Legal Aspects of Medication Administration

1. Chapter 3 Legal Aspects Affecting the Administration of Medications

2. Chapter 3 Lesson 3.1

3. Learning Objectives • List the names of major federal laws concerning drugs and drug use • Explain in what way the nurse is responsible for controlled substances

4. Learning Objectives (cont.) • Describe the differences between authority, responsibility, and accountability • Describe some of the risks associated with common over-the-counter (OTC) medications

5. Medication Regulation • Federal Guidelines (government) • State Guidelines (Board of Nursing) • Facility Guidelines (where you are practicing)

6. Federal Legislation Three drug categories in the United States: • Controlled substances – drugs that may be easily abused, are dangerous, and require a prescription • Prescription, or legend, drugs – drugs that require a prescription but are not as easily abused • Over-the-counter (OTC) medications – drugs patients may buy without a prescription

7. Federal Legislation (cont.) • Harrison Narcotic Act of 1914 – limited indiscriminate use of addictive drugs • Federal Food, Drug, and Cosmetic Act of 1938 – gave authority to government to determine the safety of a drug prior to marketing, labeling, specification, and advertising • Durham-Humphrey Amendment of 1952 – restricted number of prescription refills

8. Controlled Substances Nurses may possess these only if: • They are administering the drugs to the patient for whom they were prescribed • They themselves are the patient for whom the physician has prescribed the drug • They have been delegated the responsibility for the unit supply

9. Prescription, or Legend, Drugs • Carefully tested prior to marketing • Use is carefully controlled • Prescription is required • Majority of drugs nurses administer in the hospital • Geriatric patients are at special risk • Safety may not have been determined for children

10. Over-the-Counter Medications • Low risk for patient when taken appropriately • Low dosage • Patients buy on their own • May have hidden chemicals • Require a prescription in the hospital • Herbal medications have not been tested for safety and effectiveness

11. Chapter 3 Lesson 3.2

12. Learning Objectives • List rules of states and agencies that affect how nurses give drugs • Explain in what way the nurse is responsible for controlled substances • List what information is included in a medication order or prescription

13. Learning Objectives (cont.) • Define and give examples of the four different types of medication orders • List what you need to do if you make a medication error

14. State Nurse Practice Act • Determines the level of authority and responsibility of the nurse • Different levels of nursing will have different levels of authority and accountability • Nurses must adhere to the Nurse Practice Act in the state in which they are practicing • Responsibilities may vary in State Nurse Practice Acts

15. Nursing Responsibilities • All nurses have legal responsibility for their actions. • The Nurse Practice Act determines the level of responsibility and authority of the nurse. • Nurses must have the authority to delegate to a person with the authority to carry out the task.

16. Nursing Process • Assessment • Diagnosis • Planning • Implementation • Evaluation

17. Ordering Procedure • Step 1: Physician orders medication • Step 2: Order is transcribed onto Kardex • Step 3: Charge nurse verifies accuracy of order and transcription • Step 4: Order is sent to pharmacy • Step 5: Medication is dispensed to floor • Step 6: Nurse administers according to guidelines

18. Medication Card

19. Drug Distribution Systems • Floor or ward stock system • Individual prescription order system • Unit-dose system • Computerized or automated dispensing system

20. Medication Orders • Required information includes: • Patient’s full name • Date • Name of medication • Dosage • Frequency • Duration • Route • Signature of physician

21. Types of Medication Orders • Standing orders • Emergency, or “stat,” order • Single order • As-needed, or “prn,” order

22. Medication Errors • Immediately assess the patient • Notify the physician and implement any orders • Continue to assess the patient • Notify supervisor • Document findings in patient record • Complete facility documentation