MEDICATION ADMINISTRATION Topic 1 Topic 1 Client ID Documentation Drug Schedules

As the student nurse gains experience in medication administration, psychomotor skills ( the how to ) become more refined. Psychomotor skills, however represent only a small part of medication administration. Knowledge, physical and mental status as well as client attitudes and responses can make medication administration a complex experience

List reasons for the importance of being competent in the administration of medications

REASONS All drugs prescribed or over the counter are potentially dangerous Prescription or medication order is a legal document It is a legal requirement To ensure maximum safety for person who might benefit from drugs To protect the enrolled nurse and health care facility from serious consequences of medication incidents. The nurse does not have sole responsibility fro medication administration. The prescriber and pharmacist also help to ensure the right medication gets to the right client. The nurse administering medications however is accountable for knowing what medications have been prescribed, their therapeutic and non-therapeutic effects and the clients need for the medication. The nurse supervisors the administration of the medication and provides education about the medication and its effects.

INDICATIONS FOR MEDICATION USE Maintain normal body function. Eg. Insulin. Diagnostic Eg Barium. Symptomatic relief, Eg Analgesia. Prophylaxis, Eg Vaccines. Alter psychological functions, Eg Contraception. Reverse control disease process, Eg Antibiotics.

Describe the drug controls in New South Wales

COMMONWEALTH REGULATIONS The role of the Australian Government in regulation of the pharmaceutical industry is to protect the health of the people by ensuring that medications are safe and effective.

AGED CARE ACT 1997 To ensure that the facilities employ appropriately skilled staff who can provide for the needs of the residents in their care. They must maintain accreditation standards. The enrolled nurse must work within the policy and protocols of their employing facility.

CONTROL IS AT 3 LEVELS The Therapeutic Goods Act ( 1989 ). Medication manufacturer, sales, testing, labeling and distribution. The Customs Act ( 1901 ) Advertising of therapeutic goods to health professionals and public TGA – medication manufacturer, sales, testing naming and labeling, distribution Customs – advertising of therapeutic goods to health professionals and the public National – applies to the Pharmaceutical Benefits Scheme that provides subsidised drugs to the public. It also limits the amount of drugs supplied the number of times and frequency that the supply can be repeated Not all drugs are subsidised.

CONTROL IS AT 3 LEVELS 3. The National Health Act ( 1953 ) Applies to Pharmaceutical Benefits Scheme that provides subsidized drugs to public. Also limits the amount of drugs supplied, number of times and frequency that the supply can be repeated. Not all drugs are subsidized.

DRUG CONTROLS IN NSW The Australian Therapeutic Goods Administration ( TGA ) a section of the Commonwealth Department of Health, provides a framework for the regulation of therapeutic goods to ensure their safety, efficiency, quality and timely availability. Before a drug can be marketed in Australia, it must be evaluated by TGA. The product will be assessed for quality, safety, efficacy and cost effectiveness. Before a drug can be marketed in Aust. It must be evaluated by the TGA a division of the Commonwealth Department of Health and Ageing. The product will be assessed for quality, safety, efficacy and cost-effectiveness and considers the extent to which the drug should be made available to the public The TGA makes the final decision on whether or not to register the drug and decides into what schedule

NSW LEGISTRATION NSW Poisons and Therapeutic Goods Act ( 1966 ) Poisons and Therapeutic Goods Regulation ( 2002 ) Nursing Home Act 1993. State medication laws must conform to Commonwealth Legislation Advertising of drugs is also regulated by state governments Administration of medications by nurses is subject to further control by various state regulations

POISONS AND THERAPEUTIC GOODS ACT 1966 Covers the control of poisons and outlining any criminality related to poisons

The poisons and therapeutic goods regulation 1994 has a direct impact on nurses during their day to day routines and covers the practical aspects of the possession, storage, supply, administration and recording of the poisons and the poisons list which classifies substances into their various substances.

NSW DEPARTMENT OF HEALTH Guidelines for the Handling of Medication in NSW Public Hospitals Guidelines fro the Handling of Medication in Community Based Health Services and Residential Facilities in NSW Private Hospitals and Day Procedure Centre and Nursing Homes Regulations These are the standards that regulate enrolled nurse practice Public hospitals must ensure that employees who are administrating medication have appropriate qualifications and training. Health care institutions establish individual policies that must meet Commonwealth, State and local government regulations

NSW DEPARTMENT OF HEALTH These are the standards that regulate enrolled nurse practice Public hospitals must ensure that employees who are administrating medication have appropriate qualifications and training. Health care institutions establish individual policies that must meet Commonwealth, State and local government regulations

AUSTRALIAN NURSE COMPETENCIES This organization outlines and limits the role and boundaries of the enrolled nursing practice The inclusion of medication administration in the scope of practice for the EN will ensure public safety through quality management and risk assessment intervention.

NSW NRB Enrolled Nurses who have been competent in the medication module will be permitted to administer medication by what ever route including S4 drugs but not S8 drugs of addiction. The authority to practice is endorsed by the NRB.

CLIENT IDENTIFICATION How do you Identify a client?

DOCUMENTATION Medication charts should have patients: MRN. Full name. MRN. Date of birth. Allergy. Legible order. Drug ordered by Generic name. Signature of Doctor and their printed name.

DOCUMENTATION Date medication ordered. Times for medication. Reasons for use of medication. Age and weight of paediatric patient. Cessation date. Forms of medication, eg rectally, orally, transdermal.

MEDICATION ADMINISTRATION TERMINOLOGY

DRUG SCHEDULES Schedule 1. Dangerous poisons eg Arsenic. Schedule 2. Medicinal Poisons, eg Paracetamol. Schedule 3. Potent substances, eg Insulin. Schedule 4. Restricted substances, eg Oral hypoglycaemics. Schedule 4D. Prescribed Restricted Substances, eg Diazepam.

DRUG SCHEDULES Schedule 5. Domestic Poisons, eg Bleach. Schedule 6. Industrial and Agriculture, eg Phenol. Schedule 7. Special Poisons, eg Insecticides. Schedule 8. Drugs of Addiction, eg Morphine.

PROHIBITED DRUGS Substances which are controlled under the Drug Misuse and Trafficking Act 1985 and are not specified in Schedule 8 of the Poisons and Therapeutic Goods Act, eg Heroin.

INDICATIONS An illness or disorder for which a drug has a documented specific usefulness.

CONTRAINDICATIONS A factor that makes dangerous or undesirable the administration of a drug or the performance of an act or procedure in the care of a specific patient.

SIDE EFFECT A side effect occurs when a medication causes unintended, secondary effects ( that may be predictable ) Side effects may be harmless or injurious. If the side effects are serious enough to negate the beneficial effects of medication’s therapeutic action, the prescriber may discontinue the medication. Client’s often stop taking medication because of the side effects.

ADVERSE REACTIONS/AFFECTS These are generally unexpected effects of the medication. They may be related to the pharmacological effect or they may be related to the individual taking the medication. When adverse reactions occur with medications the prescriber will modify the therapy or may discontinue the medication

NEAR MISS Error recognised prior to administration of medication given to patient

SENTINEL EVENT An error in drug administration that may cause permanent disability or death.

TRADE NAME The trade name, brand name or proprietary name is the name under which a manufacturer markets a medication Manufacturers try to choose names that are easy to pronounce, spell and remember so that laypersons will recognise trade names.

CHEMICAL NAME Is the name by which the chemist knows it, it provides an exact description of the drug’s chemical composition.

GENERIC NAME Is the name given by the manufacturer who first developed the drug. To prevent confusion and to reduce medication errors, medication orders should be written using the generic name

D – (- ) –a amino – r – benzyl penicillin trihydrate Lets look at an example D – (- ) –a amino – r – benzyl penicillin trihydrate Amoxycillin trihydrate Alphamox, Cilamox, and Amoxyn. There can be more than 1 trade name

THERAPEUTIC EFFECT The therapeutic effect of the drug is the intended use of the drug, that is , its desired effect. E.g. Panadol for a headache, the therapeutic effect is pain relief.

MEDICATION INCIDENT All health facilities should have as part of their quality improvement programs a system in place or reporting medication errors. Please check where these are kept. Object of collection information is not for punishment but for identification of system and process deficiencies that can be fixed.

ABBREVIATIONS Ac = before meals Bid/bd = twice a day h= hour pc= after meals prn= whenever there is a need/necessary It is important to check the hospital policy for acceptable abbreviations.

ABBREVIATIONS m = mane n = nocte IV = intravenous SC = subcutaneous

ABBREVIATIONS IM = intramuscular mist = mixture asap = as soon as possible qqh = every 4 hours po = by mouth ( orally )

ABBREVIATIONS qid= four times a day tds= three times a day q2h= every 2 hours q4h=every 4 hours stat=give immediately