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Ch7:Responsibilities and principles of drug administration

-safe/accurate admin of medsknowledge, judgement, skill

-responsibilities of drug admin:


*adequate up-to-date info about all meds to be administered, including purpose, side effects, cautions,
contraindications, interactions

-imperative knowledge of typical/most frequently used drugs of system


-familiar of every med before admin
-PDR, AHFS Drug info, USP/DI, package inserts, pharmacists must be consulted before admin of drug to
become familiar with dersired effect/potential side effects/precautions and
contraindications/interactions w/ drugs or foods

*Wisdom/judgment to accurately assess/evaluate/plan pt’s needs for med/response to


meds/interventions

ASSESSMENT:
+complete planning for pt care + assessment/interventions/evaluations of results
+complete history/ all medical conditions allergies, all other meds
+vitals, posture, skin temp/color, facial expression before and after drug admin

INTERVENTIONS:
+judgment in timing, d/c med if required
+take steps to counteract adverse reactions
+knowing what/when to report to phys

EVALUATION/DOCUMENTATION of results:
+plays vital role for all hcp in planning effective drug therapy

*Skill in delivery of med accurately, best interest of pt + adequate documentation

***GOAL***
maximize effectiveness of drug with least discomfort to pt
be sensitive to unique needs of each pt

*Pt Education why ,how, when meds to be admin/side effects/precautions

+for pt to benefit from drug therapy..must understand importance of proper dosage, time, route
+in language they understand both verbal and written and demonstrations of technique
+if med admin requires extra equipment or has multiple steps, return demonstration required

MEDICATION ERRORS:
-most errors reported from acute care setting where risk is greatest
-in outpt: often older adults/likely to have several chronic conditions requiring multiple meds
**more meds= increase risk of interactions/adverse side effects/error
1.wrong pt
2.wrong drug/form
3.wrong route
4.wrong time
5.wrong dosage
6.wrong documentationimproperly documenting drug admin info on pt’s medical record
+must report error immediately to person in charge so corrective action can be taken for pt’s welfare
+pt’s record should reflect corrective action taken for justification in case of legal proceedings
+incident report legal requirement
+failure to report errors may jeopardize pt’s welfare/ increase possibility of lawsuit again hcp/loss of
license or certificate
HCP responsible for quality care/pt safety-prevention of errors, and reporting med errors
USP established Medication Errors Reporting (MER) program
Agency for Healthcare Research and Quality has federally certified Institute for Safe Medication
Practices (ISMP) as Patient Safety Organization (PSO) to operate national error reporting program for
both vaccine and medication errors
-Medication reconciliation: method used to compare meds pt taking to meds ordered by pt’s physician
+comparision done everytime change in pt’s care  when pt is admitted, transferred, or discharged
+done to prevent errors caused by omissions, duplications, errors in doses, medication interactions

ACCORDING TO JCO …MEDICATION RECONCILIATION:


1.develop list of current meds
2.develop list of meds to be prescribed
3.compare meds on 2 lists
4.make clinical decisions based on comparison
5.communicate new list to appropriate caregivers and pt

PRINCIPLE OF ADMIN:

1.cleanliness:wash hands, make sure prep area is neat


2.organization: always be sure meds/supplies are in appropriate area and in adequate supply.
Restock/reorder right away
3.preparation area:well lighted/away from distracting influences

6 RIGHTS OF MEDICATION ADMIN:


1. Right med
+compare drug name (on phys’ order sheet/prescription blank/MR/medicine card) with label on
package/bottle/unit dose packet
+never give meds when med name is obscured in any way
2.right amount
+most common mistake regarded dosage form is substituting capsule for tablet/vice versa
+double check dosage form for all meds
+incorrect dosage form is big issue because can cause diff pharm effects for pt
+tabs intended to dissolve in acidic stomach where some capsules are designed not to dissolve until
they reach more basic intestine
+hydroxyzine in table form is generic for Atarax for acute puritis(itching) where as in capsule form
VISTARIL used for depression/anxiety
+responsibility to question phys/pharm
+never give meds someone else has prepared unless ordered by phys
3.right time
4.right route
5.right pt
6. Right documentation

CH8: Admin by GI Route


-GI route – often
-oral, nasogastric tube, gastric tube, rectal
Advantage for oral route:
+convenience/comfort
+safety: some meds can be retrieved in case of error or OD
+economic: few equipment cost and most meds are formulated for this route
Disadvantage for oral route:
+slower onset of absorption/action
+rate/degree of absorption vary GI contents/motility
+some drugs (insulin/hepar) are destroyed by digestive fluids; must be administered by injection
+difficult to use w/ pt + nausea/vomiting
+dangerous to use if pt has difficulty swallowing (dysphagia) because of possible aspiration
+cant use on unconscious pt
+cant use on NPO (before surgery or bc of acute medical condition)—cannot use if pt is fasting for test
such as lipid panel/scan
+admin of meds by NG tube, small –bore silicone gastric tube or percutaneous endoscopic gastrostomy
(PEG) tube is sometimes ordered when pt is unable to swallow for periods of time bc of illness, trauma,
surgery , or unconsciousness. Meds admin IV when conditions exist for short periods of time

Advantage of NG tube:
+ability to bypass mouth/pharynx
+elimination of numerous injections
Disadvantage of NG tube:
+with conscious ptdiscomfort of tube in nose/throat for prolonged periods of time
+when pt unable to take nourishment by mouth for long period, surgeon will insert gastric tube through
skin of abdomen, directly into stomach (G-tube or PEG tube) secured in place and can remain there for
feeding purposes indefinitely

RECTAL ROUTE: admin when + nausea/vomiting/unconscious/dysphagia


advantage: bypass action of digestive enzymes
+avoid irritation to upper GI tract
+useful of dysphagia

disadvantage: unavailability
+difficulty retaining suppositories (older adults/children)
+prolonged use can cause rectal irritation (bisacodyl)
+absorption irreg or incomplete if feces are present