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Objectives Image source: clipart.com

Drug Administration

General Guidelines An EMT can give, or assist a patient in taking, medications only by the order of a licensed physician. Image source: Microsoft clipart An EMT can give medications only by the order of a licensed physician. The physician’s order may be a written protocol (standing order) or a verbal order.

General Guidelines Assess the patient Obtain a medication history including: Prescribed medications (name, strength, daily dosage) Over-the-counter medications Allergies to medications Image source: Microsoft clipart Before giving any drug, you must assess the patient. The extent of the physical examination you perform will depend on the patient’s illness or present condition. The physical exam provides baseline information by which you will be able to evaluate the effectiveness of the medications given. Obtain a medication history from the patient including the following: Prescribed medications (name, strength, daily dosage) Over-the-counter medications Allergies to medications

General Guidelines You must be knowledgeable about each drug you give including the following: Mechanism of action Indications Dose Route of administration Contraindications Adverse effects Special considerations Image source: Microsoft clipart You must be knowledgeable about each drug you give, including the following: Mechanism of action—how the drug exerts its effect on body cells and tissues Indications—the condition(s) for which the drug has documented usefulness Dose—the amount of the drug that should be given to the patient Route of administration—the route and form in which the drug should be given to the patient Contraindications—the condition(s) for which a drug should not be used because it may cause harm to the patient or offer no improvement of the patient’s condition or illness Adverse effects—an undesired effect of a drug Special considerations—factors to consider when giving the drug, such as the impact of age and weight on medication administration (children, older adults, pregnant patients); tips for administration of the drug

General Guidelines Information to relay to medical direction: Patient’s age Chief complaint Vital signs Signs and symptoms Allergies Current medications Pertinent past medical history Image source: Microsoft clipart Before giving a medication, consult with medical direction. When speaking with medical direction, be sure to relay relevant information about the patient including the following: Patient’s age Chief complaint Vital signs Signs and symptoms Allergies Current medications Pertinent past medical history

Physician’s Order Order will include: Drug name Drug dose Drug route Repeat orders back to physician Image source: Microsoft clipart The physician’s order will include the name, dose, and route of the drug to be given. Make sure you clearly understand the orders received from medical direction. Repeat the orders back to the physician including the name of the drug, dose, and route of administration. If an order received from medical direction is unclear or seems incorrect, ask the physician to repeat the order.

The Six Rights of Drug Administration

The Six Rights of Drug Administration Right patient Right medication Right dose Right route Right time (frequency) Right documentation

Routes of Drug Administration

Routes of Drug Administration Enteral Parenteral Image source: Microsoft clipart

Enteral Routes of Drug Administration Oral route Requires a responsive, cooperative patient Advantages Disadvantages Image source: Microsoft clipart Commonly used oral dosage forms include liquids, tablets, and capsules. Aspirin and activated charcoal may be given by this route.

Enteral Routes of Drug Administration Oral route Technique Use appropriate personal protective equipment The inside of the medicine container, its contents, and the inside of the container’s cap are considered clean. Be careful not to touch these areas. Giving oral medications usually does not involve exposure to a patient’s blood or other body fluids. However, wearing appropriate personal protective equipment (such as gloves) is a common practice to minimize the chances of communicable disease exposure. The inside of the medicine container, its contents, and the inside of the container’s cap are considered clean. When giving a medication, be careful not to touch these areas.

Enteral Routes of Drug Administration Oral route Technique When administering a tablet: Open the medication container Pour the correct number of tablets into the inside cap of the container Pour the tablets into the patient’s hand Do not contaminate the inside cap of the container Carefully recap the container When administering a tablet, open the container and pour the correct number into the inside cap of the container. Transfer the tablets by pouring them into the patient’s hand, making sure not to contaminate the inside cap of the container, and then carefully recap the container.

Enteral Routes of Drug Administration Buccal route “Pertaining to the cheek” Advantages Disadvantages Technique Buccal means, “Pertaining to the cheek.” To give a drug by this route, a drug is placed in the mouth against the mucous membranes of the cheek until the drug is dissolved. The drug may act locally on the mucous membranes of the mouth or systemically when swallowed in the saliva. Oral glucose may be given by this route.

Enteral Routes of Drug Administration Sublingual route Drug given under the tongue Rapid absorption Advantages Disadvantages Technique Sublingual drugs are given under the tongue. The drug must remain under the tongue until it is dissolved and absorbed. The drug is absorbed rapidly into the bloodstream due to the rich blood supply under the tongue. The patient should not swallow the drug or take it with water. If swallowed, the drug may be inactivated by gastric juice in the stomach. Nitroglycerin may be given by this route

Parenteral Routes of Drug Administration Inhalation route Rapid onset of action Gas (oxygen) Mist / aerosol (albuterol) Advantages Disadvantages Drugs given by the inhalation route have a rapid onset of action due to the large surface area and blood supply of the lungs. To make sure that normal gas exchange of oxygen and carbon dioxide is continuous in the lungs, drugs given by inhalation must be in the form of a gas (such as oxygen) or fine mist (such as an aerosol). Oxygen is given for its systemic effects. A metered dose inhaler such as albuterol is given for its localized effect on the lungs.

Parenteral Routes of Drug Administration Subcutaneous route Needle inserted underneath the skin into the subcutaneous tissue Advantages Disadvantages Technique Drugs given by the subcutaneous (SubQ) route are given by means of a needle inserted underneath the skin into the subcutaneous tissue. The onset of action of SubQ drugs is faster than the oral route but slower than the intramuscular route. Absorption is delayed in circulatory collapse, such as shock. Only a small volume of drug can be given by this route.

Parenteral Routes of Drug Administration Intramuscular route Medication in a liquid form is injected into a large mass of skeletal muscle Advantages Disadvantages Technique When a drug is given by the intramuscular route, a medication in a liquid form is injected into a large mass of skeletal muscle. Sites commonly used in prehospital care include the arm (deltoid muscle) and mid-lateral thigh (vastus lateralis muscle). The injection is usually made with a longer needle than that used with a SubQ injection. Larger volumes can be given by the intramuscular route than the subcutaneous route. The onset of action is faster than the SubQ route due to the muscle’s blood supply and large absorbing surface. Epinephrine is an example of a drug that may be given by this route.

Reassessment and Documentation After giving a drug: Document the reason the drug was given Document the medication administered and the time you gave it Reassess the patient Document the patient’s vital signs and response to the drug. After giving a drug, document the reason the drug was given, the medication administered, and the time you gave it. Reassess the patient and document the patient’s vital signs and response to the drug. Monitor the patient for possible adverse effects, as well as expected results.

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