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donabelle laranjo

on 12 February 2014

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Substance administered for the diagnosis, treatment, or relief of a symptom or for the prevention of diseases

Used interchangeably with the word drug

Drug also has the connotation of an illegally obtained substance
Written directions for the preparation and administration of a drug
Responsibilities of Nurses Regarding Drug Administration
Nurses are both legally and morally responsible for correct administration of medications. They must:

- Follow institutional policy
- Consider clients’ desires and
- Foster compliance
- Correctly document all actions
related to medication
administration and medication
Medication Safety Guidelines
Medications are not given without physician’s order. Orders for medications written.

The nurse who pours or prepares the medicine must administer the medication to the patient.
Medications are administered only from properly labeled containers.

The Medication Administration Record (MAR) is checked prior to administration of medication.
Legislation: The FDA
The Food and Drug Administration (FDA) tests all drugs for toxicity before granting a company the right to market a drug.
Food and Drug Interactions
Certain drugs may interfere with the absorption, excretion, or use in the body of one or more nutrients.

Certain foods may increase or decrease the absorption of a drug into the body.

Other foods may alter the chemical actions of drugs, preventing their therapeutic effect on the body.
Requires the collaborative efforts of many health care providers.

Nurses are responsible for administering medications.

Medication administration requires specialized knowledge, judgment, and nursing skills.

Its purpose is to produce the desired drug action by maintaining a constant drug level.
Medication Management
A drug is a chemical substance intended to elicit a specific effect.

Standards are set to ensure drug uniformity in:
- Strength
- Purity
- Efficacy
- Safety

Bioavailability (readiness to produce a drug effect)

The United States Pharmacopeia and the National Formulary (USP and NF) are books of drug standards for use in the United States.
Standards & Legislation
Drugs are usually referred to by their generic name (not capitalized) or by their trade name (always capitalized).
Drug Nomenclature
A drug’s ability to combine with a cellular drug receptor.

Depending on the location of the cellular receptor, the drug can have a local effect, a systemic effect, or both.

Drug action is based on the drug’s half-life (the time it takes the body to eliminate half of the blood concentration level of the original drug dose).
Drug Action
The study of the effects of drugs on living organisms.



Parenteral (injectable)
- Intradermal
- Subcutaneous
- Intramuscular
- Intravenous
Routes of Drug Absorption
The study of the absorption, distribution, metabolism, and excretion of drugs to determine the relationship between the dose of a drug and the drug’s concentration in biological fluids.
Absorption (passage of a drug from the site of administration into the bloodstream).

Distribution (the movement of drugs from the blood into body fluids and tissues).

Metabolism (the physical and chemical processing of a drug by the body).

Excretion (the elimination of drugs from the body.
The 4 Properties of Drug Action
Drug interaction
The effect that one drug can have on another drug.
- Genetic factors - Weight
- Age - Physical conditions
- Height - Mental conditions
Factors Influencing Drug Action
Types of Orders
Stat (those that should be administered immediately).

Single-Dose (one-time medications).

Scheduled (administered routinely until order is canceled by another order).

PRN (on as-needed basis).
Three Systems of Weight and Measure
Metric (simple system based on units of 10).

Apothecary (based on the weight of one grain of wheat).

Household (drops, teaspoons, tablespoons, etc.).
All medication orders should contain:
- Client’s name
- Date & Time
- Name of Drug to be
- Dosage
- Route of administration
- Time & frequency
- Signature of person
Medication Orders
- Right drug
- Right dose
- Right client
- Right route
- Right time
- Right frequency
- Right Documentation
Seven “Rights” of Safe Drug Administration
A critical element of drug administration is documentation.

The standard is “if it was not documented it was not done.”

The nurse should document that a drug has been given after the client has received the drug.
Documentation of Drug Administration
Scheduled drugs for each client are usually dispensed in a unit dose form.

Certain drugs may be stock supplied (dispensed and labeled in large quantities) and stored in the medication room.

Narcotics and controlled substances must be administered in accordance with MOH & Hospital’s policy.
Drug Supply and Storage
The client’s understanding of why a medication was ordered and how a medication can decrease the likelihood of getting a disease or how it can lessen the effects of an existing disease.

Clients refusing medication or adjusting the scheduling or dose are noncompliance.
Medication Compliance
Topical Medications
- Eye medications
- Ear medications
- Nasal instillations
- Respiratory inhalants
- Rectal instillations
- Vaginal instillations
Drug History (Allergies, Prescription Drugs taken, Over-the-Counter Drugs used).

Medical History (Biographical data, Lifestyle and beliefs, Sensory and cognitive status).

Physical Examination

Diagnostic and Laboratory Data
Primary nursing interventions related to medication management are:



Nursing Interventions
Oral medications should be poured and measured at eye level to ensure accuracy.
Oral Drugs
Although the physician will determine the dose and route of a parenteral drug, the nurse is responsible for choosing the correct gauge and length of the needle to be used.
Parenteral Drugs
Injections typically used to diagnose tuberculosis, identify allergens, and administer local anesthetics.
Intra dermal Injection
Injections into the subcutaneous tissue, between the dermis and the muscle.

Commonly used in the administration of medications such as insulin and heparin.
Subcutaneous Injection
Used to promote rapid drug absorption and to provide an alternate route when the drug is irritating the subcutaneous tissue.
Intramuscular Injection
Requires parenteral fluids (hypotonic fluid, isotonic fluid, hypertonic fluid)

Special equipment needed:
Administration set
- IV pole
- Filter
- Regulators to control IV
flow rate
- Established venous route
Intravenous Therapy
The nurse must always carefully monitor client reactions to medications and ensure that clients are appropriately educated as to the actions, side effects, and contraindications of all medications they are receiving.

Clients receiving IV therapy require constant monitoring for complications.
The Importance of Monitoring
Medication Safety Guidelines
Medication Safety Guidelines
Each Nurse should know common dose, maximum dose and how to compute dosage according to available stock, when necessary.

All Medications requiring refrigeration should also be identified by the Pharmacy Dept. and placed in the medication refrigerator.

Narcotics are to be check on every shift change by the designated nurse and narcotic cabinets are to be kept locked at all times.

Medication cart are on constant supervision at all times.
Medication Safety Guidelines
Use standard medication administration times as per hospital policy unless the time have been specified by the physician.

- A medication shall be given within a period
of 1 hour prior to and 1 hour later than
the specified time.
- Stat medications are to be given 30
minutes of receiving the order.
- Missed doses due to diagnostic procedures,
etc., the nurse shall consult the physician
for missed meds. Dosage for rearranging the
Medication Safety Guidelines
For NPO patients, clarify with the physician if any oral medication should be given.

A medication order which is unclear or seems to be incorrect to the nurse must be verified with the physician who ordered it before any attempt of administration.

Medications brought to the hospital by the patient shall not be administered or left with the patient without written order of the physician for continuation of any such order.

If a patient has a written discharge order, the nurse shall continue to give the medication until the patient physically leaves the hospital.
Medication Safety Guidelines
- Patient must be identified by checking the ID
band against name and medical record number in
the MAR and confirmed by asking the patient/
relative. Room number should never be used as an

- Assess for contraindications to patients
receiving the medication, like allergies.

- Route must be according to the physician’s order.

- Medication must be administered by a registered
nursing staff and must be present to observe.
Document on the MAR with initial while still at
Medication Safety Guidelines

- The nurse should remain with the patient until the
medicine is actually swallowed. If the medication is
not administered, the medicine is discarded if
opened, if not return to the drawer, encircle the
time and initial it in the MAR the reason is
documented in the nurses notes.

- Provide safety for patient after a narcotic or a
sleep medication is given by raising SIDE RAILS and
instruct patient not to ambulate without assistance.
Medication Safety Guidelines
Medication Errors, Adverse Drug reactions and any discrepancies in the count of narcotic substance must be reported as per hospital policies and procedures.

Follow the seven (7) rights of medication administration.
Read the medication administration record (MAR) & remove the medication(s) from the client’s drawer.

Compare the label of the medication against the MAR. If the dosage does not match the MAR, determine if you need to do a math calculation.

Check the expiration date of the medication.
Second Check
While preparing the medication (e.g., pouring, drawing up, or placing unopened package in a medication cup), look at the medication label and check against the MAR.
Third Check
Re-check the label on the container (e.g., vial, bottle, or unused unit-dose medications) before returning to its storage place. or

Check the label on the medication against the MAR before opening the package at the bedside.
The 2nd Nurse verification is defined as 2nd Nurse who reviewed the following:
- Physician’s order of the
- Physically checked the
medication, dosage,route,
time and content.

Must place verification signature on the MAR.
Medication Safety Guidelines
Thank you for listening
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