McKenna's Pharmacology, 2e

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P A R T 1  Introduction to nursing pharmacology

Safe medication administration

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

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.

Medications: Administering Eye Drops Medications: Administering Ear Drops