Principles for Nursing Practice

Medication Administration

Dr. Belal M. Hijji, RN, PhD

February 11, 2012

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Objectives

• By the end of this lecture, students will be able to:– Discuss pharmacology applications in nursing

practice.– Describe the Jordan Drug and Food Administration

guidelines for safe narcotics administration and control– Recognise types of medications actions.– Describe factors influencing choice of administration

routes. – Correctly calculate a prescribed medication dosage,

and identify the five rights of medication administration.

– Describe the roles of the pharmacist, physician, and nurse in medication administration.

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Pharmacology Applications in Nursing Practice

• Names:– Generic: Acetaminophen– Trade (brand): Tylenol

• Classification: Medications with similar characteristics are grouped into classifications. Some medication have more than one classification. – Hypoglycemic agents– Antihypertensive agents

• Forms:– Tablets Capsules Intraocular Lotion Ointment– Solution Suppository Suspension Syrup

Sustained relase

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Jordan Drug and Food Administration Guidelines For Safe Narcotics Administration And Control

العقاقير 1. تسليم ويتم المستشفى أقسام من قسم كل في التمريض مسؤول تحديد يجبفي المسؤول الممرض قبل من موقع وتسليم استالم ضبط مقابل قسم لكل الخطرة

. المستشفى في المسؤول والصيدلي في القسم الخطرة العقاقير حفظ يتم أن يجب. االغالق محكمة خزانة

الخطرة 2. العقاقير خزانة مفتاح تسليم التمريض مسؤولي المسؤول فقط على للممرض. االخرى الورديات في

يكون 3. ان خاص يجب سجل اسم هناك فيه يسجل المستشفى في الخطرة بالعقاقيرالممرضة واسم المخدرة للحقنة الواصف الطبيب واسم السرير ورقم ملفه ورقم المريض

. االعطاء على الشاهد الممرض واسم والتاريخ أن وتوقيعها السجل على يبين ويجب. المسؤولين الممرضين قبل من وموقع الورديات بين والتسليم االستالم

الخطرة ت4. العقاقير المعتمد من صرف المسؤول الصيدلي ممرضات فقطقبل لرئيسة.القسم

على 5. للمريض يجب المخدرة المادة حقنة اعطاء المسؤول توقيع بعدالممرض من التأكدالمريض اضبارة وعلى الوصفة على ي الطبيب وأن االضبارة ، على الممرض بعد وقع

االعطاء.المتبقية 6. الكمية اتالف يجب خطر عقار حقنة محتويات من جزء المريض اعطاء حالة في

. والوقت التاريخ مع بتوقيعه الوصفة على ذلك يبين والذي الطبيب بحضورلحقنة 7. كسر حادث وقوع حالة لمشاهدة يجب في المسؤول الصيدلي حادث الاستدعاء

محضر المسؤول وعمل الصيدلي مع عليه الشهود وتوقيع حدث ما تفاصيل حالة .يبين وفيوليقوم الكسر حادث لمشاهدة المناوب الطبيب استدعاء ضرورة الصيدلي وجود عدم

المسؤول الصيدلي لدى المكسورة الحقن وحفظ الشهود توقيع بعد المحضر على بالتوقيعنسخة وحفظ Y فورا الحادثة عن تقرير ورفع الدواء مديرية تبليغ اجراءات اجل من ذلك بعد

. الكسر بحادثة المتسبب ملف في ونسخة الصيدلي لدى

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Types of Medication Action

• Therapeutic: This is the expected or predictable physiological response a medication causes. For example, nitroglycerin reduces cardiac workload and increases myocardial oxygen supply

• Side effects: This is predictable, unintended, secondary effect. For example, asymptomatic blood loss, skin reactions

• Adverse effects: Are generally severe responses to medication. For example, when a client experiences cardiac arrest following rapid administration of KCL.

• Toxic effects: These may develop after prolonged intake of medication. For example, respiratory depression caused by morphine.

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Factors Influencing Choice of Administration Routes

• Oral routes: Are convenient, comfortable, economic, and rarely cause anxiety– Disadvantages: Avoid in nausea & vomiting, reduced motility,

gastric suction, and reduced ability to swallow.

• SC, IM, IV, ID routes: Are used when oral routes are C/I. Absorption is more rapid than with oral and topical routes. IV route is valuable in critically ill clients.– Disadvantages: Risk of infection, expensive, not suitable for

clients with bleeding tendencies, risk of tissue damage with SC injections, IV and IM routes are dangerous due to rapid absorption, and anxiety.

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• Topical routes: Provide local or systemic effect, painless, limited side effects, prolonged systemic effects (transdermal), rapid relief for local respiratory problems. – Disadvantages: Skin abrasions facilitate rapid absorption and

systemic effects, clothes soiling, rectal and vaginal applications are embarrassing, ruptured eardrum cannot receive irrigations, suppositories are C/I in rectal bleeding and rectal surgery, some inhalation agents can cause serious systemic effects such as cardiac arrhythmias due to salbutamol inhalation.

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Dosage Calculation

• When preparing solid and liquid forms:– Dose ordered x Amount on hand = Amount to administer

Dose on hand

– Example (1): Give Demerol 50 mg (dose ordered) IM. Each ampoule contains 100 mg (dose on hand) in 1 ml (amount on hand). How many ml should be given?

• 50 x 1 = 0.5 ml (amount to administer)100

– Example (2): The doctor’s order is 0.125 mg PO of Digoxin. Each tablet contains 0.25 mg. How many tablets should be given?

• 0.125 x 1 = 0.5 tablet 0.25

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– Example (3): Give Erythromycin suspension 250 mg PO. Each 5 ml contains 125 mg. What amount would you give?

• 250 x 5 = 10 ml, OR

125

5 ml = 125 mg

? = 250 mg

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Rights of Medication Administration • Right medication: When preparing medication, compare the

label of the medication container with a physician’s well-written and clear order.

Handwritten prescriptions can be difficult to decipher [ شيء معنى يكتشف For example, in the following prescription the drug name Avandia .[غامضwas incorrectly interpreted as Coumadin.

• Only administer the medication you prepare                                                                                   

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• Right dose: – Chances for errors increase when a medication must be

prepared from a larger volume or strength than needed.– When performing medication calculations or conversion, check

the calculated dose with another nurse.– After calculations, prepare the medication using standard

measurement devices such as graduated cups, syringes, and scaled droppers.

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– When it is necessary to break a scored tablet, the break should be even. Unevenly broken tablet should be discarded

– When crushing a tablet, the crushing device should always be completely cleaned

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• Right client: To ensure safe medication administration, the right client must be identified. This can be done by:– Matching client identification details on his/ her bracelet with

those on the prescription chart– Asking the client to state his/ her full name

• Right route: – Consult the physician if the route of administration is not

specified or not recommended– When administering injections, it is important to prepare them

from preparations designed for parenteral use. The injection of a liquid designed for oral use can cause sterile abscess formation or fatal systemic effects.

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• Right time: The timing a medication is to be administered at is at the discretion of the physician. For example:– Give Augmentin 375 mg every 8 hour (q8h)– Give iron tablet 3 times a day (tid) after meals– Give valium 10 mg IM preoperatively– Give Demerol 50 mg IM stat– All routinely prescribed medications should be given within 30

minutes of the times ordered.

• However, sometimes the nurse should judge the proper time when a medication is to be administered. For example:– PRN (Pro Re Nata) sleeping or pain medications

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The roles of Prescriber, Pharmacist, and Nurse in Medication Administration.

• Prescriber’s role: – The prescriber could be a physician or an advanced

practice nurse– Institutional policies vary regarding the personnel who

can take verbal or telephone orders. – Common abbreviations are often used when writing

orders. These include AC (before meals), ad lib (as desired), BID (twice a day), HS (hour of sleep), PC (after meals), prn (when needed), and od or qd (every day).

– However, the current recommendation is that abbreviations should not be used because of the high number of medication errors related to their use.

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• Pharmacist’s role is to:– Prepare and distributes prescribed medications– Assess the medication plan and evaluate the client’s

medications-related needs– Fill prescription accurately and ascertaining their validity

• Nurse’s role is to:– Administer medication correctly to clients– Assess client ability to self medicate– Determine whether a client should receive medication at a given

time – Monitor the effect of prescribed medications– Provide education to client and family regarding medication

administration and monitoring