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Administering Medication

Medicine may be defined as a subtance used to promote health, to prevent, to


diagnose, to alleviate or cure disease.
The safe and accurate administration of medication is one of the major
responsibility of a nurse.
The nurse must have knowledge of drugs that is administered by her.
A fundamental rule of safe drug administration is: Never administer an unfamiliar
medication
Nurse must know generic and trade names of drugs to be administered,
classification, average dose, route of administration, use, side and adverse effects,
contraindications and nursing implications in administration.
Abbreviations and symbols used in writing medication order as per hospital policies.
Preparation of solutions and fractional doses
Storing of medicines
Rules for administration of medicines
Ethical and legal aspects
Nurses' role in the administration of medicines.
Drug knowledge
1. Names of drugs:
All drugs will have at least two names
Generic name
brand name
Example: Amlodipine (generic name)
Amlor, amvasc (brand name)
2. Classification of drugs
Drugs are classified in several ways according to their action, composition,
their purpose and uses etc.
Example:
3. Preparation of drugs
4. Dosage
5. Effects of drug on the body
Essential of medication order
The drug order by the physician has 7 essential parts for administration of drugs
safely. The nurse should know how to read a drug order.

It should have the following components:


1.
2.
3.
4.
5.
6.
7.

Patients full name.


Date and time
Drug name
Dosage
Route of administration
Time and frequency of administration
Signature of physician

Basic principles (safety) in medication administration


7 rights in medication administration
Right patient
Right dose
Right drug right route
Right time
Right frequency
Right documentation
RIGHT DRUG
Read the physicians order to study the correct name of the drug
If the order is not clear consult the physician
Make sure the drug copied correctly
Read the label of the medicine container thrice and compare it to the medication
administration sheet
Look for the color, odor and consistency of the drug. Unusual characteristics of the
drug should be questioned
administer medicine only from a clearly labelled containers
Avoid conversations while preparing medicines
RIGHT DOSE
Read the physicians order to know the correct dose
Consider the age and weight of the patient
Know the minimum and maximum dose of the medicine to be administered.
Calculate the fraction dosage correctly.

RIGHT PATIENT
An important step in administering medication safely is being sure the medication is
given to the right patient
Read the physicians order to make sure for whom the medication is ordered.
Check the patients identification band and ask the patient to state his or her name
RIGHT ROUTE
Read the physicians order to determine the route of administration
Dilute the drug if indicated
Know right method of giving drugs e.g. oral, parenteral
Know the abbreviations used to designate the route of administration e.g. IV, IM, PO
Review the available forms of drug to make sure the drug can be given according to
the order
Make sure the patient is able to take the drug by the route indicated or ordered.
COMMON ROUTES
ORAL (PO)
It is the most common route
Most convenient
The easiest and most desirable way to administer medication
Usually less expensive
Inappropriate if patient cannot swallow and if GIT has reduced motility
Inappropriate for client with nausea and vomiting
Drug may have unpleasant taste
Drug may discolour teeth
Drug may irritate mucosa
Drug may aspirated by seriously ill patient
SUBLINGUAL
A drug that is placed under the tongue where it dissolves

When the medication is in capsule and ordered sublingually, aspirate the fluid from
capsule and place under the tongue
A medication given by the sublingual route should not be swallowed, or desired
effect will not be achieved.
Same as oral
Drug is rapidly absorbed in the bloodstream
If swallowed drug may inactivated by gastric juices.
Drug must remain under the tongue until dissolved and absorbed
Buccal
A medication is held in the mouth against the mucous membranes of the cheek until
the drug dissolves
The medication should not be chewed, swallowed or placed under the tongue
Patient should be taught to alternate the cheeks with each subsequent dose to
avoid mucosal irritation
Same as oral
Drug can be administered for local effect
Ensures greater potency because drug directly enters the blood and bypass the liver
If swallowed drug may inactivated by gastric juices.
Topical administrations
Is the application of a drug directly to the surface of the skin
Includes administration of drugs to any mucus membrane
Eye, nose, eras, vagina, urethra, colon, lungs
Dose forms for topical administration include:
Skin:
Creams, ointments, lotions, gels transdermal patches, disks
Eye or ear:
Solutions, suspensions ointments
Nose and lungs:

Sprays, powders
Local therapeutic effects
Not well absorbed into deeper layers of the skin or mucus membrane
Lower risk of side effects transdermal route effects steady level of drug in the
system
Sprays for inhalation through the nose may be for local or systemic effects.
RECTAL ROUTE
Used in children
Used in vomiting/unconscious
Higher concentrations rapidly achieved
Disadvantages:
Inconvenient
Absorption is slow and erratic
Irritation or inflammation of rectal mucosa can occur.
Parenteral administration
Parenteral therapy means giving of therapeutic agent including food outside the
alimentary tract.
Types of parenteral routes: intra dermal, subcutaneous, intra muscular, intravenous
Purpose:
To get rapid and systemic effect of the drug
To provide needed effect when the patient unconscious, unable to swallow due to
neurological or surgical alterations.
To give nourishment when it cannot be taken by mouth
Intradermal
Medicine when introduced in the dermis
10-15 degree angle
0.5ml or less of medication

Form a bleb or wheal


Common site: forearm, upper back, upper dorsal aspect of the arm and upper chest
Many nerves are in the dermis- painful, burning sensation
TB and allergy testing most common
G27 needle most common
Slowly inject medication until wheal forms on skin
Avoid scarred, blemish hairy areas
Subcutaneous
Medicine introduced in to the subcutaneous tissue
45-90 degree angle
Adipose tissue
Tissue does not have as many blood vessels as muscle so medication is absorbed
slower
1ml maximum
Common sites: posterior arm, abdomen and anterior aspect of the thigh
G23-25 needle
Rotate injection sites
Give slowly

Intramuscular
Deltoid
Expose upper and shoulder
Relax arm, flex elbow to find triangle-shaped deltoid muscle
Injection site in center of triangle
Dorsogluteal
Is composed of the thick gluteal muscle of the buttocks. ( Extreme caution: sciatic
nerve and major blood vessels)

Never use for kids less than 2 years old or small children with small body
mass/muscle
Position: the patient may be prone or side lying
Vastus lateralis
The vastus lateralis is the major muscle in the anterolateral thigh and is used most
often for IM injections in infants. By school-age and adolescence this site may be
more painful because of the development of the musculature
Ventrogluteal
The ventrogluteal muscles make up the other preferred site for IM injection in
infants, although this is a useful site for other age groups as well. These muscles
contain no important nerves or vessels and are accessible when the child is in a
variety of positions.
Gluteal region
The gluteal muscles are very small and poorly developed in the infant and young
toddler. It is not recommended as an injection site until the child has been walking
for at least one year since locomotion helps to develop the gluteal musculature.
Nurses responsibility in administration of parenteral medications
Check the physicians orders for the type of injections, dosage, and the route of
administration.
Check the diagnosis and age of injections.
Check the necessity for giving test dose.
Check the form of medication available and the correct method of administration.
The nurse must have the knowledge of anatomy and physiology of the body, it is
essential for safe administration of medication for parenteral route.

Medication preparation
Prior to administration check the MAR against the physicians orders, ensure that the
correct medication has been selected based on the medication order and label.
Verify the medication is stable based on visual examination for particulates or
discoloration, ensure the medication is not expired.
Medications must be prepared for one patient at a time.

Prior to medication preparation the nurse will perform hand hygiene using
antimicrobial soap and water for 60 seconds
Medication preparation area should be clean, have good lightning and located in a
closed area to avoid distraction.
Unit dose packages must be opened at the bedside. Medications that require
preparations i.e. measuring, crushing or bulk medications must be prepared in the
medication preparation area.
All drug containers taken to the bedside (including syringes of line flushes and other
medications prepared from vials and ampoules on patient care units outside of the
patients room) must be labelled with the drug name, date, time, strength and dose.
Medications are not to be left on trays, bedside tables, etc, unless ordered by a
physician.
The nurse should not administer medications prepared by another nurse.
A nurse is not to pour a medication from one bottle to another. A nurse is not to put
a medication back into a bottle.
Nurses are not authorized to re-label medication bottles or containers. Medication
which loses its label or which lacks a legible label must never be administered to
patients.
Each nurse should know the common dose, maximum dose, and how to compute
dosage.
All medications requiring refrigeration should be identified by pharmacy department
and place in the medication refrigerator i.e. reconstituted powder drugs.
MEDICATION AADMINISTRATION
Observe the 7 rights in medication administration
At the patients bedside, verify the patients name and medical record number on
the MAR and the ID band.
Give the drugs one by one
Check for contraindications to patient receiving the medication (i.e. allergies)
The nurse shall remain with the patient until the medicine is actually swallowed.
Always give the medicine prepared by yo rself.
Do not leave the medicine with the patient

Medication errors must be reported according to the hospital policy.


DURING AND AFTER ADMINISTRATION
Observe for changes in clinical status, adverse reactions and allergic reactions.
When present, involve the family in monitoring the patient.
Monitor for acute changes in clinical status, patients subjective and objective
response.
If adverse reaction are present follow the hospital policy and procedure of reporting
adverse reaction of drugs.
RIGHT TIME AND RIGHT FREQUENCY
Administer the drug as per physicians order
The nurse must know why a medication is ordered for certain times of the day and
whether the time scheduled can be altered.
Medication that must act at certain time are given priority (i.e. insulin should be
given at a precise interval before a meal)
Know the common approved abbreviation in administering drugs as per institutional
policy.
Give the medicine as ordered in relation to the food intake (i.e. AC-before meals PCafter meals)
Give the medicines according to the action expected, (i.e. sleeping pills are given at
bed time, the diuretics are given in the morning hours)
RIGHT DOCUMENTATION
Documentation is an important part of safe medication administration
The documentation for the medication should clearly reflect the patients name, the
name of the ordered medication, the time, the dos, route and frequency.
Sign the medication sheet immediately after administration of the drug.
Use the standard abbreviations in recording the medication.
Record only the medicine which you have administered.
Never record a medication before it is given to the patient.
Record the effects observed.

Record the medications that are vomited by the patient, refused by the patient and
those drugs that are not administered to the patient and the reason for not giving
the medication.
PATIENTS RIGHT RELATED TO MEDICATION ADMINISTRATION
The patient has the right to considerate and respectful care, and the right to refuse
the medication.
To be informed of the medications name, purpose, action , potential and undesired
effects
To refuse a medication regardless of the consequences
To not receive unnecessary medications

CHECKING OF MEDICATION ROOM


MEDICATION REFRIGERATOR
Medication refrigerators will not be used for storing foods, specimens or blood for
transfusion.
Each unit/clinic must monitor and record the temperature daily in log sheet.
If temperature falls outside the range of 2-8C notify Maintenance for repair within
30 minutes
Each unit/clinic is responsible to maintain a clean and functioning refrigerator.
Refrigerators need to be plugged into essential power.
EXPIRATION
Multiple dose vials shall be dated and refrigerated when they are opened unless
otherwise specified by the manufacturer.
Discard when the manufacturers expiration date is reached, provided the
manufacturers storage conditions have been adhered to.
Discard when suspected or visible contamination occurs
Discard after 30 days of opening if expiration dating is not referenced on the
packaging or insert.
Discard when empty

Open multiple dose oral liquids should be properly labelled and kept in cool dry area
with an expiry date one month from date of opening.
Other open multiple dose containers (i.e. eye, ear, nose drops, creams, ointments,
nebulisation solutions etc.) should be properly labelled and kept in dry area , and
should be labelled with an expiry date one month from date of opening.
Drug stability
Drug stability means the ability of the pharmaceutical dosage form to maintain
physical, chemical, therapeutic and microbial properties during the time of storage
and usage by the patient.
Expiry dates
Expiry date means that drug cannot be used after this date due to the chance of
chemical degradation, harmful to patient or low potency.
It is important to comply with the storage conditions specified on the container
The stability of products is variable. A product which is stable in its container may
become unstable once the container is opened.
Factors affecting drug stability
Temperature: high temperature accelerate oxidation, reduction and hydrolysis
reaction which leads to drug degredation
pH: acidic and alkaline pH influence the rate of decomposition of most drugs. Many
drugs are stable between pH 4-8
Moisture: water catalyses chemical reactions as oxidation, hydrolysis and reduction
reaction. Water promotes microbial growth.
Light: affectsdrug stability through its energy or thermal effect which leads
oxidation.
Oxygen: exposure of drug formulations to oxygen affects their stability.
Drug Incompatibility: reactions between components of pharmaceutical dosage
forms itself or between these components and cover of the container.