Drug Administration

B. Eric E. Desquitado, M.D.Olivarez CollegeHealth-Related Sciences

Introduction Drug administration is a basic

activity in nursing practice. Nurses must know all the

components of a drug order. They must question orders that are

incomplete, unclear, or if the prescription is outside the known recommended range.

Introduction Nurses are accountable for the safe

administration of medications. They are legally liable if they give a

prescribed drug with an incorrect dosage or if the drug is contraindicated for the patient’s health status.

Introduction If you are not sure about the

expected therapeutic effect, contraindications, dosage, potential side effects, or adverse reactions and interactions of a medication, do not administer it.

Familiarize yourself with it first.

Medication Errors Potentially serious to life-

threatening. Each of the traditional five rights of

drug administration increases client safety and helps to minimize the risk of litigation.

Traditional Five Rights Right client Right drug Right dose Right time Right route

Right Client Can be assured by checking the

client’s identification bracelet and by having the client state his or her name.

Client identification should be verified each time a medication is administered.

Right Client Clients with similar last names

should have warnings on identification tools.

Identification bracelets may have codes for allergy status.

Some clients may not have identification bracelets.

Right Drug Medications may only be prescribed

by a physician, dentist, podiatrist, or a licensed health care provider with authority from the state to order medications (e.g., an advanced practice registered nurse).

Right Drug Prescriptions may be written on a

prescription pad or an order sheet (institutionalized client) and signed by the duly authorized person.

A telephone order (TO) or a verbal order (VO) for medication must be cosigned by the health care provider within 24 h.

Right Drug An incomplete drug order should

never be administered or followed. To avoid drug error, the drug label

should be read: At the time of contact with the drug

bottle or container Before pouring the drug After pouring the drug

Right Drug Drugs may be given as standing

orders, one-time or single dose, PRN, or STAT.

First dose, one-time, or PRN medication should always be checked against the original orders.

Components of a Drug Order Date and time the order is written Drug name (generic preferred) Drug dosage Route administration Frequency and duration of

administration

Components of a Drug Order Any special instructions for withholding or

adjusting dosage based on nursing assessment, drug effectiveness, or laboratory results

Physician or other health care provider’s signature (or name if TO or VO)

Signatures of licensed practitioners taking TO or VO

Right Dose The dose prescribed for a particular

client. Normally within the recommended

range for the particular drug. Must consider drug availability, the

prescribed drug dose, and the client’s weight range.

Right Dose Drug administration has been

automated with links to the pharmacy information system and current clinical client data.

Two methods of drug distribution: Stock Method Unit Dose Method

Drug Distribution Methods Stock Method

Drugs are stored on unit and dispersed to all clients from the same container.

Always available, cost-efficiency of large quantities.

Drug errors are more prevalent with multiple ‘pourers.’

More risk of abuse by health care workers.

Drug Distribution Methods Stock Method

Less accountability for amount used; unable to track usage.

Increased opportunity for contamination.

Drug Distribution Methods Unit Dose Method

Drugs are individually wrapped and labeled for single doses for 24 h use.

Eliminated many drug dosage errors. Saves time (no dose calculation

necessary). Client is billed for specific doses.

Drug Distribution Methods Unit Dose Method

More accountability. Less chance for contamination and

error. Potential delay in receiving drug. Not immediately replaceable if

contaminated. More expensive.

Right Time Time at which the prescribed dose

should be administered. Doses are given to maintain the

plasma level of the drug. Military time has the advantages of

reducing administration errors and decreasing documentation.

Right Time Drugs may be given 30 mins before

or after the prescribed time if the administration time is > 2 h.

Drugs that are affected by food intake should be given on an empty stomach.

Drugs that irritate the gastric mucosa should be given with food.

Right Time Drug administration may be

adjusted to fit the client’s lifestyle, activities, tolerances, or preferences.

Check if the client is scheduled for any diagnostic or therapeutic procedures that contraindicate the administration of medications.

Right Time Check drug expiration dates. Administer antibiotics at even

intervals to maintain therapeutic blood levels.

Right Route Necessary for adequate or

appropriate absorption. Common routes are as follows: oral,

sublingual, per feeding tube, topical, inhalation, instillation, suppository, intradermal, subcutaneous, intramuscular, and intravenous.

Right Route The client should be able to swallow

adequately before oral medications are given.

Do not mix medications with other substances before consultation with a pharmacist.

Right Route Use aseptic technique when

administering drugs. Stay with the client until oral drugs

are swallowed. If it is necessary to combine a

medication with another substance, this should be explained to the patient.

Five + Five Rights Five additional rights essential to

professional nursing practice: Right assessment Right documentation Patient’s right to education Right evaluation Patient’s right to refuse

Right Assessment Some drugs require monitoring or

examination prior to administration.

Right Documentation Appropriate information regarding

the administered drug should be immediately recorded.

This includes the name, dose, route, date/time, and the nurse’s initials or signature

Right Documentation Client response should be

documented after the administration of narcotics, nonnarcotic analgesics, sedatives, antiemetics, and adverse reactions to the medications.

Do not commit items to memory!

Right to Education The client should receive accurate

and thorough information about the medication and how it relates to his or her particular situation.

Client teaching also includes therapeutic purpose, possible side effects, diet restrictions or requirements, skill of administration, and laboratory monitoring.

Right Evaluation The effectiveness of the medication

is determined by the client’s response to the medication.

Determine the extent of any side effects or adverse reactions as well.

Right to Refuse If a patient refuses a treatment, the nurse

should determine the reason for the refusal, when possible and take reasonable measures to facilitate carrying out the treatment plan.

In order to decide whether to accept or refuse a treatment, the patient should be given necessary knowledge.

Informed Consent Involves full disclosure. The participant must comprehend

the information (written in common language).

Literacy level of the participant should be determined and recorded.

Must be mentally competent to make the decision.

Right to Refuse The client must know the risks of

refusing the medication and reinforce the reason for the medication.

If refusal is resolute, it must be documented immediately and the superior or other health care providers should be informed.

Assignment Read, understand, and rehearse

pages 29 to 39 of your main textbook.

It is possible that it will be included in the exam.