Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

READING MEDICATION LABELS

VIEWS: 177 PAGES: 81

									Introduction to
  Medication
Administration
Hold on to your seat we have a lot to
               learn
                    Objectives
• Identify the nurse’s legal responsibilities of medication
  administration
• Identify the six rights of safe medication administration
• Use the nursing process to administer medication safely
  to clients of all ages
• Identify components of a medication prescription
• Describe strategies to minimize medication errors
• Identify strategies to deliver atraumatic care to pediatric
  clients when administering medications
• Recognize risks for adverse medication reactions
                Sources of Drugs
• Earliest known pharmaceuticals: roots, herbs, bard and other
  plant live
   – Still use plants as drug source but also use animals,
     minerals, synthetic and genetic engineering

• Plant example:                   Synthetic example:

• Animal example:                  Genetic Engineering
  example:

• Mineral example:
             Drug Legislation:
• Prescribers must follow federal and state laws

• All drugs for legal use are controlled/enforced
  by?
  – Law protects the public by insuring the purity,
    strength, and composition of food, drugs, and
    cosmetics
             Drug Legislation:
• Controlled Substances Act of 1970
  – What does this law control?

  – What drugs are included?

  – Under this federal low, prescribers who dispense
    controlled substances must register with the DEA
    every 3 years
              Drug Legislation:
• Controlled Substances Classifications:
  – Schedule I
     • Describe:
  – Schedule II
     • Describe:
  – Schedule III
     • Describe:
  – Schedule IV
     • Describe:
  – Schedule V
     • Describe:
             Pharmacokinetics
• Absorption:
  – Rate dependent on:
     • Route
     • Drug itself ( some more lipid soluble, readily absorbed
       through the cell membrane due to its fatty acid layer)
     • Blood Flow
     • The individual (have to consider age, disease, gender,
       weight)
            Pharmacokinetics
• Distribution:

• Biotransformation or metabolism
  – Where is the drug primarily transformed?
     • Where else?


• Elimination or secretion:
  – Where does this happen?
            Medication Order
• Health care provider, NP or PA has the
  responsibility of diagnosing, prescribing meds
  and treatments.



• Nurses: follow orders and administer the
  meds accordingly
  – Cannot prescribe or dispense meds
            Medication Order
• A drug that is prescribed is referred to as a
  medication or medicine order

• Once prescribed it is the responsibility of any
  legally approved health professional to carry
  out the physician’s medication order.
                     Types of Orders:
• Routine or Standard order
    – May or may not have a termination date
        • If there is no order termination date the medication is
          continued until the physician discontinues it
        • Some meds because of the effect may have a “stop
          date”
            – What is done in this case?

Example: Lanoxin 0.25 mg PO daily.
               Types of Orders:
• Single/one-time order:
  – Administered one time

  – Pay attention to orders: if does not specify
    frequency verify, may want once or forgot to add
    frequency

     • Example: Lasix 80 mg IVP now or x1, or today
                Types of Orders:
• Stat order:
  – Means you give one dose immediately

  – Example: NTG gr 1/150 SL stat
                 Types of Orders:
• PRN orders
  – As needed
  – Must also include in the order the same criteria as all
    other orders (drug, dose, route, frequency) plus PRN
     • Usually includes PRN and what reason the nurse is to give
       i.e. nausea or pain or temp > 101
        – Example: Hydrocodone 10 mg PO q 4 hours PRN pain


     • Word of caution: watch those drugs with more than one
       component.
               Types of Orders:
• Standings orders:
  – Written for specific circumstances

  – For example: at your facility all patients admitted
    for CP may have the same preprinted orders
     • The physician ordering/signing can select the orders
       that applies with a check or add more orders
                  Types of Orders:
• Also have orders that are classified according to how
  the orders are received
• Written orders:
   – This is the best type from a legal standpoint

• Telephone order:

• Verbal order:
                  Types of Orders:
• When it comes to a telephone order of verbal order,
  protect your license-
   –   write it down exactly as you heard it
   –   repeat back to physician & document 100% readback
   –   follow six/seven rights of mediation administration
   –   carefully document all appropriate information about
       administration have physician co-sign within 24 hrs.
  Components of a Medication Order
• Name of the patient (may be on the bottom or top of physician order, be
  sure the name is on the order)

• Date and time the order is written

• Name of the medication (may be in generic or brand)

• Dose

• Route the medication is to be administered

• Time and frequency: exact times or number of times per day

• Signature of prescribing Dr.
                   Prescription
• A prescription is written order that is NOT part
  of the chart
  – A prescription is written on a specific form
     • With controlled substances a specific type of
       prescription pad is required

     • Prescriptions are NOT needed for OTC drugs
               Parts of a Prescription
• physician's name
•  address
•  phone
• DEA #
•  pt name, address
•  Date
• Superscription- includes symbol Rx (take thou)
• Inscription-states names and quantities of ingredients to be included in med
• Subscription- give directions to pharmacist for filling Rx
• sig (signature)- give directions for the pt
• signature blanks--M.D. can sign on appropriate blank and indicate for brand
  or generic
• REPETATUR 0123 prn- indicates whether or not the Rx can be refilled
   Reading
Medication Labels
       Drug Names
–Chemical name- describes the drug’s
     molecular structure and
     identifies it’s chemical structure

–Generic or official name- written in
     lower case letters; not protected
     by a company’s trademark
        Drug Names

• Trade or Brand name- name by
  which a specific drug manufacturer
     produces and distributes a drug
Drug Dosage & Strength
• Dosage: the amount of the drug available by
  weight and unit of measurement (mg, mcg, etc)

• Strength: solid form within a liquid (100mg/1ml)
  or solid form per tab, % per tube
      Drug Form
    Form in which the drug is
prepared by the manufacturer;
     i.e. tablets, capsules,
   suspensions, injectables,
            ointment
      Drug Manufacturing Information
•   Manufacturer’s name

• Expiration date

• Control numbers

• National Drug Code number

• Bar code

• Code identifying one of two official national  lists of approved
  drugs, either the USP (United States Pharmacopeia) or NF (National
  Formulary)
 Drug Quantity
Amount of the drug in
   the container
         Drug Administration
             Instructions
• Route indicated on the label; i.e. oral,
  sublingual, IM, topical, otic, ophthalmic

• Will indicate single or multiple- use vial

• Ratio or percent of drug, if applicable
    Label Alerts
Protect from light, store at
    room temperature,
         refrigerate
Brand Name:        ______________   NDC: _______________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Brand Name:        ______________   NDC: _______________________
Generic Name:      ______________   Dilution Instructions: ______________
Concentration:     ______________   ____________________________
Total Volume:      ______________   Precautions: ______________________
Lot #:             ______________   _________________________________
Expiration date:   ______________
Safe Medication
 Administration
       Nurse Responsibilities


• What are the nurse’s responsibilities
   when administering medications?
        Nurse Responsibilities
• Preparing, administering, and evaluating
  client responses to medications.

• Explain
  – Prepare?
  – Administer?
  – Evaluate?
               Nurse Responsibilities
                   Be Knowledgeable about:
• Your patient:
   – ASSESS your patient before giving anything

   – What should you assess that has a bearing on whether you
     will give the med or not.
   Condition    labs      VS       contraindications med hx allergies
   Current meds           Disease processes        If any difficulties taking meds
   Compliance             Tobacco or alcohol use

   Why is tobacco and alcohol use an issue?
          Nurse Responsibilities
           Be Knowledgeable about:
• How the medication works:
  – This means the physiology of how it affects the patient
     • i.e. Not that lowers BP action is how does it lower the BP


  – Principle actions of drugs:
     • May offer a cure for a disease
     • May be used to restore a diseased or disturbed physical
       state to one that is normal or improved
           Nurse Responsibilities
          Be Knowledgeable about:
• How the medication works:
  – May be prescribed because of the action that
    results
     •   Selective action          Specific action
     •   Agonist action            Systemic Action
     •   Antagonist Action
     •   Local Action
     •   Remote Action
                 Nurse Responsibilities
                  Be Knowledgeable about:
• Uses:
Analgesic         antidote            contraceptive
Anesthetic        antidote            decongestant
Antacid           antiemetic          diuretic
Antianxiety       antihistamine       expectorant
Antiarrhythmic    antihypertensive    hemostatic
Antibiotic        anti-inflammatory   hypnotic
Anticoagulant     antineoplastic      hypoglycemic
Anticonvulsant    antipyretic         laxative
Antidepressant    antitussive         sedative
Antidiarrheal     bronchodilator      vasodilator     vasopressor
           Nurse Responsibilities
            Be Knowledgeable about:
• Route:
  – Drugs are compounded in three basic types of
    preparations: liquid, solids and semisolids
     • If given orally a drug may be in the form of a liquid,
       powder, tablet, capsules, or caplet
     • If injected, it must be in the form of a liquid
     • For topical use, the drug may be in the form of a liquid,
       powder, or a semisolid
        Nurse Responsibilities
          Be Knowledgeable about:

• Safe dosage: need to know if the ordered
  dose is appropriate for your patient
        Nurse Responsibilities
          Be Knowledgeable about:
• Dosage Terms:
  – Initial dose        Cumulative dose
  – Average dose        Lethal dose
  – Maintenance dose    Toxic dose
  – Maximum dose        Minimum dose
  – Therapeutic dose
  – Divided dose
  – Unit dose
           Nurse Responsibilities
              Be Knowledgeable about:
• Dosage
  – Drug Dosage is determined by the prescriber
    after considering several factors.
     •   Weight
     •   Gender
     •   Age
     •   Patient condition/disease process
             Nurse Responsibilities
                  Be Knowledgeable about:
• Geriatric patients require special considerations because of the following
   – Decreased GI function (affects absorption)
   – Impaired or reduced metabolism
   – Changes in body composition and or deformities
   – Alterations in circulation, lever, and kidney function
   – Changes in eyes, hearing, speech
   – Increased sensitivity to drugs
   – drug interactions; consider # of meds taken
   – Psychosocial changes: confusion, forgetfulness, memory loss
   – Multiple disease processes
   – Self medication with OTC drugs
   – Cost
   – Living conditions
   – Poor water intake
          Nurse Responsibilities
             Be Knowledgeable about:

• Side/adverse/toxic responses, precautions and
  contraindications



  – Side Effects: action or effect of a drug other than
    intended but not harmful
            Nurse Responsibilities
           Be Knowledgeable about:
• Adverse Reactions: unintended effect that
  causes harm to the patient
  – Report to FDA
     •   Life-threatening
     •   Death
     •   Leads to hospitalization or prolonged rehab
     •   Results in serious or permanent disability
  – JC requires facility/hospital to have policy in place
    for reporting adverse events
         Nurse Responsibilities
           Be Knowledgeable about:

• Toxic effect:
  – may occur in response to a cumulative effect,
    may cause permanent damage or death
          Nurse Responsibilities
             Be Knowledgeable about:

• Allergic effect:
  – Immune system response: drug is seen as foreign
    substance and forms antibodies against it
  – May have rash, urticuaria, fever, diarrhea, n/v
  – Or serious: anaphylaxis: respiratory distress and
    CV collapse
     • Never Leave Patient Alone in this situation, call for
       help
     • Treated symptomatically
         Nurse Responsibilities
           Be Knowledgeable about:

• Drug Tolerance:
  – Body becomes accustomed to the effects of a
    particular drug over a period of time requiring
    increasing dosages to achieve the same effect
              Nurse Responsibilities
                 Be Knowledgeable about:

• Idiosyncratic effect:
   – Unusual response may be an over response, under response, or
      opposite response

• Interaction
   – May occur when one drug potentiates or diminishes the effect of
      another drug

• Contraindication:
   – Consequences will happen,
       • Why it is important to know YOUR PATIENT
         Nurse Responsibilities
          Be Knowledgeable about:


• Should an adverse even occur what is the priority?
          Nurse Responsibilities
• Maintain Competence in:
  – Administering meds skillfully
  – Calculations


• Determine if the medication order is accurate
  – Explain
  – What if you cannot read the physician’s writing?


• Report all medication errors and reactions
         Nurse Responsibilities
• Storing and safeguarding medications
  – Safe storage: ideally locked in a separate room or
    Pyxis system
     • Storing includes: following manufacture guidelines for
       storage (out of light, refridge)
          Nurse Responsibilities
• Storing and safeguarding medications
  – Controlled substances: must be double locked
  – Management of Controlled Substances:
     • Federal law requires that all controlled substances be
       kept separate from other drugs
     • Must be kept in a metal box or compartment that is
       equipped with double lock or a medication dispensing
       machine (Pyxis)
     • If not using electronic machine nurses will need to
       count: oncoming and off going nurse count together
     • Also must have a separate record form/book where
       documentation of the patient info and nurse or kept
        Six Rights of Medication
             Administration
• Right patient
  – How would you identify the patient?
• Right medication
  – How
  – Must know about the med; where would you find
    info about a medication?
• Right dose
  – Important to ensure you have correct dose (check
    order to label, 3 times
       Six Rights of Medication
            Administration
• Right route

• Right time
  – Must be administered within 1 hour of designated
    time (30 min before; 30 min after)


• Right documentation
  – Do NOT DOCUMENT anything you did not give
              Medication Errors
• Best to prevent:
  – Follow the Institute for Safe Medication for
    Practice Guidelines www.ismp.org
  – Observe approved and unapproved abbreviations
    designed by JC
  – Pay attention to names of meds, how they look
     • Use caution taking verbal or telephone orders
     • Use caution with high alert medications: have a
       colleague check your med and dose
              Medication Errors
• Prevention:
  – Learn to pay attention to the look alike drugs: use
    Tall man letters

  – Use the correct placement of zero’s

  – Be aware of suffixes and abbreviations with meds
     • i.e. ER, XL, SR may indicate delayed, long acting
             Medication Errors
• What constitutes a med error?
  – Wrong pt, dose, time, drug, route
  – Ideally medications are given within 60 min of
    designated time: if not given in this time it is an
    error
  – Administration of a KNOWN allergic med
  – Omission of a dose
  – Incorrect discontinuation of a medication or IV
    fluid
               Medication Error
• Should a medication error occur:
  – recognize an error has occurred
  – assess patient’s condition
  – report to supervisor
  – notify physician
  – continue to assess pt condition
  – Document the event, actions taken, and response to
    treatment
  – fill out incident report (NOT ON CHART!)
  – Evaluate the cause of the error to prevent it from happing
    again
        Basic Safety Guidelines
• Be familiar with facility system for dispensing
  of meds
• Check each order carefully: compare original
  order with MAR
  – Important to note if there are any excessive or
    duplicate medications
• Be completely familiar with the drug you are
  giving before you give it
        Basic Safety Guidelines
• Anticipate adverse events when starting or
  stopping therapy

• Regularly monitor liver and kidney function
  – Know when there are therapeutic levels that need
    monitoring
        Basic Safety Guidelines
• Patient teaching is extremely important
  – Inform the patient of potential side effects
  – teach any restrictions like foods or drugs that may
    cause interactions
  – Teach about OTC use: need to check with
    physician prior to using
  – Teach about follow up labs tests, regular visits
        Basic Safety Guidelines
• NEVER give a medication if there is any
  question about the order or if a patient
  questions you or has concerns

• Know the circumstances in which you may be
  allowed to hold a drug
  – NPO, perimeters set
     • Something to consider when administering Insulin
       Basic Safety Guidelines
• NEVER give a med you did NOT prepare; never
  allow someone else to give a med you
  prepared

• Never leave a med unattended once you have
  prepared it

• Always check expiration date
        Basic Safety Guidelines
• When giving a PRN always check when the last
  dose was given and response

• Never give a drug if normal appearance is
  altered

• Practice medical asepsis
        Basic Safety Guidelines
• When administering PO meds: stay with the
  patient until you are certain med has been
  swallowed
  – Do not leave at the bedside


• ALWAYS check for allergies

• Perform three checks prior to giving
        Basic Safety Guidelines
• When pouring liquid med hold at eye level,
  palm the label, read the lowest level of the
  meniscus
  – If giving 10 mL or less must draw up in a syringe
    for accuracy (med cup just not accurate in small
    doses)
• Do not contaminate cap of bottle; place inside
  up
        Basic Safety Guidelines
• In case of medication error: take action
  immediately
  – As SN check with instructor first before filling out
    any incident reports or forms of any kind


• Prevent distractions

• Avoid needle sticks by following needle
  precautions (do not recap used needles)
        Basic Safety Guidelines
• Keep all medications not being prepared
  secure
• Be sure the medication is the correct strength
  and form
  – Heparin comes in several strengths: 10 units, 100
    units etc
  – Some meds can be formulated in immediate
    acting and long acting
        Basic Safety Guidelines
• High alert medication should be check by
  colleague
  – Ex: insulin, K+, heparin, pedi medications


• If the patient brings own medications from
  home know the policy in securing them and or
  use

								
To top