DRUG ADMINISTRATIONBYNelson Munthali Dip/RN

OBJECTIVES

Define drug administration. Mention types of drug administration. Explain the indications for each route of drug

administration. Advantages and disadvantages of each route. List the five rights to ensure proper drug administration. Discuss important information concerning medication

to assess from the patient on admission and before medication administration.

DEFINITION

This is the process of giving out medication to the patient in order to treat or prevent disease or complication.

A drug is any substance that alters physiologic function with the potential for affecting health.

A medication is a drug administered for its therapeutic effects.

Thus all drugs are medications but not all medications are drugs.

ROUTES OF DRUG ADMINISTRATION

Oral. Parenteral- intramuscular, intradermal,

intravenous and subcutaneous. Topical – skin, otic , vagina, rectal,

nasal and ophthalmic.

COMPONENTS OF A DRUG ORDER

Medication name

The name of the medication can be written in most settings using the genetic or trade name. The name should be clear all the time.

Medication dosage

This includes the frequency and strength of the of the dose e.g. Metronidazole 500mg every 8 hours.

Route of administration

Most medications can be given by several routes e.g. orally (PO), intravenously (IV),and intramuscularly (IM).

COMPONENTS OF A DRUG ORDER

Signature

A signature of the prescribing officer must appear below the written order.

THE PATIENTS RIGHTS

To be informed of the drugs name, purpose, action and any possible adverse effects.

To refuse any medication. To have complete information about the

experimental use of drug and to refuse or consent to its use.

To receive labelled medications safely. Not to be given unnecessary

medications.

MEDICATION ASSESSMENT

To administer medication safely to any patient, it is important to collect information during the initial assessment. This is baseline data but it should be on going nursing assessment to determine drug effectiveness and promptly identification of side effects. This will also assist in individualized patient teaching to help ensure patient compliance with pharmacologic therapy.

INFORMATION COLLECTED ON ADMISSION.

Important information to elicit from the patient during the initial interview includes a medication history , allergies, medical history and pregnancy lactation status.

ASSESSMENT BEFORE MEDICATION ADMINISTATION

Medication record.

This allows the nurse to see which medication has been used most recently and whether it is time for the medication to be administered . This prevents incidences whereby a drug is administered at the wrong time.

Diet and fluid orders.

A patient may have fluids and food withheld in preparation for surgery or a diagnostic test. When a patient is ordered to have nothing per mouth most oral medications are withheld.

Cont…

But if patient is on medication which cannot be stopped abruptly, like antihypertensives , they have to take them with small sips of water.

If a diabetic patient is on NPO the physician should be contacted because of the need to adjust or withhold the medication. Patients blood glucose levels are checked regularly and if insulin dependent on NPO for more than 4 hours an infusion of dextrose should be commenced.

Cont…

Physical assessment.

-Check for the ability to of the patient by giving the patient a sip of water to swallow aswallow nd if he does not cough or chock then he can take medication orally.

-Gastrointestinal motility should be assessed too because a dysfuntional gastrointestinal system affects drug absorption.

-Check if the patient has enough muscle mass to tolerate the medication because lean muscles can result into poor absorption of medication as they are injected in the subcutaneous muscles.

-check for adequate venous access and the temperature, redness, swelling and pain at the insertion site.

- Vital signs should be checked for medication requiring this e.g. digitalis which require a heart rate of not less than 60 beats per minute because they slow the heart beat.

CONT…

Assessment of knowledge and compliance.

This ensures that the patient takes the medication with knowledge of the purpose and side effects of the medication.

FIVE RIGHTS IN MEDICATION ADMINISTRATION.

Each time a medication is administered it is important to make sure that the right patient , is given the right medication in the right dose by the right route at the right time.

1. Right patient

medication has to be given to the patient for whom it is intended. The patient should tell you their name and you check on the treatment chart.

2. Right medication

Giving the medication that was ordered for a particular patient.

Cont…

3. Right dosage.

Giving the dose that was ordered for the individual patient.

4. Right route.

Medication is given by the ordered route is safe and appropriate for the individual patient.

5. Right time..

Giving the medication at the time it is ordered e.g. before or after food, nocte or 8 hourly.

DOCUMENTATION

This is very important because it avoids medication errors like repeatition . The time when the drug was given should be indicate against the signature. If medication was not given for some reasons it should be indicated on the chart e.g. NPO. For drugs like insulin injections the site too should be indicated. The therapeutic and side effects of the medication should be included in documentation .

ROUTES OF MEDICATION ADMINISTRATION

ORAL MEDICATION

Medication that are given by mouth are designe dto be swallowed(oral route), to be held under the tongue until they dissolve (sublingual).

Purpose

1. Provide a safe, effective, economical route for administering medications.

2. Provides a sustained drug action with minimal discomfort.

ASSESSMENT

Review the order considering the five rights.

Assess patients allergy history . Assess patient ability to take oral

medications .- Level of consciousness,

cooperativeness.- Presence of swallow reflex.- Symptoms of nausea and vomiting.- Recent GIT surgery or Bowel

obstruction.- Presence of NGT to suction.- Current diet order.

Cont….

-identify any pre administration assessment of pulse, Bp, that must be done.

- Check that correct medication and dosage is available at the time scheduled.

EQUIPMENT Treatment charts/ kardex. Trolley. Disposable medication cups. Water, juice or milk.

PROCEDURE

Wash hands to reduce transfer of microorganisms from hand to medication.

Arrange medication charts next to medication trays and cups. This saves time and reduces chances of errors.

Prepare medications for only one patient at a time to prevent errors during preparation.

Calculate correct drug dosage if necessary.

Take medication directly to the patients room , do not leave unattended.

Cont….

Ask patient to state their name and compare name on medication card or record with name the patient is mentioning.

Complete any preadministration assessment e.g. (Bp) required by specific medication to determine if medication can be given at that time.

Expain the purpose of the medication to patient, in accordance with patients rights and will improve compliance.

Assist patient to sit up and take drugs, stay with patient until the medication is swallowed.

Cont…

Dispose of soiled supplies and wash hands.

Record time medication was administered and any pre- administration assessment data which were collected.

Examples of oral medication

Paracetamol, Brufen, metronidazole etc.

PARENTERAL

The giving of medication that are given by injection or infusion through intramuscular(IM), intradermal(ID), subcutaneous (SC) and intravenous(IV).

Indication

Treatment of disease / conditions whereby the appropriate is the parenteral route.

ADVANTAGES AND DISADVANTAGES

Medication given through the parenteral route usually are absorbed more completely and have a faster onset of action than other routes .

The risk for infection is high because the skin barrier is bypassed, if aseptic techniques are not used when preparing and administering parenteral medication.

Complications may occur if parenteral medications are not given tissue site or space intended.

Specialized equipment required for parenteral administration usually makes medications given by these routes more expensive than medications given by other route

EQUIPMENT

Vials – containers that hold one or two dose of medication. Medication that are in powder form come with a diluent.

Ampules – thin walled glass container that hold a single dose of a liquid medication. Before it is opened all medication should be moved to the ampule base by gently tapping the top of the ampule with a finger. To open the ampule the nurse holds an alcohol pad over the neck of the ampule with the thumb then holds the top and bottom of the ampule still with his thumb while pushing on the ampule with a thumb.

Cont…

Syringes – for drawing and administration of medication part : plunger, barrel, needle and needle guard.

INTRADERMAL INJECTIONS

Given into the dermis (the layer of tissue located underneath the skin surface). A small needle and a 1ml syringe is mostly used.

The skin is cleansed using alcohol wipe. The syring is held with the level of the

needle up almost parallel to the skin . Small volumes of medication are

injected slowly e.g. 0.25mls or less.

SUBCUTANEOUS INJECTION

Injections are given into the subcutaneous tissue the layer of fat located below the dermis and above tissue.

Absorption is usually slow, sustained and completely. Small sized syringe and needle used.

Common sites : upper arm, upper back, abdomen, buttocks and thigh.

Absorption is faster at the abdomen. Medication is injected at an angle of 45

degrees or 90 degrees .

INTRAMUSCULAR INJECTIONS Injection are given into the muscle

layer , beneath the dermis and subcutaneous tissue.

Absorption is at an intermediate rate, slower than IV administration and more rapid than SC administration.

A larger volume of medication is given . Site choices are influenced by the age, medication to be given , amount and general condition of the patient.

PROCEDURE

PURPOSE Administer medication deeply into

muscle tissue, without injury to the patient.

Administer a medication with absorption and onset of action quicker than the oral route and that may be irritating to the subcutaneous tissues.

ASSESSMENT

Review patients medical history, medication history and allergy status.

Assess for contraindications to receiving IM injections.

Assess for anxiety related to fear of injection.

Review chart for documentation of previous injection sites, if it’s a patient receiving multiple injections.

Assess adipose tissue and muscle mass of patient to determine needle size.

EQUIPMENT

Treatment charts/ order or kardex. Antiseptic swabs . Vials or ampule. Syringes. Gloves.

PROCEDURE

1. Check medication order.

2. Wash hands.

3. Assemble needle and syringe.

4. Remove needle guard.

5. Vials Rotate vial between palms to disperse medication. Cleanse top of medication vial with alcohol swab. Pull back the barrel of the syringe to an amount of

air equal to the medication dosage to be withdrawn.

Procedure cont..

Insert needle into vial and inject the air. Injected air prevents creation of negative pressure within the vial so that medication is easily withdrawn.

Invert vial and withdraw the desired volume of medication.

6. Ampules Flick upper stem of the ampule with finger nail several

times. Wrap a sterile gauze or alcohol wipe around ampule

neck and break off top by snapping it away from you.

Cont…

Insert needle into ampule and withdraw required dosage of medication.

Dispose of ampule in appropriate container to prevent broken glass from cutting other health care workers.

7. Cover needle with guard.

8. If medication is known to be irritating to subcutaneous tissues replace needle after withdrawing medication. To prevent irritating and burning subcutaneous tissues as needle passes into muscle.

Cont..

9. Select appropriate injection site by inspecting muscle size and integrity . Consider volume of medication to be injected. Larger muscles can absorb larger volumes of medication.

10. Assist patient to a comfortable position and expose only the area to be injected. Don gloves especially on non dominant hand. This promotes comfort and privacy. Maintains universal precautions if blood leaks from injection site.

11. Use anatomic landmarks to locate the exact injection site too prevent trauma to bones, nerves or blood vessels.

Cont….

12. Cleanse the site with antiseptic swab , wiping from center of site and rotating outwards.

13. Remove needle cover.

14. Expel air bubbles from syringe .

15. Hold syringe between thumb and forefinger of dominant hand (like a dart).

16. Spread skin at the side with non dominant hand. This facilitates needle insertion by firming skin surface and flattens tissues so needle penetrates into muscle.

Note: if patient has very small muscle mass, may pinch muscle before insertion.

Cont…

17. Insert needle quickly at a 90 degrees angle this enables needle to reach deep muscle layer . Rapid needle insertion minimizes patient discomfort.

18. Stabilize syringe barrel by grassing with non dominant hand . Aspirate slowly by pulling back the plunger with dominant hand . If no blood appears inject medication slowly. If blood appears in the syringe, remove needle and dispose of syringe and prepare new medication. Blood in a syringe indicates intramuscular needle placement.

19. Withdraw needle while pressing antiseptic swab above site. This minimize discomfort by supporting tissues during needle withdrawal.

Cont…

20. Gently massage site, this stimulates local circulation and speeds drug absorption.

21. Do not recap needle , dispose of equipment in proper reception to protect nurses and health care workers from accidental needle injury.

22. Wash hands.

23. Record medication and patient response according to agency protocol.

INTRAVENOUS PUSH PROCEDURE

1. Verify medication card against the written doctor’s prescription.

2. Explain procedure to reassure patient and significant other before administration.

3. Do hand hygiene before and after the procedure(use gloves especially for chemotherapeutic).

4. Check patency and other reaction signs or swelling, redness, phlebitis etc do not give the drug .

5. Prepare the necessary material for the procedure such as: right drug, right diluent needed , IV injection tray, syringes and needles, alcohol etc.

6. Disinfect injection port of the diluent, vial or ampule as appropriate.

7. Aspirate right amount of diluent for the drug if the drug needs to be diluted.

8. Aspirate the right dose and disinfect the port of the IV administration set.

9. Close the roller clamp of the IV tubing from the bottle and push IV drug aseptically and slowly or according to the manufacturer’s recommendation.

Cont…

10. Open the intravenous fluids and let it run to flush medicine given .

11. Regulate rate of IV fluids infusion as prescribed.

12. Reassure patient and observe for signs and symptoms of adverse drug reactions.

THANK YOU