CHAPTER 3 LEGAL ASPECTS OF MEDICATION ADMINISTRATION

CHAPTER 3

LEGAL ASPECTS OF MEDICATION ADMINISTRATION

LEVELS OF LAWFDA WATCHES OVER TESTING, APPROVAL

AND MARKETING OF NEW DRUGS1. FEDERAL LAWS

CONTROLLED SUBSTANCESPRESCRIPTION DRUGSOTC MEDICATIONS

2. STATE LAWS AND REGULATIONS3. INDIVIDUAL HOSPITALS OR AGENCY

RULES

Federal Legislation

Harrison Narcotic Act of 1914 – limited indiscriminate use of addictive drugs

Federal Food, Drug, and Cosmetic Act of 1938 – gave authority to government to determine the safety of a drug prior to marketing, labeling, specification, and advertising

Durham-Humphrey Amendment of 1952 – restricted number of prescription refills

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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

CONTROLLED SUBSTANCESCONTROLLED SUBSTANCES ACT OF 19705 DRUG SCHEDULES

1. HIGH LEVEL OF DEPENDENCY2. HIGH LEVEL OF DEPENDENCY3. HIGH LEVEL BUT LESS THAN 1&24. LOW LEVEL COMPARED TO 35. LOW LEVEL COMPARED TO 4

Controlled SubstancesNurses may possess these only if:

They are administering the drugs to the patient for whom they were prescribed

They themselves are the patient for whom the physician has prescribed the drug

They have been delegated the responsibility for the unit supply

It is a crime for the nurse to have a controlled substance UNLESS 1 OF THE 3 ABOVE CONDICTIONS ARE MET.

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CONTROL OF NARCOTICSMUST COUNT THE NARCOTICS BETWEEN

AN ON-COMING AND OFF-GOING STAFF MEMBERS EVERY 8 HOURS

CHART IN MAR AND NARCOTIC BOOKALL NARCOTICS FOR A DISCHARGED/

DECEASED PATIENT ARE RETURNED TO PHARMACY FOR A COUNT AND DISPOSAL

WASTED/ USED MEDICATION MUST BE WITNESSED ON DISPOSAL

NO DRUG SHARING

DEPENDENCEPHYSICAL DEPENDENCE – PHYSIOLOGICAL

NEED TO RELIEVE PHYSICAL SYMPTOMS

PHYSCHOLOGICAL DEPENDENCE – ANXIETY, STRESS, OR TENSION THAT IS FELT IF THE PERSON DOES NOT HAVE THE MEDICATION

CAN HAVE ONE, BOTH OR NEITHER

OTC MEDICATIONSDO NOT NEED PRESCRIPTIONPURCHASED AT DRUG STORESLOW DOSAGELOW RISK FOR SIDE EFFECTSWARNING LABELS AND SPECIAL

INFORMATION AVAILABLE TO PURCHASERSHERBAL MEDICATIONS

STATE LAW & HEALTH CARE AGENCIESCHECK THE NURSE PRACTICE ACT IN THE

STATE IN WHICH YOU WORKPROFESSIONAL REPSONSIBILITY:

ADMINSTER DRUGS APPROPRIATELY, ETHICALLY AND TO BEST OF ABILITY

LEGAL RESPONSIBILITY:GOOD JUDGMENTPROPER ACTIONS IN CARRYING OUT

PROFESSIONAL DUTY

State Nurse Practice Act

Determines the level of authority and responsibility of the nurse

Different levels of nursing will have different levels of authority and accountability

Nurses must adhere to the Nurse Practice Act of the state in which they are practicing

Responsibilities may vary in state Nurse Practice Acts

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Nursing Responsibilities

All nurses have legal responsibility for their actions.

The Nurse Practice Act determines the level of responsibility and authority of the nurse.

Nurses must have the authority to delegate to a person with the authority to carry out the task.

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NURSE LICENSURE COMPACTHOLD A LICENSE IN ONE STATE BUT ABLE

TO WORK IN A STATE WITHIN THE COMPACT

WWW.NCSBN.ORGNEW JERSEY IS NOT YET IN THE COMPACT

AGENCY/ INSTITUTIONAL POLICIESMAY BE MORE RESTRICTIVE OR SPECIFIC

THAN STATE NURSE PRACTICE ACTWRITTEN POLICIES –

EDUCATIONAL PREPARATIONPOLICIES

ORIENTATIONPARTICULAR POLICIES, PROCEDURES, AND

RECORD KEEPING RULES*EXPECTED TO USE NURSING PROCESS IN

MEDICATION ADMINISTRATION

Question 1

Of the following, who is not permitted by law to prescribe medication?

1. Physician assistant2. LPN3. Dentist4. Nurse practitioner

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DELEGATIONTHE RESPONSIBILITY FOR PERFORMING A T

ASK IS PASSED FROM ONE PERSON TO ANOTHER BUT THE ACCOUNTABILITY FOR WHAT HAPPENS (OUTCOME) REMAINS WITH THE ORIGINAL PERSON

MUST HAVE THE AUTHORITY TO DELEGATETHE RECEPTOR OF DELEGATION MUST BE

ABLE/ HAVE AUTHORITY TO PERFORM THE DELEGATED TASK

ADMINISTRATIONCHECK MAR AGAINST THE ORIGINAL

ORDERBAR CODING FOR MEDICATION DELIVERYUSE THREE CHECKS FOR SAFETY

BEFORE TAKING FROM DRUG CARTBEFORE PREPARING, MEASURING DOSEBEFORE OPENING THE MEDICATION AT THE

BEDSIDE, OR PUTTING THE BOTTLE BACK

DRUG DISTRIBUTION CENTERSFLOOR STOCK (FROWNED UPON)INDIVIDUAL PRESCRIPTION ORDER SYSTEMUNIT DOSECOMPUTERIZED OR AUTOMATED

DISPENSING SYSTEM (PIXIS)

NARCOTIC DISPENSING:Locked cabinet within locked med roomSigned out in narcotics book and MARCounted each shift

REQUIREMENTS FOR ORDERSPATIENT’S FULL NAMEDATE WRITTENNAME OF DRUGROUTE, DOSE AND FREQUENCYDURATIONSIGNATURE OF PRESCRIBERADDITIONAL NEEDED DETAILS

Avoid grapefruit Empty stomachTake with food, etc

TYPES OF ORDERSSTANDING ORDER

EX: TYLENOL 400mg PO DAILYSTAT ORDER

BENADRYL 50 mg PO NOWSINGLE ORDER

DEMEROL 50 mg IM X1 ON CALL TO ORAS NEEDED (PRN) ORDER

IBUPROFEN 200mg PO PRN EVERY 6 HOURS FOR TEMP 101 OR GREATER

MEDICATION ERRORSOOPSIES DO HAPPENCHECK THE PATIENT STATUS FIRSTNOTIFY THE PHYSICIANMONITOR THE PATIENTNOTIFY NURSING SUPERVISORCHART EXACT CIRCUMSTANCESINCIDENT REPORTS GO TO RISK

MANAGEMENT; DO NOT CHART IN PATIENT RECORD THAT AN INCIDENT REPORT HAS BEEN FILED

INCIDENT REPORTSBE EXACTBE FACTUALSEQUENTIAL HAPPENINGS AS BEST YOU

CAN RECALLKEEP A PERSONAL COPY. USED TO ASSESS FOR PATTERNS OF

ERRORSCOULD BE A SYSTEM ERROR OR A

PERSONAL DEFICIENCY

MEDICATION SAFETYCHECK, CHECK AND CHECK AGAINIF NOT SURE, LOOK IT UPDOUBLE CHECK CRITICAL MEDSALWAYS USE 2 CHECKS FOR PATIENT IDNEVER LEAVE MEDS FOR THE PATIENT TO

TAKE LATERNEVER EVER RECAP A USED NEEDLEDISPOSE OF ITEMS PROPERLY

Question 2

Morphine is in the category of:

1. Supplements.2. Unscheduled drugs.3. Scheduled drugs, or controlled

substances.4. Over-the-counter medications.

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Question 3

Which of the following statements is true regarding herbal products?

1. Very few people try herbal products.2. Herbal products are regulated by the

federal government.3. Herbal products are considered

supplements.4. There is a great amount of information

known about side effects.

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Chapter 4

Foundations and Principles of Pharmacology

Copyright © 2013, 2010, 2006, 2003, 2000, 1995,

1991 by Mosby, an imprint of Elsevier Inc. 25

Learning Objectives

Define the key words used in pharmacology and medication administration

Explain differences between the chemical, generic, official, and brand names of medicines

List the basic types of drug actions Describe the four basic physiologic

processes that affect medications in the body

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Drug Names

Generic nameTrade name; ® symbolChemical nameOfficial name

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Drug Receptor Sites

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Drug Attachment

AgonistAntagonistPartial Agonist

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Four Processes of Drug Utilization

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Absorption

How a drug enters the body and passes intobody fluids and tissuesAbsorption processes:

Diffusion—high concentration to lower concentration

Filtration—a filter prevents passage of certain molecules

Osmosis—diffusion through a semipermeable membrane from a less dense solution to a more dense solution

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Distribution

Blood systemLymph systemBarriers:

Blood-brainPlacental

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Metabolism

BiotransformationFirst-pass effectAffected by genetic and developmental factors

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Excretion

GI tractKidneysLungsSkin

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Question 1

A nephrotoxic drug is harmful to the:

1. Skin.2. Kidneys.3. Lungs.4. Liver.

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Basics of Drug Action

Desired actionAdverse reactionsIdiosyncratic reactions

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Bioequivalence

Define Brand name versus generic Generic equivalent

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Drug Interactions

Drug action may depend on ability to dissolve quickly or slowly

Controlled by medication formOil-based drugs

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Food, Alcohol, and Drug Interactions

Food interactionsAlcohol interactionsDrugs and laboratory testsChronotherapy

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Question 2

An idiosyncratic response is a drug reaction that is:

1. Expected.2. Predicted.3. Unique.4. Anticipated.

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Question 3

Which medicine is more likely to cause an allergic reaction?

1. Acetaminophen2. Aspirin3. Cough suppressant4. Antidepressant

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QUESTIONS?

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CHAPTER 3 LEGAL ASPECTS OF MEDICATION ADMINISTRATION