Medication Administration

Medication Administration
53 Medication Administration

Learning Outcomes 53.1 Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. 53.2 List the rights of drug administration. 53.3 Recognize the correct equipment to use for administering medications.

Learning Outcomes 53.4 Carry out the procedures for administering oral medications. 53.5 Carry out procedures for administering parenteral medications. 53.6 Carry out procedures for administering parenteral medications by other routes.

Learning Outcomes Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. 53.8 Outline patient education information related to medications. 53.9 Implement accurate and complete documentation of medications.

Introduction Drug administration Medical assistant must
Given correctly ~ restores health Given incorrectly ~ condition can worsen Medical assistant must Understand fundamentals of drug administration Know your scope of practice Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Drug administration is one of the most important and most dangerous duties for a medical assistant. This chapter prepares you to understand the fundamentals of drug administration, including the following: Rules and responsibilities of drug administration Rights of drug administration Routes of medication administration Techniques needed to administer drugs Special patient considerations Patient education Your role may vary depending upon the state and practice where you are employed.

Preparing to Administer a Drug
For common drugs know Uses Contraindications Interactions Adverse effects Be alert to any change in patient’s condition that could affect drug therapy Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Be familiar with the medications frequently prescribed in your practice. .

Preparing to Administer a Drug (cont.)
Drug and drug allergies Keep an accurate medication list in the patient record Ask about drug allergies at every appointment Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Drugs and Drug Allergies The physician must be aware of the current medications the patient is taking. Ensure that a complete and accurate medication list is maintained on the patient's chart and updated every time the patient comes for an appointment. You must also ask the patient about any drug allergies. Patients often see other physicians or specialists, who may have prescribed different medications. A patient could have had a drug reaction to a medication that has been prescribed by another physician.

Administration site Check site of administration Be sure there are no contradictions to using the site Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Administration site Drugs with local effects are applied directly to the skin, tissues, or mucous membranes. Drugs that produce systemic effects are administered by routes that allow the drug to be absorbed and distributed in the bloodstream throughout the body. Before you administer a drug, you must check the site of administration. For an oral medication, make sure the patient can take the medication. For an injection, inspect the injection site and check for any condition which may eliminate the site.

Patient condition Assess overall condition Review drug list Be sure dose is appropriate Patient consent form Answer questions Have signed before administering injection Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Patient Condition Assess the patient’s overall condition Ensure that any medications already being taken will not interfere with the ordered drug or route of administration. Verify again that the ordered dose is appropriate for the patient’s age and weight. Patient Consent Form Many physicians require that a patient sign a consent form before receiving an injection. A consent is necessary for vaccines. If a consent form is needed, make sure that the patient signs the form and that you have answered any questions prior to giving the injection.

General Rules for Drug Administration
Give only drugs the doctor orders Wash your hands Prepare in a well-lit area Focus on task Avoid distractions Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Give only the drugs the physician has ordered. Written orders are preferable, but oral orders are appropriate for emergencies. If you are unfamiliar with any aspect of a drug, consult a credible drug reference. Wash your hands before handling the drug. Prepare the drug in a well-lit area, away from distractions. Focus only on the task at hand. Perform a "Triple Check" by checking the medication three times. Check the medication three times even if the dose is prepackaged, labeled, and ready to be administered. 1st check – when you take it from the storage container and match it to the medication administration record (MAR) 2nd check – when you prepare it 3rd check – before you close the storage container or just before you administer the medication to the patient.

General Rules for Drug Administration
Triple check medication When taken from storage container and matched to MAR When prepared Before administration Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Give only the drugs the physician has ordered. Written orders are preferable, but oral orders are appropriate for emergencies. If you are unfamiliar with any aspect of a drug, consult a credible drug reference. Wash your hands before handling the drug. Prepare the drug in a well-lit area, away from distractions. Focus only on the task at hand. Perform a "Triple Check" by checking the medication three times. Check the medication three times even if the dose is prepackaged, labeled, and ready to be administered. 1st check – when you take it from the storage container and match it to the medication administration record (MAR) 2nd check – when you prepare it 3rd check – before you close the storage container or just before you administer the medication to the patient.

General Rules for Drug Administration (cont.)
Calculate the dose carefully Do not leave a prepared drug unattended Do not administer a drug you did not prepare Verify patient identity Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Calculate the dose if necessary. Remember, if you are unsure of your computation, ask another medical assistant or a licensed practitioner to check it. Ask the patient to state his name and date of birth to ensure correct identification. Double-check possible drug allergies. Do not rely on documentation in the chart; new allergy may have developed that has not been added to the record.

The physician must be in the office Have patient remain in office Instruct patient Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. If the patient develops an anaphylactic reaction to the drug or vaccine, the physician must administer epinephrine. After administering the drug, ask the patient to remain in the facility for 10 to 20 minutes so that you can observe the patient for any unexpected effects. Give the patient specific instructions about the effects of the drug as well as general information about drug use.

If patient refuses the medication Discard properly Document Report medication errors Document after administering medication Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. If the patient refuses to take the drug, discard it according to your facility policy. Do not flush it down the toilet or return it to the original container. Be sure to document the refusal in the patient’s record and tell the physician. If you make an error in drug administration, tell the physician immediately. See the Caution: Handle with Care feature, Handling Medication Errors. Immediately document the drug and dose administered; never document administration before giving medicine.

Yippee! Apply Your Knowledge What does “triple check” include?
ANSWER: The medication needs to be checked 3 times: 1st check – when you remove it from the storage area and match it to the MAR 2nd check – when you prepare it 3rd check – before you close the storage container or just before you administer the medication to the patient Learning Outcome: Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. Yippee!

Rights of Medication Administration
Basic rights Right patient Right drug Right dose Right route Right time Right documentation Additional rights Right reason Right to know Right to refuse Right technique Learning Outcome: List the rights of drug administration. The rights of medication administration are a set of safety checks the medical assistant should follow to prevent a medication administration error.

Rights of Medication Administration (cont.)
Right Patient Ask patient for name and date of birth Check against record Right Drug Check ordered drug name against label Check expiration date Look up drug if unfamiliar Perform a triple check Learning Outcome: List the rights of drug administration. Right Patient – always check the name and date of birth on the order for a drug or vaccine in the patient’s chart; then compare to the name and date of birth that the patient tells you. Right Drug – carefully compare the name of the prescribed drug or vaccine in the patient’s chart with the label on the drug container.

Right dose Read label Calculate accurately Right route Matches route ordered Can be administered by route ordered Learning Outcome: List the rights of drug administration. Right Dose Compare the dose on the order in the patient’s chart with the dose you prepare. Do not confuse the dose contained in one tablet with the number of tablets in the container. Right Route Make sure the administration route you are preparing to use matches the route the doctor ordered. Check that the medication you are using can be administered by the route ordered.

Right time Right documentation Immediately following administration Correct information Learning Outcome: List the rights of drug administration. Right Time – be sure to give the drug at the right time. Right Documentation Document immediately after administration Include the date, time, drug or vaccine name, lot number, dose, administration route, patient reaction, patient education about the drug, and your first initial and last name. Refer to CONNECT to see a video about Record a Medication in a Patient’s Chart .

Right reason Right to know – patient education Right to refuse Report to physician Document Right technique – know the correct technique Learning Outcome: List the rights of drug administration. Right Reason – the person who administers the medication should know the reason the medication is being given. Right to Know All patients have the right to be educated about the medications they are receiving. This should include the reason, the effect, and the side effects of medications. Right to Refuse – every patient has the right to refuse a medication. Right Technique Always use the proper administration technique. If you have not used a technique recently, review the technique before administering the drug.

Apply Your Knowledge Right!
How do you properly identify the patient before administering a drug? ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth. Learning Outcome: Identify rules and responsibilities regarding drug administration. Right!

Drug Routes and Equipment
You must be able to give drugs safely by any route In the medical office Buccal or sublingual medications Other routes based on scope of practice Demonstrate use of inhalers Topical drugs Learning Outcome: Recognize the correct equipment to use for administering medications. You must master a variety of techniques to give drugs safely by any route. You are likely to be asked to do the following. Place drugs in the patient’s mouth between the cheek and gum or under the tongue Administer a drug by any means other than by mouth (if permitted by your scope of practice and state laws) Demonstrate how to use an inhaler Apply topical drugs (those applied to the skin) Administer or assist in administering drugs into the urethra, vagina, or rectum Administer medications to the eye or ear, as discussed in the Assisting with Eye and Ear Care chapter. Refer to Table 53-2 Routes and Methods of Drug Administration.

Medications by Mouth Oral administration Slower absorption
Tablets, scored tablets, capsules, lozenges, and liquids Contraindications Nausea Comatose Unable to swallow Patient education Learning Outcome: Carry out the procedures for administering oral medications. Drugs that are swallowed are absorbed relatively slowly as they travel along the gastrointestinal (GI) tract. A scored tablet can be broken into pieces along a scored (indented) line on the tablet. Certain drugs are ineffective when administered orally. Ensure that the patient understands the drug and that the drug is administered safely and effectively. Refer to Procedure 53-1 Administering Oral Drugs

Medications by Mouth Buccal or sublingual administration
Buccal – placed between the cheek and gum Sublingual – placed under the tongue Faster absorption; bypasses GI tract Learning Outcome: Carry out the procedures for administering oral medications. The medication is absorbed through tissue that is rich in capillaries, and the drug enters the bloodstream directly. Because the drug does not pass into the stomach or intestines before absorption, it produces a therapeutic effect more quickly than do oral drugs. Refer to Procedure 53-2 Administering Buccal or Sublingual Drugs Refer to CONNECT to see a video about Administering Drugs by Mouth.

Apply Your Knowledge Gold star Answer! Why is it important to be able to administer medications by a variety of methods? ANSWER: You may be asked to administer drugs by any of an number of different routes. Why is absorption faster when drugs are administered sublingually or buccally? Learning Outcomes: Recognize the correct equipment to use for administering medications. 53.4 Carry out the procedures for administering oral medications. ANSWER: The drug is absorbed directly into the bloodstream bypassing the GI tract.

Medications by Injection
Parenteral administration Any route other than through the GI tract Rapid drug action Safety risks Rapid administration Exposure to blood-borne pathogens Learning Outcome: Carry out procedures for administering parenteral medications. Parenteral administration - administration of a substance such as a drug by muscle, vein, or any means other than through the GI tract. Route offers the advantage of rapid drug action. Potential disadvantages Poses more safety risks for the patient because after the drug has been injected, it cannot be retrieved. Increases your risk of potential exposure to bloodborne pathogens when you perform injections and dispose of used needles. Follow Standard Precautions during injections. Dispose of contaminated needles and other sharp items correctly.

Medications by Injection (cont.)
Needles Parts Gauge Length ~ select for Type of injection Patient size Amount of fatty tissue Injection site Learning Outcome: Carry out procedures for administering parenteral medications. Select the needle, syringe, and drug form to use on the basis of the type of injection. Needles consist of A hub – fits onto the syringe Hilt, shaft, lumen, point Bevel – helps the needle cut through the skin with minimum trauma. Needle gauges (inside diameters) The smaller the number, the larger the gauge. Use the right gauge for the type of injection and the viscosity of the drug . Needle lengths – long enough to penetrate the appropriate layers of tissue, but not so long as to go too deep. Refer to Table 53-3 Suggested Needle Gauge, Length, Injection Amount, and Location.

Medications by Injection(cont.)
Syringes Barrel ~ calibrated cylinder Plunger ~ forces drug through barrel Needlestick prevention safety device Needle Needlestick prevention safety device Syringe hub Barrel Plunger Trailing ring Leading ring Learning Outcome: Carry out procedures for administering parenteral medications. Syringes have two basic parts: a barrel and a plunger. The barrel is the calibrated cylinder that holds the drug. The plunger forces the drug through the barrel and out the needle. All syringes must include a needlestick prevention safety device. They are calibrated according to how the syringe will be used Common 3-ml syringe is divided into tenths of a milliliter. It is used to measure most drugs. A tuberculin (TB) syringe holds 1 ml and is calibrated in hundredths of a milliliter Insulin syringes are calibrated in units (U), commonly either 50 U or 100 U Insulin syringes have permanently attached needles. They have no dead space (fluid remaining in the needle or syringe after the plunger is depressed fully). These differences help the patient self-administer the correct amount of insulin.

Forms of Packaging for Parenteral Drugs
Cartridge Ampule Vial Liquid or powder ~ reconstitute with diluent Single or multiple doses Learning Outcome: Carry out procedures for administering parenteral medications. Cartridge A small barrel prefilled with a sterile drug It slips into a special, reusable syringe assembly. Ampule – a small glass or plastic container that is sealed to keep its contents sterile. Refer to Procedure 53-3 Drawing a Drug from an Ampule Vial – a small bottle with a rubber diaphragm that can be punctured by needle. Refer to Procedure 53-4 Reconstituting and Drawing a Drug for Injection Refer to CONNECT to see videos about Drawing a Drug from an Ampule and Reconstituting and Drawing a Drug for Injection.

Intradermal (ID) Into upper layer of skin Used for skin tests Subcutaneous (subcut) Provides slow, sustained release and longer duration of action 1 mL or less Rotate sites Learning Outcome: Carry out procedures for administering parenteral medications. Intradermal (ID) injection Administered into the upper layer of skin at an angle almost parallel to the skin Intradermal injections are usually used to administer a skin test, such as an allergy test or a TB test. The drug is injected under the top skin layer, and a little bubble or wheal is raised. If the body reacts to the drug, erythema (redness) and induration (hardening) occur. This reaction generally takes place 15 to 20 minutes after an allergy test and from 48 to 72 hours after a TB test. Refer to Procedure 53-5 Giving an Intradermal Injection Subcutaneous (subcut) injection Provides a slow, sustained release of a drug and a relatively long duration of action. Inject 1 ml or less of drug Insulin and heparin, are commonly administered by a subcut injection. When patients need regular subcut injections, remember to rotate injection sites systematically. Refer to Procedure 53-6 Giving a Subcutaneous (Subcut) Injection To diagram

Intramuscular (IM) More rapid absorption Less irritation of tissue Z-track method Epidermis and dermis Subcutaneous tissue Muscle Medication Z-track Method Learning Outcome: Carry out procedures for administering parenteral medications. Intramuscular (IM) injection Irritates a patient’s tissues less than a subcut injection and allows administration of a larger amount of drug. Z-track method of injecting an IM drug Used with drugs that can irritate subcutaneous tissues. Pull skin and subcutaneous tissue to the side before inserting needle at site. Release skin after injection. Creates a zigzag path in tissue layers, preventing the drug from leaking into the subcutaneous tissue and causing irritation. Refer to CONNECT to see a video about Giving an Intramuscular Injection. To diagram

IM injections – choose sites carefully Ventrogluteal Iliac Crest Deltoid muscle Clavicle Vastus lateralis (mid-portion) Learning Outcome: Carry out procedures for administering parenteral medications. Identify the site carefully to prevent injury to blood vessels and nerves in the area.

Intravenous (IV) Directly into vein Given by IV infusion Drug is dissolved into a solution Slow drip into a vein Rapid onset of action Sudden adverse reactions possible Learning Outcome: Carry out procedures for administering parenteral medications. Intravenous (IV) injections Not commonly performed in a medical office or by medical assistants Drugs may also be mixed and dissolved into a solution. Given by IV infusion into a vein. Drugs produce an almost immediate effect but can also can cause sudden adverse reactions. Medical assistants may assist by laying out supplies and equipment. To diagram

Apply Your Knowledge Super!
ANSWER: ___ prevents drug from leaking into subcutaneous tissue ___ used to administer skin tests ___ small bottle with rubber diaphragm ___ can administer a larger amount of medication ___ provides a slow, sustained release inside diameter of needle provides an almost immediate effect G Matching Intramuscular injection Gauge Subcutaneous injection Intradermal injection Vial IV injection Z-track method D E A Learning Outcome: Carry out procedures for administering parenteral medications. C B F Super!

Other Medication Routes
Inhalation Administered through the mouth or nose Read package insert Topical Direct application of a drug on the skin Some forms ~ creams, lotions, ointments Transdermal system Learning Outcome: 53.6 Carry out procedures for administering parenteral medications by other routes. Inhalation Therapies Medication that is delivered into the respiratory system during inhalation. Always read the inserts for inhaled drugs for a detailed description of the exact procedure for the type of inhalation you will be administering. Refer to Procedure 53-8 Administering Inhalation Therapy Topical Application Drugs can be in the form of creams, lotions, ointments, tinctures, powders, sprays, and solution Transdermal system Specialized type of topical administration that produces a systemic effect by slowly and evenly releasing a systemic drug. Drug is absorbed through the skin directly into the bloodstream. Refer to Procedure 53-9 Administering and Removing a Transdermal Patch and Providing Patient Instruction

Other Medication Routes
Urethral administration – local effect Vaginal Local effect Suppositories most common form Douches ~ administer liquid medications Rectal – suppositories or enemas Learning Outcome: 53.6 Carry out procedures for administering parenteral medications by other routes. Urethral Administration A small-diameter urinary catheter is inserted into the bladder The drug is instilled through the catheter which is then clamped to let the drug bathe the urinary bladder walls. Refer to Procedure Assisting with Administration of an Urethral Drug Vaginal Administration Packaged as suppositories, solutions, creams, ointments, and foams. Douche – vaginal irrigation used to administer liquid forms of vaginal medication Medical assistant may provide patient education for this route of administration. Refer to Procedure Administering a Vaginal Medication Rectal Administration – given in the form of suppositories or enemas and may produce local or systemic effects. Refer to Procedure Administering a Rectal Medication

Great job! Apply Your Knowledge
List parenteral routes other than an injection. ANSWER: Other parenteral routes include: Inhalation Topical Urethral Vaginal Rectal Great job! Learning Outcome: 53.6 Carry out procedures for administering parenteral medications by other routes.

Special Considerations
Pediatric patients Drug effects are less predictable Require dosage adjustments and careful measurements of doses Learning Outcome: Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. Pediatric, pregnant, breastfeeding, and geriatric patients require special considerations when administering medications. When giving a drug to these patients, you must adjust patient care and technique as needed. Geriatric patients will be addressed in the chapter Assisting in Geriatrics Pediatric Patients Drug effects less predictable because drugs are absorbed, distributed, metabolized, and excreted differently in children than in adults Observe a pediatric patient closely for adverse effects and interactions. A child’s small size increases the risk of overdose and toxicity. Always check your calculations for providing a prescribed dose, and then ask a licensed practitioner to double-check them.

Special Considerations (cont.)
Pediatric patients Observe pediatric patients closely for adverse effects and interactions Administration sites and techniques differ Patient education ~ parents vs. child Learning Outcome: Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. Pediatric Patients Administration sites and techniques for a child may differ from those for an adult. For infants, teach the parents about a drug. Include parents and older children in the teaching sessions Patience and sensitivity are important when working with pediatric patients.

Pediatric patients Oral medications ~ use calibrated dropper or spoon Injections Sites Restraining methods Learning Outcome: Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. Oral Medications Administer the medication to the side of the tongue. Hold the child until you are sure the medication is swallowed. See text for other guidelines. Injections Pediatric Injection Sites The vastus lateralis site –for infants and children because it is not near major nerves and blood vessels. Ventrogluteal or dorsogluteal site – for a child who has been walking for about a year. Needle gauge and length varies based on the size of the patient usually a 25-gauge, 5/8-inch needle is used for vaccines. Restraining Methods. Have the child “hug the mother.” Weight-bearing restraining is better than muscular control. Have the child sit on the edge of the examining table and use your weight to immobilize the child’s legs against the table.

Pregnant patients – check drug references for safety during pregnancy Patients who are breast-feeding Check drug references for safety during lactation May need to supplement with formula Learning Outcome: Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. Pregnant Patients Caring for two patients at once: the mother and her fetus. It is extremely important to double-check the drug in a credible drug reference for toxicology or pregnancy warnings. Patients Who Are Breast-Feeding Some drugs are excreted in breast milk . Ingestion by the infant can be dangerous as they may not be able to metabolize and excrete drugs that are safe for the mother. Teach the mother to recognize signs of adverse drug effects in her infant. She may need to supplement breast-feedings with infant formula.

Fantastic! Apply Your Knowledge
Why are drug effects less predictable in children? ANSWER: Drugs are absorbed, distributed, metabolized, and excreted differently in children than adults. Learning Outcome: Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. Fantastic!

Patient Education about Medications
Over-the-counter drugs May not produce therapeutic effect May be dangerous in combination with other substances May mask or aggravate symptoms May have more than one active ingredient Learning Outcome: Outline patient education information related to medications. Medical assistant Role in patient instruction about medications. This role may vary depending upon your state, training, or place of employment, Patients should also know how to take and record their medications safely and correctly. Over-the-Counter Drugs – patients should not treat themselves with OTC drugs as a way to avoid medical care.

Patient Education about Medications (cont.)
Prescription drugs When and how to take the medication Drug safety precautions How to read a prescription label Special instruction Warnings Learning Outcome: Outline patient education information related to medications. Before patients begin drug therapy, they should be informed when and how to take the drug and drug safety precautions. Provide instructions orally and in writing. Teach the patient how to read a prescription drug label and to be particularly alert for special instructions and warning labels.

Drug-drug interactions Types Effects may be increased Effects may be decreased One drug may be increased by another Lead to adverse reactions Check patient drug use Patient education Learning Outcome: Outline patient education information related to medications. Interactions may occur between two prescription or nonprescription drugs or between a drug and food and may cause serious effects. The greater the number of drugs the patient takes, including over-the-counter medications or supplements, the greater the chance of a drug interaction. Drug-Drug Interactions The effects of both drugs may be increased, causing either a toxic or beneficial effect. The effects of both drugs may decreased, or one drug cancels out the effect of the other. The effect of one of the drugs may be increased by the other. Interactions can lead to adverse reactions. To help prevent unintentional drug interactions, check the patient’s medication use. Prescribed ,drugs OTC drugs and supplements Past and present use of alcohol and recreational drugs as well as herbal remedies. Also teach patients about possible drug interactions and how to avoid or minimize them.

Food-drug interactions Alter the therapeutic effect Interfere with body’s use of nutrients Patient education Be specific about foods to avoid and when Explain what to expect if interaction occurs Describe what to do Learning Outcome: Outline patient education information related to medications.

Adverse effects May be mild to life-threatening Elderly or patient with kidney and liver disease ~ more susceptible Patient education Take as instructed Recognition of significant adverse effects Report to physician Learning Outcome: Outline patient education information related to medications. Adverse Effects Adverse effects or reactions associated with a drug and reported are somewhat predictable. Unpredictable adverse effects can also occur; they are unique to each patient. When drugs are not metabolized properly or excreted from the body quickly enough, drugs can reach toxic levels, even with normal doses – elderly or patients with liver or kidney disease. Patient education Take the drug at the right time, in the right amount, and under the right circumstances. To recognize significant adverse effects and to call the office if any of them occur. To report any change in overall health.

Complete medication list Prescription and OTC drugs Supplements and herbals Past and present use of recreational drugs and alcohol Patient education Tell all of their doctors about their medications Keep an up-to-date list with dosages Learning Outcome: Outline patient education information related to medications. This information can help patients and healthcare professionals prevent and monitor for drug interactions.

Patient compliance – patient education How and when to take each drug How long to take each drug How to identify possible adverse effects Learning Outcome: Outline patient education information related to medications. Confirm that the patient completely understand the name, dosage, and purpose of each drug prescribed. Explain how and when to take each drug to ensure its safety and effectiveness. Explain how to identify possible adverse effects of each drug and safety measures related to adverse effects.

Patient compliance – patient education What to do with old medication How to store drugs When to call the doctor Learning Outcome: Outline patient education information related to medications. Tell patients not to save medications that are over one year old or share them with anyone else. Suggest that patients avoid alcohol when taking certain drugs. Tell patients to ask their pharmacists where to store each medication. Tell patients to take their drugs in a well-lit area so they can read each drug label carefully before taking each dose. Instruct patients to call the doctor if they have any questions about their drug therapy.

Bravo! Apply Your Knowledge
What should you instruct the patient about regarding drug administration? ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly. Learning Outcome: Outline patient education information related to medications. Bravo!

Charting Medications Entries – accurate
Be consistent with charting methods used Tips Have the right chart, document in right place Chart directly from physician’s order Be specific Do not leave gaps or skip lines Learning Outcome: Implement accurate and complete documentation of medications. Whenever a patient receives some form of treatment, such as medication, a record is kept of that treatment. Most charting in the physician’s office is documented on a progress note or a medication administration record (MAR). The medical record is considered a legal document and is taken as proof that medication or treatment was administered to the patient. All chart entries must be factual, accurate, complete, current, organized, and confidential.

Charting Medications (cont.)
Tips (cont.) Correct errors in proper manner Do not use ditto marks Write neatly; enter carefully in EHR Use approved abbreviations and symbols If unsure, ask supervisor Learning Outcome: Implement accurate and complete documentation of medications. .

IMPRESSIVE! Apply Your Knowledge
When charting that you gave the patient a subcutaneous injection, you wrote intravenously by mistake. What should you do? ANSWER: If you make an error, do not erase it. Draw a line through intravenously. The mistake should still be visible, so do not black it out. Initial it and then chart “subcut”. Learning Outcome: Implement accurate and complete documentation of medications. IMPRESSIVE!

In Summary 53.1 Before administering a medication, you should check the patient for allergies and also evaluate any drug-drug interactions. You should check all injection sites for abnormalities. Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary. 53.2 The rights of drug administration include the right patient, right drug, right dose, right route, right time, right documentation, right reason, right to know, right to refuse, and right technique. 53.1 Before administering a medication, you should check the patient for allergies and also evaluate any drug-drug interactions. You should check all injection sites for abnormalities such as scars, bruises, burns, rash, edema, moles, birthmarks, traumatic injuries, redness, cyanosis, tattoos, warts, side of a mastectomy, and paralyzed areas. Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary.

In Summary (cont.) 53.3 Drugs may be administered for either local or systemic effects. Table 53-2 outlines the many drug administration routes. 53.4 Oral medications typically are swallowed and absorbed through the digestive tract. Sublingual medications go under the tongue, and buccal medications go between the cheek and gum. 53.5 The three most common injection routes are ID, subcut, and IM. IV is less frequently used in a medical office. All injections are given using aseptic technique. 53.3 Drugs may be administered for either local or systemic effects. Generally, drugs that have local effects are applied directly to the skin, tissues, or mucous membranes. Drugs that produce systemic effects are administered by routes that allow the drug to be absorbed and distributed in the bloodstream throughout the body. 53.5 The three most common injection routes are ID, subcut, and IM. IV is less frequently used in a medical office. All injections are given using aseptic technique. Intradermal (ID) injections are administered between the upper layers of skin and create a wheal. Subcutaneous (subcut) injections are administered just under the skin, and intramuscular (IM) injections are administered into a muscle.

In Summary (cont.) 53.6 Other medication routes include inhalants (respiratory), topical (including transdermal), urethral, vaginal, and rectal. 53.7 Certain special considerations must be made when caring for pediatric, pregnant, and breastfeeding patients. Pediatric patients require extreme care when calculating doses. Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential. 53.7 Certain special considerations must be made when caring for pediatric, pregnant, and breastfeeding patients. Pediatric patients require extreme care when calculating doses due to the differences in how their bodies absorb, metabolize, eliminate, and distribute the medications. Treat pediatric patients with special care and communication to make the experience as positive as possible. Restraining may be necessary. Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential.

In Summary (cont.) 53.8 Patients should be educated about why, when, and how they should take medications. This includes instruction to ensure patient compliance. Patients should also be instructed about the dangers of medication combinations, the importance of reporting an adverse effect, and maintaining a complete medication list. 53.9 Documentation of medication administered should occur immediately after the given and should include the name, date, time, medication administered, dose, route, location, lot #, and how the patient tolerated it. 53.8 Patients should be educated about why, when, and how they should take medications. This includes instruction to ensure patient compliance regarding nonprescription and prescription drugs as well as herbal remedies and supplements. Patients should also be instructed about the dangers of medication combinations, the importance of reporting an adverse effect, and maintaining a complete medication list.

Words are the most powerful drug used by mankind.
End of Chapter 53 Words are the most powerful drug used by mankind. ~Rudyard Kipling

Medication Administration

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