MEDICATION ADMINISTRATION Topic 1

1. MEDICATION ADMINISTRATION Topic 1 Topic 1 Client ID Documentation Drug Schedules

2. As the student nurse gains experience in medication administration, psychomotor skills ( the how to ) become more refined. Psychomotor skills, however represent only a small part of medication administration. Knowledge, physical and mental status as well as client attitudes and responses can make medication administration a complex experience

3. List reasons for the importance of being competent in the administration of medications

4. REASONS • All drugs prescribed or over the counter are potentially dangerous • Prescription or medication order is a legal document • It is a legal requirement • To ensure maximum safety for person who might benefit from drugs • To protect the enrolled nurse and health care facility from serious consequences of medication incidents.

5. INDICATIONS FOR MEDICATION USE • Maintain normal body function. Eg. Insulin. • Diagnostic Eg Barium. • Symptomatic relief, Eg Analgesia. • Prophylaxis, Eg Vaccines. • Alter psychological functions, Eg Contraception. • Reverse control disease process, Eg Antibiotics.

6. Describe the drug controls in New South Wales

7. COMMONWEALTH REGULATIONS The role of the Australian Government in regulation of the pharmaceutical industry is to protect the health of the people by ensuring that medications are safe and effective.

8. AGED CARE ACT 1997 To ensure that the facilities employ appropriately skilled staff who can provide for the needs of the residents in their care. They must maintain accreditation standards. The enrolled nurse must work within the policy and protocols of their employing facility.

9. CONTROL IS AT 3 LEVELS • The Therapeutic Goods Act ( 1989 ). Medication manufacturer, sales, testing, labeling and distribution. • The Customs Act ( 1901 ) Advertising of therapeutic goods to health professionals and public

10. CONTROL IS AT 3 LEVELS 3. The National Health Act ( 1953 ) Applies to Pharmaceutical Benefits Scheme that provides subsidized drugs to public. Also limits the amount of drugs supplied, number of times and frequency that the supply can be repeated. Not all drugs are subsidized.

11. DRUG CONTROLS IN NSW The Australian Therapeutic Goods Administration ( TGA ) a section of the Commonwealth Department of Health, provides a framework for the regulation of therapeutic goods to ensure their safety, efficiency, quality and timely availability. Before a drug can be marketed in Australia, it must be evaluated by TGA. The product will be assessed for quality, safety, efficacy and cost effectiveness.

12. NSW LEGISTRATION • NSW Poisons and Therapeutic Goods Act ( 1966 ) Poisons and Therapeutic Goods Regulation ( 2002 ) • Nursing Home Act 1993.

13. POISONS AND THERAPEUTIC GOODS ACT 1966 Covers the control of poisons and outlining any criminality related to poisons

14. The poisons and therapeutic goods regulation 1994 has a direct impact on nurses during their day to day routines and covers the practical aspects of the possession, storage, supply, administration and recording of the poisons and the poisons list which classifies substances into their various substances.

15. NSW DEPARTMENT OF HEALTH • Guidelines for the Handling of Medication in NSW Public Hospitals • Guidelines fro the Handling of Medication in Community Based Health Services and Residential Facilities in NSW • Private Hospitals and Day Procedure Centre and Nursing Homes Regulations

16. NSW DEPARTMENT OF HEALTH • These are the standards that regulate enrolled nurse practice • Public hospitals must ensure that employees who are administrating medication have appropriate qualifications and training. • Health care institutions establish individual policies that must meet Commonwealth, State and local government regulations

17. AUSTRALIAN NURSE COMPETENCIES This organization outlines and limits the role and boundaries of the enrolled nursing practice The inclusion of medication administration in the scope of practice for the EN will ensure public safety through quality management and risk assessment intervention.

18. NSW NRB Enrolled Nurses who have been competent in the medication module will be permitted to administer medication by what ever route including S4 drugs but not S8 drugs of addiction.

19. CLIENT IDENTIFICATION • How do you Identify a client?

20. DOCUMENTATION • Medication charts should have patients: • Full name. • MRN. • Date of birth. • Allergy. • Legible order. • Drug ordered by Generic name. • Signature of Doctor and their printed name.

21. DOCUMENTATION • Date medication ordered. • Times for medication. • Reasons for use of medication. • Age and weight of paediatric patient. • Cessation date. Forms of medication, eg rectally, orally, transdermal.

22. MEDICATION ADMINISTRATION TERMINOLOGY

23. DRUG SCHEDULES • Schedule 1. Dangerous poisons eg Arsenic. • Schedule 2. Medicinal Poisons, eg Paracetamol. • Schedule 3. Potent substances, eg Insulin. • Schedule 4. Restricted substances, eg Oral hypoglycaemics. • Schedule 4D. Prescribed Restricted Substances, eg Diazepam.

24. DRUG SCHEDULES • Schedule 5. Domestic Poisons, eg Bleach. • Schedule 6. Industrial and Agriculture, eg Phenol. • Schedule 7. Special Poisons, eg Insecticides. • Schedule 8. Drugs of Addiction, eg Morphine.

25. PROHIBITED DRUGS • Substances which are controlled under the Drug Misuse and Trafficking Act 1985 and are not specified in Schedule 8 of the Poisons and Therapeutic Goods Act, eg Heroin.

26. INDICATIONS An illness or disorder for which a drug has a documented specific usefulness.

27. CONTRAINDICATIONS A factor that makes dangerous or undesirable the administration of a drug or the performance of an act or procedure in the care of a specific patient.

28. SIDE EFFECT A side effect occurs when a medication causes unintended, secondary effects ( that may be predictable ) Side effects may be harmless or injurious. If the side effects are serious enough to negate the beneficial effects of medication’s therapeutic action, the prescriber may discontinue the medication.

29. ADVERSE REACTIONS/AFFECTS These are generally unexpected effects of the medication. They may be related to the pharmacological effect or they may be related to the individual taking the medication.

30. NEAR MISS • Error recognised prior to administration of medication given to patient

31. SENTINEL EVENT • An error in drug administration that may cause permanent disability or death.

32. TRADE NAME The trade name, brand name or proprietary name is the name under which a manufacturer markets a medication

33. CHEMICAL NAME Is the name by which the chemist knows it, it provides an exact description of the drug’s chemical composition.

34. GENERIC NAME Is the name given by the manufacturer who first developed the drug. To prevent confusion and to reduce medication errors, medication orders should be written using the generic name

35. Lets look at an example D – (- ) –a amino – r – benzyl penicillin trihydrate Amoxycillin trihydrate Alphamox, Cilamox, and Amoxyn.

36. THERAPEUTIC EFFECT The therapeutic effect of the drug is the intended use of the drug, that is , its desired effect. E.g. Panadol for a headache, the therapeutic effect is pain relief.

37. MEDICATION INCIDENT All health facilities should have as part of their quality improvement programs a system in place or reporting medication errors. Please check where these are kept.

38. ABBREVIATIONS Ac = before meals Bid/bd = twice a day h= hour pc= after meals prn= whenever there is a need/necessary

39. ABBREVIATIONS m = mane n = nocte IV = intravenous SC = subcutaneous

40. ABBREVIATIONS IM = intramuscular mist = mixture asap = as soon as possible qqh = every 4 hours po = by mouth ( orally )

41. ABBREVIATIONS qid= four times a day tds= three times a day q2h= every 2 hours q4h=every 4 hours stat=give immediately