Chapter 7

1. Chapter 7 Responsibilities and Principles of Drug Administration

2. Responsible Drug Administration • Responsibilities of the health care provider • Adequate, up-to-date information about all medications to be administered • Wisdom and judgment to accurately assess the patient’s needs for medications, to evaluate the response to medications, and to plan appropriate interventions as indicated • Skill in accurate delivery of the medication, in the best interests of the patient, and with adequate documentation

3. Responsible Drug Administration (cont’d.) • Patient education to provide the necessary information to the patient and family about why, how, and when medications are to be administered and potential side effects and precautions with administration by the layperson

4. Responsible Drug Administration (cont’d.) • Requirements • Be familiar with medication before administration • Typical and most frequently used drugs of the systems • Plan thoroughly for patient care • Prior assessment, interventions, and evaluations

5. Responsible Drug Administration (cont’d.) • Train to develop skills in delivery of medications • Maximize the effectiveness of the drug with the least discomfort to the patient • Educate patients • Emphasize the importance of taking medications in the proper dosage, on time, and in the proper way

6. Responsible Drug Administration (cont’d.) • Take moral, ethical, and legal responsibilities into account • Consult those in authority—supervisors or administrators—and/or policy and procedure books • Documentation on the patient’s record is always required

7. Medication Errors • Occur in all health care settings • More errors are reported from acute care settings, where the risk is greatest • Common situations in which errors occur • Administering a drug to the wrong patient • Administering the wrong drug • Administering a drug via the wrong route • Administering a drug at the wrong time • Administering the wrong dosage • Wrong documentation

8. Medication Errors (cont’d.) • Meticulous care in preparation and administration reduces chances of error • However, if a mistake is made, report it immediately • Medication Errors Reporting (MER) program • Institute for Safe Medication Practices (ISMP) Patient Safety Organization (PSO)

9. Medication Errors (cont’d.) • Medication reconciliation • Method used to compare what the patient is taking to what the patient’s physician ordered • Performed every time there is a change in the patient’s care • Aims to prevent medication errors caused by omissions, duplications, errors in doses, or medication interactions

10. Medication Errors (cont’d.) • Steps in medication reconciliation • Develop a list of current medications • Develop a list of medications to be prescribed • Compare the medications on the two lists • Make clinical decisions based on the comparison • Communicate the new list to appropriate caregivers and to the patient

11. Principles of Administration • Basic principles • Cleanliness of self and area • Organization of medications and supplies • Preparation area location and lighting

12. Principles of Administration (cont’d.) • Six Rights of Medication Administration • Right medication • Right amount • Right time • Right route • Right patient • Right documentation

13. Right Medication • Confirm that you have the right medication • Compare the name of the drug prescribed with the label on the package, bottle, or unit-dose packet • Never give medication when the name of the medication is obscured in any way • Never give medications that someone else has prepared • Never leave medications at the bedside unless specifically ordered by the doctor

14. Right Amount • Administering the right amount of drug is extremely important • Drug dosage ordered must be compared very carefully with the dose listed on the label of the package, bottle, or unit-dose packet • Consult a table of equivalents if necessary, to convert from one system to another • Calculations must be checked by another trained health care practitioner, pharmacist, or doctor to verify accuracy

15. Right Time • For maximum effectiveness, drugs must be given on a prescribed schedule • Physician’s order specifies the number of times per day that the medicine is to be administered • Intervals • Before or after meals • Hour of sleep

16. Right Route • Route of administration effects vary • Degree of absorption, speed of drug action, and side effects • Physician’s order specifies the route of administration • Route may not be changed without the physician’s order

17. Right Patient • Identify the patient by use of certain techniques to reduce the chance of error • Wrist identification band • Call or ask patient to state their name • Date of birth in ambulatory care setting

18. Right Documentation • Every medication given must be recorded on the patient’s record • Dose, time, route, and location of injections • Unusual or adverse patient reactions • PRN basis • Administrator signature • Narcotics administered

19. MedWatch • FDA form to assist health care professionals in reporting serious, adverse events or product quality problems • Associated with medications, medical devices, or nutritional products regulated by the FDA • Goal is to help the FDA better monitor product safety and take swift action to protect patients and healthcare providers