The purpose of this class is to increase/improve
patient safety by increasing awareness and
providing education on practical skills and
knowledge in medication administration
Upon Completion of the class the MA, Nurse
will be able to:
Demonstrate safe preparation of oral and
List the “Five Rights” of safe medication
Discuss the difference in the Scope of
Practice for the following care Providers:
MA’s, LVN’s , and RN’s
* Provide accurate and appropriate documentation of
medication administration per KP’s Policy and
* Correctly calculate a prescribed medication dosage
and demonstrate appropriate preparation.
* Provide demonstration in administration techniques.
* Discuss common medication errors and how to avoid
Your Role in Drug Administration
Medication Administration demands
responsibility and accountability on your
part and should be at the forefront of your
Scope of Practice determines the maximum level
of patient care that may be provided under
The purpose of Scope of Practice is to enhance
the quality of patient care and promote
continued competency in care given.
What Does this mean to you?
The Supervising MD will Medical Assistants may
authorize the MA to perform administer medication:
the service but shall be Oral
responsible for the treatment. Sublingual
All orders from a licensed Inhalation
physician must be written. Intramuscular
MA’s cannot take verbal Intradermal
Scope of Practice Continued
All medications to be administered by a MA
shall have medication and dosage verified
by a licensed person (LVN, RN, MD).
See/Review Scope of Practice handout-KP
No medication can be administered without a
written or verbal order from a licensed physician.
A verbal order should be signed within 24 hours
Must have insulin or heparin double checked
prior to administration with a licensed nurse or
Drug: A Pharmacologic agent capable of interaction
with living organisms to produce biological effects.
Prescription Drug: A Drug that can only be used safely
under the supervision of a health care professional
who is licensed to prescribe or dispense drugs
according to state Laws,
Non Prescription Drug: a drug that can be used by
consumers safely without the supervision of a
licensed health care practitioner, provided the
directions are followed.- Commonly known as OTC
Controlled Drug: a drug that may lead to drug abuse or
drug dependence, so it’s use is controlled by federal,
state and local law.
Recreational Drug: a drug that is used for its pleasure
and psychological or physical effects and with no
Routes of Medications
A drug’s route of administration
Proper Preparation and Administration
Gather equipment and medication.
Check medication, dosage and route against MD’s orders. (Check 3X)
Draw up medication with proper syringe and needle using sterile technique (I.e.,
IM, SC ID)
Check drawn medication, dose, and route to vial or ampoule and against order.
Check with the above with a licensed person (MD, RN, LVN)
Identify your patient. Ask the patient “What is your Name”
Explain to the patient what you are going to do and what they can expect from
the medication. If they have questions, have them speck to the MD again
before administering the medication.
Easy Self Medication
Easy retrieval for dilution is possible by lavage or vomiting
in case of an overdose.
Can not be used in emergencies due to slow absorption
May be metabolized in the liver
Irritating to GI tract
Discolor teeth or taste unpleasant
Can easily be aspirated
Available in tablet, enteric coated tablets, capsules, syrups,
elixirs, suspensions, granules, and powder
Medicine Cup or Syringe
A Beverage (Compatible with Medication)
Assess the patients Condition
Have patient take the tablet/Capsule by
placing at the back of the mouth.
Supply appropriate beverage as needed to
aid in swallowing
Stay with the patient until medication is
Return and reassess the patients response.
Safe if patient is vomiting, unconscious, or unable
Will not irritate the GI tract
May be uncomfortable and embarrassing
Can cause diarrhea, rectal bleeding
Drug absorption may be irregular or incomplete
Can not be given in most emergencies
Vagal response may be stimulated- a risk for
Suppository or tube of ointment and applicator
4 X 4 Guaze
Water soluble lubricant
Store in refrigerator until needed to prevent
softening and possible decreased
Place patient on left side
Drape with covers and expose only buttocks
Put on Gloves
Remove suppository from wrapper and lubricate with water
Lift upper buttock with your non-dominant hand and expose
Instruct patient to take several deep breaths thru mouth to
help relax the sphincter
Using index finger of your dominant hand, insert the
suppository- tapered end first- about 3 inches in an adult,
until you feel it pass the internal anal sphincter.
Ensure comfort and encourage patient to lie quietly and to
retain the suppository for appropriate length of time.
Sublingual and Buccal
Takes Effect quickly
Absorbs directly into the bloodstream
Can be taken even if patient can not
Does not cause GI tract irritation
Sublingual and Buccal Continues…
For Buccal: Place tablet in the
Medicine Cup buccal pouch, between the cheek
Instruct the patient to keep the
medication in place until it dissolves
completely to ensure absorption
For Sublingual: Place tablet under
Self administration is possible.
Medication can be absorbed slowly, prolonging side effects
No IV site is necessary
May damage skin tissue
Can not use with patients with Occlusive Vascular Disease, with poor tissue perfusion,
since decreased peripheral circulation delays absorption.
Can not use when patient’s skin grossly adipose, edematous,burned, hardened, or
Insulin syringe if administering Insulin
Refer to previous slides
Can handle aqueous suspensions and solutions in oil
Provides long-term absorption
Can administer up to 3 mls
Eliminates need for IV site
May not be absorbed if patient is hypotensive or has poor blood supply
to the muscle
Possible pain and local tissue irritation
May damage bone, or blood vessels
May cause bleeding
Nerve damage causing unnecessary pain or paralysis
* 21-23G * 1-2in
For Z track method use:
* 20G * 1 1/4-2in
Attach one needle to the syringe and draw up
Draw up 0.2cc of air into syringe after you draw up
Remove the first needle and attach the second, to
prevent tracking the medication through the SC
tissue as the the needle is inserted.
• Used primarily for diagnosis
• Usually produces a local effect
Appropriate size needle:
3/8, 5/8, or ½ inch needle
Gloves Alcohol wipes
Easily administered and provides fast relief
for itching and topical pain
Not likely to cause severe allergic reactions
Fewer adverse reactions
Dosage accuracy is difficult to achieve
May stain clothes and bedding
Sterile tongue blade
Transparent semipereable dressing
Help patient assume a comfortable position that will provide access to the
Check skin for open areas
Appling medication to broken or abraded skin may cause unwanted systemic
absorption (may be ordered for a lesion or ulcer)
Clean the skin of debris, including crusts and epidermal scales
Remove previous applications to prevent skin irritation
Change your glove if it becomes soiled
Assess patients skin for signs of irritation, allergic reaction or breakdown
Applying a Paste, Cream or Ointment:
Open the container. Place the lid or cap upside down to prevent
contamination of the inside surface.
Remove a tongue blade from its sterile wrapper and cover one end with
Transfer the medication from the tongue blade to your gloved hand.
Apply the medication to the affected area with long, smooth strokes that
follow the hair growth.
To prevent contamination of the medication, use a new tongue blade each
time you remove medication from the container.
Administration of any drug begins a series of
physiochemical events in the body.
Drug combines with cellular drug receptors
causing the drug to act.
What results from the drugs action is the effect
the drug will have.
Depending on the number of different cellular
drug receptors affected by a drug, the drug
effect can be local, systemic or both.
Local drug effects are specific to a limited
number of receptors:
For Example: In Contrast:
The antipeptic ulcer A systemic drug effect
drug Cimetidine acts is generalized and
solely by blocking affects different and
histamine receptor cells diverse organ systems.
in the parietal cells in As in Benadryl, which
the stomach, limiting blocks histamine
drug action and effect to receptors throughout
one area of the body, the body.
Before a drug can act-It must be absorbed into
the blood stream.
Factors that affect absorption; the drugs
physiochemical effects, the form of
medication, route of administration,
interactions with other substances in the GI
tract and other patient characteristics.
The above factors also determine the speed of
A tablet or capsule may have to disintegrate first to free
particles so they can dissolve in liquids such as
After dissolving in liquids the drug can be absorbed and
circulated in the blood stream.
Oral solutions and elixirs do not have to be dissolved
and are absorbed more rapidly.
Once absorption starts, a drug moves from
the bloodstream into various fluids and
Distribution of an absorbed drug depends
on several factors, such as blood flow.
i.e., Dehydrated patient may need to have
medication dose decreased, a patient with
edema may need to have a medication dose
Metabolism and Excretion
Most drug’s are metabolized in the Liver and
excreted in the Kidneys.
The rate at which a drug is metabolized varies
with the individual.
Some drugs can alter the effect and excretion of
* For Doctors to specify the frequency of the
drug dosage schedule, they must determine
how long a drug will remain in the body.
* This is estimated from the drug’s half life,
the time required for the total amount of a
drug in the body to diminish by one half.
Tolerance and Dependence
A patient’s decreased response to a
repeated drug dose, differs from
A drug dependent patient displays a
physical or psychological need for
Blood Concentration Level
A drug’s blood concentration level helps
indicate whether dosing has achieved
Patients with Special Considerations
Children-Because a child responds more
rapidly-and unpredictably- to drugs than
adult doses, pediatric drug administration
requires special care. Such as Ht/Wt,
BSA, and drug form and route may
dramatically affect a child’s response to a
Patients with Hepatic and or Renal disease.
A drug improperly stored can alter its
Most drugs should be stored in tightly
capped containers protected from direct
sunlight and extremes in temperature and
Drug interactions may occur between drugs.
Drug interactions may alter absorption,
distribution, metabolism and excretion of the
Question the patient regarding OTC medications
that they currently take.
Expected adverse reactions include Drowsiness
Unexpected adverse reactions- Rashes, Hives,
A adverse reaction may be tolerated for a
necessary therapeutic effect.
Medication Errors and Preventing
Medication Errors can be prevented.
Medication Errors are drug errors that cause or
could cause harm to the patient and are
Five Right of Drug Administration
Right Time T =IME
Right Route A =MOUNT
Right Patient M =EDICATION
Right Reason P =ATIENT
Right to Refuse
Questioning a Medication Order
If it doesn’t look right QUESTION it !!!!!
IF the drug is something that you have never given, look it
up in a nursing drug book and check for dosage, routes
of administration and side effects and precautions.
Do not use abbreviations from the “Do not use List”
Any written order that is unclear has to be verified with the
doctor prior to administration of the medication.
Medication Errors can result in serious
Emotional Trauma to staff, patients and
Loss of Trust. This contributes to higher
costs for malpractice insurance and legal
Complications can lead to death.
Components of a Correct Medication
The Medication order form should be used
for all medication orders. The Fee
Ticket is not an order.
Date and Time
Name of the medication
Signature- all orders are to be written.
Ordering a medication dose that is either too
strong or too weak.
Prescribing medications that have dangerous
interactions or trigger an allergic reaction.
Medication Errors Continues…..
Dispensing the wrong medication.
The right medicine in the wrong form or
…..Medication Error Continues
The right medicine in The storage and
the wrong form or stocking of
Administering the The risk of
wrong route, time, or someone picking
dose. up the wrong drug
is higher when
different drugs are
stored side by
Medication Errors Continue…
Drug labeling and packaging- Medications
can be entered into the computer with the
Lack a clearly visible label.
Common Sources of Medication Errors
Patient Information: Age, Weight, Clinical
Status, Drug and Food Allergies, and use
of other medications.
Do not use standardized abbreviations
Handwriting that is too hard to read
Verbal miscues-(mispronouncing drug’s name)
Common Sources of Medication Errors
Unclear decimal points.
Do not carry appropriate warnings.
Misuse of equipment.
Patient misidentification-Ask the patient their
Lack of staff education.
Common Sources of Medication Errors
For example, the risk of
Too much someone picking up the
conversation, ringing wrong drug is higher
telephones, and interruptions packaged (but very
can cause even the most different)drugs are
stored side by side.
careful health-care worker to
lose concentration. Storing medications at
the wrong Temperature.
Common Sources of Medication Errors
Equipment used to administer medications:
Variations in the design of IV’s and infusion pumps can
Poor maintenance and not understanding how to program
High- Alert Medications
Have the potential to cause serious injury or death
if not used exactly as intended.
High Alert Medications include:
Reporting Medication Errors
Confidential Incident Report- (See
Proper Preparation and
The liter of the metric system equals
approximately 1 quart in volume.
Liters are used when ordering and
administering IV fluids.
Ml’s are used in administration of parenteral
and some oral medications.
Metric System –
Gram serves as the basis
for solid measures or units of
Over the Counter Medications
Occasionally conversions X gr =
from one system to another 1gr
occurs. To solve X, Cross multiply
Doctor orders 300mg of
Label reads aspirin : gr V 300mg = 60mg
300 = 60X
Remember 1gr equals
5gr = X
Therefore, the patient should receive 1
tablet of aspirin.
D=Desired or ordered dose X amount supplied (cc or mg) =the amount to give
H= Dose on Hand
Doctor orders Demerol 50mg IM
Demerol is supplied 100mg / 1cc
50mg = X 100 mg X = 50mg
100mg 1cc 100 100
50 /100 = 0.5 cc or ½ cc
Proper documentation should include:
The date and time of administration
Whether the order is verbal or written.
The medication and dose given.
The route and site of administration
The outcome or evaluation of the result and
how the medication was tolerated.