1. 08/24/101 Therapies management Generic overview – Carolyn Kirker, IV CNS, CCDHB

2. Session objectives Recognise the national medicines chart and it’s purpose Understand medication administration principles Understand student responsibilities related to medication administration 08/24/10

3. 5 rights Right medicine – Name, formulation, frequency, expiry Right route Right dose Right time – Check prn, stat administration sections of drug chart. Right patient 9/30/2016

4. National medication chart 9/30/2016

5. NMC - aims promote consistent best-practice prescribing standardise the way medicines are prescribed nationally reduce the risk of medication errors and improve patient safety enable District Health Boards (DHBs) to easily adopt the national medication charting standards 9/30/2016

6. NMC aims cont’d reduce the need for re-education on hospital- specific medication charts for prescribers, dispensers and administrators when moving between DHBs allow standardised training to begin at undergraduate level for all health professionals who use this medication chart standardise documentation recording so ePrescribing and Administration (ePA) is able to be more easily implemented in the future.

7. Administrators instructions Record time of administration using 24-hour clock i.e. 0600 or 1800 For variable route, record actual route used i.e. 50-100mg prescribed, 50mg given For variable dose, record actual dose given Giv/chck – given checked by. 9/30/2016

8. If dose not given 9/30/2016

9. Administrators rights Every nurse has a responsibility to ensure they can clearly read and understand the order before administering any medicine. The prescriber should be contacted to clarify incomplete or unclear orders. It is appropriate to withhold a medicine if there is a known allergy or adverse reaction to it, until the prescriber has been contacted for instructions. 9/30/2016

10. Allergies vs adverse drug reactions 08/24/10

11. Allergies  Unexpected reactions to a medicine, food (such as seafood, gluten, eggs, peanuts), substance (eg, iodine, preservatives, sulphur) which has been administered, taken, or used in the intended way.  Anything that has caused a skin rash, urticaria (hives), facial or throat swelling, or anaphylaxis should be documented as causing an allergy.  Allergies can also include reactions to plasters or latex. 9/30/2016

12. Adverse reactions  Adverse reactions are commonly listed in the medicine’s data sheet as a known side effect.  Adverse reactions tend to be more common patient occurrences than allergies (such as diarrhoea with penicillin or nausea with morphine). 08/24/10

13. Enteral (via digestive tract) – Oral (by mouth, PO) – Sublingual (under the tongue, SL) – Rectal (via the rectum, RE) Medication Routes Core IV Study Day

14.  Parenteral – Topical – Inhalation (IH) – Endotracheal (ET) – Transdermal (TD) – Subcutaneous (SQ) – Intramuscular (IM) – Intraosseous (IO) – Intravenous (IV) Medication Routes Core IV Study Day

15. Risk Assessment  Is the treatment necessary?  Is there a lower risk alternative?

16. Patient assessment Ask yourself about the patient, are there any conditions you will have to note: Renal Liver Cardiac Diabetes

17. Are there high risk medications? Insulins Anticoagulants Opioids Electrolytes

18. Plain  Release profile has not been modified (immediate release)  Examples: Frusemide, Amitryptiline  Often sugar coated/uncoated tablets or capsules  In general tablets may be crushed or capsules opened  Do not crush cytotoxics, hormones, buccal or sublingual preparations – risk of exposure 08/24/10

19. Enteric Coated Special coating to ensure drug released into body in small intestine “EC”, “EN” Protect drug from stomach acid (eg PPIs) OR Protect stomach from drug (eg NSAIDs) 08/24/10

20. Modified release  Release into the body has been modified  Controlled release  Sustained release  MR, SR, CR, XL, LA  Examples: Diltiazem (Cardizem CD) Isosorbide Mononitrate (Duride) Morphine (M-Eslon) Oxycodone (Oxycontin) 08/24/10

21. 9/30/2016 21 Why Intravenous Therapy?  Main indications for IV Therapy  Restore and maintain fluid and electrolyte balance  Administer medication  Transfuse blood products  Deliver parenteral nutrition

22. Vials (Single or Multi-dose) Ampules PVC Infusion Bags Glass Bottles Plastic Bottles Prefilled Syringes IV Medication Packaging Core IV Study Day

23. Delivery How do you want to give it? Bolus Intermittent Continuous If you are using a pump do you know how it works? If not...ASK and CHECK

24. Blood flow

26. Student policy The purpose of this policy is for student nurses/midwives to develop the skills necessary to administer medicines and fluids safely. Administration from 2 nd year onwards once IV and related therapy theory and calculations education and learning has been completed. Central and peripheral access devices. 9/30/2016 26

27. Procedure The intravenous medicines and fluids are legally prescribed. The patient receiving the intravenous medicine/fluid is informed that it will be administered by a student, and agrees to the process. The registered nurse/midwife supervises the student from the selection of medicine/fluid through to its administration and is responsible for the safety and risk management of the procedure. If the medicine/fluid being administered requires double checking eg. Opioid or blood product administration, two registered nurses/midwives are required to carry out this procedure. The student is not used as part of the double checking process. 9/30/2016 27

28. Risks and precautions The registered nurse/midwife is accountable for the safe practice of the student nurse/midwife. The administration of intravenous medicines and fluids by a student nurse/midwife is done under direct supervision of a registered nurse/midwife who holds a current C&C DHB generic intravenous therapy certification. The student nurse/midwife is directly supervised by the registered nurse/midwife throughout the entire process of medicine/fluid administration. 9/30/201628

29. Double Checking Drug Administration Double checking Double checking is necessary when the Nurse/Midwife: is unfamiliar with the work area, the patient, the medical diagnosis or the medicine/fluid lacks the confidence to safely assume sole responsibility for ensuring the patient receives the correct medicine/fluid calculates medicine doses and infusion rates experiences personal anxiety and stress, frequent interruptions, unrealistic work expectations, lack of sleep or hunger where it is legally necessary or required e.g. controlled drug, blood products, telephone prescriptions

30. Allergic reaction Allergen causes mast cells to produce histamine and other mediators – Bronchoconstriction > Dyspnoea – Angiooedema (swelling of the head and neck) – Vasodilation > Hypotension – Skin reactions > rashes

31. Immediate actions Remove allergen Call for help ABC Administer 0.5ml (0.5 mg) of 1:1,000 Adrenaline intramuscularly 100% O2 via mask Fluids if needed – which?

32. 32 Questions ???