53. Medication Administration. Learning Outcomes. 53.1 Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. 53.2 List the rights of drug administration.
53 Medication Administration
Learning Outcomes 53.1 Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration. 53.2 List the rights of drug administration. 53.3 Recognize the correct equipment to use for administering medications.
Learning Outcomes 53.4 Carry out the procedures for administering oral medications. 53.5 Carry out procedures for administering parenteral medications. 53.6 Carry out procedures for administering parenteral medications by other routes.
Learning Outcomes 53.7 Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients. 53.8 Outline patient education information related to medications. 53.9 Implement accurate and complete documentation of medications.
Introduction • Drug administration • Given correctly ~ restores health • Given incorrectly ~ condition can worsen • Medical assistant must • Understand fundamentals of drug administration • Know your scope of practice
Preparing to Administer a Drug • For common drugs know • Uses • Contraindications • Interactions • Adverse effects • Be alert to any change in patient’s condition that could affect drug therapy
Preparing to Administer a Drug (cont.) • Drug and drug allergies • Keep an accurate medication list in the patient record • Ask about drug allergies at every appointment
Preparing to Administer a Drug (cont.) • Administration site • Check site of administration • Be sure there are no contradictions to using the site
Preparing to Administer a Drug (cont.) • Patient condition • Assess overall condition • Review drug list • Be sure dose is appropriate • Patient consent form • Answer questions • Have signed before administering injection
General Rules for Drug Administration • Give only drugs the doctor orders • Wash your hands • Prepare in a well-lit area • Focus on task • Avoid distractions
General Rules for Drug Administration • Triple check medication When taken from storage container and matched to MAR When prepared Before administration
General Rules for Drug Administration (cont.) • Calculate the dose carefully • Do not leave a prepared drug unattended • Do not administer a drug you did not prepare • Verify patient identity
General Rules for Drug Administration (cont.) • The physician must be in the office • Have patient remain in office • Instruct patient
General Rules for Drug Administration (cont.) • If patient refuses the medication • Discard properly • Document • Report medication errors • Document after administering medication
Apply Your Knowledge What does “triple check” include? ANSWER: The medication needs to be checked 3 times: 1st check – when you remove it from the storage area and match it to the MAR 2nd check – when you prepare it 3rd check – before you close the storage container or just before you administer the medication to the patient Yippee!
Additional rights Right reason Right to know Right to refuse Right technique Rights of Medication Administration • Basic rights • Right patient • Right drug • Right dose • Right route • Right time • Right documentation
Rights of Medication Administration (cont.) • Right Patient • Ask patient for name and date of birth • Check against record • Right Drug • Check ordered drug name against label • Check expiration date • Look up drug if unfamiliar • Perform a triple check
Rights of Medication Administration (cont.) • Right dose • Read label • Calculate accurately • Right route • Matches route ordered • Can be administered by route ordered
Rights of Medication Administration (cont.) • Right time • Right documentation • Immediately following administration • Correct information
Rights of Medication Administration (cont.) • Right reason • Right to know – patient education • Right to refuse • Report to physician • Document • Right technique – know the correct technique
Apply Your Knowledge How do you properly identify the patient before administering a drug? ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth. Right!
Drug Routes and Equipment • You must be able to give drugs safely by any route • In the medical office • Buccal or sublingual medications • Other routes based on scope of practice • Demonstrate use of inhalers • Topical drugs
Medications by Mouth • Oral administration • Slower absorption • Tablets, scored tablets, capsules, lozenges, and liquids • Contraindications • Nausea • Comatose • Unable to swallow • Patient education
Medications by Mouth • Buccalor sublingualadministration • Buccal – placed between the cheek and gum • Sublingual – placed under the tongue • Faster absorption; bypasses GI tract
Apply Your Knowledge Gold star Answer! Why is it important to be able to administer medications by a variety of methods? ANSWER: You may be asked to administer drugs by any of an number of different routes. Why is absorption faster when drugs are administered sublingually or buccally? ANSWER: The drug is absorbed directly into the bloodstream bypassing the GI tract.
Medications by Injection • Parenteral administration • Any route other than through the GI tract • Rapid drug action • Safety risks • Rapid administration • Exposure to blood-borne pathogens
Medications by Injection (cont.) • Needles • Parts • Gauge • Length ~ select for • Type of injection • Patient size • Amount of fatty tissue • Injection site
Medications by Injection(cont.) • Syringes • Barrel ~ calibrated cylinder • Plunger ~ forces drug through barrel • Needlestick prevention safety device Plunger Leading ring Barrel Syringe hub Needle Trailing ring Needlestick prevention safety device
Forms of Packaging for Parenteral Drugs • Cartridge • Ampule • Vial • Liquid or powder ~ reconstitute with diluent • Single or multiple doses
Medications by Injection (cont.) • Intradermal (ID) • Into upper layer of skin • Used for skin tests • Subcutaneous(subcut) • Provides slow, sustained release and longer duration of action • 1 mL or less • Rotate sites To diagram
Medications by Injection (cont.) • Intramuscular(IM) • More rapid absorption • Less irritation of tissue • Z-track method Epidermis and dermis Subcutaneous tissue Muscle Medication Z-track Method To diagram
Medications by Injection (cont.) Iliac Crest Clavicle Vastus lateralis (mid-portion) • IM injections – choose sites carefully Deltoid muscle Ventrogluteal
Medications by Injection (cont.) • Intravenous (IV) • Directly into vein • Given by IV infusion • Drug is dissolved into a solution • Slow drip into a vein • Rapid onset of action • Sudden adverse reactions possible To diagram
Apply Your Knowledge ANSWER: G ___ prevents drug from leaking into subcutaneous tissue ___ used to administer skin tests ___ small bottle with rubber diaphragm ___ can administer a larger amount of medication ___ provides a slow, sustained release inside diameter of needle provides an almost immediate effect Matching Intramuscular injection Gauge Subcutaneous injection Intradermal injection Vial IV injection Z-track method D E A C B F Super!
Other Medication Routes • Inhalation • Administered through the mouth or nose • Read package insert • Topical • Direct application of a drug on the skin • Some forms ~ creams, lotions, ointments • Transdermal system
Other Medication Routes • Urethral administration – local effect • Vaginal • Local effect • Suppositories most common form • Douches ~ administer liquid medications • Rectal – suppositories or enemas
Apply Your Knowledge List parenteral routes other than an injection. ANSWER: Other parenteral routes include: • Inhalation • Topical • Urethral • Vaginal • Rectal Great job!
Special Considerations • Pediatric patients • Drug effects are less predictable • Require dosage adjustments and careful measurements of doses
Special Considerations (cont.) • Pediatric patients • Observe pediatric patients closely for adverse effects and interactions • Administration sites and techniques differ • Patient education ~ parents vs. child
Special Considerations (cont.) • Pediatric patients • Oral medications ~ use calibrated dropper or spoon • Injections • Sites • Restraining methods
Special Considerations (cont.) • Pregnant patients – check drug references for safety during pregnancy • Patients who are breast-feeding • Check drug references for safety during lactation • May need to supplement with formula
Apply Your Knowledge Why are drug effects less predictable in children? ANSWER: Drugs are absorbed, distributed, metabolized, and excreted differently in children than adults. Fantastic!
Patient Education about Medications • Over-the-counter drugs • May not produce therapeutic effect • May be dangerous in combination with other substances • May mask or aggravatesymptoms • May have more thanone active ingredient
Patient Education about Medications (cont.) • Prescription drugs • When and how to take the medication • Drug safety precautions • How to read a prescription label • Special instruction • Warnings
Patient Education about Medications (cont.) • Drug-drug interactions • Types • Effects may be increased • Effects may be decreased • One drug may be increased by another • Lead to adverse reactions • Check patient drug use • Patient education
Patient Education about Medications (cont.) • Food-drug interactions • Alter the therapeutic effect • Interfere with body’s use of nutrients • Patient education • Be specific about foods to avoid and when • Explain what to expect if interaction occurs • Describe what to do
Patient Education about Medications (cont.) • Adverse effects • May be mild to life-threatening • Elderly or patient with kidney and liver disease ~ more susceptible • Patient education • Take as instructed • Recognition of significant adverse effects • Report to physician
Patient Education about Medications (cont.) • Complete medication list • Prescription and OTC drugs • Supplements and herbals • Past and present use of recreational drugs and alcohol • Patient education • Tell all of their doctors about their medications • Keep an up-to-date list with dosages
Patient Education about Medications (cont.) • Patient compliance – patient education • How and when to take each drug • How long to take each drug • How to identify possible adverse effects
Patient Education about Medications (cont.) • Patient compliance – patient education • What to do with old medication • How to store drugs • When to call the doctor