MEDICATION

• "7 Rights" of Safe Medication Administration

  • Right Drug
  • Right Dose
  • Right Time
  • Right Route
  • Right Patient
  • Right Reason
  • Right Documentation
• Right Drug


  • Check all orders, labels and confirm that the drug is appropriate for this client/condition
• Right Dose


  • Is the dose is appropriate for the drug, age, size and patient condition
• Right Time


  • Follow agency policy
• Right Route


  • Follow medication order and knowledge of appropriate routes for specific drugs
• Right Patient


  • ALWAYS identify the patient 2 ways (the patient's room number should not be one of the options)
• Right Reason


  • Requires knowledge of medication; knowledge of patient; question appropriateness of order if applicable
• Right Documentation


  • Follow agency policy and procedure for immediate documentation = time, route, response
• Medication Documentation


  1. Make sure you have the right chart

  2. Never chart a drug before it is administered

  3. Document name of drug, dosage, route, and time

  4. Record location when giving parenteral medications

  5. Follow agency policy if a medication was not given

  6. Document client's response to the medication
• Preventing Medication Errors


  • Minimize verbal and telephone orders
  • Refrain from attempting to decipher illegibly written orders
  • Always adhere to the 7 rights
  • Read the label 3 times, checking against the medication administration record
  • Listen to the patient - any concerns are the nurse's concerns
  • Double check with literature if in doubt about an order
  • Minimize interruptions while processing and preparing medications
  • Do not agree to give medications in an area where you are not experienced
• Nursing Process and Medication Administration

  1. Assessment

  2. Diagnosis

  3. Planning

  4. Implementation

  5. Evaluation
• Patient Assessments in Medication Administration

  • Assess patient variables that might influence drug therapy
  • Assess drug history prior to the start of a new drug
  • Assess patient's response to the medication
  • Assess physical parameters prior to administration
• Medical-Surgical Asepsis and Medication Administration

  • Medical Asepsis: Handwashing, Standard precautions
  • Surgical Asepsis: Use of sterile supplies
• National Patient Safety Goals related to Medication Administration

  • Use at least 2 patient identifiers just prior to medication administration
  • Verify verbal or telephone orders by verbally reading back the order to the Licensed Independent Practitioner (LIP) out loud
  • Take action to prevent errors involving sound-alike or look-alike drugs
  • Label all medications containers both on and off the sterile field
• U.S. Laws Affecting Medication Administration

  • Food, Drug & Cosmetic Act (1906, 1962)
  • Harrison Narcotic Act (1914)
  • Durkham-Humphrey Amendment (1952)
  • Controlled Substance Act (1970)
• Rules Governing Administration of Controlled Substances

  • Keep in "burglar" proof containers
  • Double-locked carts or cabinets
  • Accurately complete controlled Substance Inventory form
  • 2 nurses must witness and document when wasting a controlled substance
• Medication Orders


  • Should be written clearly, legibly and in easy-to-understand language
  • Should be clarified if unclear – check with direct supervisor first
  • Should not include blanket, summary statements such as "resume all pre-op orders"
• Essential Parts of a Medication Order

  • Patient's full name
  • Date and time order written
  • Name of medication to be administered
  • Dosage (strength and amount to be given)
  • Frequency of administration
  • Route
  • Number of doses or days medication is to be given
  • Signature of the ordering physician
• "Do-Not-Use" Abbreviations


  • U for unit
  • IU for international unit
  • Q.D., qd, QOD, q.o.d.
  • A trailing zero (i.e. 2.0 mg. Instead use 2 mg)
  • MS, MSO4, MgSO4
  • > for greater than
  • < for less than
  • Abbreviations for drug names
  • Apothecary units
  • @ for at
  • C.c. for cubic centimeters
  • Ug for microgram
• Sources for Locating Drug Information

  • Physician's Desk Reference
  • National Formulary or Hospital Formulary
  • Pharmacists
  • Drug reference books
  • Pharmacology textbooks
  • Computer-based Indexes
• Drug Misuse


  Improper use of any medication which leads to acute/chronic toxicity
• Drug Abuse


  Inappropriate intake of a substance
• Drug Dependence


  Person's reliance on or need to take a substance
• Physiological dependence


  Biochemical changes in body tissue, especially the nervous system, which lead to a requirement by the tissues to function normally
• Psychological dependence


  Emotional reliance to maintain a sense of well-being
• Pharmacokinetics


  What the body does to the drug
• Factors Affecting Absorption


  • Route of administration and conditions at absorption site
  • Drug dosage and form
  • Fat (lipid) solubility
  • Gastrointestinal factors
• Factors Affecting Distribution


  • Blood flow
  • Plasma protein binding
  • Amount of the drug
• Factors Affecting Metabolism/Biotransformation


  • Condition of the liver
  • Age
  • Nutritional status
  • Hormones (thyroid)
• Factors Affecting Excretion


  • Renal excretion
  • Liver or lung pathology
• Drug Half-Life


  The time it takes for ½ of the original amt of the drug to be removed from the body
• Loading Dose


  A larger than standard dose given at the beginning of drug therapy to quickly raise the blood level of the drug into therapeutic range
• Maintenance Dose


  A dose that continues to keep the drug in the desired therapeutic range, used after a loading dose
• Therapeutic Index


  Relates to drug's margin of safety, the ratio of effective dose to a lethal dose
• Tolerance


  Means that a larger dose is needed to bring about the same response
• Adverse Effect


  Any non-therapeutic response to the drug therapy-consequences may be minor or significant
• Drug Interactions


  Action of one drug on a second drug or other element creating one or more of the following: increased or decreased therapeutic effect of either or both drugs, a new effect, an increase in the incidence of an adverse effect
• Causes of Drug Interactions

  • GI absorption
  • Enzyme induction
  • Renal excretion
  • Pharmacodynamic effects
  • Patient care variables
• Allergic Reactions


  Altered physiologic reactions to a drug that occur because a prior exposure to the drug stimulated the immune system to develop antibodies
• Anaphylaxis


  The most serious allergic reaction