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Dosage Calculations

Implementation: The 10 “rights” of medication


administration:
1. Right drug
2. Right dose
3. Right time
4. Right route
5. Right patient
6. Right reason
7. Right documentation
8. Right evaluation
9. Right patient education
10. Right to refuse
Jones and Treiber (2018) advocate for additional ‘rights’ of medication
administration for nurses:

Right to Right to Right to


Sufficient Time Workload Environment

Right to Properly Right to Call for


Right to Time for
Functioning “Help” Without
Documentation
Technology Repercussions

Right to Have a
Voice
According to Stats Canada (2015), 19% of hospital nurses
acknowledged that over the previous year, they had been
involved in a medication error “occasionally” or
“frequently”
How or why do medication errors occur?

What are some examples?

How can the example errors be avoided?


 Can an RPN take a verbal medication order
from a physician?

 Can an RPN take a telephone medication


order from a physician?

 Can an RPN administer a medication ordered


by a Nurse Practitioner?
Common Sense + Math = Dosage
Calculations

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 Common sense should prevail!

 If the drug dose seems wrong, it probably is:


recalculate, double check, and/or confirm
with another nurse.

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 Registered Practical Nursing regulatory
licensing exam – calculators are NOT
ALLOWED.
 The College of Nurses of Ontario (CNO)
currently expects Ontario nurses to
demonstrate mathematical skills without the
use of calculators.

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 Tablets
 Drug Dose Desired (D) = Drug Dose Given(G)
Drug Dose on Hand(H)

Formula: D = G
H
 Liquids (PO, IM, SC)
 Drug Dose Desired(D) X Amount of Liquid(A) = Amount Given(G)
Drug Dose on Hand(H)

Formula: D X A = G
H

10
Formulas
Volume X drop factor = rate (gtts/min)
time in minutes 1

Total mL ordered = mL/hr


# of hours
**Drop factor = # of drops per mL
Common drop factors are 10, 15 and 60
How many mL per hour will the client receive?

Order: 1000mL D5W over 10 hours

Answer: 1000mL = mL/hr = 100mL/hr


10 hrs

Total mL ordered = mL/hr


# of hours
How many gtts/min will the client’s IV be set at?
Order: NS at 150mL/hr using a 15 drop factor
administration set
Answer: 150 X 15 gtts/mL = gtts/min = 37.5 gtts/min
60 min

**Answer rounded to 38 gtts/min

Volume X drop factor = rate (gtts/min)


time in minutes 1
How many mL per hour will the client receive?

Order: 750mL 0.9%NS over 2.5 hours

Answer: 750mL = mL/hr = 300mL/hr


2.5 hrs

Total mL ordered = mL/hr


# of hours
How many gtts/min will the client’s IV be set at?
Order: D5W at 175mL/hr using a 60 drop factor
administration set

Answer: 175 X 60 gtts/mL = gtts/min = 175 gtts/min


60 min

Volume X drop factor = rate (gtts/min)


time in minutes 1
Mr. HY is being admitted for DVT therapy. He
weighs 58.8 kgs.
1. What loading dose of Heparin would be
required?
2. What is the initial maintenance dose?
3. After 6h of therapy, Mr. HY’s aPTT is 320
sec. How long do you hold the therapy?
What is the rate change? When do you draw
another aPTT level?
Jones, J. & Treiber, L. (2018). Nurses’ rights of
medication administration: Including authority
with accountability and responsibility. Nurses
Forum, 1(5), doi: 10.1111/nuf.12252

Statistics Canada. (2015). Findings. Retrieved


from https://www150.statcan.gc.ca/n1/pub/82-
003-x/2008002/article/10565/5202501-eng.htm