DRUG ADMINISTRATION ABBREVIATIONS physician or nurse practitioner who prescribes a drug,

the pharmacist who dispenses the drug, and the nurse

ABBREVIATIONS MEANINGS who administers the drug. Often the nurse is the
ac Before meals final check in the process because the nurse is the
ad lib As desired/as directed one who administers the drug and is the one
AM Morning responsible for patient education before the patient is
bid (bie in die) twice a day discharged to home.
cap Capsule Nurse’s Role
gtt Drop
h or hr Hour  Ensuring medication safety with all of the
IM Intramuscular potential problems that could confront the
IV Intravenous patient
no Number  This can be managed by consistently using
pc (post cebum) after the “rights” of medication administration
meals/after eating
PO (per orem) by mouth Patient’s Role
PM Afternoon
 Only the patient really knows what is being
PRN (pro re nata) when
taken and when, and only the patient can
needed/necessary
qid (quake in die) four report the actual as opposed to the
times per day prescribed drug regimen being followed
q2h Every 2 hours (even or  Patient and family education play a vital
when first given) role in the prevention of medication errors
q4h Every 4 hours (even)  Encourage patients to be their own
q6h Every 6 hours (even) advocates and to speak up and ask questions
q8h Every 8 hours (even) which helps to prevent medication errors
q12h Every 12 hours (even)  Teach the patient to:
Rx Take o Keep a written list of all medications
STAT Immediately/at once they are taking, including prescription,
tab Tablet OTC, and herbal medications
tid Three times a day o Know what each of the drugs is being
Note: The Institute for Safe Medical Practices used to treat.
recommends that the following abbreviations be o Read the labels, and follow the
avoided because they can lead to medication errors: directions
q: instead use “every”; qh: instead use “hourly” or o Store drugs in a dry place, away from
“every hour”; qd: instead use “daily” or “every day”; children and pets
qhs: instead use “nightly”; qod: instead use “every o Speak up – “you are the most important
other day.” For other recommendations, see the person in the health care team”
official Joint Commission “Do Not Use List” at
http://www.jointcommission.org/facts_about_the_off
icia
PROPER DRUG ADMINISTRATION

14 R’s of Drug Administration

MEDICATION SAFETY
1. Right Drug - right client receives the drug
Drug regimen process includes: that was prescribed; for hospitalized
patients, the drug orders are written on the
 Prescribing doctor’s order sheet, signed by the duly
 Dispensing authorized person
 Administering a drug to a patient o A telephone order (TO) for
medications must be cosigned by the
It has a series of checks along the way to help to
physician within 24 hours
catch errors before they occur. These include the
 o Check the drug label 3 times before
administering the medication
2. Right Client
o Check ID bracelet
o Have client state his or her name
o Address the person by name before
giving the drug
o Always double check orders that
the client questions
o Verify patient’s allergies with chart and
with patient
3. Right Route – necessary for adequate and
appropriate absorption
o Includes the correct route of
administration, and administration in
such a way that the client is able to take
the entire dose od the drug and receive
maximal benefit from it
o Nursing implications:
 Know the prescribed route of
administration
 If no route is specified in the order,
question the physician about
intended route
 Always gain the patient’s
cooperation before attempting to
administer the medication
 Consider patient’s developmental
level
 Assess the patient’s ability to
swallow (for oral meds.)
 Use aseptic technique in the
preparation of parenteral
medications
4. Right Dose – refers to the dose prescribed
for a particular patient
o Nursing implications:
 Be familiar with the various
measurement system and the
conversion from one system to
another
 Always use the appropriate
measuring device and read it
correctly
 Always measure the volume of
liquid medication at the lowest
point of the meniscus
 Shake all suspensions and
emulsions
 When measuring drops of
medication with a dropper, always
hold the dropper vertically and
close to the medication cup
 Do not attempt to divide unscored
tablets and do not administer
tablets which have been broken
unevenly along the scoring
o Measuring devices:
 Medication cups
 Dropper
 Syringe
 Tuberculin
 Insulin
5. Right Time/Frequency – time at which the
prescribed dose should be administered
o Nursing implications:
 To achieve maximum
effectiveness, medications are
scheduled to be administered at a
specific time
 Administer drugs that are affected
by food, such as tetracycline and
penicillin before meals
 Administer drugs such as
potassium and aspirin after meal or
with food
 It is the nurses’ responsibility to
check whether the client is
scheduled for diagnostic purposes
such as endoscopy, fasting blood
sugar etc.,
 Check the expiration date,
DISCARD /or return to pharmacy
if expired
 Antibiotic should be administered
at even intervals throughout a 24-
hour period to maintain therapeutic
blood level
6. Right Assessment
o Check your patient actually needs the
medication
o Check for contraindications
o Baseline observations if required
o Properly assess patient and tests to
determine if medication is safe and
appropriate
o If deemed unsafe or inappropriate,
notify ordering physician and document
notification
o Document that medication was not
administered and the reason that dose
was skipped
7. Right Approach o Inform responsible party of
8. Right to Education – this right is a principle consequences of refusing medication
of informed consent which is based on the o Verify that responsible party
individual’s having the knowledge to make a understands all of these consequences
decision o Notify physician that ordered
o Patient teaching topics: medication and document notification
 Name of medication o Document refusal of medication and
 Purpose of medication that responsible party understands
 How and when to take medication consequences
 How to monitor drug’s 12. Right Principle of Care
effectiveness o How we administer the drugs
 Drugs/food that may cause o Encompasses the 14 rights
interactions o How a prudent nurse should behave,
 Possible adverse effects that is knowing what should and
 Signs and symptoms to bring to the shouldn’t be given to the patient
doctor’s attention 13. Right Prescription
 Storing and handling
9. Right Evaluation
o After the medication has been
administered:
 Assess patient for any adverse side
effects
 Assess patient for effectiveness of
medication
 Compare patient’s prior status with
post medication status
 Document patient’s response to
medication
10. Right Documentation – each time a
medication is administered, it must be
documented; documentation must be done
at the time the medication is given; all of
the documentation that is required on the
medication log must be completed
o Documentation should be done in blue
or black ink
o No pencil or white out can be used
o Never cross out or write over
documentation
o If you make a mistake when you are
documenting on the medication log,
circle your mistake and write a note on
the log to explain what happened
o Never document before medication is
administered
11. Right to Refuse
o The legally responsible party (patient,
parent, family member, guardian, etc.)
for patient’s care has the right to refuse
any medication
 o The person’s name 2. Apothecary System – very old system of
o Name of medication measurement that was specifically
o Name and telephone number of the developed for use by apothecaries or
licensed practitioner pharmacists
o Time of administration o The minim as the basic unit of liquid
o Dosage, method and duration of measure
medication o Grain as the basic unit of solid measure
14. Right Nurse Clinician o An interesting feature of this system is
o Medications are only administered by that it uses Roman numerals placed
the licensed nurse who has prepared after the unit of measure to denote
them
o Medications may be self-administered
by the patient under licensed nurse,
specifically ordered by a Licensed
Independent Practitioner

DRUG CALCULATIONS

Measuring Systems

At least four different systems are currently

used in drug preparation and delivery:

 the metric system

 the apothecary system
 the household system
 the avoirdupois system

1. Metric System – the most widely used
system of measure
o Based on the decimal system, so all
units are determined as multiples of 10
o Used worldwide and makes the sharing
of knowledge and research information
easier
o Uses the gram as the basic unit of solid
measure
o Liter as the basic unit of liquid measure
amount
3. Household System – measuring system that
is found in recipe books
o Uses the teaspoon as the basic unit of
fluid measure
o Pound as the basic unit of solid
measure
o When a patient is using a liquid
medication at home, it is important to
clarify that the measures indicated in
the instructions refer to a standardized
measuring device

4. Avoirdupois System – another older system
that was very popular when pharmacists
routinely had to compound medications
o Uses ounces and grains, but they
measure differently than those of the
apothecary and household systems
o Seldom used by prescribers but may be
used for bulk medications that come
directly from the manufacturer
compound medications
Methods for Calculation
Two general methods for calculating drug doses are
the basic formula and the ratio and proportion.
These methods will be used for calculating oral and
injectable drug doses. For drugs that require
individualized dosing, calculation by body weight
(BW) or body surface area (BSA) may be necessary.
Adult Drug Calculation
1. Basic formula
D child’s dose = × weight of child (lb) = average adult dose
×V=A
H
o D is the desired dose: drug dose
ordered by the physician
o H is the on-hand dose: drug dose on
the label of the container
o V is the vehicle: drug form which the
drug comes in (tablet, capsule, liquid)
o A is the amount calculated: to be given
to the patient
2. Ratio and Proportion
KNOWN DESIRED
H:V :: D:X
o H is the drug on hand
o V is the vehicle or drug form
o D is the desired dose (as ordered)
o X is the unknown amount to give
o :: stands for “as” or “equal to”
o Multiply the means and the extremes
and solve for X which is the divisor
Pediatric Drug Calculation
The purpose of learning how to calculate pediatric
dosages is to ensure that children receive the
correct dose within the approved therapeutic
range.
o Pediatric dosage per body weight
o Check drug parameters
o Check against dose orders
o Compute using basic formula or ratio &
proportion
Example:
Order: Cefaclor (Ceclor) 50 mg QID
Child weighs: 15 lbs or 6.8 kg (/ by 2.2)
Drug parameter: 30mg-40mg/day
Available: Cefaclor 125 mg/ 5ml
Is the prescribe dose safe?
o Clark’s Rule – a method of
determining the correct drug dose for a
child based on the known adult dose
(assumes that the adult dose is based on
150 lb
a 150-lb person)
o Fried’s Rule – a calculation method
Child’s dosage = Age in months X Adult dosage
that applies to a child younger than 1
year of age; assumes that an adult dose
would be appropriate for a
150
 child who is 12.5 years (150 months)
old

o Young’s Rule – uses age which makes

it easier to remember, the word young
refers to age
Adult Dose X (Age ÷ (Age+12)) = Child's Dose