3 - Medication Administration

KING FAHAD HOSPITAL - AL BAHA
Nursing Department
COMPETENCY CHECK-OFF
NAME of staff being evaluated ______________________________________________________________ Unit _______________

Position Number ______________________________________________________________
(3) MEDICATION ADMINISTRATION

STANDARD OF CARE
: Nurse will administer medications with the knowledge of hospital policies and procedures ensuring
appropriate compliance.
COMPETENCY STATEMENT
: Nurse will administer medication as per7 rights
REFERENCES
: Nursing Administration Policy
: Lippincott, Manual of Nursing Practice, 10th Edition, May 2013
EFFECTIVE : June - 2016
APPROVAL : MR. SULTAN G. AL-ZAHRANI / DIRECTOR OF NURSING
CHECK-OFF CHECK-OFF
PERFORMANCE CRITERIA Met ()/ Not Met (x) Met ()/ Not Met (x)
/ X Remarks / X Remarks
1. Verifies physician’s order for medications
( drug name, dosage, route and time interval ) -
2. Check for any history of allergies.
- Reviews patient’s record for allergies, risk factors and any other
data relevant for contraindicating the administration of ordered
medications and reports appropriately, if noted –
- Marks ‘No known allergies’ in case of no history of allergies, with
red ballpoint pen in order sheet, medication sheet and kardex -
3. Assess patient’s need for potential response to medication by
checking the patient's record –
4. PREPARATION
a) Ensures that all medications are supplied by the hospital pharmacy
with proper labels and preferably in unit doses -
b) Ensures medications are kept in the cart/shelf.
c) Compares label on the medication with the transcribed order on
medication chart-
d) Prepares medication for only one patient at a time, and ensures
drug label and expiry date are checked
e) Calculates & Double-checks the correct dosage of the medications
- For all high risk medications (controlled drugs, narcotics, high alerts and
pedia doses), the medication and dosage is doubled-checked with another
staff and both nurses sign in medication sheet-
f) Gathers all necessary supplies/ equipment.
g) Wash hands and wear gloves as indicated.
KFH/ Nursing Department/ Standard Nursing Competencies (NR 65.3) Medication Administration/ June – 2016 Page 1 of 8
Nursing Department
CHECK-OFF CHECK-OFF
5. Administers the medication as required by strictly observing the
7 Rights for medication administration: Right Patient; Right Drug,
Right Dosage, Right Route, Right Time, Right Interval and Right
Documentation
a) Identifies the patient correctly by letting them state their name
(if able to do so) and verifies MRN in their medical file
- For unconscious patient, two nurses will identify them -
b) Explains the procedure and its purpose to client to gain their
cooperation and alleviate anxiety -
c) Position the patient comfortably and appropriately for the
administration
d) Takes pre- administration assessment (like Vital Signs) and
checks diagnostic laboratory results if required for the specific
medication-
e) Assess the appropriateness of the route of medication
administration for the client.
ORAL ROUTE
o
Assists the patient to sitting position -
o
Handovers the medicine in the medication cup to the client -
o
Offers water or other permitted fluid ( except cough mixture ) -
oRemains with patient until the medicine has been swallowed.
o
If uncertain, let the client open the mouth and checks politely to
ensure that the medicine was swallowed -
VIA NGT
o Whenever possible, use liquid medication.
- If unavailable in its liquid form, talk with the doctor or pharmacist about
dissolving and crushing tablets. Crush all tablets as long as they are stable if
crushed.
- do not administer sustained-release, chewable, long-acting, or enteric-coated
tablets and capsules through an NG tube.
o If the patient is receiving a continuous feeding, do not mix the
medications in the enteral feeding solution.
- stop the feeding for 30 minutes , give the medications and then resume the
feeding after 1 hour.
o Position the patient in bed in high fowler’s position.
o Verify placement of tube in the stomach.
- Attached a syringe to the end of NGT. Place a stethoscope over the left upper
quadrant of the abdomen and inject 10-20 cc of air while auscultating abdomen
o Check gastric residual.
- Connect 50 ml syringe to the end of the NGT, then pull back evenly and gently
on the syringe to aspirate contents.
- If the aspirate is less than the amount of fluid or enteral formula given via the
tube in the past 2 hours, return it to the stomach and administer the
medications.
- If the aspirate is more than what has been given enterally in the past 2 hours,
return it to the stomach, withhold medications, and notify the patient’s
physician.
- A large volume of aspirate can indicate delayed gastric emptying, which can
cause gastric distention, reflux, and vomiting.
Nursing Department
CHECK-OFF CHECK-OFF
oAdministers medication allowing it to flow by gravity-
oFlushes the tubing with 20 – 30 ml of water after each
medication -
o Covers the end of the feeding tube with plug , once completed-
o Maintains the elevation of head part of the bed for 20 – 30
minutes to prevent aspiration of the stomach contents -
INTRAVENOUS (IV) ROUTE
o Wash hands and Wear Examination Gloves
o Assess the IV site for any complications (i.e. signs of infiltration/
phlebitis/..) and verify the patency of IV cannula and vein -
a) IV Medication Push Through An Intermittent Infusion Device Or
Heplock
o Unclamps cannula port and disinfects the port with the alcohol
wipes -
o Attaches the flush syringe to port, and slowly inject 3mL of
normal saline.
o Removes syringe and cleanses port again with alcohol wipes -
o Administers medication as prescribed by the physician at a safe
rate into the cannula port while assessing patient and IV site -
o After injecting medication, cleans the port with alcohol wipes for
15 seconds and flushes 3 mL of normal saline slowly at the same
rate into the cannula port-
o If heparin flush saline is allowed; cleans the 3 way port with
alcohol and inject 1-3 cc of heparinized saline flush and caps the
port -
b) IV Medication Push Into A Primary IV-Line
o Checks for compatibility of IVP medication with infusing IV fluid -
o Selects 3-way connector in IV tubing that is closest to IV insertion
site
o Cleanse port with alcohol wipes for 15 seconds (unless indicated
otherwise due to caustic med) and allows it to dry -
o Close the IV primary tubing above the injection port by using the
3-way stopper -
o Attaches normal saline syringe and flushes slowly into the
cannula port using 3 or more ml of saline (depending on port being used)
o Attaches pre loaded medication syringe to the 3-way port and
injects medication slowly at prescribed rate, while assessing
patient and IV site -
o Uses seconds watch to monitor the theme of administering rate -
o Removes medication syringe, clean the port with alcohol wipes
and attach normal saline syringe. Slowly flush in the cannula
port 3ml or more of normal saline. (depending or port being used) -
o Ensure that the medication is delivered and line is clear of the
medication -
o Turn the 3-way port to open the primary IV line. Ensures that IV
fluids are flowing and regulate the rate as per pre set up/
calculations.
Nursing Department
CHECK-OFF CHECK-OFF
c) IV Medication Into A Central Line VIA BOLUS METHOD
o Cleans the accessible central line port with alcohol wipes for 15
seconds -
o If not heparin locked:
- unclamps the lumen and attaches 10ml syringe
- aspirates 3 ml to check for placement of catheter (blood return)
- Flushes central line using “push pause (turbulent) method” with 5-10ml
of Normal Saline, Reclamps if appropriate,
o If lumen is heparinized:
- checks on the lumen for the amount blocked and aspirates the
drug from the lumen according to the amount noted on the
lumen ---
- Withdraws back 3mls more and flushes the line with 5mls of 0.9% saline
using “push pause (turbulent) method” to assess catheter patency and
to clear the line of medications,
- Reclamps if appropriate,
o Confirms that the central line is still located within the vessel and
removes potential clots -
o Attaches medication syringe to port and administer medication
at correct rate while assessing patient -
o Cleans the accessible central line port –
o Flushes the line with a 10 ml of 0.9% saline , clamps and closes
the lumen with a cap -
o If lumen needs heparin instillation –
- Uses positive pressure technique --- Slowly injects the heparin and
while instilling the last 0.2 ml, slowly begins to clamp the line. (This
technique creates a positive pressure within the lumen and minimizes
the reflux of blood into the tip of the catheter and therefore, reduces
the risk of clotting)
- Labels on the dressing noting-
 Date and time, Name of the medication-added, Amount of heparin
and strength,
 The label should be signed by administering nurse
oSecures the central line with dressing
d) IV Piggyback
o Ensures the compatibility with primary infusion solutions -
o Attaches the tubing of administration set to prepared admixer
container and closes the clamp -
o Cleans the port with antiseptic swab for 15 seconds -
o Attaches the tubing to recessed connection port above
backcheck valve -
o Uses the back-priming method to prime the secondary tubing -
o Closes the roller clamp, squeezes the drip chamber and fills half
full -
o Keeps the primary IV line at lower level -
o Opens the clamp on mini-bag infusion -
o Sets rate on the IV pump or Regulate to deliver the secondary
bag for correct flow-rate or volume to be infused -
Nursing Department
CHECK-OFF CHECK-OFF
Intradermal Skin Testing
o Prepares needed supplies
- prepare tuberculin syringe / insulin syringe/ 1ml syringe with
needle Needle gauge 26-27
- Draws up 0.05 ml of testing material into the syringe
o Explains the procedure and asks if patient has taken any
antihistamines within the past 72 hours -
o Assists to the appropriate position for the site selection.
- Chooses a site that is free of lesions and injuries and are relatively
hairless.
- The inner aspect of mid forearm is an ideal location
o Prepares the selected site by cleaning with alcohol swab in a
circular motion, from inner to outer way and then allows to dry.
o Stretch the skin taut with non-dominant hand and holds the
syringe with the dominant hand, between the thumb and
forefinger.
o Insert the needle at 10°-15° angle to the patient’s skin (almost flat
against the skin) with the bevel side up.
- Insert the needle only about 1/8” with the entire bevel under the
skin ensuring the point of the needle can be seen through the
skin.
o Once the needle is in place, steady the lower end of the syringe
and slides the dominant hand to the end of the plunger and
slowly injects (approximately 0.02 ml) making small wheal or
blister or “bleb” formation with approximately 2mm in diameter.
- If a wheal does not form, repeats the procedure
o Withdraws the needle gently at the same angle that it was inserted
after the completion of procedure-
o Blots the site gently with dry gauze to remove blood or fluid stains.
Ensures not to massage the area or rub the site or apply pressure
after removing the needle.
o Outlines the site of “bleb” formation with a black ballpoint noting
the date & time-
o Explains to the patient not to scratch the site or wipe or wash
during the 15-minute waiting interval before the reaction is
graded.
o 15 minutes after, Measures the diameter of the induration (wheal)
and erythema (flare) in 2 perpendicular axes through the center of
reaction and records in millimeters.
- “Strokes” the region with fingertip, marking the point at which the
skin is raised, if the area of induration appears to merge with the
surrounding normal skin
o Observes the patient closely for signs of impending anaphylaxis
(Itching , Flushing, Shortness of breath, Lump in the throat…)
- Reports any undesirable effects from medication to patient’s
physician or ordering physician –
Nursing Department
CHECK-OFF CHECK-OFF
Subcutaneous Administration
o Prepares needed supplies
- prepare needle length 1/2” – 5/8 ”; Needle gauge 26-30
o assists the patient to the appropriate position for an appropriate
site selection and drapes as needed to expose only area of site to
be used
- checks previous injection sites and ensure rotating the sites for the next injection
- The preferred appropriate administration sites ( anterolateral thigh/ upper outer
tricep area; upper buttocks; abdomen- avoid 2” radius around umbilicus; outer
aspect of upper arm)
o Prepare injection site by cleaning the site and area around it with
an alcohol swab.
- Uses a firm, circular motion while moving outward from the injection site
and allows the area to dry -
o Removes the needle guard or cover with the non-dominant hand
by pulling it straight off rather than twisting or sideward motion as
this may bend the needle.
o Stabilize the injection site by grasping or bunch the area
surrounding the injection site.
o Holds the syringe in the dominant hand between the thumb and
forefinger and Insert needle quickly at a 45°–90° angle into patient
site selected for injection. (90° angle is used more commonly due to short
needles especially with pre-filled syringes)
o After the needle is in place, releases the tissue. Immediately
moves non-dominant hand to steady the lower end of the syringe
and slide dominant hand to the end of the plunger. Avoids moving
the syringe
o Then aspirate syringe. (Avoids pulling back on the plunger or aspirate if
giving anticoagulant-Heparin or insulin.)
o Injects the medication slowly and firmly (at a rate of 10 seconds per ml) -
o Withdraws the needle quickly at the same angle at which it was
inserted, while supporting the surrounding tissue with non-
dominant hand -
o Applies gentle pressure to the site after needle is withdrawn using
a small cotton ball or square gauze –
- Avoids massaging the site especially giving anticoagulant.
o Cover injection site as needed.
Intramuscular Administration
o Prepares needed supplies and assists the patient to the
appropriate position for an appropriate site selection and drapes
as needed to expose only area of site to be used
- Infants <18 months: use vastus lateralis muscle (≤0.5 ml vol); needle
length 7/8” to 1”; 25-27 G
- Children > 18 months and walking to 18 years: deltoid muscle/
ventrogluteal site/ vastus laterlais muscle/ Dorsogluteal site – not
recommended for <3 years old; needle length 7/8” to 1 ¼”; 22-25 G
- Adults >18 years old: deltoid & ventrogluteal iste maybe best for
cachectic adults/ dorsogluteal site – avoid in obese adults/ vastus lateralis
muscle; needle length 1” – 1 ½ “(up to 3” for large adults); 19-25 G
Nursing Department
CHECK-OFF CHECK-OFF
o checks previous injection sites and ensure rotating the sites for the
next injection
o Clean site thoroughly using friction with an alcohol wipe and let it
dry.
o Establish anatomic landmarks and prepare to position the needle
at a 90-degree angle for IM injections
- vastus lateralis muscle (thigh) ; Look at the thigh and divide it into 3
equal parts between the greater trochanter and the knee . The lateral
middle third is where the injection will go. A good site for children
younger than 3 years old. When injecting, lift the vastus lateralis
muscle away from the bone.
- Deltoid muscle (upper arm muscle): Completely expose the upper arm
and give injection 1-3 finger breadths/ 1-2 inches below the lower edge
of acromion process of the scapula over the midaxillary line. Not a good
site for person who is very thin or the muscle is very small
- Dorsogluteal Muscle (buttocks): Expose one side of the buttocks. Site is
above an imaginary line between the greater trochanter and the
posterior superior iliac crest. The injection is administered laterally and
superior to this imaginary line.
- ventrogluteal muscle (hip)
o Spread the skin taut (except in vastus lateralis which requires lifting the muscle)
with your non-dominant hand and with the dominant hand, insert
the needle at a 90° angle into the muscle with a quick, darting
motion.
o Let go of the skin with your non-dominant hand and hold the
syringe so it stays pointed straight in the muscle.
o Slightly pull back the plunger of the syringe to check for any blood
vessel puncture.
- If blood appears: withdraw the needle immediately and don not
inject the medicine. Dispose both the syringe and the medicine
properly and prepare a new injection. When you give the 2nd
injection (new), use other site.
o If no blood is present, push down the plunger to inject the
medicine. (Do not force the medicine by pushing hard, some medicines hurt/ inject
slowly to reduce pain)
o Once the medication is injected, remove the needle at the same
angle it went in.
o Place gauze over the area where you gave injection and firmly
massage the site (unless contraindicated).
- May encourage activity that will use the muscle site of the
injection to promote dispersal of medication and decreases
soreness
o Cover injection site as needed.
6. Evaluate the effects of the medication given.
o Observes patient's response, behavior and evaluate the effects of
medication accordingly:
- after 15 minutes of giving IV medications
- after 30 minutes after giving injections
- after an hour after giving oral medications.
Nursing Department
CHECK-OFF CHECK-OFF
o Recognizes, intervenes, manages and reports, if adverse drug
reaction noted and documents according to policy -
7. Disposes of medical waste accordingly.
- Dispose expended needle/ syringe
8. Remove gloves (if used) and do handwashing.
9. Documentation
o Documents the medication given in the appropriate forms:
medication administration form; measuring intake and output
form; Diabetic chart
o Documents all relevant data / information in an appropriate
forms: effect of medications in nurses progress notes and
Adverse Drug Reaction Form if there is any ADR
GRADE/ Evaluation Criteria

0 - Don’t know how to do it
1 - Can do it under supervision
2 - Competent to do it alone
3 - Can master the process
Additional Remarks
METHOD OF EVALUATION
DO – Direct Observation
SI – Structured Interview
RR – Record Review
EVALUATED BY:
Name of Evaluator
Position
Signature
Date of Evaluation (DD/MM/YY)

3 - Medication Administration

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

3 - Medication Administration

Uploaded by

Copyright:

Available Formats

KING FAHAD HOSPITAL - AL BAHA

NAME of staff being evaluated ________________________________________________ Unit _

(3) MEDICATION ADMINISTRATION

GRADE/ Evaluation Criteria

Date of Evaluation (DD/MM/YY)

You might also like