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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
    injectable medications
   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
Objectives Continued

    * 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
     clinical behavior
Scope of Practice determines the maximum level
  of patient care that may be provided under
  your license.

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
                                           Topical
                                           Suppository
    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,
Terminology Continues……..
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
  therapeutic intent.
Routes of Medications
  A drug’s route of administration
   influences absorption
Proper Preparation and Administration
Gather equipment and medication.
Check medication, dosage and route against MD’s orders. (Check 3X)
Wash Hands
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.
Provide Privacy
Oral Medications
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
  to swallow
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
  cardiac patients

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
Implementation Continues…….

Remove suppository from wrapper and lubricate with water
   soluble lubricant
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…
 Equipment:                Implementation:

                             Wash Hands
                         Explain procedure
                   For Buccal: Place tablet in the
Medicine Cup      buccal pouch, between the cheek
                              and teeth
                  Instruct the patient to keep the
                 medication in place until it dissolves
                  completely to ensure absorption

                 For Sublingual: Place tablet under
              Subcutaneous Injections

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
  Prescribed Medication
  Appropriate Syringe:
      1-cc Syringe
      Insulin syringe if administering Insulin

  Appropriate Needle:
   25-27g 3/8-5/8in

  Alcohol Wipes

Refer to previous slides
Can handle aqueous suspensions and solutions in oil
Provides long-term absorption
Relatively rapid
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
        Prepared Medication
            Alcohol Wipes
         Appropriate Needle:
        * 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
     Tuberculin Syringe

     Appropriate size needle:
       3/8, 5/8, or ½ inch needle
     Prescribed Medication

     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
Prescribed medication
Sterile tongue blade
Sterile 4x4’s
Transparent semipereable dressing
Adhesive tape

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
Absorption Continues………

 A tablet or capsule may have to disintegrate first to free
    particles so they can dissolve in liquids such as
    gastric juices.

 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
  other drugs.
Half Life
 * 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
 that drug.
Blood Concentration Level

 A drug’s blood concentration level helps
   indicate whether dosing has achieved
   therapeutic goals.
    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.
Elderly Patients

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

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.
 Adverse Reactions

Expected adverse reactions include Drowsiness
  from Histamines.
Unexpected adverse reactions- Rashes, Hives,
  Difficulty Breathing.
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
     EVERYONE’S concern.
     Five Right of Drug Administration

Right Drug/Medication
Right Dosage/Amount
Right Time              T =IME
                        R =OUTE
Right Route             A =MOUNT
Right Patient           M =EDICATION
Right Reason            P =ATIENT
Right to Refuse
Right Documentation
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
Physical Problems…..
Emotional Trauma to staff, patients and
  their families.
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
        Dosage
        Route
        Duration/Therapy Term
        Signature- all orders are to be written.
Medication errors………

       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

Administering                Storage:

    The right medicine in       The storage and
     the wrong form or            stocking of
     strength.                    medications:
    Administering the              The risk of
     wrong route, time, or           someone picking
     dose.                           up the wrong drug
                                     is higher when
                                     packaged but
                                     different drugs are
                                     stored side by
Medication Errors Continue…


       Drug labeling and packaging- Medications
        can be entered into the computer with the
        wrong information.
       Lack a clearly visible label.
Common Sources of Medication Errors

    Drug Information
    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

    Distractions:                   Storage:

                                        For example, the risk of
             Too much                    someone picking up the
    conversation, ringing                wrong drug is higher
                                         when similarly
    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
         cause confusion.
        Poor maintenance and not understanding how to program
         automated equipment.
        Malfunctioning equipment.
         High- Alert Medications

Have the potential to cause serious injury or death
  if not used exactly as intended.
High Alert Medications include:
      KCL
      Heparin
      Insulin
      Calcium
      Chemotherapy Drugs
      Opioid Narcotics
      Lidocaine
      Magnesium
    Reporting Medication Errors

Confidential Incident Report- (See

   MD
            Dosage calculations

     Proper Preparation and
Measurement Systems


       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

        * Mg
        * Kg
Household Systems

        Food Products
        Over the Counter Medications

                                 300mg                   60mg
Occasionally conversions                     X gr                     =
from one system to another                   1gr

occurs.                          To solve X, Cross multiply
Doctor orders 300mg of
                                 300mg =60X
Label reads aspirin : gr V       300mg = 60mg
                                     60mg     60mg
per tablet
                                 300 =        60X
                                    60           60X
    Remember 1gr equals
                                              5gr = X
                                   Therefore, the patient should receive 1
                                               tablet of aspirin.
Basic Calculations

    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.