Principles for Nursing Practice Medication Administration Dr. Belal M. Hijji, RN, PhD February 11, 2012

Objectives By the end of this lecture, students will be able to: Discuss pharmacology applications in nursing practice. Describe the Jordan Drug and Food Administration guidelines for safe narcotics administration and control Recognise types of medications actions. Describe factors influencing choice of administration routes. Correctly calculate a prescribed medication dosage, and identify the five rights of medication administration. Describe the roles of the pharmacist, physician, and nurse in medication administration.

Pharmacology Applications in Nursing Practice Names: Generic: Acetaminophen Trade (brand): Tylenol Classification: Medications with similar characteristics are grouped into classifications. Some medication have more than one classification. Hypoglycemic agents Antihypertensive agents Forms: Tablets Capsules Intraocular Lotion Ointment Solution Suppository Suspension Syrup Sustained relase

Jordan Drug and Food Administration Guidelines For Safe Narcotics Administration And Control يجب تحديد مسؤول التمريض في كل قسم من أقسام المستشفى ويتم تسليم العقاقير الخطرة لكل قسم مقابل ضبط استلام وتسليم موقع من قبل الممرض المسؤول في القسم والصيدلي المسؤول في المستشفى. يجب أن يتم حفظ العقاقير الخطرة في خزانة محكمة الاغلاق. على مسؤولي التمريض تسليم مفتاح خزانة العقاقير الخطرة فقط للممرض المسؤول في الورديات الاخرى. يجب ان يكون هناك سجل خاص بالعقاقير الخطرة في المستشفى يسجل فيه اسم المريض ورقم ملفه ورقم السرير واسم الطبيب الواصف للحقنة المخدرة واسم الممرضة وتوقيعها والتاريخ واسم الممرض الشاهد على الاعطاء. ويجب على السجل أن يبين الاستلام والتسليم بين الورديات وموقع من قبل الممرضين المسؤولين. تصرف العقاقير الخطرة من قبل الصيدلي المسؤول المعتمد فقط لرئيسة ممرضات القسم. يجب على الممرض المسؤول اعطاء حقنة المادة المخدرة للمريض بعد التأكد من توقيع الطبيب على الوصفة وعلى اضبارة المريض، وأن يوقع الممرض على الاضبارة بعد الاعطاء. في حالة اعطاء المريض جزء من محتويات حقنة عقار خطر يجب اتلاف الكمية المتبقية بحضور الطبيب والذي يبين ذلك على الوصفة بتوقيعه مع التاريخ والوقت. في حالة وقوع حادث كسر لحقنة يجب استدعاء الصيدلي المسؤول لمشاهدة الحادث وعمل محضر يبين تفاصيل ما حدث وتوقيع الشهود عليه مع الصيدلي المسؤول. وفي حالة عدم وجود الصيدلي ضرورة استدعاء الطبيب المناوب لمشاهدة حادث الكسر وليقوم بالتوقيع على المحضر بعد توقيع الشهود وحفظ الحقن المكسورة لدى الصيدلي المسؤول بعد ذلك من اجل اجراءات تبليغ مديرية الدواء ورفع تقرير عن الحادثة فوراً وحفظ نسخة لدى الصيدلي ونسخة في ملف المتسبب بحادثة الكسر.

Types of Medication Action Therapeutic: This is the expected or predictable physiological response a medication causes. For example, nitroglycerin reduces cardiac workload and increases myocardial oxygen supply Side effects: This is predictable, unintended, secondary effect. For example, asymptomatic blood loss, skin reactions Adverse effects: Are generally severe responses to medication. For example, when a client experiences cardiac arrest following rapid administration of KCL. Toxic effects: These may develop after prolonged intake of medication. For example, respiratory depression caused by morphine.

Factors Influencing Choice of Administration Routes Oral routes: Are convenient, comfortable, economic, and rarely cause anxiety Disadvantages: Avoid in nausea & vomiting, reduced motility, gastric suction, and reduced ability to swallow. SC, IM, IV, ID routes: Are used when oral routes are C/I. Absorption is more rapid than with oral and topical routes. IV route is valuable in critically ill clients. Disadvantages: Risk of infection, expensive, not suitable for clients with bleeding tendencies, risk of tissue damage with SC injections, IV and IM routes are dangerous due to rapid absorption, and anxiety.

Topical routes: Provide local or systemic effect, painless, limited side effects, prolonged systemic effects (transdermal), rapid relief for local respiratory problems. Disadvantages: Skin abrasions facilitate rapid absorption and systemic effects, clothes soiling, rectal and vaginal applications are embarrassing, ruptured eardrum cannot receive irrigations, suppositories are C/I in rectal bleeding and rectal surgery, some inhalation agents can cause serious systemic effects such as cardiac arrhythmias due to salbutamol inhalation.

Dosage Calculation When preparing solid and liquid forms: Dose ordered x Amount on hand = Amount to administer Dose on hand Example (1): Give Demerol 50 mg (dose ordered) IM. Each ampoule contains 100 mg (dose on hand) in 1 ml (amount on hand). How many ml should be given? 50 x 1 = 0.5 ml (amount to administer) 100 Example (2): The doctor’s order is 0.125 mg PO of Digoxin. Each tablet contains 0.25 mg. How many tablets should be given? 0.125 x 1 = 0.5 tablet 0.25

Example (3): Give Erythromycin suspension 250 mg PO Example (3): Give Erythromycin suspension 250 mg PO. Each 5 ml contains 125 mg. What amount would you give? 250 x 5 = 10 ml, OR 125 5 ml = 125 mg ? = 250 mg

Rights of Medication Administration Right medication: When preparing medication, compare the label of the medication container with a physician’s well-written and clear order. Handwritten prescriptions can be difficult to decipher [يكتشف معنى شيء غامض]. For example, in the following prescription the drug name Avandia was incorrectly interpreted as Coumadin. Only administer the medication you prepare                                                                                   

Right dose: Chances for errors increase when a medication must be prepared from a larger volume or strength than needed. When performing medication calculations or conversion, check the calculated dose with another nurse. After calculations, prepare the medication using standard measurement devices such as graduated cups, syringes, and scaled droppers.

When it is necessary to break a scored tablet, the break should be even. Unevenly broken tablet should be discarded When crushing a tablet, the crushing device should always be completely cleaned

Right client: To ensure safe medication administration, the right client must be identified. This can be done by: Matching client identification details on his/ her bracelet with those on the prescription chart Asking the client to state his/ her full name Right route: Consult the physician if the route of administration is not specified or not recommended When administering injections, it is important to prepare them from preparations designed for parenteral use. The injection of a liquid designed for oral use can cause sterile abscess formation or fatal systemic effects.

Right time: The timing a medication is to be administered at is at the discretion of the physician. For example: Give Augmentin 375 mg every 8 hour (q8h) Give iron tablet 3 times a day (tid) after meals Give valium 10 mg IM preoperatively Give Demerol 50 mg IM stat All routinely prescribed medications should be given within 30 minutes of the times ordered. However, sometimes the nurse should judge the proper time when a medication is to be administered. For example: PRN (Pro Re Nata) sleeping or pain medications

The roles of Prescriber, Pharmacist, and Nurse in Medication Administration. Prescriber’s role: The prescriber could be a physician or an advanced practice nurse Institutional policies vary regarding the personnel who can take verbal or telephone orders. Common abbreviations are often used when writing orders. These include AC (before meals), ad lib (as desired), BID (twice a day), HS (hour of sleep), PC (after meals), prn (when needed), and od or qd (every day). However, the current recommendation is that abbreviations should not be used because of the high number of medication errors related to their use.

Pharmacist’s role is to: Prepare and distributes prescribed medications Assess the medication plan and evaluate the client’s medications-related needs Fill prescription accurately and ascertaining their validity Nurse’s role is to: Administer medication correctly to clients Assess client ability to self medicate Determine whether a client should receive medication at a given time Monitor the effect of prescribed medications Provide education to client and family regarding medication administration and monitoring