Nursing Role with Medication Administration PDF

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Nursing Role with Medication Administration Describe reasons for the procedures for medication standards.  Ensuring meds are safe and effective  Ensure all meds free of impure products  Local governments regulate use of alcohol/tobacco  Control unnecessarily prolonged medication therapy  Protect public from unskilled, uneducated, and unlicensed personnel Describe publications that list official medications.  National Formulary  Institute for Safe Medication Practices (ISMP)  Sources of medication information : o Physician’s Desk Reference o Hospital formularies o Medication handbooks o Pharmacist and package insert Briefly discuss the important components of drug legislation that affect the nurse.  Federal Regulations o Nurse reports when medication event causes harm to pt by completing Medwatch form  Health Care Institution and Medical Laws o Health care agencies establish policies to meet federal, state, and local regulations  Medication Regulations and Nursing Practice o NPA’S - State nurse practice acts: Defines scope of nurse professional functions and responsibilities. o Legal provisions when administering controlled substances such as opioids  Controlled Substances o Sign; wasting; forms o Count at end of shift o Violations:  Fine, imprisonment, or both  May lose license Understand the general concepts pharmaceutics, pharmacokinetics, and pharmacodynamics and their application in drug therapy and the nursing process.  Pharmaceutics: The science of preparing and dispensing drugs, including dosage form design.  Pharmacokinetics: The study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body.  Pharmacodynamics: The study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the effect of the drug on the body. o Agonist- Creates a response (ex-insulin) o Antagonist- Attach to receptor and not cause response (ex-narcan,benadryl) o Enzyme Interaction- Body creates angiotensin I that converts to angiotensin ii than vasoconstricts and raises BP o Non Selective Interactions- Antibiotics Discuss developmental factors that influence pharmacokinetics.  Absorption o Factors that influence absorption: o Route of administration o Ability of a medication to dissolve o Blood flow to the site of administration o Body surface area o Lipid solubility  Bioavailability- How much of the drug actually absorbs into bloodstream. Food can alter this. Give 1 hour before a meal, or 2 hours after to give food on an empty stomach.  Distribution-

Dependent on the physical & chemical properties of the medication Physiology of the person taking the medication  Circulation  Membrane permeability  Protein binding  Metabolism o Biotransformation- enzymes break down medications o First‐pass effect o Factors that affect Metabolism  Age  Nutrition  Other drugs  Excretion o Medication exits the body through the  Kidney  Liver  Bowels  Lungs  Exocrine glands Describe factors to consider when choosing routes of medication administration. Route Advantages Disadvantages Oral  Avoided when pt has  Convenient, comfortable, alterations in GI function economical, Buccal  Contraindicated for pt  easy to administer, Sublingual who cannot swallow,  often produce local or unconscious, confused or systemic events, unable/unwilling to  rarely cause anxiety for pt swallow or hold med under tongue  Cannot be administered to pts with gastric suction  Some meds irritate GI, discolor teeth, or unpleasant taste  Gastric secretions destroy some meds  Risk of infection  Can be used when oral parenteral Routes:  Some meds are expensive meds are contraindicated Intramuscular (IM)  Pain from needlesticks  More rapid absorption Intradermal (ID)  SC, IM, ID routes are than topical/oral route Subcutaneous (SC) avoided in pt with  IV therapy provides Intravenous (IV) bleeding tendency medication delivery when  Risk of tissue damage pt needs it  IM/IV have higher  If peripheral perfusion is absorption rates thus poor, IV route is preferred placing pt at higher risk over injection for reactions  Can cause anxiety in pt, especially children  Pt with skin abrasions at Topical Routes (skin)  Local effect risk for rapid med  Painless absorption and system  Limited Side effects effects  Meds are absorbed through skin slowly o o

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Transdermal Mucous Membranes (suppository)

Inhalation

Intraocular Disc

Prolonged systemic effects with limited side effects  Therapeutic effects by application to involved sites  Aqueous solutions readily absorbed and capable of systemic effects  Route when Oral meds contraindicated Rapid relief or local respiratory problems  Used for introduction of general anesthesia gases Does not require frequent administration as eye drops do 

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Leaves residue of oil or pastes Mucous membranes are highly sensitive  Pt with ruptured eardrum cannot receive ear irrigations  Insertion of rectal/vaginal meds often cause embarrassment  Rectal contraindicated if recent surgery or bleeding Some local agents cause serious systemic effects 

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Expensive Pt must be taught to insert/remove

Describe the significance of the first-pass effect.  First Pass Effect: The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream. o Drug administered must pass through the liver before entering circulation. If a large portion of a drug is chemically changed into inactive metabolites in the liver, then a smaller amount will ACTUALLY go into circulation. o PO meds have a bioavailability of less than 100% o Iv meds are 100% bioavailable First-Pass Routes Non First Pass Routes  Aural (into ear)  Hepatic arterial  Buccal  Oral  Inhaled  Portal venous  IM  Rectal **can be both**  Intraarterial  Intranasal  Intravaginal  IV  SC  SL  Transdermal 8.

Differentiate among different forms of medication.  Oral solids o Caplet o Capsule o Tablet o Enteric-Coated Tablet  Oral liquid o Elixir o Extract o Aqueous solution o Aqueous suspension o Syrup

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Other oral forms o Troche (lozenge) o Aerosol o Sustained release  Topical meds o Ointment o Liniment o Lotion o Paste o Transdermal disk/patch  Parenteral route forms o Solution (sterile prep solution) o Powder (sterile particles to mix in sterile liquid)  Body Cavity forms o Intraocular disc o Suppository 9. Describe the different indications for administering a medication.  The indication is the appropriateness for administering a medication to a pt  Confirm the rationale for use through researching pt history while asking asking out why they are taking the drug  Understanding the indication helps nurses catch potential errors, provide explanations to family/pt, and decrease challenges to medication reconciliation 10. Discuss factors that influence medication actions and interactions.  Medication Interaction: When one med modifies the action of another. o Factors that Influence:  Pt that takes several meds  Alcohol  Synergistic Effect: When two meds have a combined effect greater than the meds given separately. 11. Compare and contrast the roles of the health care provider, pharmacist, and nurse in medication administration.  Health Care Provider  Prescribes meds by written(hand or electronic)verbal, or telephone order or talking to nurse in person  Read back all orders and chart weather order was TO or VO (telephone or verbal order)  Pharmacist  Prepares and distributes meds  Fill prescriptions and validate them  Proper dosage with accurate labels  Provide info about side effects, toxicity, interactions, and incompatibilities  Nurse  Medication Reconciliation  Administering meds  Assess pt ability to self administer  Assess pt before giving med  Monitor effects of med  Proper family/pt med education  Do not delegate administration process to NAP 12. Discuss nursing roles and responsibilities in medication administration.  First determine if med ordered is the correct one  Assess pt if they need med at this time  Administer correctly and monitor effects  Educate pt and family on med  Instructions on meds to be taken home

13. Discuss factors to include in assessing a patient's needs for and response to medication Therapy.  Assessing Pt need for Med: o Consider pt preferences, values, and needs while determining their needs for meds o Take pt history to understand indications or contraindications of med o Allergies o Medication they are currently taking o Diet history o Pt ability to self prepare dose and administer med o Pt current condition o Pt attitude about medication use o Factors affecting adherence to medication therapy o Pt learning needs  Response to medication therapy: o Nurses need to use variety of measures to evaluate pt response to meds such as  Direct observation or physiological measures (BP, Labs)  Behavioral responses (Agitation)  Rating scales (rating on pain/nausea scale) *Most common measure is the physiological measure 14. Discuss methods to educate patients about prescribed medications.  Have to explain their medication schedule for a typical day  Have pt read medication label and explain it  Have a pt show how to give med dose  Teach about med purpose, action, timing, dose, and side effect  Offer easy to read teaching sheets  Teach back method!  Aseptic technique  Teach family members too incase pt is ill or physically unable to handle med 15. Describe the procedure of administration of medications. Things to Know:  Medication information  Drug action  Interactions  Side effects  Adverse reactions  Teaching needs  Medication Set Up: o Pour tablet into cap lid and then pour into pill cup o Do not open individual dose packages until at the bedside o Check expiration date - DO NOT USE IF EXPIRED o Dropped pills - DO NOT ADMINISTER, WASTE IT Steps:  Step 1 – hand hygiene  Step 2 – check the medication order to the MAR  Step 3 – gather the medication & complete check 1 (checking actual medication label with MAR)  Step 4 – gather supplies  Step 5 – prepare medication & complete check 2 (checking actual medication label with MAR)  Step 6 – go to the clients room & hand hygiene  Step 7 – verify client with patient identifiers (Name, DOB)  Step 8 – verify/check for allergies  Step 9 – complete check 3 (checking actual medication label with MAR) at patient’s bedside  Step 10 – explain the purpose, action, side effects of each medication to the client  Step 11 – obtain any assessment data needed  Step 12 – position client if necessary  Step 13 – administer medication  Step 14 – complete hand hygiene after leaving client’s room

 Step 15 – document  Step 16 – evaluate for response  16. Identify the six rights of medication administration and apply them to the clinical setting. 1. Right patient 2. Right med 3. Right route 4. Right dose 5. Right time 6. Right documentation Types of Orders  Standing/Routine  Single/One Time  Now  PRN  STAT  Prescriptions Medication Forms  Aqueous solution-Dissolved in water and syrups  Elixir- Clear fluid containing water and or alcohol  Capsule- encased in a gelatin shell  Ointment- Semi solid applied externally  Suppository- Solid form mixed with jelly for insertion into body cavity  Syrup- Dissolved in a concentrated sugar solution  Tablet- Powdered medication can be scored or enteric coated  Lozenge- dissolves in mouth 17. Implement nursing actions to prevent medication errors.  Prepare medications for only one patient at a time.  Follow the six rights of medication administration.  Be sure to read labels at least 3 times (comparing medication administration record [MAR] with label) before administering the medication.  Use at least two patient identifiers and review the patient's allergies whenever administering a medication.  Do not allow any other activity to interrupt administration of medication to a patient (e.g., phone call, pager, discussion with other staff) (Hopkinson and Jennings, 2013).  Double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia) and verify with another nurse.  Do not interpret illegible handwriting; clarify with health care provider.  Question unusually large or small doses.  Document all medications as soon as they are given.  When you have made an error, reflect on what went wrong and ask how you could have prevented the error. Complete an occurrence report per agency policy.  Evaluate the context or situation in which a medication error occurred. This helps to determine if nurses have the necessary resources for safe medication administration.  Attend in-service programs that focus on the medications commonly administered.  Ensure that you are well rested when caring for patients. Nurses make more errors when they are tired (Murphy and While, 2012).  Involve and educate patients when administering medications. Address patients' concerns about medications before administering them (e.g., concerns about their appearance or side effects).  Follow established agency policies and procedures when using technology to administer medications (e.g., automated medication dispensers [AMDs] and bar-code scanning). Medication errors occur when nurses “work around” the technology (e.g., override alerts without thinking about them)

18. Discuss the influences of the client’s age on the effects of drugs and drug responses.  Child Precautions o Developmental level o Smaller doses o Liquid forms are safer to swallow vs pills o If mixing in foods use only small amount of food o Use caution when selecting intramuscular sites o Use appropriate restraints if needed to administer  Elderly precautions o Cumulative effects and toxicity o Drug interactions o Smaller doses o Stay with patient o Explain and teach o Discharge: special containers, forgetful 19. Explain the client's right to refuse medication/treatments.  A patient has the right: o To be informed about a medication o To refuse a medication o To have a medication history o To be properly advised about experimental nature of medication o To receive labeled medications safely o To receive appropriate supportive therapy o To not receive unnecessary medications o To be informed if medications are part of a research study...