MEDICATION

ADMINISTRATION
IN THIS LECTURE, we will discuss…

1. Standards of Medication
Administration

2.Roles and responsibilities of

medication nurses.

3.Brief review of the 10 rights in

giving medication.

4.Ways to prevent medication error.

 Standards of
Medication
Administration
Basic Terms:
 STAT orders – used on emergency
basis or medicine is administered as
soon as possible.

 Single order - administration of

medicine at a certain time, but only 1
time. It could be at daytime or bedtime

 Standing order – a pre-written

medication orders and specific
instruction from a physician. (for
Anaphylactic reaction, give 0.3mL of
Epinephrine 1:1000 IM)
Basic Terms:
 Tapering order – order in which the dose is
decreased by designated amount with each
dosing interval. (Prednisone 20mg PO for 2 days,
then taper dose to 15 mg PO for 1 day, then to 10mg for
1 day, then stop)

 Titration order - orders which the dose

adjustment (increase or decrease) of the
medication is in response of the patient’s
clinical status. (Dopamine 5 mcg/kg/min, titrate
infusion rate q15 mins to maintain MAP 60-80mmHg)

 Range order – medication orders that express

the dose or dosing interval with a lower or
upper limit (depends on patient condition.
(Pethidine 50 – 100mg, q3-4hrs prn for pain)
Basic Terms:
 Automatic Stop order – a type of
order to automatically stop the
issuance of a prescribed medication
to prevent continued administration
of potentially hazardous medication
without appropriate review or patient
re-assessment.

 High Alert Medications – are drugs

that bears heightened risk of
causing significant patient harm
when they are used in error.
You must know these:
1. You need to have a Saudi council
license and passed medication
administration competency before
you are allowed to give medication.

2. You must be aware of the different

protocols and guidelines issued by
the Pharmacy Department and posted
in your bulletin boards or in E-learning.

3. Self-drug administration is prohibited

in our hospital.
You must know these:
4. It a must to verify the doctors order
(Nursing Instruction in HIS) comparing it
to the drug card before medications will
be given.

5. During administration, nurses are

expected to bring the drug card or
laptop with barcode scanner (paperless
system) with them along with the
medication itself.

6. Only nursing staff who prepared the

medication must be the one to
administer and sign the drug card.
You must know these:
7. Medication nurses must be aware of
their responsibilities when giving
HAM, Concentrated Electrolytes &
Narcotics and Controlled
Medications.

8. Nurses has the right to question the

doctor’s or pharmacists prescription or
container information which are
unclear, illegible or ambiguous, and to
refuse to administer the medication
the matter has been clarified.
You must know these:
9. No medications will be prepared
ahead of time, rather it must be done
closest to the time of
administration.

10.Medication rooms must be locked at

all times and access must be limited
only to the assigned medication nurse
of the shift.

11. Medication trolleys must be labeled

& locked at all times except during
preparation.
You must know these:
12.The decision to alter the
administration time should be
agreed upon by the nurse and
doctor based on the physician
documented order. If the doctor
wants a dose given outside the
standard administration schedule,
he/she must indicate specific time
for administration.

13.All medications must be properly

labeled.
AS A MEDICATION NURSE, you must

1.Ensure that the ten (10)

rights of drug
administration have been
observed before
medication will be given to
the patient.
10 RIGHTS YOU MUST KNOW, you
must
AS A MEDICATION NURSE, you must

2. Check medication expiry

date, discards expired
medications, and correctly
labels patient’s medications.
AS A MEDICATION NURSE, you must

3. Consider any substance

that may interact
dangerously with each
other, or any drug- food
interaction.
DRUG-FOOD INTERACTION, nice to know
DRUG-FOOD INTERACTION, nice to know
AS A MEDICATION NURSE, you must

4. Determine whether it is
necessary or advisable to
withhold medicine pending,
consultation with the
medical practitioner,
pharmacist or senior
colleague.
WHY WITHHOLD? know the most common reasons

1.Medications with BP considerations.

2.Medications with pulse considerations.

3.Medications with bleeding

precautions.

4.Unclear/not legible/erroneous Doctor’s

order.

5.Nurse’s judgment and experience.

AS A MEDICATION NURSE, you must

5. Contact prescriber without

any delay where
contraindications are
observed, taking advice from
the pharmacist when
appropriate.

6. Make clear, accurate,

continuity of medication record.
AS A MEDICATION NURSE, you must

7. To inform attending physician

immediately when refusal to take
medication is decided by the patient
let the patient or significant other
sign the AMA form, after
explanation by Doctor on duty.

8. Enhance the patient’s or his/her

significant others understanding
of the effects and side effects of the
medication.
AS A MEDICATION NURSE, you must

9. Record effects and adverse

effects of medication.

10. Medication nurses should

ensure that all IV medications
should be regulated on
appropriate time and they should
go back and make a follow up if
above medications are already
consumed.
AS A MEDICATION NURSE, you must

11. Report immediately any signs

of allergies or adverse drug
effects.

12. Ensure that patient had taken

the medication before leaving
his/her room, and to never leave
the patient without taking his/her
medicine.
AS A MEDICATION NURSE, you must

13. NEVER leave

medication at bedside.

14. Reports non labeled

high alert medications
received from pharmacy
through OVR.
AS A MEDICATION NURSE, you must

15. Make an incident

report/OVR and medication
error to be submitted to the
Nursing Office & QM within
24H.
AS A MEDICATION NURSE, you must

16. Make use of

Medication Tray when
preparing and taking
medications from
Medication Cabinet /
Room / Tray .
AS A MEDICATION NURSE, you must

16. Know basic medication

calculations:
UNIVERSAL FORMULA
WEARING OF GLOVES:
1. When there is a likelihood of
coming into contact with
patient’s blood or other
potentially infectious materials.

2. If the nurse’s skin is NOT intact.

3. During preparation of skin

staining medications.
STANDARD MEDICATION TIME

APPROVED
INSTRUCTION ABBREVIATION STANDARD MEDICATION TIME
DESCRIPTION
Daily Everyday 0600H or 1000H
At Bedtime Nocte 2200H
Twice Daily bid 0600H – 1800H
Every 12 Hrs. q12 Hrs. 0600H – 1800H / 1000H – 2200H
Three Times Daily tid 0600H – 1400H – 2200H
Every 8 Hrs. q8 Hrs 0600H - 1400H - 2200H
Four Times Daily qid 0600H – 1000H – 1400H – 1800H
Every 6 Hrs. q6 Hrs 0600H-1200H-1800H-2400H
Every 4 Hrs. q4Hrs 0600H-1000H-1400H-1800H-2200H-0200H
Three Times a Day with   As per Unit Meal time
Meals
Twice a Day with Meals   Twice a day with scheduled meal
Before Meals ac 30 minutes before meal
After Meals pc 30 minutes after meal
In-Patient Prescription Sheet
In-Patient Prescription Sheet
In-Patient Prescription Sheet
LET’S PRACTICE:
how will you deal with this situation?
1.A 62 y.o. male patient was admitted
with a case of Transient Ischemic
Attack. This patient is known to be
hypertensive and diabetic and has a lot
of maintenance medication. When your
entered the room, you saw that his son
is about to give him his usual dose. You
also saw a big plastic bag full of
medication.

As a medication nurse, what are

you suppose to do in this situation?
YOUR ISSUES,
you consider these…
1. You caught the son about to
give medication to his father.

2. There are medication in the room

– bag full of medication from
home.

3. Dealing with POM – patient’s

own medications.

Resolve these issues.

LET’S PRACTICE:
how will you deal with this situation?
2.A 78 y.o. female patient is for
discharge following a Left Total
Knee Replacement performed by
Dr. Olayan. You happened to check
his medication drawer and you saw
plenty of stocks remaining for him.
What will you do with these
remaining medications?
As a medication nurse, what are
you suppose to do in this situation?
YOUR ISSUES,
you consider these…
1. Patient is for discharge – going
home.

2. There are still plenty of

remaining medication in her
drawer.

3. Returning remaining
medication in the Pharmacy.

Resolve these issues.

LET’S PRACTICE:
how will you deal with this situation?
3.Five (5) minutes after starting a drip of
Metronidazole 500mg IV to a patient who
will undergo appendectomy, the
attendant called you. You came to check
the patient and you discovered that the
patient started to have rashes on his
arms and chest. The patient begins to
anxious about what he feels. You were
thinking that he developed allergic
reaction from the medication.
As a medication nurse, what are you
suppose to do in this situation?
YOUR ISSUES,
you consider these…
1. Patient is receiving
Metronidazole 500mg IV drip.
2. The attendant called you.
3. You discovered that the
patient had rashes – arms &
chest.
4. You are thinking that he
developed ADR-allergic drug
reaction.

Resolve these issues.

LET’S PRACTICE:
how will you deal with this situation?
4.An 80 y.o. male patient is prepared for
ICCU admission with a diagnosis of
Complete Heart Block. This patient now
is in ER under the care of an ER doctor.
As your colleague is preparing TCP for
this patient, the ER doctor said you will
give Atropine 0.5mg for this patient.
Patient’s vital signs are fluctuating. The
patient saw you and he told you, “I don’t
like that medicine. I will not take it.”
As a medication nurse, what are you
suppose to do in this situation?
YOUR ISSUES,
you consider these…
1. Patient is for ICCU admission.
2. A case of complete heart
block.
3. TCP is being prepared.
4. Patient’s vital signs are
fluctuating.
5. Becoming unstable.

Resolve these issues.

LET’S PRACTICE:
basic medication calculation

5.A 20 y.o. male patient is having

urine retention. The Doctor
ordered to give Furosemide
(Lasix) 40 mg IV stat. The
available concentration of the
ampoule is 20mg/2ml. How many
ml of Furosemide are you going
to administer to the patient?
Answer:

Stock = 20mg/2ml Ampoule

DOSE = 40 mg x 2 ml
20 mg

DOSE = 2 x 2ml

DOSE = 4 ml
LET’S PRACTICE:
basic medication calculation

6. The Doctor ordered to give

Levothyroxine (Euthyrox) 25mcg
once daily orally. The available
concentration is 50mcg / tablet.
How many tablets of
Levothyroxine are you going to
administer to the patient?
Answer:

Stock = 50 mcg/tablet

DOSE = 25 mcg x 1 tab

50 mcg

DOSE = 0.5 x 1 tab

DOSE = 0.5 or 1/2 tab

LET’S PRACTICE:
basic medication calculation

7. The Doctor ordered to give

Ipratropium (Atrovent) 250mcg
via nebulization Q8H. The
available concentration is
500mcg / 2ml. How many mL of
Ipratropium are you going to
administer to the patient per
dose?
Answer:

Stock = 500 mcg/2ml Respule

DOSE = 250 mcg x 2mL

500 mcg

DOSE = 0.5 x 2 mL

DOSE = 1 mL
LET’S PRACTICE:
basic medication calculation

8. The Doctor ordered to give

Cefuroxime 1.5 gram IV over 1
hour as ;loading dose of
prophylactic antibiotic, 30 mins
prior to OR. The available
concentration is 750 mg / 50 mL
of D5W. How many mL are you
going to infuse?
Answer:

Stock = 750 mg/ 50ml

Conversion: 1 gram = 1000 mg
DOSE = 1500 mg x 50 mL
750 mg

DOSE = 2 x 50 mL

DOSE = 100 mL
 ANY
QUESTIONS?
THANK
YOU!