Lecture 8 - Medication Administration

• Authority • Competence • Safety

nurses must have the necessary authority to perform medication practices - nurses can accept orders for medication administration that are clear, complete and appropriate - orders can be direct (one patient) or directives (multiple) –> controlled substances require direct orders

nurses ensure that they have the knowledge, skill, and judgement needed to perform medication administration practices safely - nurses must never perform medication practices that they are not competent in

nurses promote safe care, and contribute to a culture of safety within their practice environments when involved in medication practices

issues a legal authorization for a medication to be dispensed to a designated individual by writing or odering a prescription for a medication

prepares, dispenses, labels, monitors, and evaluates the effects of prescribed medication

administration of the medication to the client needs to know: 1. what med is prescribed 2. medication purpose 3. appropriate dosages and routes 4. therapeutic and adverse effects 5. assessment and monitoring requirements 6. patient education needs 7. appropriate timing for administration

med administration orders that are carried out until canceled by: a) writing a new prescription b) the prescribed number of doses or days have elapsed c) the medication stop date has passed

medication is administered only when the patient requires it - prescriber sets a minimum interval between doses - prescriber sets a maximum dosage per day - nurse documents assessment findings, evaluations (effects) and dosages given

a single dose of medication to be given one time only, at a specific time - “on call” medications provided on the way to the OR

a single dose of medication to be given immediately and only once - usually in emergency situations

a single dose of medication is to be administered within 90 minutes of order being given - to be administered quickly, but not immediately (less urgent)

medication orders given to patients to self-administer outside of the hospital setting

• Right Medication • Right Dose • Right Patient • Right Route • Right Time and Frequency • Right Documentation • Right Reason • Right to Refuse • Right to Patient Education • Right Evaluation

verification that the medication being prepared is the correct medication, and the correct one for the patient (according to prescription) - administer ONLY medications that you prepare - compare against patient record, prescription

1) before removing the container from the storage location 2) when the medication prescribed is removed from the container 3) before returning the container to storage location

medicine dosage calculations should be checked by another nurse prior to administration - only scored medication can be broken - crushed medication can be mixed with small amounts of liquid or food (NOT the patient’s favourite food)

verify patient’s full name and date of birth against their chart, name on the prescription, and patient bracelet prior to administration

the medication must be administered in compliance with the designated route of adminstration per the prescription - if a designated route is not specified, consult with the prescriber

understand the designated administration frequency and schedule –> understand whether or not it can be altered - routine, on call, pc, STAT NOW orders

accurate documentation to communicate: - patient name and date of birth - prescribed medication (written in full) –> time of administration, dose, route and frequency - accurate administration of the medication –> evaluate effects

verify medical rational for prescribed medication - verify expected onset of action, effects, desired responses - verify the requirement of pre-administration and follow-up nursing assessments

ensure that the patient is aware of the medications being administered to them, and that they can make an informed decision to refuse - patient must be informed of rights - patient must be informed of consequences of refusal

patients need to be educated about their medications, desired effects, potential side effects, and consequences of medication refusal