1. Medication/ Medication Administration Part 3

2. Learning Outcomes 1. Discuss the basic guidelines to prevent medication errors regarding drug administration. 2. Describe how to assess the patient before administering any drug. 3. Perform dosage calculations accurately. 4.Describe the medication documentation. 5.Explain what information you need to teach the patient about drug use, interactions, and adverse effects.

3. Basic Guidelines to Prevent Medication Errors 1- Assess the patient's Medication history (history for allergies, drug-drug or drug-food interactions, and drug contraindications, and notify the physician if any exists - and patient ability to take med in the form provided. - Assessment for allergic reaction.

4. Mild allergic reactions Skin rash: Small, raised vesicles that are usually reddened; often distributed over entire body. Pruritus: itching of the skin with or without rash. Angioedema: edema due to increased the permeability of the blood capillaries. Rhinitis: Inflammation of mucous membranes lining nose; causes swelling and clear, watery discharge.

5. Assessment For Reactions Assessment needs vary and depend on route and medication. Always assess pt after giving drugs that affect RR, HR, BP, LOC, blood sugar and pain. These approximate time table will help guide you in your assessment. Approximate Onset 3 – 5 minIV 3 – 20 minIM 3 – 20 minSC 30 – 45 minPO

6. intravenous 30-60 seconds intraosseous 30-60 seconds endotracheal 2-3 minute inhalation 2-3 minutes sublingual 3-5 minutes intramuscular 10-20 minutes subcutaneous 15-30 minutes rectal 5-30 minutes ingestion 30-90 minutes transdermal (topical) variable (minutes to hours) Route for administration -Time until effect-

7. Con.. 3-Patients must be correctly identified by using 2 identifiers; complete name and file number checked against the ID band. Do not identify patient using room or bed number. 4- Only administer medications you have personally prepared. 2- Follow Infection Control Policy during the entire process of Medication Administration.

8. Con.. 5- Do not administer medications from containers that are unmarked or illegible. Do not give medications that have changed color, appearance, or from which the container is broken or crusted. 6- Always adhere to the 5 rights. 7- Measure liquid medication at eye level. 8- Always check medication expiration dates.

10. Con… 9- Tablets and capsules should be maintained in their wrappers and opened at the bedside immediately prior to use. 10-With each drug, inform the patient of the drugs name, purpose, action, and potential side effects

11. Con… 11- Any order that is incomplete, illegible, or of any concern should be clarified prior to administration. 12- In situations such as: Not given- Not tolerated- Refused- Notify the physician and justify the reason in the Interdisciplinary Progress Notes. 13- Do not leave medications unattended

12. Con… 14- Triple Checking Read the label 3 times, checking against the medication administration record: 1- when the nurse reaches for the container. 2- immediately before pouring or opening the medication. 3- when replacing the container to the drawer or shelf or before giving the medication dose to the patient. 15- Minimize interruptions while processing and preparing medications.

13. Dosage Calculations Measurement systems – Metric – Apothecaries – Household Most doctors use the metric system

14. Dosage Calculations (cont.) Basic units of volume and weight Metric system – Liter (L) – volume – Grams (g) – weight Apothecaries’ system – Fluidounces, fluidram, pints, quarts – volume – Pounds – weight Household system – Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume

15. Dosage calculations Desired dose (D) Known dose on hand (H) x Quantity of dose on hand (Q) = Desired quantity (X) D X Q = X H Home

16. Calculations based on weight Desired dose (D) x Weight in kg (W) Known dose on hand (H) X Quantity of dose on hand (Q) = Desired quantity (X) D x W x Q = X H Home

17. Example You are to give 0.5 mg/kg IV push. Your patient weighs 80 kg. The drug comes packaged: 100mg/10cc. How many mg will you give? How many cc’s will you deliver? Your equation to determine mg will look like this: – 0.5 mg/kg x 80 kg = 40 mg to be given Your equation to determine cc will look like this: – 40 mg x 10 cc = 4cc 100 mg Home

18. 18 Calculating Dosages Practice the following: Dose on hand = 250mg Quantity on hand: 1 tablet = 250mg Desired dose (dose ordered) = 500mg ?? = # of tablets required And the answer is….

19. 19 Calculating Dosages (continued) 250 = 500 (cross multiply and divide) 1 x 500/250 = 2 The answer is 2 tablets

20. 20 Calculating Dosages (continued) Practice the following (requires conversion): Dose on hand = 250mg Quantity on hand: 1 capsule = 250mg Desired dose (dose ordered) = 0.5gm ?? = # of tablets required And the answer is….

21. 21 Calculating Dosages (continued) Convert 0.5gm to mg. 1 gm = 1000mg so 0.5 gm = 500mg 250 = 500 (cross multiply and divide) 1 x 500/250 = 2 The answer is 2 tablets

22. 22 Calculating Dosages (continued) Practice the following (units): Dose on hand = 10,000 units Quantity on hand: 10,000 units per 1 ml Desired dose (dose ordered) = 5000 units ?? = # of ml required And the answer is….

23. 23 Calculating Dosages (continued) 5,000 units = x (cross multiply and divide) 10,000 units = 1 5000/10,000 = ½ or 0.5 The answer is 0.5 ml

24. 24 Calculating Dosages (continued) Practice the following (dose based on weight): Medication order: Lovenox 1mg/kg BID Dose/quantity on hand = 80mg/ml Patient’s weight = 154 pounds ?? = # of ml required And the answer is….

25. 25 Calculating Dosages (continued) Convert pounds to kilograms (2.2 lbs = 1 kg) 154/2.2 = 70kg 1mg x 70kg = 70mg Cross multiply and divide: 80mg = 70mg  70/80 = 0.8 1ml = x The answer is 0.8 ml

26. Drip calculations volume (ml) x drop factor (gtt/ml) = gtt/min time (in minutes) - Verify drop factor (number of drops in 1 ml) of equipment in use. - Example: Administer 1000 ml D5W over 10 hours, gtt/ml = 60. calculate the gtt/min. = 100gtt/min Home

27. 27 Medication Documentation First, make sure you have the right chart! Never chart a drug before it is administered. Documenting includes name of drug, dosage, route, and time. Record location when giving parenteral medications. Follow agency policy if a medication was not given. Document client’s response to the medication.

28. Educating the Patient About Drug Administration How to read the prescription drug label Interactions – Drug-drug interactions – Drug-food interactions

29. Adverse effects – Report changes – Recognize significant adverse effects Instructions on taking the drug – At the right time – In the right amount Educating the Patient About Drug Administration (cont.)