1. Copyright © 2015 Cengage Learning® Chapter 7 Safe Medication Administration

2. Copyright © 2015 Cengage Learning® Medication Administration Record (MAR) Although some differences exist among health-care facilities, most MARs are fairly similar. 7-2

3. Copyright © 2015 Cengage Learning® MAR Similarities Large column usually on left-hand side of MAR form contains: –Drug names Both scheduled and as needed (prn) –Drug dosage –Frequency of drug administration (continues) 7-3

4. Copyright © 2015 Cengage Learning® MAR Similarities (cont’d) Usually three columns designated for documenting medication administration for day, evening, and night shifts (continues) 7-4

5. Copyright © 2015 Cengage Learning® MAR Similarities (cont’d) Space for precautions related to administration, such as checking: –Pulse –Blood pressure –Body weight (continues) 7-5

6. Copyright © 2015 Cengage Learning® MAR Similarities (cont’d) Column included for initials of person transcribing medication from order sheet to MAR. May include “start” and “stop” columns. –Indicate what day and time medication is to be started and stopped. (continues) 7-6

7. Copyright © 2015 Cengage Learning® MAR Similarities (cont’d) Area where all staff initials identified with full name and title May be one sheet (front and back) or two sheets to separate scheduled and prn medications 7-7

8. Copyright © 2015 Cengage Learning® Six Rights of Medication Administration Right drug Right dosage Right route Right time Right person Right documentation 7-8

9. Copyright © 2015 Cengage Learning® Right Drug Check every drug three times: –When drug is located –Just before opening or pouring medication –Immediately prior to administration 7-9

10. Copyright © 2015 Cengage Learning® Right Dosage Compare to average dosages. Metric dosages containing decimals are of particular concern. – Ask yourself if the dosage makes sense. 7-10

11. Copyright © 2015 Cengage Learning® Right Route Oral Sublingual –Under tongue Drops –For eye, ear, and nose Topical (continues) 7-11

12. Copyright © 2015 Cengage Learning® Right Route (cont’d) Transdermal Inhalation Creams Suppositories (continues) 7-12

13. Copyright © 2015 Cengage Learning® Right Route (cont’d) Parenteral routes –IV Most common –Intramuscular (IM) –Subcutaneous –Intradermal 7-13

14. Copyright © 2015 Cengage Learning® Right Time Standard time. 12:00 am for midnight to 11:59 pm for one minute before midnight. Times are duplicated during 24-hour period. –Only am and pm differentiate. (continues) 7-14

15. Copyright © 2015 Cengage Learning® Right Time (cont’d) Military time 0001 for one minute after midnight to 2359 for one minute before midnight (continues) 7-15

16. Copyright © 2015 Cengage Learning® Right Time (cont’d) After one o’clock in the afternoon, 12 hours added to each time until midnight –For example, 1300 = 1:00 pm, 1700 = 5:00 pm, 2200 = 10:00 pm 7-16

17. Copyright © 2015 Cengage Learning® Right Person Most important nursing intervention. Check ID band, and read both surname and first name and birthdate. Do this every time medication given. –No exceptions 7-17

18. Copyright © 2015 Cengage Learning® Right Documentation When medication is administered, must be documented immediately. Never record before administered medication. 7-18

19. Copyright © 2015 Cengage Learning® Right of Refusal Partner with client. If client questions medication, consider client correct until proven otherwise. Client also has right to refuse medication. 7-19

20. Copyright © 2015 Cengage Learning® Medication Errors Estimated 100,000 people die each year from medication errors. Occur during: –Prescribing –Transcribing –Administering 7-20

21. Copyright © 2015 Cengage Learning® Joint Commission’s “Do Not Use” List U –Write “unit” IU –Write “International Unit” QD, Q.D., q.d., or qd –Write “daily” (continues) 7-21

22. Copyright © 2015 Cengage Learning® Joint Commission’s “Do Not Use” List (cont’d) QOD, Q.O.D., q.o.d., or qod –Write “every other day” MS –Write “morphine sulfate” MSO4 or MgSO4 –Write “magnesium sulfate” (continues) 7-22

23. Copyright © 2015 Cengage Learning® Joint Commission’s “Do Not Use” List (cont’d) Omit trailing zero –For example, write X.0 mg as X mg Use zero before decimal number –For example, write.X mg as 0.X mg 7-23

24. Copyright © 2015 Cengage Learning® Actions When Medication Errors Occur Report as soon as discovered. Institute necessary remedial measures immediately. Determine reason for error. Prepare incident/accident report. Institute corrective policies/procedures to prevent recurrence, if possible. 7-24

25. Copyright © 2015 Cengage Learning® Medication Errors The major factors in nursing medication administration errors are distraction and Fatigue. Personnel are held legally responsible if wrong drug or dosage given regardless of source of error. 7-25