2. 2012/2013 1 Administration of Medications

3. SLO’s 2 See outline for SLO’s

4. Overview 3 Legislation Medication administration Essential info you should know prior to administering a med Routes Side effects Nursing implications 8 Rights to med administration

5. Introduction 4 Increased level of responsibility Preparation is the key to success Knowledge re: Medication & how it works Knowledge re: How to administer meds Knowledge of your client – so that you are able to make responsible judgments

6. Introduction 5 Medication Drug Drug Misuse Substance Abuse

7. I. Legislation 6 Administration of medications controlled by law You are responsible for what you do or do not do Federal laws Controlled Substance Act State laws Including “Nurse Practice Acts”

8. California Nurse Practice Act 7 “ Direct and indirect patient care services, including, but not limited to, the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist,” as defined by Section 1316.5 of the Health and Safety Code

9. II. Administration of Medication 8 Client Rights Information Education Safety Right of refusal

10. III. Basic Nurses’ Knowledge 9 Generic, official, chemical, or brand names Classification

11. III. Basic Nurses’ Knowledge 10 Dosage Range Routes

12. 11 Oral/ NG Sublingual Buccal Parenteral (SQ, ID, IM, IV) Topical

13. Routes/ Topical 12 Skin Eyes Ears Nasal application Inhalation Instillations Rectum Vaginal

14. What preparations would you need to make prior to administering an oral mediacation ? 13

15. Perry, Potter & Elkin 14 Prepare client Prepare equipment 3 checks 8 rights

16. Topical / Skin 15 Patches & creams Intact skin Remove previous application Medication absorbed via skin – therefore you will need to wear gloves Medication – open areas Prepare area – cleanse if indicated Use applicator Use gloves

17. Routes Eyes Treat as sterile Have client look up Use sterile 2 by 2 to put pressure on the inner canthus after administration to prevent systemic effects Ointment from inner surface to outer surface 16

18. Routes/ Ears Adult Pull pinea upward and back Make sure bottle does not touch the side of the ear Have client lay on their side and maintain that position after drops instilled 17

19. Routes / Ears Child Pull pinea down and back 18

20. Routes / Inhalation 19

21. Topical Rectal and vaginal suppositories considered topical applications Be sure and remove wrappers 20

22. Routes 21 Parenteral – routes other then oral or topical Injections (skills lab in a couple of weeks )

23. Injections: 22 Injections and IV meds must be prepared using surgical aseptic technique Syringe size and needle length selection are based on type of medication, location of administration, and route (SQ vs. IM) Site selection includes identification of anatomical landmarks site conditions

24. III. Basic Nurses’ Knowledge 23 Desired actions and therapeutic effects How does this med work – physiological effects within the body

25. III. Factors Affecting Medication Action 24 Developmental factors Gender Cultural, Ethnic, Genetic factors Diet Environment Psychological Factors Illness and diseases Time of administration

26. 25

27. III. Basic Nurses’ Knowledge 26 Side effects How do they disrupt the body – at times the side effects are what we give the meds for Adverse reactions* Untoward effects*

28. III. Basic Nurses’ Knowledge 27 Interaction with other meds or with foods

29. What Are Some Common Allergic Responses ? 28

30. III. Basic Nurses’ Knowledge 29 Toxic and undesirable effects Drug allergy – anaphylactic reaction Drug tolerance Cumulative effect

31. III. Basic Nurses’ Knowledge 30 Nursing Implications What does administering this medication do for or to the patient. What assessments must you make prior to administering the med Or to watch for after administering the medication

32. IV. Application 31 Valid - medication order Client’s name Date Drug name Dosage Route MD signature

33. Time for a Stretch Break 32

34. V. Eight Rights 33 Right client -Check Id band Patient name Medical Id number Have client state name Right medication - Check 3 times Pick up Pour Put away

35. Check Three Times 34

36. V. Eight Rights 35 Right dose Correct math Appropriate preparation Time release medications Enteric coating – do not crush or break up Pre mix (Protonix + sodium bicarb) Interactions Do not combine medications absorbed in the stomach with antacids (acidic based meds)

37. Time Release Medication Enteric coated pills Do not crush Time release capsules – do not take with hot water or chew otherwise may result in overdose 36

38. V. Eight Rights (Dose) 37 Check MD’s order MAR Your text books 24 hour max dose Why is this med being given i.e. baby ASA prophylactic as anticoagulant vs. 600 mgm. for elevated headache

39. V. Eight Rights 38 Time Before or after meals On an empty stomach ? The MD’s order will indicate the number of times a day but may not specify before or after meals – you need to know that info

40. V. Eight Rights 39 Right Route IM SQ PO Sublingual etc

41. V. Eight Rights 40 Right to information Expectation that clients be informed re: what their medication is for Opportunity for teaching Be sure an include side effects Ex. This med may make you dizzy – please put on call light if you wish to get up

42. V. The Eight Rights 41 Right of refusal Documentation of refusal

43. 42 Approach (#9) - Physiological effects of a medication may be enhanced or diminished by how you present the medication - “This will help your pain” vs. Try this it might help. V. The Eight Rights

44. 43 Documentation MAR in timely fashion Time, Route if different If medication is refused If medication is held If medication not in cart

45. Documentation Pixis Contains Narcotics Commonly prescribed meds Maintains records – but you still need to document in the MAR 44

46. EMAR 45 Follow 8 Rights Client Med Time Dose Route Know Refuse Document http://www.hendricks.org/?id=374&sid=1#

47. It is time for meds and your client is off the unit for x-ray where would you document this? 46

48. Signing Out Narcotics 47 Students can not do this independently When discarding a partial or complete dose – must be witnessed by RN or LVN Will need to sign for it on a special form or in Pixis Narcotic count must be accurate before & end of shift Two RNs count, if not correct unusual occurrence report

49. VI. Medication Errors 48 Should a medication error occur, document it and report it. An unusual occurrence report may have to be made Safety review – check med 3 times, good communication with LVNs and RNs

50. Med Errors 49 Following 8 rights and adhering to the hospital polices and procedures is only the beginning You must use your judgment – with each medication you administer

51. Med Errors 50 Wrong client Wrong medication Wrong dose Wrong time Wrong route Wrong information Incorrect assessment or failure to obtain base lines Not taking into account interaction with other meds or with foods Math miscalculation

52. Double Check Meds (Be sure and check with the hospital) 51 Insulin Heparin KCL IV Lasix IV Chemo All math Must be double checked & cosigned - 2 licensed individuals

53. Final Comments 52 “A nurse that administers the written incorrect order(e.g. Demerol 500 mgm.) is responsible for the error as well as the physician.” (Kozier p. 787) Medication administration provides an opportunity to put pieces together Requires skills and knowledge re meds as well as delivery methods

54. References 53 Adams, M.P. & Urban, C. Q. (2013) Pharmacology: connections to practice (2 nd ed.) Boston: Pearson California Nurse Practice Act (downloaded 10/9/2007) Carpenito-Moyet, L., (2010) Handbook of nursing diagnosis (13ed.) Philadelphia: Lippincott.

55. References Continued 54 Perry, A. G., Potter, P.A., Elkin, M.K. (2012) Nursing interventions & clinical skills (5 th ed.).St Louis, MO: Elsevier Potter, P.A., Perry, A. G. (2009) Fundamentals of nursing (7 th ed. ). St. Louis, MO: Mosby.