Medication Administration

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

2. Today’s 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, (<50) 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 pt’s 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 does…at 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 <5 yrs or >20 yrs highest error % • Shift with most med errors? • Average amount of med errors annually by RN’s? • 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