Chapter 10 Administration Procedures

Three Checks and Six Rights Three Checks When Preparing Medications Read the label: 1. Check the drug label with the medication administration record (MAR) when removing the container or unit-dose package. 2. Check the drug label again immediately before pouring or opening the medication, or preparing the unit-dose. 3. Check the drug label once more when replacing the container and/or before giving the unit-dose to the patient/client.

Three Checks and Six Rights Six Rights Before Administering Medications 1. Right medication 2. Right patient/client 3. Right dosage 4. Right route 5. Right time 6. Right documentation

Medication Orders A correct medication order or prescription bears the patient/client’s name, room number, date, name of drug (generic or trade), dose of the drug, route of administration, and times to administer the drug It ends with the signature of the physician or healthcare provider ordering the drug

Types of Orders 1. Standing order with termination. Example: Keflex (cephalexin) 500 mg PO every 6 hours × 7 days 2. Standing order without termination. Example: digoxin (Lanoxin) 0.5 mg PO every day  3. A prn order. Example: morphine 2 to 4 mg IV q 4 h prn pain 4. Single-dose order. Example: atropine 0.3 mg subcutaneous 7:30 a.m. on call to OR 5. Stat order. Example: morphine sulfate 4 mg IV stat 6. Protocols. Example: for K <3.5, K 20 mEq PO q 4 hour × 2 days

Mobile Cart System Place the patient/client’s drawer on the top of the cart. Read each medication order, and choose the unit-dose from the drawer and compare the label with the order. After comparing the order with the unit measure, compute the dose. Check the drug label, then open or prepare the unit-dose, or pour the amount of a liquid medication. Label the unit-dose, read the order again, and verify the dose. After preparing all of the patient/client’s medications, read the name on the medicine sheet, check the patient/client’s identification band, and administer the drugs.

How medications are administered Enteral: Through the gastrointestinal system Usually oral or through nasogastric tube Oral is most common, cost-effective route Can also be given dissolved on or under the tongue (sublingual), rectal route if needed Parenteral: Injected Intramuscular Subcutaneous Intradermal Intravenous Other routes: skin, eyedrops, eardrops, inhaled, time-release patch, nose drops, vaginal suppository

Oral Medications Check expiration dates. Check for allergies. Check with the physician if certain drugs are administered when the patient/client is NPO (nothing by mouth). Do not touch stock medications with hands. Do not break tablets that are not scored. Do not crush enteric-coated tablets.

Liquid Medications Shake liquid medications thoroughly before pouring. Pour liquids at eye level. Wipe the lip of the bottle with a paper towel before recapping. Disguise liquids if distasteful or irritating. Juice Straw Don’t dilute liquid cough medicines.

Parenteral Route Adult maximum one site Angle of insertion 3 mL 2 mL deltoid Angle of insertion Intramuscular (IM): 90-degree angle Subcutaneous: 45-degree angle; use a 90-degree angle if the subcutaneous layer of fat is thick and the needle is short

Medication Administration Techniques Skin and mucous membranes Ear drops Adult: Pinna up and back Child: Pinna down and back Rest on the unaffected side for 10 to 15 minutes Eye drops or ointment Drops: lower conjunctival sac Ointment: spread inner to outer canthus of eye

Nasogastric Route Head of bed elevated 30 degrees Check placement 15 mL of air Aspirate stomach contents. Check acidity of stomach contents. Flush at least 30 mL of warm water to ensure patency.

Neonatal and Pediatric Considerations Offer a popsicle to numb the taste buds. Mix with a teaspoon of puréed fruit, ice cream, or syrup. Pinch the nostril closed and drink medication through a straw. Distract the child with conversation or a toy. Use a decorative adhesive bandage to cover the injection site.

Geriatric Considerations Offer a popsicle to numb the taste buds. Mix with a teaspoon of puréed fruit, ice cream, or syrup. Injections Predetermine the injection site. Insert the needle quickly. Inject the medication slowly.