copyright © 2015 cengage learning® chapter 7 safe medication administration

Copyright © 2015 Cengage Learning®

Chapter 7

Safe Medication Administration

Copyright © 2015 Cengage Learning®Copyright © 2015 Cengage Learning®

Medication Administration Record (MAR)

• Although some differences exist among health-care facilities, most MARs are fairly similar.

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MAR Similarities

• Large column usually on left-hand side of MAR form contains:– Drug names

• Both scheduled and as needed (prn)

– Drug dosage– Frequency of drug administration

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MAR Similarities (cont’d)

• Usually three columns designated for documenting medication administration for day, evening, and night shifts

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• Space for precautions related to administration, such as checking:– Pulse– Blood pressure– Body weight

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• Column included for initials of person transcribing medication from order sheet to MAR.

• May include “start” and “stop” columns.– Indicate what day and time medication is to be started

and stopped.

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• Area where all staff initials identified with full name and title

• May be one sheet (front and back) or two sheets to separate scheduled and prn medications

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Six Rights of Medication Administration

• Right drug• Right dosage• Right route• Right time• Right person• Right documentation

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Right Drug

• Check every drug three times:– When drug is located– Just before opening or pouring medication– Immediately prior to administration

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Right Dosage

• Compare to average dosages.• Metric dosages containing decimals are of

particular concern. – Ask yourself if the dosage makes sense.

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Right Route

• Oral• Sublingual

– Under tongue

• Drops– For eye, ear, and nose

• Topical

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Right Route (cont’d)

• Transdermal• Inhalation• Creams• Suppositories

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Right Route (cont’d)

• Parenteral routes– IV

• Most common

– Intramuscular (IM)– Subcutaneous– Intradermal

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Right Time

• Standard time.• 12:00 am for midnight to 11:59 pm for one

minute before midnight.• Times are duplicated during 24-hour period.

– Only am and pm differentiate.

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Right Time (cont’d)

• Military time• 0001 for one minute after midnight to 2359

for one minute before midnight

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Right Time (cont’d)

• After one o’clock in the afternoon, 12 hours added to each time until midnight– For example, 1300 = 1:00 pm, 1700 = 5:00 pm,

2200 = 10:00 pm

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Right Person

• Most important nursing intervention.• Check ID band, and read both surname and

first name and birthdate.• Do this every time medication given.

– No exceptions

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Right Documentation

• When medication is administered, must be documented immediately.

• Never record before administered medication.

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Right of Refusal

• Partner with client.• If client questions medication, consider

client correct until proven otherwise.• Client also has right to refuse medication.

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Medication Errors

• Estimated 100,000 people die each year from medication errors.

• Occur during:– Prescribing– Transcribing– Administering

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Joint Commission’s “Do Not Use” List

• U– Write “unit”

• IU– Write “International Unit”

• QD, Q.D., q.d., or qd– Write “daily”

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Joint Commission’s “Do Not Use” List (cont’d)

• QOD, Q.O.D., q.o.d., or qod– Write “every other day”

• MS– Write “morphine sulfate”

• MSO4 or MgSO4– Write “magnesium sulfate”

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Joint Commission’s “Do Not Use” List (cont’d)

• Omit trailing zero– For example, write X.0 mg as X mg

• Use zero before decimal number– For example, write .X mg as 0.X mg

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Actions When Medication Errors Occur

• Report as soon as discovered.• Institute necessary remedial measures

immediately.• Determine reason for error.• Prepare incident/accident report.• Institute corrective policies/procedures to

prevent recurrence, if possible.

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Medication Errors

• The major factors in nursing medication administration errors are distraction and Fatigue.• Personnel are held legally responsible if

wrong drug or dosage given regardless of source of error.

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copyright © 2015 cengage learning® chapter 7 safe medication administration

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