NSG 3100 Objectives for Unit #7 & 8-Medication Administration

NSG 3100 Objectives for Unit #7 & 8-Medication Administration Chapter 35 page 781-849 1. Know the six rights of medication administration. (P. 797-800) 1. Right Drug-give the right medication as ordered 2. Right Dose-the dose ordered is appropriate for the patient. Check the dosage. 3. Right Time-Give the med at the right frequency and at the correct time 4. Right Route-Give the med by the ordered route. Check the rout is safe and appropriate 5. Right Patient-Med is given to the intended patient. Check ID band with each med 6. Right Documentation -document med administration AFTER giving the med 2. Know how to calculate/check the dose for a medication that a physician has ordered. (P. 796-797) slide 5-6 Units of measure/Solving for= Given x Conversion= Answer Conversion 1 kg = 1000 g 1 g = 1000 mg 1mg = 1000 mcg 1 L = 1000 mL 3. Know what to do if a medication is not listed on the MAR. (p. 130, 130 safe practice alerts, p, 789-790) MAR is a list of ordered medications, along with dosages, routes, and times of administration. Safe practice alert medications administered must be documented immediately to avoid confusion about what has been given and the possibility of double dosing. If it’s not listed on the MAR, get an order for it 4. Understand what to do if an IV or IM medication is infusing/or given and the patient shows s/s of an adverse drug reaction or a severe allergic reaction. (p 786) Immediately discontinue the drug and administer epinephrine (an antagonist), IV fluids, steroids, and antihistamines while providing respiratory support 1 Make sure to put a bracelet or tag identifying the drug substance allergy for that patient to alert other medical staff Adverse reactions when AE occurs, immediately stop med and provide the information to PCP so they can forward it to FDA by using MedWatch program. To avoid: make sure to check allergy band before administering med or ask patient if possible Alert patients should remain in facility 20-30 minutes after receiving med to be monitored for severe allergic reaction. 5. Know the essential parts of a drug order. (p. 788 Figure 35.2) Medication Orders A physician determines the client’s medication needs and orders medications, although in some settings nurse practitioners and physician assistants now order some drugs. Order & prescription are the same/ A dr. will always give order Usually an order is written, although telephone and verbal orders are accepted in a number of agencies. With all verbal or telephone orders the nurse must first write down the order and then read it back, verbatim, to the prescribing care provider. The essential parts of a medication (or drug) order are:*** • Full name of the client • Date and time the order was written • Name of the drug to be administered • Dosage of the drug • Frequency of the drug ex: q6hr • Route of administration ex: PO • Signature of the person writing the order nurse’s initials and signature/ prescribing PCP may also be identified 6. Identify the necessary assessment that should be given before administering a medication. (p. 801-802) • Information about patients’ allergies to drugs and food and the patient’s pregnancy or breastfeeding status is especially critical • Important data to be collected o Patients’ medical history o Allergy information o Medication history o Including any prescription OTC or alternative therapies o Physical examination results with a focus on medication effects on the body. o relevant laboratory results 2 Safe practice alert patient allergies to food, drugs, and other substances are noted in the medical record in the history and physical section and on the medication administration record (MAR). The pharmacy and dietary department are notified about allergies, and an allergy band is placed on the patient’s wrist. • Nurse completes a physical assessment to identify body systems that may be affected by prescribed medications • Because meds may affect temp, pulse, respirations, and blood pressure, vital signs that may be affected should be measured before and after administering a medication • Assessing the patient’s ability to swallow is important before administration of an oral medication. Adequate muscle mass is needed for proper absorption of IM medication and functioning IV access must be available for intravenously administered medication. The skin sit for topical medication must be inspected • The most important steps for the nurse to take when preparing to administer medications are assessment of the patient and adherence to six rights of medication administration 7. Understand the situations in which a medication error can happen. (p. 800, Table 35.10) • Right drug o Incorrectly giving a med with a name like the one prescribed o Administering a medication that the nurse did not prepare o Incorrectly Identifying a medication o Not listening to the patient who reports that med looks different from what was given previously • Right dose o Need multiple tabs, caps, or med cups, to prepare a single dose o Having a large change in a prescribed dosage o Having a unit dose or dose supplied by the pharmacy that does not match prescribed doses o Not listening to a patient o Using nonstandarized measuring devices, such as a plastic spoon o Breaking tablets that are not scored into pieces or not using an accepted cutting device o Leaving part of a crushed med behind in the crushing device or the pt is not eating all the food or liquid in which the crushed med is mixed o Not knowing the usual, or safe, dosage range o Incorrect calculations of dose ordered compared to supplied med • Right time o Giving all meds at convenient times for the nurse instead of times prescribed o Not administering drugs medications according to specific needs, such as with food or an empty stomach o Missing doses and needing to reschedule o Not adhering to prescribed frequency for PRN doses (giving more frequently than permitted • Right patient o Incorrectly identifying patients with similar names 3 o Bypassing the identification process and relying on memory of previous patient interactions o Preparing medications for more than one pt at a time o Relying on unsafe identification means, such as room # o Using a smudged or illegible name band as an identifier • Right documentation o Using incomplete, inaccurate, or illegible medication information o Lacking documentation of assessment data required for med, like labs or apical HR o Documenting administration before med administration o Failing to document the medications administered, which is especially dangerous for medications scheduled at a shift change times (morning insulin dose) o Failing to document notification of provider when a dose is not administered o Failing to doc the patient response to meds 8. Know how to “read” a syringe? 9. Know how to interpret an order that is not correct or unusual and what to do with that order-clarification. (p. 795) • The order must be clearly written or entered correctly into an electronic system • Clinical judgement is needed to evaluate whether the medication, amount prescribed, and route are safe for the patient. • The nurse must understand the purpose, typical dosage, route, and side effects of the medication before administration • Nurse assumes legal responsibility for all medication they administer • The nurse should clarify order with prescriber that are difficult to read, do not contain all of the critical information needed for safe administration, or contain prohibited or unfamiliar abbreviations. 10. Know what to do if a medication error is made. (p. 795-796) • Determine the effect on the patient and intervene to offset any adverse effects of the error • Actions include: o Immediate and ongoing assessment, notif