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Module 7

Module 7. Pharmacology I: Medication Administration. Safe Practices in Medication Administration. “7 Rights” of Safe Medication Administration. Right Drug Right Dose Right Time Right Route Right Patient Right Reason Right Documentation. “7 Rights” (continued). Right Drug

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Module 7

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  1. Module 7 Pharmacology I: Medication Administration

  2. Safe Practices in Medication Administration

  3. “7 Rights” of Safe Medication Administration • Right Drug • Right Dose • Right Time • Right Route • Right Patient • Right Reason • Right Documentation

  4. “7 Rights” (continued) • Right Drug • Check all orders, labels and confirm that the drug is appropriate for this client/condition • Right Dose • Is the dose is appropriate for the drug, age, size and patient condition

  5. “7 Rights” (continued) • Right Time • Follow agency policy • Right Route • Follow medication order and knowledge of appropriate routes for specific drugs

  6. “7 Rights” (continued) • Right Patient • ALWAYS identify the patient 2 ways (the patient’s room number should not be one of the options) • Right Reason • Requires knowledge of medication; knowledge of patient; question appropriateness of order if applicable • Right Documentation • Follow agency policy and procedure for immediate documentation = time, route, response

  7. Right Documentation • Remember the 5 W’s when documenting medication administration on chart: • When (time) • Why (include assessment, symptoms, complaints, lab) • What (medication, dose, route) • Where (site) • Was (med tolerated?/helpful to the patient?) (See Study Guide #2 for additional charting tips and legal aspects of medication documentation)

  8. Medication Documentation • First, make sure you have the right chart! • Never chart a drug before it is administered • Documenting includes name of drug, dosage, route, and time • Record location when giving parenteral medications • Follow agency policy if a medication was not given • Document client’s response to the medication

  9. Preventing Medication Errors • Minimize verbal and telephone orders • Refrain from attempting to decipher illegibly written orders • Always adhere to the 7 rights • Read the label 3 times, checking against the medication administration record • Listen to the patient - any concerns are the nurse’s concerns!

  10. Preventing Medication Errors (continued) • Double check with literature if in doubt about an order • Minimize interruptions while processing and preparing medications • Do not agree to give medications in an area where you are not experienced

  11. Nursing Process and Medication Administration • Assessment • Medication history, allergies, ability to take med in the form provided? • Diagnosis • Is this the right drug, dose, patient, etc? • Planning • How will the drug be given? • Implementation • Correct route; need for standard precautions? • Evaluation • Was the medication effective?

  12. Patient Assessments in Medication Administration • Assess patient variables that might influence drug therapy. • Assess drug history prior to the start of a new drug • Assess patient’s response to the medication • Assess physical parameters prior to administration • Apical pulse, BP

  13. Nursing Responsibilities in Medication Administration • Be knowledgeable about medications being administered and being taken by the patient • Know what to do in the event of an adverse reaction • Verify and clarify orders that seem inappropriate • Be knowledgeable and informed concerning agency policies, especially concerning JCAHO’s National Patient Safety Goals • Follow standards of nursing practice • Observe standard precautions and use medical-surgical asepsis if indicated • Confirm “7 rights” of safe medication administration • Document medication delivery and patient response accurately and appropriately • Report adverse events or incidents per agency policy

  14. Medical-Surgical Asepsis and Medication Administration • Medical Asepsis • Handwashing • Standard precautions • Surgical Asepsis • Use of sterile supplies

  15. National Patient Safety Goals related to Medication Administration • Use at least 2 patient identifiers just prior to medication administration. (i.e. ask the patient to relate to you their name and date of birth) • Verify verbal or telephone orders by verbally reading back the order to the Licensed Independent Practitioner (LIP) out loud.

  16. National Patient Safety Goals related to Medication Administration (continued) • Take action to prevent errors involving sound-alike or look-alike drugs (see agency policy for specific precautions and actions to implement) • Label all medications containers both on and off the sterile field. (This applies to syringes of drawn-up medications to be given later, medication cups of oral medications to be given later, etc.)

  17. National Patient Safety Goals related to Medication Administration (continued) • Follow agency policy concerning a comparison of the patient’s currently prescribed medications with those just ordered during the current visit.

  18. Legal Implications for Medication Administration • Nurse’s roles and responsibilities for administration of medications are defined and described by standards of care and the Nurse Practice Act • Additionally, there are agency specific policies and procedures

  19. U.S. Laws Affecting Medication Administration • Food, Drug & Cosmetic Act – (1906) • Required accurate labeling and testing for harmful effects • 1962 added requirement of proof of safety and effectiveness • Harrison Narcotic Act (1914) • Established legal term “narcotic” • Regulated importation, manufacture, sale and use of habit-forming drugs

  20. U.S. Laws Affecting Medication Administration (continued) • Durkham-Humphrey Amendment (1952) • Clearly differentiates drugs that can be sold only with a prescription, those that can be sold without a prescription, and those that cannot be refilled without a new prescription.

  21. U.S. Laws Affecting Medication Administration (continued) • Controlled Substance Act- (1970) • Also known as: Comprehensive Drug Abuse Prevention and Control Act • In response to growing misuse/abuse of drugs • Categorizes controlled substances • Limits how often a prescription can be filled • Established government-funded programs to prevent and treat drug dependence

  22. U.S. Laws Affecting Medication Administration (continued) • Comprehensive Drug Abuse Prevention and Control Act (continued) • Promotes drug education • Strengthens enforcement authority • Establishes treatment and rehabilitation facilities

  23. Schedules of Controlled Substances • See schedules Study Guide 5 • Give an example of one drug from each category

  24. Rules Governing Administration of Controlled Substances • Keep in “burglar” proof containers • Double-locked carts or cabinets • Accurately complete controlled Substance Inventory form • 2 nurses must witness and document when wasting a controlled substance

  25. Medication Orders… • Should be written clearly, legibly and in easy-to-understand language • Should be clarified if unclear – check with direct supervisor first. • Should not include blanket, summary statements such as “resume all pre-op orders”

  26. Essential Parts of a Medication Order • Patient’s full name • Date and time order written • Name of medication to be administered • Dosage (strength and amount to be given) • Frequency of administration • Route • Number of doses or days medication is to be given • Signature of the ordering physician

  27. “Do-Not-Use” Abbreviations • U for unit • IU for international unit • Q.D., qd, QOD, q.o.d. • A trailing zero (i.e. 2.0 mg. Instead use 2 mg) • MS, MSO4, MgSO4 • > for greater than • < for less than • Abbreviations for drug names • Apothecary units • @ for at • C.c. for cubic centimeters • Ug for microgram See Study Guide 7 for more information

  28. Sources for Locating Drug Information • Physician’s Desk Reference • National Formulary or Hospital Formulary • Pharmacists • Drug reference books • Pharmacology textbooks • Computer-based Indexes

  29. Drug Misuse • Drug misuse - Improper use of any medication which leads to acute/chronic toxicity • Drug abuse - Inappropriate intake of a substance

  30. Drug Dependence • Drug dependence - Person’s reliance on or need to take a substance • Physiological dependence – biochemical changes in body tissue, especially the nervous system, which lead to a requirement by the tissues to function normally • Psychological dependence – emotional reliance to maintain a sense of well-being

  31. Pharmacokinetics • “What the body does to the drug” • Absorption • Distribution • Metabolism/Biotransformation • Excretion

  32. Pharmacokinetics (continued) • Drug Effects • Onset- Time it takes for a therapeutic response • Peak - Time it takes for maximum therapeutic response • Duration of action - Length of time that drug concentration is sufficient for a therapeutic response

  33. 4 Factors Affecting Absorption • Route of administration and conditions at absorption site • Oral medications have slowest rate of absorption • IV drugs the fastest • Drug dosage and form • Enteric coatings delay absorption • Liquid form absorbed faster than pills • Some parenteral/topicals have additives that delay/prolong absorption

  34. Factors Affecting Absorption (continued) • Fat (lipid) solubility • More lipid soluble the more rapid it’s absorption • Gastrointestinal factors • Gastric emptying time • Motility - diarrhea, constipation • Presence of food • Integrity of GI tract

  35. 4 Factors Affecting Distribution • Blood flow • Plasma protein binding • Amount of the drug • Physiological barriers to absorption • Blood-brain-barrier • Placental barrier

  36. 4 Factors Affecting Metabolism/Biotransformation • Condition of the liver • Liver filters most medications • Age • Infants and elderly usually have decreased metabolism of drug • Nutritional status • malnutrition • Hormones

  37. 2 Factors Affecting Excretion • Renal excretion • Drugs are filtered in or out by kidneys • Renal pathology will decrease excretion • Decreased excretion increases circulating blood levels of the drug • Liver or lung pathology

  38. Drug Half-Life • The time it takes for ½ of the original amt of the drug to be removed from the body • Useful for determining amount of drug in blood level in relation to amount removed by elimination • Used to determine the frequency of drug administration

  39. Pharmacodynamics • “How the drug affects the body” • Biological, chemical, and physiologic actions of a drug within the body • Drugs can promote, block, or turn on/off a response • They cannot create a new response

  40. Loading Dose • A loading dose is one that is larger than the standard dose: • It is given at the beginning of drug therapy to quickly raise the blood level of the drug into therapeutic range. • It is used when the desired therapeutic response is required more quickly than can be achieved with the standard dose.

  41. Maintenance Dose • A maintenance dose is one that continues to keep the drug in the desired therapeutic range: • It is used after a loading dose. • For many drugs, patients receive the maintenance dose both at the start of therapy and throughout therapy.

  42. Therapeutic Index • Relates to drug’s margin of safety, the ratio of effective dose to a lethal dose

  43. Tolerance • Means that a larger dose is needed to bring about the same response

  44. Adverse Effect • Any non-therapeutic response to the drug therapy-consequences may be minor or significant

  45. Drug Interactions • Action of one drug on a second drug or other element creating one or more of the following: • Increased or decreased therapeutic effect of either or both drugs • A new effect • An increase in the incidence of an adverse effect

  46. Causes of Drug Interactions • GI absorption • Enzyme induction • Renal excretion • Pharmacodynamic effects • Patient care variables

  47. Allergic Reactions • Allergic reactions are altered physiologic reactions to a drug that occur because a prior exposure to the drug stimulated the immune system to develop antibodies. • Anaphylaxis is the most serious allergic reaction.

  48. Accumulation • Occurs when the dosage exceeds the amount the body can eliminate through metabolism and excretion • Is called toxicity if tissue/organ damage occurs • Factors contributing to accumulation: • Age • Underlying disease

  49. Toxicity: Evaluating Drug Levels • When receiving certain medications, blood samples are drawn to maintain blood levels within a therapeutic margin • Peak: draw a peak level 30 min after IV administration and 1 hour after IM administration • Trough: draw a trough level just before the next dose (sometimes before the 3rd dose)

  50. Nursing Responsibilities for Toxicity Assess for signs of: • Ototoxicity: balance and hearing • Nephrotoxicity: I & O, proteinuria • GI toxicity: diarrhea • Neurotoxicity: drowsiness, seizures

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