Chapter 7 Principles of Medication Administration and Medication

Chapter 7 Principles of Medication Administration and Medication Safety Jeanelle F. Jimenez RN, BSN, CCRN Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Legal and Ethical Considerations • Standards of care: developed by each state’s nurse practice act, state and federal law, The Joint Commission, professional organizations • Before administering medication, the nurse must have: § § § Current license to practice Clear policy statement authorizing the act Signed medication order Understanding of rationale for drug use Understanding of drug action, dosing, dilution, route and rate of administration, common and serious adverse effects, and contraindications Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 2

Contents of Patient Charts • • • Summary sheet Consent forms Physician’s order form History and physical examination form Progress notes Critical pathways Core measures Nurses’ notes Laboratory tests record Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 3

Contents of Patient Charts (cont’d) • • • Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or medication profile PRN or unscheduled medication record Case management Patient education record Kardex Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 4

Drug Distribution Systems • • • Floor or ward stock system Individual prescription order system Computer-controlled dispensing system Unit dose drug distribution systems Long-term-care unit dose system Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 5

Narcotic Control Systems • Controlled substances must be kept in a locked cabinet • Records are kept to document the dispensing of each type of medication issued • Two nurses are needed when accounting for any discarded narcotics • Discrepancies are carefully checked; if the inaccuracy is not resolved by checking the patient’s chart, the pharmacy and nursing service is notified Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 6

Drug Disposal • Environmental concerns regarding drugs contaminating water prompted guidelines for disposal of medications in 2007 • Do not flush prescription drugs in toilet (unless instructed by manufacturer) • If no instructions are given, throw in trash • Utilize drug take-back programs, which allow public to dispose of unused drugs Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 7

The Drug Order • Stat order – emergency use • Single order – one time use • Standing order – given for specific number of doses • PRN order – administer as needed • Verbal orders – avoid whenever possible • Electronic transmission of patient orders Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 8

Medication Errors • • • Prescribing errors Transcription errors Dispensing errors Administration errors Monitoring errors Adverse Drug Events (ADE) – costly errors § Using CPOE, bar coding, smart pumps, and other technologies helps to prevent errors • Medication reconciliation – five-step process Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 9

Nurse Responsibilities • Verification § Nurse makes professional judgment regarding medication orders • Includes type of drug, usual dose, therapeutic intent, potential allergic reactions, contraindications • Transcription § Nurse is responsible for verification of orders transcribed by others Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 10

The Six Rights • Right drug § Compare exact spelling and concentration of drug with medication card and drug container; drug label should be read three times • Right time § Standard abbreviations for specific times § Standardized administration times to maximize drug absorption § Maintenance of consistent blood levels; generally laboratory tests used § PRN medications determine the last time given Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 11

The Six Rights (cont’d) • Right dose § § § Abnormal hepatic or renal function Any nausea and vomiting Accurate dose forms Accurate calculations Correct measuring devices • Right patient § ID bracelet checking § Considerations for pediatric and older adult patients Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 12

The Six Rights (cont’d) • Right route § § Oral route Subcutaneous route Intramuscular (IM) route Intravenous (IV) route • Right documentation § Safety/ethical considerations § Legal considerations § Always include date/time, drug name, dose, route, site of administration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 13