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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.

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Medication Administration

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    1. 53 Medication Administration

    2. 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.

    3. 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.

    4. 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.

    5. 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

    6. 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

    7. 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

    8. Preparing to Administer a Drug (cont.) • Administration site • Check site of administration • Be sure there are no contradictions to using the site

    9. 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

    10. 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

    11. General Rules for Drug Administration • Triple check medication When taken from storage container and matched to MAR When prepared Before administration

    12. 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

    13. General Rules for Drug Administration (cont.) • The physician must be in the office • Have patient remain in office • Instruct patient

    14. General Rules for Drug Administration (cont.) • If patient refuses the medication • Discard properly • Document • Report medication errors • Document after administering medication

    15. 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!

    16. 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

    17. 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

    18. Rights of Medication Administration (cont.) • Right dose • Read label • Calculate accurately • Right route • Matches route ordered • Can be administered by route ordered

    19. Rights of Medication Administration (cont.) • Right time • Right documentation • Immediately following administration • Correct information

    20. 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

    21. 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!

    22. 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

    23. Medications by Mouth • Oral administration • Slower absorption • Tablets, scored tablets, capsules, lozenges, and liquids • Contraindications • Nausea • Comatose • Unable to swallow • Patient education

    24. Medications by Mouth • Buccalor sublingualadministration • Buccal – placed between the cheek and gum • Sublingual – placed under the tongue • Faster absorption; bypasses GI tract

    25. 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.

    26. 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

    27. Medications by Injection (cont.) • Needles • Parts • Gauge • Length ~ select for • Type of injection • Patient size • Amount of fatty tissue • Injection site

    28. 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

    29. Forms of Packaging for Parenteral Drugs • Cartridge • Ampule • Vial • Liquid or powder ~ reconstitute with diluent • Single or multiple doses

    30. 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

    31. 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

    32. Medications by Injection (cont.) Iliac Crest Clavicle Vastus lateralis (mid-portion) • IM injections – choose sites carefully Deltoid muscle Ventrogluteal

    33. 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

    34. 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!

    35. 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

    36. Other Medication Routes • Urethral administration – local effect • Vaginal • Local effect • Suppositories most common form • Douches ~ administer liquid medications • Rectal – suppositories or enemas

    37. Apply Your Knowledge List parenteral routes other than an injection. ANSWER: Other parenteral routes include: • Inhalation • Topical • Urethral • Vaginal • Rectal Great job!

    38. Special Considerations • Pediatric patients • Drug effects are less predictable • Require dosage adjustments and careful measurements of doses

    39. Special Considerations (cont.) • Pediatric patients • Observe pediatric patients closely for adverse effects and interactions • Administration sites and techniques differ • Patient education ~ parents vs. child

    40. Special Considerations (cont.) • Pediatric patients • Oral medications ~ use calibrated dropper or spoon • Injections • Sites • Restraining methods

    41. 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

    42. 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!

    43. 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

    44. 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

    45. 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

    46. 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

    47. 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

    48. 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

    49. 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

    50. Patient Education about Medications (cont.) • Patient compliance – patient education • What to do with old medication • How to store drugs • When to call the doctor