication from the pharmacy
• Always confirm the correct count of all narcotics
  when oncoming and off going.

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Safety Rules

• Right Client
• Right Drug
• Right Dose
• Right Time
• Right route
• Right Documentation

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(Continued)

• No medication should ever be given without a
  doctors order
• Encourage client to take meds as prescribed
• Keep an MAR on each client
• For Each medication, your MAR should include drug
  name, the amount to be given how often the drug
  should be taken

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(Continued)

• Medication should always be administered within 1
  hour of the time it is prescribed
• If a client refuse medication, try find out why
• You can not force a client to take medication
• Write R in the block of the date it supposed to
  be given circle it
• Write on the back of the MAR in the designated
  area about the refusal

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(Continued)

• Document in the progress note the refusal and the
  reason
• Inform the Administrator
• Notify the physician
• Notify the team

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Conclusion

1. Remember to do the three checks
2. Remember If there are more than three pills
   recheck the order before administering
3. Remember 6 checks
4. Remember Client education must be done each time
   medication is given

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Other Services

• Medication Administration
• Seizure Management
• Behavior Management
• Client Abuse
• Incidents
• Ten Traits of a Professional
• Boundaries

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Other Services

• Mental Illness
• Bloodborne Pathogens
• Autism
• Developmental Disabilities
• Develop Procedure Policy Manual

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To Contact Instructor

• www.ewsastaffingnetwork.com
• www.qprofessionalmentalhealtservice.com
• 1008-F Big Oak Court
• Knightdale, NC 27545
• [phone]