Module C- Administering Medications

1. Module C- Administering Medications By Brenda D. Rigsby, MSN, RN, CRNP

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

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

4. 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.

7. 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.

8. Equipment disposal • Put the syringe and needle into the sharps container • Needless system

9. Reporting needle sticks • What are the steps involved in reporting a needle stick?

10. Misinterpretation Miscalculations Misadministration Difficulty in interpretation handwritten orders Misunderstanding of verbal orders Drug name confusion Lack of employee/patient knowledge Elements leading to Medication Errors

11. 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

12. Medication Orders • Reading and interpreting medication orders • Parts of a medication order • Types

13. Essential Order Components • Client name • Date/Time • Medication name • Dose • Route • Time & Frequency • Signature

14. Medication administration record: example

15. Medication orders & documentation

17. Reading and interpreting medication orders • See the provided handout.

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

19. Reading and interpreting labels • Common abbreviations • No longer approved abbreviations

20. Drug packaging • Mix-O-Vials • Cartridges/Tubex • Dose Packs • Vials • Ampules • Pre-filled syringes

21. Drug Administration • equipment/adaptive equipment • Systems of distribution • Computerized system • Unit Dose • Stock • Narcotic Control Systems

22. Reconstitution of medications • Diluent • Labeling

23. Calculating dosages • Use of approved formulas • Compare order to safe dose

24. Preparing dosages for administration • Read physician’s 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

25. Behaviors to avoid during medication administration • What are some behaviors to avoid during medication administration?

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

27. Routes for administering medications • Enteral • Parenteral • Intradermal • Subcutaneous • Intramuscular • Z-track • IV • Percutaneous

28. 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

29. 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.

30. Tablets

31. 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.

32. Equipment • Unit Dose or Single Dose • Soufflé’ Cup • Medicine Cup • Medicine Dropper • Teaspoon • Oral Syringe • Nipple

33. 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.

34. 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.

35. Enteral Administration • Administering rectal suppositories • Administering disposable enemas See textbook

36. 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

37. Syringe parts

38. 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 cc’s 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)

39. Syringe • Factors Affecting Syringe Choice * Volume of Medication * 1cc or less = ID SQ IM IV * 1 – 3cc = IM IV * >3cc = IV

40. Needle: parts

41. 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

42. Needles • Factors Affecting Needle Choice * General Principle * Use smallest gauge of appropriate length * Goal is to deliver to “target” tissuewith leasttrauma * 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

43. Giving an Intramuscular Injection

44. 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

45. Parenteral Administration

46. IM injection: needle length selection

47. 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

48. Intradermal injection technique

49. 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

50. 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->out, using dominant hand • Put cleansing swab btw 3rd & 4th fingers of non-dominant hand