Administration of Medications Unit 2

Abbreviations & Symbols Approved list per facility See Calculate text pgs. 149 & 150 for standard approved abbreviations See Calculate text pg. 151 for “DO NOT USE” abbreviations Pgs. 156 & 157

Medication Order Components Patient’s full name Date & time of order Drug name Dose Route Frequency Prescriber signature Special instructions if necessary Physician ID number & DEA number if controlled substance

Medication Orders Written / Electronic Verbal Telephone Methods of receiving orders: Written / Electronic Verbal Telephone

Types of Medication Orders One time order – specific treatment; not repeated PRN order – administer per pt request/need; requires nursing judgment Routine orders – given to patient regularly Self-terminating order – includes a specific time frame or number of doses to be administered Standing order – provides standard protocol for possible or commonly occurring events in patient care Stat order – one-time order administered immediately

Verbal & Telephone Orders LPN’s can take orders; follow policy of institution 3 Steps: 1. Write order exactly as heard 2. Read order back 3. Confirmation Document all appropriate information Nurse signature… physician cosign within 24 hrs.

Written & read in following order: Interpret a Med order Written & read in following order: Name of medication Dose Route Frequency ***BE Systematic***

Transcription Steps After med order verified, order is written/typed onto a medication administration record (MAR) MAR sheets should contain patient's information - name, DOB, medical record number, room number, allergies Dates (when written, when to start, when to stop, etc) Medication information Administration times Initials of person transcribing order Special directions When transcribed, follow policy of institution of noting orders

Drug Distribution Systems Unit-dose system Provides a single dose Computer-controlled dispensing system Automated dispensing cabinets Bar coded medications

Read Medication Labels Generic name Trade name Strength of med Form Route Total volume Total amount in container Any directions Precautions Expiration date Additional info Controlled med labeling Combination meds

6 BASIC Rights Set of Safety Checks RIGHT MEDICATION RIGHT TIME RIGHT DOSE RIGHT PATIENT RIGHT ROUTE RIGHT DOCUMENTATION

ADDITIONAL SAFETY RIGHTS Right Indication Right to KNOW Right to Refuse Right Response

Medication Verification Minimum 3 time check When obtaining medication from drawer When opening package or pouring medication When returning medication to cabinet or before discarding wrapper

Medication Errors Patient safety evaluation IMMEDIATELY Physician notification Nursing Supervisor notification Documentation

Routes of Administration 3 general ways medications enter body Enteral (GI tract) Percutaneous (skin / mucous membranes) Parenteral (other than PO or GI tract)

Administration Routes Oral Tubal Rectal Topical Instillation Sublingual Buccal Inhalation Intranasal Parenteral

Medication Forms Tablet = Enteric coated = Capsule = Lozenge = Suspension = Emulsion = Elixir = Syrup =

Medication Forms Suppository = Enema = Transdermal = Ointment = Lotion = Inhalers = Metered-dose inhalers = Eye, ear, nose drops =

Equipment Medicine cup Soufflé cup Calibrated dropper Oral syringes 30 mL or 1 oz measurements; when < 5mL need another device for accuracy Soufflé cup Smaller paper or plastic cup Calibrated dropper Drop size varies so usually marked in mL Oral syringes Markings in mL & tsp Gloves, lubricant, spacers

Medication Administration Guidelines Oral tablets & capsules Oral for liquid med Tubal Rectal suppositories Topical Eye drops & ointments Ear drops Nose drops Nasal sprays Sublingual & buccal Inhalant

Pediatric Considerations Oral Do not use med cup, use nipple or dropper Elevate head, give few drops at a time DO NOT lay on back Never hold their nose to force swallowing Dilute tablets if allowed but not with too much liquid Do mouth checks Use a syringe to measure small amounts

Pediatric Considerations Nose drops Have help available Suction before inserting drops if nose is congested Lie child down with head tilted back Ear drops Warm drops to room temperature Under the age of 3, pull ears down & back Eye drops Put drops in lower conjunctival sac

Other Special Considerations Never allow med cart or tray out of sight Never returned unwrapped or prepared med to cart Check med. record if pt. questions you about his meds Give liquid form of med if pt. unable to swallow whole tablet or capsule or if med can be crushed; need physician order for change of route

Calculate Medication Dosages Best to convert to same unit / system that medication is available in When measuring oral liquids, do not confuse dose strength with total volume Avoid using slash mark for “per; write it out → 40 mg per 2 mL When pouring liquids, have label away from the liquid