1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Drug Therapy Chapter 3 – Administering Medications

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Eight “Rights” Right medication Right dose Right client Right route Right time Right documentation Right to refuse ** Right rationale or reason **

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

4. Three Checks When Preparing Medications Removing medication Before pouring or opening medication Before replacing container or giving unit dose

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Accurate Drug Administration Principles Follow “rights” consistently Learn essential information about meds to be given Interpret prescriber’s orders accurately Read med labels carefully Minimize abbreviation use Calculate & measure doses accurately Use correct procedures & techniques for all routes

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Accurate Drug Administration Principles (cont.) Learn about client’s diagnoses & condition in relation to med administration Verify identity of clients before administering meds Omit/delay doses as indicated by client’s condition & document accordingly Be especially careful when administering to children

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Responsibilities Safe, accurate med administration Recognizing & questioning erroneous orders Refusing to administer unsafe meds Delegating in compliance with the law

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Errors Can result in –Serious illness –Conditions that prolong hospitalization or require additional treatment –Death Common medication errors –Giving incorrect dose –Not giving ordered med –Giving unordered med

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Errors Prevent them Don’t make them Don’t be in a hurry ** If / when you do make them, learn from your mistakes and don’t make them again

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Systems Unit-dose Computerized, locked cabinets Additional security for controlled substances

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins ** Medication Orders ** Must include –Client’s full name –Name of the med –Dose, route, frequency of administration –Date, time, signature of prescriber

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Order Transcription Typed into computer Handwritten on an order sheet Verbal orders –Signed by transcriber, countersigned by prescriber Telephone orders –Signed by transcriber, countersigned by prescriber

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Order Interpretation Must know commonly used abbreviations –Routes, dosages –Times of administration “Do not use” abbreviations Illegible, seemingly erroneous orders must be clarified before administration

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Abbreviations: Routes of Drug Administration IM:intramuscular IV:intravenous PO:by mouth, oral SL:sublingual SubQ: subcutaneous

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Abbreviations: Drug Dosages g: gram mg: milligram mcg: microgram mL: milliliter oz:ounce tbsp: tablespoon tsp: teaspoon

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Abbreviations: Drug Dosages g: gram mg: milligram mcg: microgram mL: milliliter oz:ounce tbsp: tablespoon tsp: teaspoon

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins ad lib: as desired PRN: as needed q4h: every 4 hours stat: immediately Abbreviations: Times of Drug Administration

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Drug Preparation & Dosage Forms Systemic medication forms –Liquids –Tablets, capsules –Suppositories, transdermals –Injections

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Practices to Measure Liquids Accurately Pour liquids to line Pour liquids at eye level

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Delivery Systems Pump delivery systems By mouth (PO) –Tablets –Capsules –Sublingual

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Delivery Systems (cont.) Controlled release –Enteric coated, tablets, capsules Maintain more consistent serum drug levels Allow less frequent administration Contain high amount of drug Intended to be absorbed slowly over prolonged period of time Should never be broken, open, crushed, chewed

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nasogastric Route HOB elevated 30 degrees Check placement –15 mL of air –Aspirate stomach contents –Check acidity of stomach contents Flush at least 30 mL of warm water to ensure patency

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Delivery Systems (cont.) Transdermal –Systemic absorption through skin Pump delivery systems –External or implanted –Refillable or long-acting without refills Insulin, opioid analgesics, anticancer meds

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

25. Medication Delivery Systems (cont.) Topical –Solutions –Creams –Suppositories –Frequently used for local treatment

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Administration Techniques Skin and mucous membrane Ear drops –Adult: Pinna up and back –Child: Pinna down and back –Rest on unaffected side for 10 to 15 minutes Eye drops or ointment –Drops: lower conjunctival sac –Ointment: spread inner to outer cantus of eye

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

28. Medication Administration Techniques Nose drops Rectal suppository Respiratory inhaler Skin applications Nitroglycerin ointment Transdermal disks, patches, and pads Sublingual tablets

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Neonatal and Pediatric Considerations Offer popsicle to numb taste buds Mix with pureed fruit, ice cream syrup Pinch nostril closed and drink medication through a straw Distract child with conversation or toy Use decorative adhesive bandage to cover injection site

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Geriatric Considerations Offer popsicle to numb taste buds Mix with pureed fruit, ice cream syrup Injections –Predetermine injection site –Insert the needle quickly –Inject the medication slowly

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Calculating Medication Dosages Accuracy is of utmost importance & requires –Mathematic abilities –Knowledge of common units of measurement –Knowing how to use data in performing calculations

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Calculating Medication Dosages (cont.) D = X H V D = desired dose (dose ordered, often in mg) H = available dose (on drug label, often in mg per tablet/capsule/mL) X = unknown (# of tablets/capsules/mL) V = volume or unit

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Equivalents

34. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Routes of Administration Oral Parenteral –Intradermal –Subcutaneous (SubQ) –Intramuscular (IM) –Intravenous (IV) Topical

35. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medications for Injection Must be prepared, packaged, & administered maintaining sterility Typical medication containers –Vials –Ampules –Prefilled syringes with attached needles

36. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Equipment for Injections Sterile needles –Various gauges -  number =  lumen –Various lengths, use depends on Route of administration Thickness of solution Size of the client

37. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Needles

38. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Needles for Injection Subcutaneous: 25, 26, 28 gauge IM children and emaciated patients: 25, 26, 28 gauge Intradermal: 26 gauge or other fine needle IM injections: 22 and 23 gauge IV therapy: 20 and 21 gauge * Blood transfusion: 16 and 18 gauge *

39. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Equipment for Injections (cont.) Needleless systems –Developed to prevent injury & spread of bloodborne pathogens Syringes –Made of plastic –Calibrated to measure doses accurately –Insulin, tuberculin syringes for small doses

40. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Syringes 3 mL syringes –Marking to nearest tenth 1 mL syringe –Marking to nearest hundredth Insulin syringe –Marking in units

41. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Rounding off Numbers for Syringes 3 mL syringe: carry out two decimal places and round off to the nearest tenth 1 mL precision syringe: carry out three places and round off to the nearest hundredth

42. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Injections General principles Subcutaneous heparin Subcutaneous insulin Z track technique for intramuscular injections

43. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injection Sites SubQ common sites –Upper arms, abdomen, back, thighs IM common sites –Deltoid, dorsogluteal, ventrogluteal, vastus lateralis muscles IV common sites –Back of hands, forearms

44. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IM Injection Sites Adult –Dorsogluteal –Ventrogluteal –Vastus lateralis –Deltoid Children –Vastus lateralis Dorsogluteal over 5 years of age

45. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Parenteral Route Adult maximum one site –3 mL –2 mL deltoid Angle of insertion –IM 90 degree –SC 45 degree and 90 degree subcutaneous fat and needle short

46. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins SubQ Injection Sites

47. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IM Injection Sites: Ventrogluteal

48. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IM Injection Sites: Deltoid

49. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IM Injection Sites: Vastus Lateralis

50. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IM Injection Sites: Dorsogluteal

51. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins IV Injection Sites

52. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Less Common Injection Sites Nurses may perform –Intradermal –Intra-arterial Physicians must perform –Intra-articular –Intrathecal