Right Patient

When using the medication card system,

compare the name of the patient on the medication card with the patients identification bracelet. With the unit dose system, compare the name on the drug profile with the individuals identification bracelet.

Contd
Some institutional policies require that the

individual be called by name as a means of identification. This practice must take into consideration the patients mental alertness and orientation. It is much safer ALWAYS to check the identification bracelet

Right Drug
it is imperative to compare the exact

spelling and concentration of the prescribed drug with the medication card or drug profile and the medication container.

Contd
Regardless of the drug distribution system used, the

drug label should be read at least three times:

Before removing the drug from the shelf or unit dose

cart. Before preparing or measuring the actual prescribed dose Before replacing the drug on the shelf or before opening a unit dose container (just prior to administering the drug to the patient)

Right Dose
Check the drug dosage ordered against the range specified in the reference books available at the nurses station

Right Route
The drug order should specify the route to be used for the administration of the medication.
Never substitute one dosage form of medication

for another unless the physician is specifically consulted and an order for the change is obtained. There can be a great variation in the absorption rate of the medication through various routes of administration

Right Time
When scheduling the administration time of a medication, factors such as timing abbreviations, standardized times, consistency of blood levels, absorption, diagnostic testing, and the use of p.r.n. medications must be considered.

Contd
Standard AbbreviationsThe drug order specifies the frequency of drug administration. Standard abbreviations used as part of the drug order specify the times of administrati0n
Standardized Administration TimesFor patient safety, certain medications are administered at specific times.

Contd
Maintenance of Consistent Blood LevelsThe schedule for the administration of a drug should be planned to maintain consistent blood levels of the drug in order to maximize the therapeutic effectiveness.

Right Documentation
Documentation of nursing actions and patient observations has always been an important ethical responsibility, but now it is becoming a major medicolegal consideration as well
Always chart the following information: date and time of administration, name of medication, dosage, route, and site of administration.

Contd
Documentation of drug action should be made in the

regularly scheduled assessments for changes in the disease symptoms the patient is exhibiting. Promptly record and report adverse symptoms observe. DO record when a drug is not administered and why. DO NOT record a medication until after it has been given. DO NOT record in the nurses notes that an incident report has been completed when a medication error has occurred.

Right Client Education

Explain information about the medication to the client (e.g. why receiving medication, what to expect and what are the precaution)
Nursing Responsibilities:

Clients may need guidance to enhance drug effectiveness and prevent complications. Some clients convey fear about their medication, the nurse can allay fears by listening carefully to clients concerns and giving correct information

Right to Refuse
Adults client have the right to refuse any medication
Nursing Responsibilities:

Assess the reason for refusing the medication. If knowledge deficit underlies clients reason for refusal, provide appropriate explanation why the medication was ordered. Document if client refuses, the medication and the reason

Contd
The nurses role is to ensure that the client is fully informed of the potential consequences of refusal to the health care provider

Right Assessment
Some medication require specific assessment prior to administration (e.g. apical pulse, blood pressure, lab results)
Nursing responsibilities:

Medication orders may include specific parameters for administration (e.g. do not give if pulse less than 60 or systolic blood pressure less than 100). Obtain baseline data before administration. Assess client vital signs.

Right Evaluation
Conduct appropriate follow-up (e.g. was the desired effects achieved or not? Did the client experience any adverse effects or adverse reaction?)

DRUG COMPUTATION

IV COMPUTATION
DROP RATE= total vol.(ml) x drop factor (gtts/ml)

Time (hr) x 60 min/hr

VOLUME= drop rate (gtts/min) x time (min)

Drop factor (gtts/ml)

IV COMPUTATION
TIME= total volume (ml) x drop factor ( gtts/ml)

Drop rate (gtts/min) x 60 (min/hr)

FLOW RATE= drop rate (gtts/min) x 60 min/hr

Drop factor (gtts/ml)

Examples
Doctors order: Give 500 cc D5LR to be infused in 6

hours. You should regulate the IV at: DR= V x DF T x 60 min/hr = 500 ml x 15 gtts/ml 6 hrs x 60 min/hr = 7500 gtts/ 360 min DR = 20.8 gtts/min

Contd
FR= DR x 60 min/hr

DF = 20.8 gtts/ min x 60 min/hr 15 gtts/ml FR = 80 ml/hr

Examples
The doctor ordered PNSS 1 liter to run for 10 hours using

microset. What is the rate per minute? Answer: DR= V x DF T x 60 min/ hr = 1000 ml x 15 gtts/ min 10 hr x 60 min/hr = 15000 600 DR =25 gtts/min

 You received D5IMB 500cc at 400cc level at 7am. If the

rate is 30 ugtts/min, how much is infused to the patient in 5 hours?

Examples
D5LR 1 liter to run for 6 hours using macroset. What is

the rate per minute? Solution: DR= Volume x DF Time x 60 min/hr = 1000 x 15 gtts/min 6 x 60 mins/hr =15000 360 DR = 40 gtts/mins

Drug computation
Drug order /Stock on hand x quantity or volume=

desired dose
D/S x Q= desired dose

Contd
An antihypertensive, Minoxidil (Loniten) 5mg p.o has been ordered. Stock is 2.5 mg/tab. How many tabs should be administered?
Solution: 2.5 x 2= 5.0

Therefore 2 tabs of Minoxidil should be administered

Contd
The expectorant guiafenesin ( robitussin) 300 mg p.o has been ordered. The bottle is labeled 1oo mg/5ml. How many ml should be given?
Solution: 300/100 x 5= 15 ml