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Drug Administration
Roach Ch 2
8
Pharmacology
Undergraduate 1
11/28/2012
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Term
“The 5 + 1 Rights of Drug Admin/prep” 
 Definition

 

  1. Right PATIENT, use 2 methods: 

  1. Visual – check nameband 

  2. Verbal – ask pt to identiy self and ask another identifier like DOB; don’t say “are you John Doe?” 

  1. Right DRUG – don’t hurry, look up if unsure, some are easily confused (APP B); compare med, container label to med record 

  2. Right DOSE – Obrain PCP written order with pt name, drug name, dosage form and route, dosage and frequency with PCP signature; can use verbal order in emergency but must get written as soon as emerg is over (write dose and repeat to pcp and ask to confirm); many hospitals require verifying with pharm first 

  3. Right ROUTE – “          ” 

  4. Right TIME- “       ” 

  5. Right DOCUMENTATION –record immediately esp PRN so others know and effectiveness can be assessed 

     

    “5 rights + 3 checks” in lecture; not sure if 3 checks are to make sure the above are correct 3 times (below) or if they are doc, allergies and expiration date… 

     

    Also added in lecture were the additions of checking for allergies and expiration date.
Term
Types of MED ORDERS
 Definition

 

  1. STANDING ORDER – pre-established for use by nurses routinely without PCP 

  2. SINGLE ORDER – one time only 

  3. STAT ORDER – one time for ASAP 
Term
Drug preparation
 Definition

 

  • Check and clarify written order if needed 

  • One pass at a time; be focused and take it slow.  No rushing! 

  • Wear gloves when prepping creams, patches, etc. 

  • Don’t touch med! 

  • Be alert for similar drug names (APP B) 

  • Wash hands before, do not touch drug 

  • Always check/compare label with MAR 3 times 

  1. when taken from storage 

  2. right before removing from container 

  1. before admin 

  • Chart immediately 

  • Never crush without checking with pharm 

  • Don’t give a drug that someone else prepared! 

  • Return immediately to storage 
Term
Preventing errors:
 Definition

 

  • If happens, report ASAP even if no harm 

  • Confirm unclear orders 

  • Check calculations with another nurse 

  • Listen to pt (e.g. I just took that) and check into 

  • CONCENTRATE ON THIS TASK ONLY 

  • For some reason INSULIN AND HEPARIN are more commonly administered wrong 

  • DO NOT USE (REMEMBER THIS!): 

  • U for unit, write “unit” 

  • IU, write “international unit” b/c mistaken for IV 

  • Q.D. QD q.d. or qd, write out daily or every other day 

  • Q.O.D. QOD q.o.d. or qod 

  • X.0, write X 

  • .X, write 0.X 

  • MS can mean multiple things, write it out 

  • MS04 cofused with MgSO4, don’t use 
Term
National Patient Safety Goals
 Definition
established by Joint Comission (was JCAHO) on a yearly basis, includes med administration, e.g. requires id improvements and must use at least 2 methods to id pt (and NOT the room number); they banned certain abbreviations 
Term
Institue for Safe Medication Practices
 Definition
a nonprofit that studies errors and prevention; educates on topic; also has Medication Error Reporting Program similar to MedWatch of FDA – goal to identify error to improve 
Term
Types of Drug Distribution Systems:
 Definition

 

  1. UNIT DOSE SYSTEM – pharm fills for 24 hr use, each unit=dose is separated; pharm refills every 24 hrs 

  2. MULTI UNIT DOSE – still separate dosed but may be 1-2 months worth 

  3. AUTOMATED MEDICATION MGMT SYSTEM – computerized, mostly used in hospitals, drugs in drawers of machine, nurse enters in info and …. 

  4. BAR CODED POINT-OF-CARE MED SYSTEM – bar codes on band, med, even nursed may have a bar code 

  5. FLOOR STOCK – commonly prescribed drugs kept at nurses station 
Term
Routes of administration:
 Definition

 

  1. ORAL– most frequent; nurses responsibilities: 

  1. Verify able to swallow and not nauseous/vomiting 

  2. Make sure sitting up 

  1. Give water 

  2. Instruct to put pill back of tongue and put head slight forward or back, then drink 

  3. Give other instructions necessary\ 

  4. Never leave a med unless ordered by PCP 

  5. Make sure buccal/sublingual are retained not swallowed 

  6. G-tube flush first, give then flush again (tap water) 

  1. PARENTERAL (Injection – actually means not through GI) – use gloves, clean site, if IM aspirate and make sure no blood, provide pressure afeter and dispose of needle properly.  Various routes: 

  1. INTRADERMAL – eg TB test, allergy skin test (sensitivity tests) 

  1. Use inner fore arm or upper back 

  2. Should be hairless, avoid scars, moles, etc 

  3. Angle is 15 degrees 

  4. If doesn’t produce WHEEL, then too deep (into subcut) 

  1. SUBCUTANEOUS – b/t skin and muscle, slower absorb than IM; e.g. blood thineers and antidiabetics 

  1. Smaller volume than IM 

  2. Use upper arm, upper abdomen, upper thigh; rotate sites 

  3. 45 degree angle usually 

  4. if obese may need longer needle and/or 90 degree angle 

  5. if thin, upper abdomen in the best 

  6. usually don’t aspirate for blood 

  1. INTRAMUSCULAR (IM) – more rapid than a. and b. b/c lots of blood at muscles 

  1. Can give larger volume (up to 3mL) 

  2. May need pt to relax muscles 

  3. Give at upper arm/deltoid, hips, thigh (these are well developed muscles) 

  1. thigh = VASTUS LATERALIS 

  2. hip = VENTROGLUTEAL 

  3. butt = DORSOGLUTEAL 

  4. upper arm = DELTOID 

  1. 90 degree angle 

  2. are particular positions for particular injection sites (know these positions?) 

  3. Z-TRACK METHOD FOR IMs – when a drug is very irritating or staining – keeps drug in muscle away from skin 

  1. pull up med and discard needle 

  2. with new needle pull u pair 

  3. pull subcut laterally 

  4. inject at 90degree 

  5. hold 10 sec then release overlying tissue 

  1. Other parenteral routes e.g venous ports require surgical insertion/removal, but LPNs do not administer to these 

  1. IV ADMINISTRATION – more information in CH 55 – very rapid response and are different methods 

  2. SKIN/MUCOUS MEMBRANE ADMIN 

  1. TOPICAL ROUTE – skin only, does not absorb; softens, disinfects, lubricates; some debrides;  

  1. Includes SUPPOSITORIES, ORAL LOZENGES, CREAMS, EYE DROPS, NASAL SPRAYS, etc. 

  1. TRANSDERMAL ROUTE – absorbed through skin into system gradually 

  1. Maintains a constant blood level, lower toxicity risk and less adv rxns, also less frequent admin 

  2. E.g. Duragesis for pain and OrthoEvra birth control 

  3. Make sure to remove old patch 

  4. Apply to dry hairless (no not shave) intact skin 

  5. Clean, apply, rotate sites 

  6. Document the actually patch 

  1. INHALATION ROUTE – e.g face mask nebulizer, bronchodilator, mucolytics; usually affects only the lungs; many inhalers not taken correctly – pt edu important 
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