PRINCIPLES OF DRUG ADMINISTRATION I.
The The “Fi “Five ve Plus Plus Five ive Rig Righ hts” ts” of of Dru Drug g Ad Admin ministr istrat atio ion n 5 Traditional Rights 1. righ rightt clie client nt 2. righ ight dru drug 3. righ ight dos dose 4. righ ight tim time 5. righ ight ro route ute
5 Additional Rights 1. righ rightt ass asses essm smen entt 2. right right docum document entati ation on 3. clien client’s t’s righ rightt to educ educati ation on 4. righ rightt eva evalu luat atio ion n 5. clien client’s t’s right right to to refus refuse e
A. Righ Rightt Clie Client nt Nurse must do: verify client check ID bracelet & room number have client state his name distinguish bw 2 client’s with same last names
B. Righ Rightt Drug Drug medication order may be prescribed by: a. Physic ysicia ian n b. Dentist c. Podiatr iatris istt d. Advanced practice registered nurse (APRN)
Components of a drug order: 1. date & time the order is written 2. drug name (generic preferred) 3. drug dosage 4. frequency & duration of administration 5. any special instructions for withholding or adjusting dosage 6. physician or other health care provider’s signature or name if TO or VO 7. signature of licensed practitioner taking TO or VO
Nurse must do: check med order is complete & legible. know general purpose or action, dosage & route of drug compare drug card with drug label three times. times. 1. at time time of contact contact with with drug drug bottle bottle// containe container r 2. befo before re pou pouri ring ng dru drug g 3. afte afterr pour pourin ing g drug drug • • •
4 Categories of Drug Orders: 1. Standing Order / Routine Order ongoing order may have special instructions to base administration include PRN orders
ex. digoxin 0.2 mg PO q.d., maintain blood level at 0.5 – 2.0 ng/ml 2.
One-time (single) order given only once, at a specific time ex. Cefixime 2mg IM at 7 AM on 12-1-05
3. PRN or order given at client’s request & nurse’s judgement for need & safety ex Mefenamic Acid 500mg q 4h PRN for pain 4. STAT order der given once, immediately ex. Morphine 2mg IV STAT
C. Righ Rightt Dose Dose Nurse must do: Calculate and check drug dose accurately. Check PDR, drug package insert or drug handbook for recommended range of specific drugs. Check heparin, insulin and IV digitalis doses with another nurse. • •
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Stock- method vs Unit-dose method
D. Righ Rightt Time Time Nurse must do: Administer drugs at specified times. Administer drugs that are affected by foods, before meals. Administer drugs that can irritate stomach, with food. Drug administration may be adjusted to fit schedule of client’s lifestyle, & activities. & diagnostic procedures. Check expiration date. Antibiotics shld be administered at even intervals. • • • •
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E. Righ Rightt Rout Route e Nurse must do: do : assess ability to swallow before giving oral meds. Do not crush or mix meds in other substances before consultation with physician or pharmacist Use aseptic technique when administering drugs. Administer drug at appropriate sites. Stay with client until oral drugs have been swallowed. • •
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F. Righ Rightt Asses Assessm smen entt get baseline data before drug administration.
G. Right Right Docu Document mentatio ation n Immediately record appropriate info Name, dose, route,time & date, nurse’s initial or signature •
Client’s response: narcotics analgesics antiemetics sedatives unexpected reactions to meds. • • • • •
Use correct abbreviations & symbols.
H. Right Right to to Educ Educati ation on Client teaching : therapeutic purpose side-effects diet restrictions or requirements skill of administration laboratory monitoring • • • • •
Principle of Informed Consent
I. Rig Right Eval Evalu uatio tion client’s response to meds. effectiveness o extent of side-effects or any adverse reactions. o
J. Righ Rightt to Ref Refu use Nurse must do: determine, when possible, reason for refusal. facilitate px’s compliance. explain risk for refusing meds & reinforce the reason for medication. Refusal shld be documented immediately. Head nurse or health care provider shld be informed when omission pose threat to px. • • • • •
ALL MEDICATION ERRORS ARE SERIOUS OR POTENTIALLY SERIOUS!!!!!!!! Medication Misadventures include: 1. adminis administrat tration ion of wrong wrong medica medication tion & IV fluid fluid.. 2. incorr incorrect ect dose dose or rate rate 3. adminis administrat tration ion to to the the wrong wrong patie patient nt 4. inco incorr rrec ectt rout route e 5. incorr incorrect ect sche schedu dule le interv interval al 6. adminis administrat tration ion of known known allerg allergic ic drug drug or IV fluid fluid 7. omission of dose or discontinuation discontinuation of med or or IV fluid that was not discontinued. discontinued.
II. II.
Guid Guidel elin ines es for for Cor Corre rect ct Admi Admini nist stra rati tion on of Medi Medica cati tion ons s A. Prep Prepar arat atio ion n 1. Wash Wash hands hands before before preparin preparing g meds. meds. 2. Chec Check k for for aller allergie gies. s. 3. Check medication medication order with with physician’s physician’s orders, orders, medicine medicine sheet, sheet, & medication medication card. card. 4. Check Check label label on on drug drug conta container iner 3 times. times. 5. Check Check expira expiratio tion n date date on drug label. label. 6. Recheck Recheck drug drug calcul calculati ation on with anoth another er nurse. nurse. 7. Verify doses doses of drugs drugs that are potentially potentially toxic toxic with another another nurse nurse or pharmacist pharmacist.. 8. With unit dose, open open packet packet at bedside bedside after verifying client identificati identification. on. 9. Pour Pour liqu liquid id at at eye eye leve level. l. 10.Dilute drugs that irritate gastric mucosa or give with meals.
B. Admi Admini nist stra rati tion on 11. Administer only those drugs that you have prepared. 12. Identify the client by ID band or ID photo. 13. Offer ice chips when giving bad tasting medicine. 14. Assist client to appropriate appropriate position. 15. Provide only liquids liquids allowed on the diet. 16. Stay with client until meds are taken. taken. 17. Administer no more than 2.5 to 3 ml of solution by IM at one site. 18. Infants receive no more than 1 ml of solution by IM at 1 site & no more than 1 ml subcutaneously. NEVER recap needles. 19. Give drugs last to client who need extra assistance. assistance. 20. Discard needles & syringes in appropriate containers. 21. Follow appropriate drug disposal based on institution policy. 22. Discard unused unused solutions from ampules. 23. Store appropriately unused solutions from open vials. 24. Write date & time opened & initials on label. 25. Keep narcotics in a double-locked drawer or closet. Med cart – locked at all times when nurse is not around.
26. Keys to narcotics drawer must be kept by the nurse & not stored in drawer. 27. Avoid contamination of one’s own skin or inhalation to minimize chances of allergy.
C. Rec Recordi ording ng 28. Report drug error immediately to nurse manager & physician. Complete an incident report. 29. Charting: Charting: record drug given, dose, time, route & your initials. 30. Record drugs promptly after given, esp STAT doses. 31. Record effectiveness & results of meds given, esp PRN meds. 32. Report to physician & record drugs that were refused with reason for refusal. 33. Record amount of fluid taken with medications on input & ouput chart.
Behaviors to Avoid During Medication Administration: Do not be distracted when preparing meds. Do not give drugs poured by others. Do not pour drugs from containers whose labels are partially removed or have fallen off. Do not transfer drugs from one container to another. Do not pour drugs into the hand. Do not give expired medications. Do not guess about drugs & drug doses. Ask when in doubt. Do not use drugs that have sediment, are discolored, or are cloudy (& shld not be). Do not leave medications by the bedside or with visitors. Do not leave prepared medications out of sight. Do not give drugs if the px says he has allergies to the drug or drug group. Do not call the px’s name as the sole means of identification. Do not give drug if the client states the drug is different from drug he has been receiving. Check the order. Do not recap needles. Use universal precautions. Do not mix with large amount of food or beverage that are contraindicated.
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III. III.
Form Forms s & Rout Routes es for for Drug Drug Admi Admini nist stra rati tio on A. Tablet Tablets s & Caps Capsule ules s •
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oral meds not given to pxs who are: o vomiting o lack gag reflex o comatose Do not mix with large amt of food or beverage or contraindicated food or infant formula Enteric- coated & timed-release capsules must be swallowed whole. Administer irritating drugs with food to lessen GI discomfort. Administer drugs on empty stomach if food interferes with absorption.
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Drugs given sublingually or bucally must remain in place until fully absorbed. Encourage use of child-resistant caps.
B. Liquids Forms : elixir, emulsions, suspensions read label if dilution or shaking is required. read the MENISCUS. refrigerate once reconstituted. • • • •
C.
Transdermal systemic effect more consistent blood levels & avoid GI absorption problems associated with oral products. patches should NOT be cut . • •
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D. Topic opica al Applied to skin with a glove, tongue blade or cotton - tipped applicator. Apply to clean dry skin when possible. Do not contaminate the medication in a container. Do not “double dipped” . Observed sterile technique when skin is broken. Use firm strokes if medication is to be rubbed in. • • • • • •
E. Inst Instil illa lati tion ons s Eyedrops 1. 2. 3. 4. 5. 6. 7. •
wash ash hands nds lie or or seat seat down down and look up toward towards s ceiling ceiling remove remove any discha discharge rge by wiping wiping out out from inner inner canthus canthus rest hand hand holding holding the dropper dropper against the client’s client’s head. gently draw draw skin skin down below affected affected eye eye to expose expose conjunctival conjunctival sac adminis administer ter drops drops into into center center of of the sac gently press press lacrimal lacrimal duct with sterile sterile cotton cotton ball or tissue for 1 to 2 mins after instillation 8. keep eyes eyes closed closed for for 1 to 2 mins follo following wing appli applicat cation ion
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Eye Ointment 1, 2, 3, 4,- same as above 5 . squeeze strip of ointment (abt ¼ inch, unless stated otherwise). 5. keep eyes close for 2-3 mins. 6. instruct instruct px for blurr blurred ed vision vision for for a short short time. time. 7. apply apply at at bedti bedtime, me, if possibl possible. e. Ear Drops 1. wash ash ha hands nds. 2. med med shld shld be be at room room tem temp. p. 3. sit up with head head tilted tilted slightly slightly toward toward unaffected unaffected side. side.
child: pull auricle down & back . (after 3yo ,same as adult) adult: pull up & back. 5. insti instillll presc prescrib ribed ed drops. drops. 6. do not not contam contamin inate ate drop dropper per.. 7. maintai maintain n posit position ion for 2-3 minutes minutes.. 4.
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Nose Drops & sprays 1. have have clie client nt blow blow nos nose. e. 2. tilt head head back back for for drops drops to reach reach fronta frontall sinus. sinus. tilt head to affected side to reach ethmoid sinus. 3. Adminis Administer ter prescr prescribed ibed numb number er of drops drops or sprays sprays.. Some sprays, close 1 nostril, tilt head to closed side & hold breath or breathe thru nose for 1 minute. 4. Keep head tilted backward backward for 5 minutes after instillation instillation..
F. Inha Inhala lati tion ons s Semi-fowlers or high-fowler’s position. Teach correct use of nebulizer & metered-dose inhalers. • •
G. Pare Parent nter eral al
1.
ID
Action > local effect > small amt > for tuberculin / skin test
site > ventral midforearm, clavicular / scapular area
2. SC
> systemic effect > slow, sustained effect > small amt of non-irritating, water soluble
> abdomen, upper hips/ back, upper arms, lateral thighs
3. IM
> systemic effect > rapid effect than SC > for irritating, aqueous suspensions, oil solutions
> ventrogluteal, dorsogluteal, deltoid, vastus lateralis
4. IV
> systemic effect > more rapid than IM or SC
> cephalic vein, median cubital v. dorsal vein of the hand
Remember!!!! Ventrogluteal site – preferred for IM inj. in adults & infants >7 mos old. DONOT use DORSOGLUTEAL site for IM inj in children. Vastus lateralis - infants < 7 mos old
Developmental needs: Stranger anxiety – infant Hospitalization/ ilness viewed as punishment – 3-6 yo Fear of mutilation – 3- 6 yo
Technological advances: Patient- Controlled Anesthesia (PCA) systems Eutectic mixture of local anesthetics (EMLA) • •
