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Medication Administration

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Medication Administration

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    2. Chapter 12

    3. Medication Administration Introduces medication dose into the body Requires proper knowledge of: medications techniques safety precautions Quality assurance standards of excellence are at the core of safety

    4. OSHA Standards Wear barrier equipment if possibility of splashing or spraying body fluids Wear gloves when performing injections Place all equipment coming in contact with body fluids in infectious waste containers

    5. OSHA Standards (cont’d) Place sharp materials in puncture-proof containers located close to area of use

    6. OSHA Standards (cont’d) Do NOT recap, bend, or break used needles, remove from disposable syringes, or otherwise manipulate by hand If must recap needle, use one-handed scooping method

    7. OSHA Standards (cont’d) Use safety needles to protect against accidental needle sticks

    8. OSHA Standards (cont’d) Dispose of contaminated waste properly Evaluate any exposure with a postexposure plan Failure to comply may result in fines—$7,000 (first offense) to $70,000 (repeated violations)

    9. Quality Assurance Ensure patient receives quality drugs given safely in correct manner Provide properly transported, stored, and current (unexpired) medications Verify medication maintained at appropriate temperature during transport

    10. Quality Assurance Avoid reordering stock medications close to weekends and holidays because delivery may be delayed Store medications at recommended temperatures Organize medications by predetermined groupings (e.g., route, specific use) Always store with label facing forward

    11. Quality Assurance Check expiration dates—stock oldest in front Store away from heat, light, moisture, and air Keep external- and internal-use medications separate Always keep label intact, medication in original container Destroy any container without a label

    12. Patient Safety Notify physician of any changes occurring since medication was ordered Assess size and age of patient Note changes in vital signs Check for contraindications to drug Check for food or animal allergies Note any change in medical condition that might hinder administration route

    13. Question prescriber if any doubts as to proper dosage of medication Ensure presence of appropriate person in the event allergic reaction occurs Maintain safe surroundings, especially after administering pain medications Assess presence of family members Maintain quiet environment Patient Safety

    14. Quality Assurance Rules Give only ordered medication Know the drug being given Calculate dose in quiet area; have someone recheck calculation Always wash hands Do not handle medication Identify the patient Ask about possible allergies

    15. Quality Assurance Rules Never return unused medications to original containers—dispose of properly Do not document administration of a medication before actually giving it Observe patient for adverse reactions Document any reactions Report any errors to physician immediately

    16. Three “Befores” Always read label three times: before removing drug from shelf before preparing medication for administration before returning drug to shelf Never give medications not personally prepared by YOU

    17. Seven “Rights” Right patient Right drug Right strength Right time Right route Right technique Right documentation

    18. Right Patient Verify person’s name with medication order. If possible confusion, ask patient to state his/her name Ask parents to identify young children

    19. Right Drug Use the three “befores” Check for exact concentration, spelling of ordered drug Never give expired drugs Learn to palm the label when pouring medication

    20. Right Strength Ensure dose within acceptable dose range for patient Have working knowledge of medication being given Double-check calculations Use proper device to obtain most accurate measurement

    21. Right Time Important in maintaining consistent blood levels May affect how patient reacts to drug

    22. Right Route Match route with medication order Evaluate whether patient has injury that might prevent use of desired site

    23. Right Technique Use aseptic technique Select appropriate site, use appropriate delivery technique

    24. Right Documentation Document after drug administration Record: any patient assessment date and time medication given name of medication, dose administered lot numbers, manufacturer, expiration date of immunizations patient reactions, patient education, patient refusal of medication

    25. Documenting the Seven Rights

    27. Medication Routes Enterally—absorbed through GI tract; safe, convenient, economical, slow absorption Parenterally—by injection; systemic effects, rapid absorption, greater cost of supplies, increased chance of adverse reactions Percutaneously—absorbed through skin, tissue, mucous membranes; local effects, slow absorption, evaluate condition of patient’s skin and mucous membranes

    28. Review Exercise #1 How would you document the following scenario? Sara Medici, age 2, has come in for an MMR vaccine. The doctor orders Sara receive the vaccine in the vastus lateralis muscle. The lot number if 12356; manufacturer is Sohol Drugs. The dose for MMR is 1 vial (or 1 mL) after reconstitution. You informed the patient’s mother of the side effects to expect and possible reactions, including the possibility of rash and low-grade fever in 2–3 days.

    29. Review Exercise #1 x/x/20xx (Time) MMR vaccine 1 mL (Sohol Drugs), Lot # 12356, exp. date 10/04/09 given in Ž vastus lateralis with no apparent side effects. Mother instructed of possible side effects and adverse reactions. Signed permission from mother attached.----------------------------------SMA

    30. Review Exercise #2 How would you document the following scenario? Mary Allero has come to the office to receive her allergy injection. She has a standing order from the doctor to receive the next dose unless a reaction occurred to the previous dose. She says she had no problems with the last dose. Today’s dose comes from Allergy Extract Bottle no. 4, 0.2 mL of extract. You give the injection subcutaneously in the right deltoid area. Ms. Allero always waits 20 minutes after the injection to ensure no reaction occurs. When you check her, there’s no redness or swelling at the injection site, and she shows no signs of allergic reaction.

    31. Review Exercise #2 x/x/20xx (Time) Reports no adverse reactions from last inj of allergy extract. Allergy Extract #4 0.2 mL SC Ž deltoid area with no apparent adverse reactions p 20 min.------------------SMA

    32. Review Exercise #3 How would you document the following scenario? Mr. Johanson has a history of kidney stones. The doctor examines him and finds him to be in severe pain with nausea. The doctor orders Demerol 50 mg, and Phenergan 25 mg to be given intramuscularly in the deltoid area. You ask Mr. Johanson if there’s anyone to drive him home, as it’s dangerous for him to drive after taking these medications. You also tell him he should go home and lie down to allow the medication to have full effect.

    33. Review Exercise #3 x/x/20xx (Time) Demerol 50 mg and Phenergan 25 mg IM Ž deltoid area. Instructed not to drive, to relax at home to allow medication to have effect. No apparent adverse reaction on leaving the office.-------------------------------SMA

    34. Review Exercise #4 How would you document the following scenario? Malia comes to the office with a high fever and earache. Dr. Merry asks you to give Malia aspirin gr x for fever before she leaves the office. You discuss with Malia ways in which she can lower her fever at home.

    35. Review Exercise #4 x/x/20xx (Time) Aspirin gr x administered as ordered/Dr. Merry. Patient education for lowering fever at home. ------------------SMA

    36. Review Exercise #5 How would you document the following scenario? Ms. Robbins is seen by Dr. Merry for congestive heart failure. Her pulse is 84. Dr. Merry orders Lanoxin 0.5 mg po as directed. Ms. Robbins asks you if there are any instructions she needs to know to take Lanoxin at home. You tell her to take her pulse every day just prior to taking Lanoxin, and to call the office if her pulse is below 60 beats per minute.

    37. Review Exercise #5 x/x/20xx (Time) P-84, Lanoxin 0.5 mg po administered as ordered/Dr. Merry. Instructed to take pulse daily prior to taking Lanoxin; report pulse >60 before taking medication. ------------------------------SMA

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