Medication Administration

Medication Administration: Objectives After reviewing this chapter, you should be able to: State the consequences of medication errors Identify the causes of medication errors Identify the role of the nurse in preventing medication errors Identify the role of the Institute for Safe Medication Practices (ISMP) and The Joint Commission (TJC) in preventing medication errors

Medication Administration: Objectives (cont) State the six “rights” of safe medication administration Identify factors that influence medication dosages Identify the common routes for medication administration Define critical thinking Explain the importance of critical thinking in medication administration

Medication Administration: Objectives (cont) Identify important critical thinking skills necessary in medication administration Discuss the importance of client teaching Identify special considerations relating to the elderly and medication administration Identify home care considerations in relation to medication administration

Medication Errors Meds administered incorrectly can be harmful or fatal Result in emotional and legal consequences for the nurse Most common cause of client injury despite advances in technology 44,000 to 98,000 deaths per year estimated 540,000 med errors with children per year

Medication Errors (cont) Causes for errors Cohen, M. (2007). Medication Errors, 2 ed. Failure to identify client and miscommunication Lack of information about patient – allergies, meds Lack of information about the drug Communication and teamwork failures Unclear, absent, or look-alike and sound-alike meds Unsafe standardization, storage, distribution, and devices Calculation errors and failure to adhere to “rights”

Critical Thinking and Medication Administration Definition: A process of thinking that includes being reasonable and rational Organizational skills Autonomy: Willingness to challenge wrong orders and get clarification Reasoning: selection of right tools and client assessment Nurse administering med is legally liable —regardless of MOST causes of error

Factors Influencing Medication Dose & Action All must be considered Route of administration Time of administration Age of client Nutritional status of client Absorption and excretion of the drug Health status of the client Sex of the client Ethnicity and culture of the client Genetics

Special Considerations for Elderly Two thirds use Rx and OTC meds Most scripts are for older adults Number in population will double by 2030 Physiologic changes slow function Changes in circulation, absorption, metabolism, excretion, and stress response Lowered body mass, change in mental status

Special Considerations for Elderly (cont’d) Require lower doses as a rule May need Special delivery devices Visual aid to read labels Easy-open lids Allow extra time for teaching Polypharmacy and Beer’s criteria

Six “Rights” of Medication Administration Right Medication Compare medication administration record (MAR) with order Right Dose Check calculations and labels Right Client Two unique identifiers NOT room number

Six “Rights” of Medication Administration (cont’d) Right Route Check orders and drug guides Special considerations with feeding tubes Right Time Time of day and frequency Right Documentation Accuracy—no documentation leads to double-dosing Avoid “Do Not Use” abbreviations Outcomes of medications

Figure 10-1 A, Example of a container that holds a day’s medications, stored by hour of administration. B, Container that holds a week’s medications. C, The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A From Ogden SG: Calculation of drug dosages, ed. 8, St. Louis, 2007, Mosby; B From Elkin MK, Perry AG, Potter PA: Nursing interventions and clinical skills, ed. 4, St. Louis, 2008, Mosby.)

Other “Rights” Right to refuse Document and notify caregiver Kendra’s Law Potentially dangerous mentally ill Court-ordered assisted outpatient treatment (AOT) Emergency Court Orders May give forcibly Requires Judge’s order

Other “Rights” (cont’d) Right to education about medication being given Right to understand interactions with herbals Right to medication reconciliation across continuum of care

Teaching Clients About Meds Imperative for preventing errors Helps prevent adverse reactions Improves adherence Include the following: Brand and generic names, explanation of amount, explanation of timing for dose, measuring devices, and route Follow up on teaching

Home Care Considerations Home health care is increasing with increased population and early discharges Special considerations for “home” setting Practice requires more autonomy Teaching focuses on devices from local pharmacies and calibrated home devices Communication is critical!

Routes of Administration Oral (p.o.) Sublingual (SL) Buccal Parenteral (IV, IM, Subcut, ID) Insertion—in cavities Instillation—body cavity, eyes, ears, nose

Routes of Administration (cont’d) Inhalation—metered-dose inhalers, nebulizers, spacers Intranasal Topical—lotions, ointments, pastes Percutaneous—on skin, on mucous membranes Transdermal—patches

Equipment for Med Administration Medicine cup (30 mL/1 oz) Soufflé cup Calibrated dropper—use only supplied dropper Nipple—adapted for some infant meds

Figure 10-2 Medicine cup. (Modified from Brown M, Mulholland JL: Drug calculations: process and problems for clinical practice, ed. 8, St. Louis, 2008, Mosby.) Figure 10-3 A, Plastic medicine cup. B, Soufflé cup. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-4 Medicine dropper. (Modified from Clayton BD, Stock YN Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.)

Figure 10-5 Nipple. (From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-6 Oral syringes. (Courtesy of Chuck Dresner. From Clayton BD, Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.) Figure 10-7 Parts of a syringe. (From Potter PA, Perry AG: Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)

Figure 10-8 Types of syringes. A, Luer-Lok syringe marked in 0.1 mL (tenths). B, Tuberculin syringe marked in 0.01 mL (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked in units (100). D, Insulin syringe marked in units (50). (From Potter PA, Perry AG: Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)

Figure 10-9 A, Acceptable devices for measuring and administering oral medication to children (clockwise): measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated dropper, hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via a syringe. (A, From Hockenberry MJ, Wilson D: Wong’s nursing care of infants and children, ed. 8, St Louis, 2007, Mosby. B, Courtesy Paul Vincent Kuntz, Texas Children’s Hospital, Houston.)

Medication Administration

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