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P A R T 1
Introduction to nursing pharmacology
Safe medication administration
1. Right drug. To prevent medication errors, always check to
make sure the drug you are going to administer is the one
that was prescribed. Many drugs may look alike and/or
have sound-alike names. Ask for the generic as well as the
brand name if you are unsure. Never assume the computer
is correct; always double-check. Avoid abbreviations, and if
you are not sure about abbreviations that were used, ask.
Make sure the drug makes sense for the person for whom
it is ordered.
2. Right storage. Be aware that some drugs require specific
storage environments (e.g. refrigeration, protection from
light). Check to make sure that general guidelines have
been followed.
3. Right route. Determine the best route of administration;
this is frequently established by the formulation of the
drug. Nurses and midwives can often have an impact
in modifying the route to arrive at the most efficient,
comfortable method for the person based on the person’s
specific situation. For example, perhaps a person is having
trouble swallowing, and a large capsule would be very
difficult for the person to handle. The healthcare provider
could check and see if the drug is available in a liquid form
and bring this information to the attention of the person
prescribing the drug. When establishing the prescribed
route, check the proper method of administering a drug
by that route. Review drug administration methods
periodically to make sure you have not forgotten important
techniques. If you have instructed a person in the proper
administration of a drug, be sure to have them explain it
back to you and demonstrate the proper technique. This
should be done not only when the person first learns this
technique, but also periodically to make sure they have
not forgotten any important points. Throughout this book,
Focus on Safe Medication Administration boxes provide
reviews of proper medication administration technique.
4. Right dose. Always double-check calculations, and always
do the calculations if the drug is not available in the dose
ordered. Calculate the drug dose appropriately, based
on the available drug form, the person’s body weight
or surface area or the person’s kidney function. Do not
assume that the computer or the pharmacy is always right;
you are one more check in the system. Do not cut tablets
to get to a correct dose without checking to make sure
the tablet can be cut, crushed or chewed. Many of the
new tablets cannot. Be very cautious if you see an order
that starts with a decimal point; these orders are often the
cause of medication errors. You should never see .5 mg as
an order because it could be interpreted as 5 mg, 10 times
the ordered dose. The proper dose would be 0.5 mg.
If you see an order for 5.0 mg, be cautious; it could be
interpreted as 50 mg. If a dose seems too big, question it.
Throughout this book, Focus on Calculations boxes provide
reviews for calculating dose properly.
5. Right preparation. Know the specific preparation required
before administering any drug. For example, oral drugs
may need to be crushed or shaken; parenteral drugs may
need to be reconstituted or diluted with specific solutions;
and topical drugs may require specific handling, such
as the use of gloves during administration or shaving
of a body area before application. Many current oral
drugs cannot be cut, crushed or chewed. Checking that
information can help to prevent serious adverse effects.
If a drug needs to be diluted or reconstituted, check the
manufacturer’s instructions to make sure that this is done
correctly.
6. Right time. When drugs are studied and evaluated, a
suggested timing of administration is established. This
timing takes into account all aspects of pharmacokinetics
to determine a dosing schedule that will provide the
needed therapeutic dose of the drug. Recognise that
the administration of one drug may require coordination
with the administration of other drugs, foods or physical
parameters. In a busy hospital setting, getting the drug to
the person at the prescribed time can be a real challenge.
As caregivers most frequently involved in administering
drugs, nurses and midwives must be aware of and
manipulate all of these factors, as well as educate people
to do this on their own. Organising the day and the drug
regimen to make it the least intrusive on a person’s lifestyle
can help to prevent errors and improve compliance.
7. Right recording. Always document drug administration. If it
isn’t written, it didn’t happen. Document the information
in accordance with the local requirements for recording
medication administration after assessing the person,
making the appropriate care decisions and delivering the
correct drug by the correct route, in the correct dose and
at the correct time. Accurately record the drug given and
the time given only once you have given the drug to avoid
inadvertent overdoses or missing doses, which would lead
to a lack of therapeutic effect. Encourage people to keep
track of their drugs at home, what they take and when they
take it, especially if they could be confused.
Medications:
Preparing Unit Dose-Packaged
Medications
Medications:
Administering Oral Medications
Medications:
Administering a Subcutaneous Injection
Medications:
Administering an Intramuscular Injection
Medications:
Administering IV Medication by
Piggyback Infusion via an Electronic Infusion Device
Medications:
Administering Eye Drops
Medications:
Administering Ear Drops
