1. Introduction to Clinical Pharmacology Chapter 2
Administration of Drugs

2. The Five + 1 Rights of Drug Administration
Right patient: check patient’s wristband; ask patient to identify him- or herself
Right drug: compare medication; container label; medication record
Right dose
Right route : obtain written order
Right time
Right documentation: record immediately

3. Considerations in Drug Administrations
General principles of drug administration
Factual knowledge of each drug given: Reasons for use; general action; common adverse reactions; special precautions in administration; normal dose ranges
Check current and approved references for all drug information
Consider before administering a drug: Patient’s allergy history; previous adverse reactions; patient comments; change in patient condition

4. Considerations in Drug Administrations (cont.)
The medication order: to administer medication, a physician’s order is essential
Common orders: standing; single; PRN; STAT
Box 2.1 page21
Once-a-week drug: doses designed to replace daily doses of drugs; beneficial for those experiencing mild adverse reactions
Example: Alendronate (Fosamax)—treat osteoporosis

5. Considerations in Drug Administrations (cont.)
Guidelines for preparing a drug for administration
Check health care provider’s written orders and compare label of the drug with MAR
Wash hands and do not let hands touch capsules or tablets

6. Considerations in Drug Administrations (cont.)
Guidelines for preparing a drug for administration (cont.)
Never remove a drug from an unlabeled container or a package with an illegible label
Never crush tablets or open capsules or administer a drug prepared by someone else
Alert: drugs with similar names

7. Considerations in Drug Administrations (cont.)
Guidelines for preparing a drug for administration (cont.)
Return drugs requiring special storage to the storage area immediately after they are prepared for administration
Unit dose: remove wrappings when the drug reaches the patient; chart immediately after administering the drug

8. Considerations in Drug Administrations (cont.)
Each time a drug is prepared and administered: follow the five + 1 rights
Precautions taken by the nurse: confirm any questionable orders; verify calculations with another nurse; listen to the patient; concentrate on only one task at a time
Most common occurrence of errors: insulin and heparin

9. Considerations in Drug Administrations (cont.)
Drug errors: patient receives:
The wrong dose
The wrong drug
An incorrect dosage of the drug
A drug by the wrong route
A drug given at the incorrect time
Nurses: last defense against detecting drug errors; if error occurs, report immediately

10. Considerations in Drug Administrations (cont.)
National Patient Safety Goals
- Accrediting body for hospitals: Joint Commission
- Approve National Patient Safety Goals yearly
Institute for Safe Medication Practices
- Medication Errors Reporting Program
See tables 2.1 and 2.2 page 23

11. Considerations in Drug Administrations (cont.)
Drug dispensing system
Computerized dispensing system
Unit dose system
Bar-code scanner

12. Administration of Drugs by Oral Route
Most frequent route of drug administration
Oral drug forms: tablets; capsules; liquids
Sustained-release drugs
Nursing responsibilities: verify the drug; identify the patient; assess need for assistance; keep water readily available; instruct; never leave a drug at the patient’s bedside to be taken later
Buccal – drug place against mucous membrane between cheek and jaw
Sublingual-drugs placed under the tongue

13. Administration of Drugs by Parenteral Route
Parenteral drug administration routes: subcutaneous (SC); intramuscular (IM); intravenous (IV); intradermal route; intradural; intra-arterial; intracardiac; intra-articular
Nursing responsibilities: wear gloves; use standard precautions; cleanse skin

14. Administration of Drugs by Parenteral Route (cont.)
Administration of drugs by subcutaneous route: places the drug into the tissues between the skin and the muscle
Nursing responsibilities:
Volume of injection: single/multiple sites
Subcutaneous injection sites: upper arms; upper abdomen; upper back
Needle length and angle of insertion: obese/thin patients

16. Needle insertion for parenteral drug. A
Needle insertion for parenteral drug. A. Intradermal injection: a 26-gauge, 3/8-in-long needle is inserted at a 10-degree angle. B. Subcutaneous injection: a 25-gauge, 1/2-in-long needle is inserted at an angle (45 to 90 degrees) that depends on the size of the patient. C. Intramuscular injection: a 20- to 23-gauge, 1- to 3-in-long needle is inserted into the relaxed muscle at a 90-degree angle with a quick (dart-throwing) type of hand movement. D. Intravenous injection: the diameter (18 to 26 gauge) of the needle used depends on the substance to be injected and on the size of the vein.

17. Administration of Drugs by Parenteral Route (cont.)
Administration of drugs by intramuscular route: administration into a muscle
Nursing responsibilities: 22-gauge needle
Volume of injection: single/multiple sites
Injection sites, needle length, and angle of insertion: deltoid muscle; ventrogluteal or dorsogluteal sites; vastus lateralis
Z-track technique: prevents backflow of drug into the subcutaneous tissue

18. sites for intramuscular administration. A
sites for intramuscular administration. A. Ventrogluteal site: your palm is placed on the greater trochanter and the index finger is placed on the anterior superior iliac spine; the injection is made into the middle of the triangle formed by your fingers and the iliac crest. B. Vastus lateralis site: the patient is supine or sitting. C. Deltoid site: the mid-deltoid area is located by forming a rectangle, the top of which is at the level of the lower edge of the acromion, and the bottom of which is at the level of the axilla; the sides are one third and two thirds of the way around the outer aspect of the patient’s arm. D. Dorsogluteal site: to avoid the sciatic nerve and accompanying blood vessels, choose an injection site above and lateral to a line drawn from the greater trochanter to the posterior superior iliac spine.

20. Administration of Drugs by Parenteral Route (cont.)
Drug administration—intravenous route: directly into blood; needle inserted into a vein
Methods of administration: slow; rapid; piggyback infusions; existing IV line; using intermittent venous access device; added to an IV solution; venipuncture
Intravenous infusion controllers, pumps: detectors, alarms alert the nurse
Possible problems: air in line; occlusion; low battery; completion of infusion; inability to deliver preset rate

21. Administration of Drugs by Parenteral Route (cont.)
Administration of drugs by intravenous route (cont.)
Nursing responsibilities:
Record type of IV fluid and drug added to the IV solution after start of infusion; check infusion rate and inspect needle site
Swelling around the needle: extravasation or infiltration

23. extravasation
infiltration

24. Administration of Drugs by Parenteral Route (cont.)
Drug administration—intradermal route: sensitivity tests—tuberculin; skin allergy
Nursing responsibilities:
Injection sites: inner part of forearm; upper back; hairless; avoid areas near moles, scars, or pigmented skin
1-mL syringe; 25- to 27-gauge needle; 1⁄4 to 5⁄8 in
Needle insertion: 15-degree angle; do not aspirate syringe or massage the area

26. Administration of Drugs by Parenteral Route (cont.)
Other parenteral routes of drug administration: intracardial; intra-arterial; intra-articular
Nursing responsibilities:
Prepare drug for administration; ask primary health care provider
Venous access ports: for chemotherapy or long- term therapy

27. Administration of Drugs Through the Skin and Mucous Membranes
Application to the skin and mucous membranes
Several routes
Topical
Transdermal
Inhaled through the membranes of the upper respiratory tract

28. Administration of Drugs Through the Skin and Mucous Membranes (cont.)
Administration of drugs by the topical route
Act on the skin; not absorbed through the skin
Nursing responsibilities:
Follow special instructions: drug action may depend on correct administration of the drug

30. Administration of Drugs Through the Skin and Mucous Membranes (cont.)
Administration of drugs by the transdermal route
Readily absorbed from the skin
Drug dosages: implanted in a small patch-type bandage
Drug system maintains constant blood concentration; reduces the possibility of toxicity

31. Administration of Drugs Through the Skin and Mucous Membranes (cont.)
Administration of drugs by the transdermal route (cont.)
Nursing responsibilities:
Wear gloves; apply patch on clean, dry, nonhairy areas of intact skin; apply next dose to new site—remove old patch
Commonly used sites: chest, flank, and upper arm

33. Administration of Drugs Through the Skin and Mucous Membranes (cont.)
Administration of drugs through inhalation
Drug droplets, vapor, or gas: through mucous membranes of the respiratory tract
Use face mask, nebulizer, or positive-pressure breathing machine
Nursing responsibilities:
Provide proper instructions

35. Nursing Responsibilities After Drug Administration
Record administration of the drug; IV flow rate; site used for parenteral administration; problems with administration; vital signs taken immediately before administration
Evaluate and record patient’s response to the drug
Observe and record adverse reactions and frequency

36. Administration of Drugs in the Home
Home setting caregivers: patient or family members
Ensure patient or caregiver understands the treatment regimen
Home care checklist: for administering drugs safely in the home