Drug Administration

By: Ms Atiqah Chew Abdullah

Learning objectives

Explain the two types of order and the responsibilities in carrying out order

List and elaborate the 6 right of administering medication

Identify the do and don’t in administering medication

Identify the common abbreviation when administering medication

Discuss the important consideration of medication administration

Practice the right technique in administering medication by following the 6 rights

Introduction

Drug(pharmacological definition):

A chemical substance administered for the diagnosis, cure, treatment, relief or prevention of disease. Used to otherwise enhance physical or mental well-being

Introduction

Drug administration is very important and can be a dangerous duty › Given correctly – restore patient to

health› Given incorrectly – patient’s condition

can worsen

Introduction

Nurses must:

› Understand principles of pharmacology› Understand fundamentals of drug

administration Routes Dosage calculations Techniques for injection Six rights Patient education

Types of Doctor’s Order: : 

Standing Order- it is carried out until the specified period of time or until it is discontinued by another order.

Single Order- it is carried out for one time only.

Stat Order- it is carried out at once or immediately.

PRN Order- it is carried out as the patient requires.

Principles in Administering Medications

1. Observe the “6 Rights” of drug administration. › 1. Right drug› 2. Right dose› 3. Right time› 4. Right route› 5. Right patient› 6. Right documentation

2. Practice asepsis 3. Nurses who administer medications

are responsible for their own actions. Question any order that you consider incorrect.

4. Be knowledgeable about medications that you administer.

5. keep narcotics and barbiturates in locked place.

6. Use only medications that are clearly labeled containers in.

7. Return liquid that are cloudy or have changed in colour to the pharmacy

8. Before administering a medication, identify the client correctly.

9. Do not leave the medications at the bedside.

10. If the client vomits after taking oral medication, report this to the nurse in charge and/or physician.

Right drug Identify the drug from the Dr.’s order. Clarify

with the Dr. if in doubt.

Check the drug three times: - before removing it from the trolley or

shelf - when the drug is removed from the

container - before the container is returned to

storage - check the expiry date of the drug

Check the drug with another RN for DDA & barbiturate.

Right drug

The nurse should be familiar with the generic drug name as well as the trade name.

The use of generic name in clinical practice is preferred to reduce the risk of medication errors.

Right dose

- Check the dose, read the container label, calculate the dose & check with a RN if necessary.

- Use proper measuring devices for liquids, do not crush tablets or open capsules unless directed to by the pharmacist. (do not crush enteric coated tablets).

If a drug is required in another form you may get it from the pharmacy.

Pediatric & elderly more sensitive to medications – need extra caution with drug dosage.

Right time For routine medication orders, the

medications must be given no more than 30 min before or after the actual time specified in the prescriber’s order. E.g., 9.00am med, may be given between 8.30am-9.30am.

The effect of changing in dosing or timing of medication should never be underestimate because one missed dose of certain medication can be life threatening.

Right time

Other factors must be considered when determining the right time e.g., multiple drug therapy, drug-drug or drug-food compatibility, scheduling of diagnostic studies, bioavailability of drug (e.g., the need for consistence timing of doses around the clock to maintain blood levels), drug actions, and any biorhythm effects such as occur with steroids.

Right route Oral Route Forms: a) solid: tablet, capsule, pill,

powder.

b) liquid: syrup, suspension, emulsion.

Enteric coated tablets should not be crushed before administration. Suspensions are never administered intravenously. If the patient vomits within 20 – 30mins of taking the drugs, notify the physician. Do not readminister the drug without a physicians order.

Right route 2. Sublingual- drug placed under the

tongue, where it dissolves. 3. Buccal- medication is held in the mouth

against the mucous membranes. of the cheek until the drug dissolves.

4. Topical a) Dermatologic- lotions, liniments, ointment, pastes and powders. b) Ophthalmic- instillations and irrigations. c) Otic, d) Nasal, e) Inhalation, f) Vaginal- tablet, cream, jelly, foam, suppository

5. Rectal- (objectionable taste or odor)

18

Right route

6. Parenteral- administration of medications by needle.

a) Intradermal (ID)- under the epidermis (into the dermis).

b) subcutaneous (SC)- in the subcutaneous tissue (also, hypodermic)

 c) intramuscular (IM)- into the muscle. d) intravenous (IV)- into a vein. e) intraarterial- into an artery. f) intraosseous- into the bone.

Right patient › Checking the pt’s identity before giving

each medication dose is critical to the pt’s safety.

› Ask the patient to state his/her name and check his ID band to confirm pt’s name, ID number, age, and allergies against the medication chart.

Right documentation

Documentation of information r/to administrations is crucial to pt safety.

The pt’s chart should always have the following: › Date & time of the medication administered› Name of medication, dose, route & site of

administration. › Drug action – to assess the changes of

symptoms the pt experiencing, adverse effects, toxicity & other drug-related physical & physiologic symptoms.

Right documentation

Improvement of the pt’s condition, symptom, disease process.

No changes/lack of improvement. Patient’s teaching/degree of pt’s

understanding.

Right documentation

Other info:› if a drug not administered & reason why?› Refusal of a medication & reason for

refusal.› Actual time of drug administration› Data regarding clinical observations &

treatment of the pt if a medication error has occurred.

NAMES OF DRUGS

Drugs can have three types of names:

a. chemicalb. genericc. trade/brand/proprietary

NAMES OF DRUGS

a.Chemical name:

- a very precise description of the drug’s chemical composition, identifying the drug’s atomic and molecular structure.

- this name is of significance to the pharmacist.

NAMES OF DRUGS

b. Generic name:

- The name assigned by the manufacturer who first develops the drug. Often the generic name is derived from the chemical name.

- the official name is the name by which the drug is identified in the official publication.

NAMES OF DRUGS

c.Trade/ Brand/ Proprietary name:

- Is selected by the drug company selling the drug and is copyrighted

- a drug can have several trade names when produced by different manufacturers

NAMES OF DRUGS

e.g. Chemical name= Acetylsalicylic acid

Generic name = Aspirin Trade names include Aspro, Disprin

Be aware that in different countries generic and trade names will also differ, e.g. in Australia & the United States one drug has the generic names of paracetamol & acetaminophen, i.e. Panadol/Tylenol.

Categories/Classifications of Drugs

Drugs can be classified from different perspectives

e.g. drugs may be classified by -(a) body systems i.e. drugs affecting the respiratory system drugs affecting the cardiovascular system OR(b) the symptom relieved by the drug, or the

clinical indication for the drug i.e. analgesic, antibiotic

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequency

MANE MIDI NOCTE BD/BID TDS/TID QID STAT PRN

morning midday Night twice a day three times a day four times a day give immediately when required when necessary

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequency

ac Pc q.h.or 1/24 q2h or 2/24 q4h or 4/24 qod

before meals after meals every hour every two hours every four hours Every other day

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route

BUC O/P.O S/L

ID IM SC/SQ

inside cheek oral/per oral sublingal (under the tongue) intradermal intramuscular subcutaneous

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route

SCI

IVI IVT

NEB PR TOP VAG

subcutaneous injection intravenous injection intravenous therapy

nebuliser per rectum topical/skin vaginal

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS- Drug administration

Rx NPO/NBM

Prescribe, take Nil per oral/nil by

mouth

Thank you…