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PRINCIPLES OF DRUG ADMINISTRATIONI.The “Five Plus Five Rights” of Drug Administration
5 Traditional Rights1.right client2.right drug3.right dose4.right time5.right route5 Additional Rights1.right assessment2.right documentation3.client’s right to education4.right evaluation5.client’s right to refuse
A.Right ClientNurse must do:
verify client
check ID bracelet & room number
have client state his name
distinguish bw 2 client’s with same last names
B.Right Drug
medication order may be prescribed by:a.Physicianb.Dentistc.Podiatrist
d.
Advanced practice registered nurse (APRN)
Components of a drug order:
1.
date & time the order is written
2.
drug name (generic preferred)
3.
drug dosage
4.
frequency & duration of administration
5.
any special instructions for withholding or adjusting dosage
6.
physician or other health care provider’s signature or name if TO or VO
7.
signature of licensed practitioner taking TO or VO
Nurse must do:
•
check med order is complete & legible.
•
know general purpose or action, dosage & route of drug
•
compare drug card with drug label
three times
.1.at time of contact with drug bottle/ container 2.before pouring drug3.after pouring drug
4 Categories of Drug Orders:
1.
Standing Order / Routine Order
ongoing order
may have special instructions to base administration
include PRN orders
ex. digoxin 0.2 mg PO q.d., maintain blood level at 0.5 – 2.0 ng/ml
2.
One-time (single) order
given only once, at a specific timeex. Cefixime 2mg IM at 7 AM on 12-1-053.PRN order
given at client’s request & nurse’s judgement for need & safetyex Mefenamic Acid 500mg q 4h PRN for pain4.STAT order
given once, immediatelyex. Morphine 2mg IV STAT
C.Right Dose
Nurse must do:
•
Calculate and check drug dose accurately.
•
Check PDR, drug package insert or drug handbook for recommended range of specific drugs.
•
Check
heparin, insulin and IV digitalis
doses with another nurse.
Stock- method vs Unit-dose method
D.Right Time
Nurse must do:
•
Administer drugs at specified times.
•
Administer drugs that are affected by foods, before meals.
•
Administer drugs that can irritate stomach, with food.
•
Drug administration may be adjusted to fit schedule of client’s lifestyle, &activities. & diagnostic procedures.
•
Check expiration date.
•
Antibiotics shld be administered at even intervals.
E.Right Route
Nurse must do
:
•
assess ability to swallow before giving oral meds.
•
Do not crush or mix meds in other substances before consultation withphysician or pharmacist
•
Use aseptic technique when administering drugs.
•
Administer drug at appropriate sites.
•
Stay with client until oral drugs have been swallowed.
F.Right Assessment
get baseline data before drug administration.
G.Right Documentation
Immediately record appropriate info
•
Name, dose, route,time & date, nurse’s initial or signature
Client’s response:
•
narcotics
•
analgesics
•
antiemetics
•
sedatives
•
unexpected reactions to meds.
Use correct abbreviations & symbols.
H.Right to Education
Client teaching :
•
therapeutic purpose
•
side-effects
•
diet restrictions or requirements
•
skill of administration
•
laboratory monitoring
Principle of Informed Consent
I.Right Evaluation
client’s response to meds.
o
effectiveness
o
extent of side-effects or any adverse reactions.
J.Right to Refuse
Nurse must do:
•
determine, when possible, reason for refusal.
•
facilitate px’s compliance.
•
explain risk for refusing meds & reinforce the reason for medication.
•
Refusal shld be documented immediately.
•
Head nurse or health care provider shld be informed when omission posethreat to px.
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