Chapter 26: Medication Administration PPT Notes

Chapter 26 Medication Administration PPT Notes Drug Names Mechanisms to Promote Drug Safety Legal Considerations Medication Systems • • • • Chemical Generic Official Brand • • • • • • • • Pharmacopoeia and formularies Nursing drug handbooks Physician’s Desk Reference (P D R) Pharmacology texts Electronic and Internet-based formularies A clinical pharmacist Medication package inserts Institutional medication policies and procedures • U.S. Drug legislation and Nurse Practice Acts • Stock supply o Bulk quantity o Central location o Not client specific Unit Dose o Individually packaged o Client-specific drawers o 24-hr supply Automated dispenser o Password-accessible locked cart o Computerized tracking o Can combine stock and unit doses Self-administration Medication (S A M) o Individual containers o Kept at client’s bedside • • • Pharmacological Considerations • • Pharmacokinetics • Absorption • • Distribution • Pharmacokinetics o What happens to the drug in the body? Pharmacodynamics o How does the drug affect the body? Four processes o Absorption o Distribution o Metabolism o Excretion Movement of drug into the bloodstream Factors affecting absorption o Route of administration o Drug solubility o pH/ionization o Blood flow Drug transport to tissues and organs • Metabolism Excretion Concepts Related to Pharmacokinetics Factors Affecting Pharmacokinetics Pharmacodynamics: Effects of Drugs • • Factors affecting distribution o Local blood flow o Membrane permeability o Protein-binding capacity Biotransformation: Chemical conversion of drug Factors affecting metabolism o Liver function o Health/disease status o First-pass effect Elimination of the drug Factors affecting excretion o Organ function, especially the kidneys, liver, and lungs o Exocrine glands Time until onset and peak Therapeutic range o Peak level o Trough level o Therapeutic level Biological half-life Concentration of active drug • • • • • • • • • • • Age Body mass (weight) Gender Pregnancy Environment Route of administration Timing of administration Fluids Pathological states Genetic factors Psychological factors • Primary effects o Therapeutic effects o Predicted o Intended o Desired o Why the drug was prescribed Secondary effects Unintended Nontherapeutic Can be o Predictable o Harmless o Harmful Types of secondary effects o Side effects o Adverse reactions o Toxic reactions o Allergic reactions o Idiosyncratic reactions • • • • • • • • • • • Drug Interactions Drug Abuse or Misuse Measure and Calculate Dosage • • • o Cumulative effect Antagonistic Synergistic Incompatibilities • • • • • Tolerance Dependence Misuse Abuse Illicit drugs • Measurement systems o Metric o Apothecary o Household o Units o Milliequivalents Calculating dosages o Ratios o Solving for X o Nomograms o Clark’s rule Client’s full name (some locales require address) Date and time Name of medication Dosage size, frequency, number of doses Route of administration Printed name and signature of prescriber, including relevant credentials and legal registration identifier or DEA # (written prescriptions) Types of medication prescriptions o Written prescription o Automatic “stop” date o STAT prescription o Single o Standing prescription o A prn prescription Communication of prescriptions (orders) o Handwritten o Preprinted o Oral o By telephone The nurse manager is investigating several “near misses” and an increase in medication errors on the unit. The nursing staff discusses that they are having difficulty reading the handwriting of a particular provider. They convey that she becomes very annoyed when asked to clarify her prescriptions and has on several occasions stated, “I am sure you will figure it out.” The nurses have been having other nurses interpret the prescriptions. What should be your initial actions? • Components of the Medication Order/Prescription • • • • • • • Nursing Considerations: The Medication Prescription • • Socratic Reasoning • Medication Errors Technology to Prevent Errors What Should I Do if I Commit a Medication Error? Assessment: Medications Analysis/Nursing Diagnosis Planning Outcomes/Evaluation and Interventions/Implementation Teaching Medication SelfAdministration • What safety concerns are evident in this scenario? • What options are available to the provider? • • • • • Lack of knowledge or information Faulty communication Equipment errors Calculation and measurement errors Other • • • • Computerized prescriber order entry (C P O E) Barcode medication administration Smart pumps Automated dispensing cabinets • • • Immediately assess the patient’s vital signs and physical status. Report findings to the primary care provider. Notify the nurse manager of your unit and report the events surrounding the event. Check with your institution for agencyspecific policy regarding incident reporting. • • • • • • • • Before During After Medication history Physical examination Injury Risk Ineffective Health Management Depend on the nursing diagnoses • • • • • • • Know and understand what you are taking. Take the drug as prescribed. Communicate with your provider. Think about safety. Administer your drugs correctly. Store your drugs safely. Maintain your supply. Three checks!!! Nursing Considerations: Medication Administration Safety 1. Before you pour o Check the medication label against the medication administration record (M A R). 2. After you pour o Verify the label against the M A R. 3. At the bedside o Check the medication again. Six rights • • • • • • • • • Routes of Administration Right drug Right dose Right time Right route Right patient Right documentation Right reason Right to know Right to refuse Oral medications • Most commonly used route • Includes o Tablets, capsules o Liquids o Buccal o Sublingual o Enteral medications Topical medications: Applied directly to body surface/body cavities • Local (and sometimes systemic) effects o Lotions, creams, ointments o Transdermal patches o Eye and ear o Nasal o Vaginal o Rectal • Respiratory inhalations • Use concept of nebulization • Absorption via alveoli and blood supply o Atomizers o Aerosol o Metered dose inhaler • Intradermal • Transdermal • Subcutaneous • Intramuscular • Intravenous • • Parenteral medications • Parenteral Medication Administration • Equipment preparation o Syringe/needle (size, gauge) Medication preparation o Vials and ampules o Reconstituting from powder o Two medications in one syringe Safety issues o Use sharps containers. o Avoid recapping a dirty needle. Use the correct site. o Wrong site could mean wrong route. • • Be familiar with the technique required for the medication (e.g., heparin, insulin). Intravenous medications o IV push o IV piggyback o Medicated drips