Medication Administration (Adults) Presented by: Educator Group Two

Topics Oral (PO)Administration Subcutaneous (SQ) Intravenous (IV)

Objectives At the end of the unit, students will be able to Outline the Principles of medication administration in general. Administration, and the documentation required for medications administered. Describe how to properly administer medications via PO, SQ and IV routes of administration.

Nursing Assessments SAFETY is Key! It is the nurse’s responsibility Check the order – scheduled or PRN, route of administration and dose ? Assess for patient’s medication allergy When was the medication given last if PRN and patient’s response? If PO, can the patient swallow the medication? If IV , does the patient has a working IV access?

Principles Be Knowledgeable about the medication: Know the name of medication Drug action Drug interactions Dosing and dosages Route and rate of administration Side effects Adverse effects to report Contraindications Accurate calculation, preparation, and administration of medications

National Patient Safety Goals for Medication Safety Improve the accuracy of patient identification at least two identifiers Improve effectiveness of communication among caregivers Record and read back complete orders and test results Standardize abbreviations, acronyms, symbols and dose designations Identify look alike/sound alike medications

National Patient Safety Goals Cont. Reconcile medications across the care continuum Avoid the use of unnecessary decimal points Write out the word “microgram” mistaken for milligram. Do not abbreviate microgram as “μg”. Always use a leading zero (0) for doses less than 1 mg. Example: 0.1 mg vs .1mg

Five RIGHTS OF MEDICATION ADMINISTRATION (+2) Right Patient Right medication Right dose Right time Right route Additional “rights” Right documentation Right reason/rational

BEFORE ADMINISTERING ANY Medication: Wash hands!!! Assess patient for medication administration Identify patient using two identifiers per hospital policy Check or Scan armband and compare with identifiers Facility policy determines two identifiers to be used: (name / birth date or last 4 social security numbers) Ask patient to verbalize name or required identifiers Patient teaching

Oral medication Administration Forms solids enteric coated Liquids PILL

Oral Medication cont. Oral or nasogastric tube It is safe, convenient, and more economical. Has slower rate of onset of action Not used if patient: Is vomiting At risk for aspiration Unconscious Can not swallow

Oral Medication Cont. Review medication orders check for drug allergies. Wash hands. Identify patient per hospital policy. Assess patient for alertness and ability to swallow. Place patient in sitting or fowler position.

Oral Medication Cont. Remove unit-dose from packaging at bedside, place in a medication cup. Give patient medication cup and a glass of water for swallowing (may offer other liquids -milk or juice if not contraindicated). Remain with patient until medications are all swallowed. DO NOT LEAVE MEDICATIONS AT BEDSIDE!!!!!!!!

Oral medication cont. Sublingual: Do all the above checks Place sublingual tablet under tongue Instruct patient not to chew or swallow tablet.

Oral Medication Cont. http://www.youtube.com/watch?v=xofnnPS2KyY&feature=related

Intravenous Injection (IV) Has rapid onset of action Injections require skill and special care to prevent infection and adverse reactions Review medication orders, and check for drug allergies. Verify compatibility of drug to be admixed with primary IV solution. Wash hands and wipe injection port on IV bag with alcohol swab,

Intravenous Injection (IV) Inject medication through the port. Gently rotate IV bag to mix solution. Inspect solution for any precipitate ( discard if precipitate ) Visibly Label- date, time, medication, and dosage of additive . Prime IV tubing, removing air Administer as ordered

Administering IV Bolus Review medication orders and drug allergies. Verify compatibility with primary solution. Wash hands. Identify patient by Hospital policy Assess IV site and for patency. Clean Y-site injection port (closest port to infusion site) with alcohol swab Pinch off IV tubing above Y-site injection port. Insert needle into port, and inject medication over specified time interval.

IV Bolus or Push Technique

Injection through IV Heplock Assess IV site and for patency. Cleanse injection port with alcohol swab. Flush with normal saline to assess patency. Insert needle into port, and inject medication over specified time interval. Flush with normal saline or Heparin flush per hospital policy).

IV medication http://www.youtube.com/watch?v=PFGn3GMTO0M

IV medication http://www.youtube.com/watch?v=qoG9aasJzcQ

Subcutaneous (SQ) Review medication orders, and check for drug allergies. Wash hands, and put on gloves. Identify patient per policy. Use 1 - 3 cc syringe and 23 - 25 gauge, 1/2 - 5/8 inch needle. Maximum amount of fluid to administer SQ is 1 cc.

Subcutaneous (SQ) Cont. Sites: abdomen, lateral and anterior aspects of upper arm or thigh, scapular area of back, or upper ventrodorsal gluteal area. Wipe with alcohol in a circular motion to cleanse. Allow to dry. Pinch skin between finger and thumb , spread skin if obese Insert needle at 45° or 90° angle : 90° if obese; 45° if average weight, if patient is very thin, pinch skin and administer at 90° angle. Inject medication slowly, remove needle quickly, and gently massage site with alcohol swab. (No massage after heparin)

SQ Injection

Subcutaneous medication http://www.youtube.com/watch?v=xwA4wqQ7eF0

Mixing Insulin http://www.youtube.com/watch?v=WIYcAy6P-hE&feature=channel_page

Required Documentations THE RIGHT DOCUMENTATION MUST INCLUDE: Medication name Dosage Route Time Nurse signature Site of injection Other information Omitted drugs Reason Notify MD Refused drugs

References Food & Drug Administration. (2009). Medication Errors. Retrieved 7/8/09 from http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm. Institute of medicine. (2006). Preventing Medication Errors. Retrieved 7/8/09 from http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf. Wilson, B.A., Shannon, M., & Stang, C. (2003). Drug Guide 2003. Retrieved 7/18/09 from http://wps.prenhall.com/chet_wilson_drugguides_1/0,5513,403558-,00.html. Wilson, B.A., Shannon, M., & Stang, C. (2003). Medication Administration Techniques. Retrieved 7/18/09 from http://wps.prenhall.com/chet_wilson_drugguides_1/0,5513,403558-,00.html.