Legal Considerations

1. NURS 1510 Unit 2: Administering MedicationsMetro Community CollegeNURS 1510Nancy Pares, RN, MSN

2. Legal Considerations • U.S. drug legislation • Sets official drug standards • Defines prescription drugs • Regulates controlled substances • Improves safety • Requires proof of efficacy • Nurse Practice Acts • Identify nursing responsibilities for administration and client monitoring

3. Medication Systems Unit Dose: • Individually packaged • Client-specific drawers • 24-hour supply Stock Supply: • Bulk quantity • Central location • Not client-specific

4. Medication Systems Automated Dispenser: • Password-accessible locked cart • Computerized tracking • Can combine stock and unit doses Self-Administration: • Individual containers • Kept at client’s bedside

5. Pharmacological Considerations Pharmacokinetics: • What happens to the drug in the body Pharmacodynamics: • How the drug affects the body

6. Pharmacokinetics Four processes: • Absorption • Distribution • Metabolism • Excretion

7. Absorption • Movement of drug into the bloodstream • Factors affecting absorption: • Route of administration • Drug solubility • pH/ionization • Blood flow

8. Distribution • Drug transport to tissues and organs • Factors affecting distribution: • Local blood flow • Membrane permeability • Protein-binding capacity

9. Metabolism • Biotransformation: chemical conversion of drug • Factors affecting metabolism: • Liver function • Health/disease status • First-pass effect

10. Excretion • Elimination of the drug • Factors affecting excretion: • Organ function, especially the kidneys, liver, and lungs

11. Concepts Related to Pharmacokinetics • Time until onset and peak • Therapeutic range • Peak level • Trough level • Therapeutic level • Half-life • Concentration of active drug

12. Pharmacodynamics: Effects of Drugs Primary effects: • Therapeutic effects • Predicted • Intended • Desired • Why the drug was prescribed

13. Pharmacodynamics Secondary effects: • Unintended • Nontherapeutic • Can be: • Predictable • Harmless • Harmful

14. Pharmacodynamics Types of secondary effects: • Side effects • Adverse reactions • Toxic reactions • Allergic reactions • Idiosyncratic reactions • Cumulative effect

15. Drug Interactions • Antagonistic • Synergistic • Incompatibilities

16. Nursing Considerations: The Medication Order Types of medication orders: • Written order • Automatic “stop” date • STAT order • Standing order • PRN order

17. Nursing Considerations: The Medication Order Communication of orders: • Handwritten • Preprinted • Orally • Telephone

18. Components of the Medication Order • Client’s full name • Date and time order was written • Name of medication • Dosage size, frequency, number of doses • Route of administration • Signature of prescriber

19. Nursing Considerations: Medication Administration Safety Three checks: • Before you pour: • Check the medication label against the MAR • After you pour: • Verify the label against the MAR • At the bedside: • Check the medication again

20. Nursing Considerations: Medication Administration Safety Other Rights: • Right reason • Right to know • Right to refuse Six Rights: • Right drug • Right client • Right dose • Right time • Right route • Right documentation

21. Routes of Administration • Tablets, pills, capsules • Liquids(syrups, elixers, suspensions, emulsions • Buccal • Sublingual • Enteral medications • Troche Oral medications: • Most commonly used route • Includes:

22. Overview of Medication Administration, by Routes • Lotions, creams, ointments • Transdermal patches • Eye and ear • Nasal • Vaginal • Rectal Topical medications: • Applied directly to body surface/body cavities • Local effects:

23. Routes of Administration Respiratory inhalations: • Use concept of nebulization • Absorption via alveoli and blood supply • Atomizers • Aerosol • Metered dose inhaler

24. Routes of Administration Parenteral medications: • Intradermal • Subcutaneous • Intramuscular • Intravenous

25. Parenteral Medication Administration Equipment Preparation: • Syringe/needle (size, gauge) Medication Preparation: • Vials and ampules • Reconstituting from powder • Two medications in one syringe

26. Parenteral Medication Administration Safety issues: • Use sharps containers • Never recap dirty needle

27. Parenteral Medication Administration • Use the correct site • Wrong site could mean wrong route • Be familiar with the technique required for the medication (e.g., heparin, insulin)

28. Parenteral Medication Administration Intravenous medications: • IV push • IV piggyback • Medicated drips

29. Avoiding Medication Errors • Use the six rights • Calculate doses carefully; double-check with a second RN • Watch for drugs with similar names • Watch for clients with same last names

30. Avoiding Medication Errors • Clarify illegible orders • Know and use your resources • Keep up with changes in medication orders