Medication Administration

1. Medication Administration • Parenteral Medications Administration (SQ, IM, ID)

2. Actions and effects of medications • Pharmacokinetics : Absorption- how drug enters body Distribution- how drugs move to sites of action Metabolism- chemical reaction to break down drug to be inactive Excretion- elimination of drug from body thru GI tract, kidneys, other body secretions

3. Actions and effects of medications • Time Intervals Onset of action: time from ingestion to first effect Peak Action: time to reach highest effective concentration Duration: time from ingestion to no further effect

4. Safety :Medication preparation and administration • It is legally advisable to administer only the medication that you prepare. • Be familiar with information on medication labels. • Know the reason or indication WHY THIS PATIENT is taking THIS MEDICATION.

5. Safety :Medication preparation and administration • Safely calculate medication dosages. • Medications are not always dispensed in the ordered unit of measure. • The metric system is organized into units of 10. • Household measurements may need to be converted. • Solutions are units of mass per units of volume.

6. Perform a complete pain assessment before administering medications. Assess the type of pain the patient is experiencing. Review the last medication administered (dose, route, frequency, and degree of relief). Medicate for pain: As soon as it occurs. Before it increases in severity. Before pain-producing procedures or activities. Routinely, around-the-clock, or on a scheduled basis. Provide care during peak analgesic effects. Monitor for adverse effects. Pharmacological Pain Management

7. Special Handling of Controlled Substances • Follow legal regulations and agency policy when administering controlled substances. • Know and follow agency policies for: • Accessing controlled substances. • Inventory guidelines. • Discarding and wasting doses. • Shift change procedures. • Discrepancy reporting.

8. Medication Preparation

9. Medication Orders • Physician or nurse practitioner order is required for all medications. • May be written, electronic, verbal, or telephone; must read back. • Must include name of medication, dose, route, frequency, reason to give, and signature of prescriber

10. Medication Orders • Five common types of medication orders: • Standing order • PRN (as needed) order • Single (one-time) order • Stat order • Now order.

11. Medication Orders • Follow agency policy for required time frames. • Examples • Daily medication may be given +/- 2 hours within the scheduled time • A medication ordered three times a day, may be given +/- 1 hour of the scheduled time • A medication that is ordered Now is given with in one hour of the order • A medication ordered every 3 hours may be given +/- 15min. With in the scheduled time

12. Medication Orders • MAR (Medication Administration Record) Form to verify right medication at correct time (may be paper or computer based) • Orders for medications are transcribed from the docotor’s prescription in the chart and checked by nurse and pharmacist before being written on the MAR *Drugs obtained through the pharmacy are assessed and prepared by pharmacists

13. Drug Distribution Systems Unit Dose- 24-hour supply for each patient A cart contains a patients individually wrapped medications given with in a 24 hours period. Each patient has their own “drawer” of prescribed meds. Automated Medication Dispensing Systems (AMDs) A unit hold multiple drugs for multiple patients. Each nurse is given a security code to access individual medications. Each med has its own drawer. When a med is taken from the drawer the computer charges the patient for that medication

14. Medication Administration

15. Six ”RIGHTS” of Medication Administration Right Drug Right Documentation Right Dose Right Client (ID band matches MAR) Right Route Right Time

16. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time

17. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time

18. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time Wrong Dose

19. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time

20. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time Route is missing in the order P.O.?

21. Six ”RIGHTS” of Medication Administration Right Drug Right Dose Right Client Right Route Right Time

22. Six ”RIGHTS” of Medication Administration Right Drug Right Documentation Right Dose Right Client Right Route Right Time The nurse documents his/her intials /signature, indicating the medication was administered at 8am as ordered per hospital policy

23. Nursing Process • Use the nursing process to integrate medication therapy into patient care.

24. Nursing Process

25. Plan and organize medication administration. Reduce distractions. Limit interruptions. • Assess • medical history,(including allergies and all medications) • Review vital signs. • Review laboratory values. Nursing Diagnosis: (reason/indicaiton for prescribed medication)

26. Implement safe and effective medication administration. Review the six rights. Open medications at the patient’s bedside. Respect the patient’s right to refuse medication. Record medication administration immediately. (not before) Teach the client the medication name, dose and reason for use, side effects

27. Evaluate and monitor: • Therapeutic effects. • Side effects. • Adverse reactions.

28. What is the first step the nurse should take to ensure that the right medication is being given to the client? • Check the client’s ID band • Read the information insert for directions as to correct administration • Check the order with the medication administration record (MAR) • Check the expiration date on the medicaiton

29. What is the first step the nurse should take to ensure that the right medication is being given to the client? • Check the client’s ID band (the question asks about the right medication not idenifying the right client) • Read the information insert for directions as to correct administration • Check the order with the medication administration record (MAR) • Check the expiration date on the medicaiton

30. PARENTERAL Medications • Intramuscular = IM, deep in muscle • Subcutaneous = SC or SQ, in fatty layer • Intradermal = ID, just under skin • Intravenous = IV, into the vein

31. NEEDLE STICK Prevention • Needle stick Safety & Prevention Act (2001) Federal Law; Mandates health care facilities to use safe needle devices • Device examples Safety syringe (plastic guard) Needleless IV line connections Sharps disposal in puncture-proof, leak- proof containers

32. Parenteral Injection Equipment • Syringes

33. Parenteral Injection Equipment • Types: 3 ml marked in tenths 1 ml Tuberculin marked in hundredths *Insulin marked in Units (Note: 1 Unit is not 1 cc or ml)

34. Parenteral Injection Equipment • Needle Parts • Types: ¼ to 3 inches; 18-27 gauge *the smaller the gauge the larger the needle

35. Preparing Injections Vials and Ampules • Ampules contain single doses of medications. • Use a filter needle to withdraw medication. • Do not use filter needles to administer medications.

36. Preparing Injections Vials and Ampules • Vials may be single-dose or multidose. • Check agency policy regarding expiration of multidose vial once opened. • Follow instructions regarding dilution of vials containing dry medications. • Follow manufacturer’s instructions for preparation of two-chambered vials.

37. Preparing Injections: Vials and Ampules • Maintain strict asepsis when withdrawing medications from ampules or vials. • Change needle if injecting into patient. • Keep needle covered when not in use. • Ensure correct volume of medication. • Remove air bubbles. • Label multidose vial with date opened and initials. • Verify dose with second nurse if required.

38. Subcutaneous Injections : • A subcutaneous injection is given in the fatty layer of tissue just under the skin.

39. Subcutaneous Injections : Why are subcutaneous injections given? These injections are given because there is little blood flow to fatty tissue, and the injected medication is generally absorbed more slowly, sometimes over 24 hours. Some medications that can be injected subcutaneously are growth hormone, insulin, epinephrine, and other substances.

40. Subcutaneous Injections : • Needle selection and angle : Determined by body weight and amount of adipose tissue (needle length is ½ width of skin fold) *To ensure entering SQ tissue, pinch/elevate; *Use 45-90 o angle

41. Subcutaneous Injections Sites • Sites: (1)Outer posterior upper arm; (2) abdomen from below costal margin to iliac crests (2 inches from umbilicus); (3)anterior aspect of thighs

42. Choosing the right syringe and needle for Subcutaneous injections • Insulin is given in an insulin syringe marked in units. The needle is usually attached.

43. Choosing the right syringe and needle for Subcutaneous injections • Tuberculin syringe is marked in hundredths (0.01) for doses less than 1mL • Subcut. Injections reserved for small volumes of medication (0.5-1mL) • 25 gauge needle 5/8 to ½ inch long

44. Subcutaneous Injections: Special considerations • Administration of INSULIN • Rotating sites • Rates of absorption • Blood Glucose level • Onset,peak,duration • S/S hypoglycemia, hyperglycemia * Insulin is a naturally-occurring hormone secreted by the pancreas. Insulin is required by the cells of the body in order for them to remove and use glucose from the blood.

45. Subcutaneous Injections: Insulin • Rotating Sites: potential for insulin to cause hypertrophy is now a low risk and some clients may not rotate sites anymore. • Rates of absorption: based on site • 1 Abdomen………Fastest • #2 Arms • #3 Thighs • 4 Buttocks……….Slowest

46. INSULIN & Blood Glucose Monitoring • Assess glucose control in patients with Diabetes Mellitus (Normal Blood Glucose is ~70-110) • Administer Sliding Scale Insulin Coverage- as Ordered- MD Order determines scale and amount of insulin coverage dose

47. INSULIN & Blood Glucose Monitoring • Assess blood glucose level using a glucometer • Measure the glucose in a sample of capillary blood, obtained from fingertip (skin puncture) by placing the sample on a test strip and placing it into a calibrated glucometer.

48. Sliding Scale/Correctional Coverage Insulin Coverage Sliding-scale coverage: Sometimes given to manage some inpatients' hyperglycemia. Patients receive insulin when glucose levels are high; the higher the glucose level, the more insulin is typical given. The scale is determined by the physician

49. Sliding Scale/Correctional Coverage Insulin Coverage Example: If Patients BG is 180mg/dL, This Patient would receive 2 units of regular insulin *hypoglycemia protocol may require the administration of glucose

50. Hypo and Hyper GLYCEMIA Hypoglycemia (low) Hyperglycemia (high)