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Medication Administration: Oral

The Five Rights Plus 2

Right Medication, Dose, Route, Time, Patient

And..

  • Allergies
  • Expiration Date

Right Medication

Compare drug to provider written order

When administering, check label on Medication against ______

Check expiration date

Review 5 rights +2 X 3

Medication Administration Systems

Med Cart

______

From Pharmacy

Multi-dose containers

Unit-dose medications

  • Punch cards
  • Individual

Medication Labels

Extra abbreviations after a drug name may identify additional drugs in the preparation or a special action

Narcotics/Barbiturates

Always kept in locked med cart, med room or pyxis system

Special forms are used for recording these meds when not in pyxis:

Name of client, drug, dose, date/time administered, MD prescribing, signature of person giving

These meds are counted by ______at the end of each shift

If a narcotic is wasted, 2 staff members must witness and sign

Controlled Substances

Schedule

  • I – no acceptable medical use
  • Heroin, LSD
  • II – high dependency
  • Narcotics, stimulants (Ritalin)
  • III – lesser potential for dependency
  • Narcotics and barbiturates
  • IV – lesser potential for abuse
  • Valium
  • V – low abuse potential
  • Narcotics in antitussives and anti-diarrheals

Dispensing

Inventorying

Right Dose

Perform and check calculations carefully

Some need double checks

  • ______
  • Heparin
  • Chemotherapy

Right Route and Right Time

PO: liquid, tablet, cap enteric coated, SR, narcotic

SL, NG, IV, IM, Sub-Q

Drug at right time, interval

Think critically about time

Right Patient

Ask two identifiers

  • Name
  • DOB
  • MRN

Check name against the MAR

Never go by room # ______

Joint requirements for patient identification

What is the intent of the requirement for using "two identifiers"?

  • To reliably identify the individual as the person for whom the service or treatment is intended
  • To match the service or treatment to that individual

Allergies and Expiration Date

Allergies

  • Need to know classes
  • Verify with chart and pt

Expiration Date

  • On package
  • After opening

Medication Preparation

Use separate med cups when med must be identified or assessments made

Unit dose: do not remove from package until in patient’s room unless required to do so by the client’s condition

Medication Preparation

You are taking an aspirin out of the bottle. Accidentally, 3 spill out into your hand. Can you return the two you don’t need?______

Use a dropper: hold at right angle

Add liquid to smaller dose

Larger liquid doses

  • Pour away from label on flat surface at eye level

measure at bottom of meniscus

Assessments

Review Medication

  • Action
  • Purpose
  • Normal dosage
  • Side effects
  • Time of onset
  • Peak action
  • Nursing Assessments

Contraindications

Nursing Implications

Ability to ______

Knowledge of medications

Teaching

Provide written information

Drug safety

Things to avoid

Medication storage

Administration

Medication administration

Once medications are prepared, they must remain within the nurse’s ______

Meds should NOT be left at the bedside except lotions, liniments, inhalants, certain eye meds, non-narcotic cough syrups and nitroglycerin (check with agency policy)

DO NOT give a medication if you feel unsafe or question the dosage.

Clarify order from the MD order sheet

Check with a pharmacist or a drug reference

Other rights to consider

Right documentation

Right to know

Right to refuse

Documentation

Only YOU can chart your medications

Meds must be given within time frame set by agency

Regular scheduled meds and those ordered STAT, PRN or one-time must be recorded in appropriate place

Document: site, pulse/BP if appropriate

When meds not given – record omission on chart

Med errors are reported immediately to the nurse in charge – fill out an incident report

All med orders written in chart must be verified daily or per policy

When a patient goes to surgery, Pre-op meds are discontinued. Post-op meds must be ordered/re-ordered (check your facility policy)

Wasting meds

HIPAA compliant

Check for facility guides

Do not

  • Put in sharps
  • Flush down toilet

Witness if needed

Dropped Meds

Need to reorder med

If no pharmacy, check contingency supply

Dispose of properly

What is wrong with this order?

What do you do?

Med Error Waiting to Happen

Parameters?

Key Concepts

Be thorough

Take your time

5+2x3

Error on the side of safety

Follow policy/procedure

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