Chapter 35: Medication Administration (Part 2)

Bonnie M. Wivell, MS, RN, CNS

Routes Of Administration• PO – Oral• SL – Sublingual• Buccal• Inhalation• Nasal• Ears, Ears• Topical / Skin

Application• Rectal• Vaginal

• IM - Intramuscular• IV – Intravenous• SC – Subcutaneous • ID - Intradermal

Process of AdministrationProcess of Administration

• Identify the client

• Inform the client

• Administer the drug

• Provide adjunctive interventions as indicated

• Record the drug administered

• Evaluate the client’s response to the drug

Types Oral of Medications

• SOLID FORMS– Caplets– Capsules– Tablets

• Scored

– Gel Caps– Enteric Coated– Extended Release

• LIQUID FORMS– Elixir– Extract– Acqueous Solution/

Suspension– Syrup– Tincture

Oral Administration Of Medication Cont’d.

• Other Oral Forms– Troche/ Lozenge

• Not meant to be swallowed

– Aerosol• Topical

Oral Administration

• Swallowed• Dissolved in Liquid• Crushed and put in applesauce/pudding• Crushed and given via tube (pg. 718)

– Gastric Tube (G-tube or PEG)– Enteral Feeding Tube– Nasogastric Tube (NG)

• Always refer to drug book or check with pharmacist before crushing a medication

Oral Administration Cont’d.• Cutting and Crushing Tablets

• Do not crush:• Enteric Coated• Capsules • Beads from capsules

– Cut only “scored” tablets

• Do not swallow or chew sublingual tabs unless directed to do so

Buccal and Sublingual Administration

• Buccal – between the cheek and gums– Tablet– Semi-Solid– Paste– Thick Liquid

• Sublingual – under the tongue

Topical and Transdermal Application

• Types of meds given topically– Anti-arthritis (Heat)– Cardiac Meds (NTG Paste)– Pain Med (Patch)

• Fentanyl (Duragesic)

– Other Patches• Nicotine• Estrogen• Scopolamine

• What is the prescribed length of time for application?

Topical Application

• Sprays– Oral– Topical– Nasal– Inhaled

• MDI• DPI

• Vaginal / Rectal– Suppositories– Creams

• Ear Drops– Position ear

• Eye Drops

• Irrigations

Parenteral Administration

• Intramuscular

• Subcutaneous

• Intradermal

• Intraosseous

• Intravenous

EquipmentEquipment

• Syringes– Insulin– TB– Hypodermic

Luer Lok vs Non Luer LokLuer Lok vs Non Luer Lok

Types of Insulin PensTypes of Insulin Pens

Parts of NeedleParts of Needle

Sizes of NeedlesSizes of Needles

• Length 3/8” to 3”• Gauge 30 – 19• 20-22G, 1-1.5” for IM• 25-30G, 3/8-1/2” for

SQ

Filter Needle

Single Dose Ampule

Single Dose Vial

Multi-dose Vial

Insulin Preparation

• Rapid, short, intermediate, and long acting• Know onset, peak and duration• ONLY regular insulin can be given IV• Sliding scale based on blood glucose • Gently roll cloudy• DO NOT SHAKE• Prepare last and administer first if mixed

because regular can become “contaminated” and action can be affected

• CLEAR to CLOUDY

Injection Angles

Intradermal InjectionIntradermal Injection

Intramuscular• PAIN MEDICATION

• ANTIBIOTICS

• VACCINATIONS

• SUPPLEMENTS– IRON– B12

IM Injection SitesIM Injection Sites

Deltoid IM Injection SiteDeltoid IM Injection Site

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Carpuject

Tubex

Where Do You Get IV and Injectable Medications?

• IV Solutions are standard, mixed for the patient in the pharmacy or ordered from the outside– IVPB (IV Piggyback) meds are mixed in the

pharmacy– Pre-mixed– Add-Vantage

• Injectable Medication– Unit dose

• Carpuject• Ampules• Vials

NEEDLELESS SYSTEMS

3ml Luer Lock Syringe + Clave Adapter

Where do Drugs Come From in LTC FACILITY?

• MEDICATIONS ARE DELIVERED FROM AN OUTSIDE PHARMACY– ORDERS ARE FAXED TO PHARMACY– MEDICATIONS ARE DELIVERED BY THE

PHARMACY

• SOME STOCK DRUGS AND NARCOTICS ARE ON SITE FOR PRN USE

Medication Safety

““SIX”SIX”(OR SEVEN) (OR SEVEN) RIGHTSRIGHTS

RIGHT MEDICATIONRIGHT MEDICATIONRIGHT DOSERIGHT DOSE

RIGHT PATIENTRIGHT PATIENTRIGHT TIMERIGHT TIME

RIGHT ROUTERIGHT ROUTERIGHT DOCUMENTATIONRIGHT DOCUMENTATION

THE RIGHT OF THE PATIENT THE RIGHT OF THE PATIENT TO REFUSETO REFUSE

The RIGHT Medication • As the physician prescribed?

• Trade name or generic?

• Does the drug match the MAR? (medication administration record)

• Is the drug appropriate for the patient?

• Does it make sense??

The RIGHT Dose • DOES THE DOSE OF MEDICATION IN

YOUR HAND AGREE THE DOSE ON THE MAR?

• ARE THE MG, MCG, ML THE SAME?

• IS THIS THE TIME TO DO MATH OR GO ON A BREAK!?

The RIGHT Patient

– HAVE YOU CHECKED USING TWO PATIENT IDENTIFIERS?

– PATIENT STATES…VERIFIES BD– PATIENT ARMBAND– COMPARE PT. ID NUMBER TO MAR– WHAT IF THERE IS NO ARM BAND?

The RIGHT Time • AM or PM

• Q4

• Tid

• Bid

• Qid

• qd

The RIGHT Route• PO

• IV

• SC (SQ)

• TRANSDERMAL

• RECTAL

• IM

• DOES IT MAKE SENSE??

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Patient Controlled Anelgesia

PCA PUMP

MOD – Medication on Demand

•The Radio Frequency Identification (RFID) based wrist band, the first of its kind to be implemented successfully, assist nurses by automating the process of administering patient medication.