Medication Administration

Question 1

What are the 5 Patient Rights? (“5+5”)

Answer 1

1. Right Patient (Identify)
2. Right medications –> keep meds in the original packaging
3. Right Dose
4. Right Route
5. Right Time
   - Routine Times/daily: TYPICALLY 9 AM; if its BID or twice a day, then it’s given 9AM and 9PM!
   
   • PRN (as needed) –> ex: if they need insulin bc they’re blood sugar become suddenly high; pain meds
   • Stat (Immediately) –> WITHIN 15-30 mins
   • Urgent:
     - Time critical vs. Non-time critical
     (Time critical: have 30 mins window) (Non time critical: have 1 hour window)
6. Right Assessment
7. Right Documentation
8. Right to Refuse
9. Right Education
10. Right Evaluation

Question 2

A medication is ordered to be given BID. What times will the medication need to be given?

Answer 2

9 AM and 9 PM!!
(Remember that if it’s routine times/daily, typically are given at 9am. If it’s BID or twice a day, it’s given at 9AM and 9PM)

Question 3

How many times should you verify the 5 Rights of med admin? When should you do that?

Answer 3

1st: When medication obtained from AMDS (Automated medication dispensing system)
2nd: During preparation of medication
3rd: At patient bedside immediately prior to administration

Question 4

What is the Ordering & Administering process?

Answer 4

1st–> Computerized physician order entry
2nd –> pharmacy review
3td –> Medication administration record (MAR)

Question 5

What are the factors contributing to medication errors?

Answer 5

1. failure to follow 5+5 rights
2. Failure to check order accuracy
3. failure to assess the patient for high-risk variables
4. Giving meds before verification
5. Incomplete illegible orders with unapproved abbreviations
6. Stressful conditions with interruptions (don’t interrupt others when they’re getting meds)

Question 6

What are the medication reconciliation

Answer 6

• Completed on admission, discharge, and transition to another level of care
• Review all medications (OTC/ over the counter & Herbals)
• Verify what patient is taking and what is ordered
• Educate during process

Question 7

What is the 7 Safety Processes?

Answer 7

1. AMDS (Automated Medication Dispensing System)
2. BCMA (Barcode Med admin)
3. Three safety checks (5 rights) before administering
4. Avoid overrides (unless its a true emergency)
5. Avoid workarounds (armbands) –> scan arm band & make sure they stay in the patient’s arm
6. Pay attention to alerts
7. Question large or small doses

Question 8

What should you do when medication errors occur?

Answer 8

• Assess patient
• Notify HCP
• Follow protocols related to
  
  • Notify supervisor
  • Completing incident report that placed or mentioned in patient’s medical record
• Document appropriately

Question 9

What are the strategies for reducing medication administration errors?

Answer 9

1. Use TWO patient identifiers (name &DOB)
2. Use appropriate administration techniques
3. Verify dosage calculations (double-check for high risk)
4. Notice sound-alike medications
5. Clarify unclear orders
6. Don’t leave meds at bedside
7. Know what you’re doing
8. NEED WITNESS for insulin, heparin, TPN, chemotherapy, and narcotic wasting
9. Educate patients
10. Recognize right to refuse
11. Observe/assess before and after PRN and new medications for efficacy and adverse events
12. Confirm allergies

Question 10

What are the Nurses’ & Patients’ rights?

Answer 10

Nurses’ Rights:
1. Complete & clearly written order
2. Correct medication & dose dispensed
3. Accurate information on medications
4. Relevant policies to guide practice

Patients’ Rights:
1. To be educated about the medications
2. To refuse medications
3. To have qualified HCW assess medications hx
4. To be properly advised about medications
5. To receive medications safely
6. To receive appropriate supportive therapy
7. To NOT receive unnecessary medications
8. To be informed if medications are part of research study

Question 11

What are the med administration process?

Answer 11

• Hand hygiene/gloves
• 2 patient identifiers
• Allergies
• Open unit dose meds AFTER 3rd safety check and scanning
• NEVER leave meds at bedside
• Document VS (vital signs) and assessments related to med admin before leaving bedside
• Separate medications dependent on BP, pulse, or lab data
• Reassess 30 minutes for desired or adverse effects (ex: pain medication)

Question 12

What are the factors for selecting specific route?

Answer 12

1. Costs (oral less expensive)
2. Level of unconsciousness (unconscious can’t safely take oral meds)
3. Generalized vs Localized effect
4. Emergency situations (speed of absorption & desired effect)
5. Dosing accuracy

Question 13

What is Enteral (Oral) – Enter the digestive tract (PO)?

Answer 13

• Liquid vs solid
• Regular vs Extended release, controlled release & enteric-coated –> Extended release, controlled release & enteric-coated CANNOT BE CRUSH!!!
• Less costly
• More convenient
• Safer
• Typically takes longer to start working
• When to avoid:
  
  • When they have nausea or vomiting
  • If they have reduced GI motility
  • If they aren’t able to swallow

Question 14

What type of Enteral/oral (PO) medication can NOT be crushed???

Answer 14

Extended release, controlled release & enteric-coated CANNOT BE CRUSHED!

Question 15

What do you need to know about Nasogastric & Gastrotomy tubes?

Answer 15

1) Check for placement. HOW?
- by using X-RAY
- Aspirate (pull back) to see what it looks like. If u see stomach- looking contents, then there’s a good chance it’s in the stomach
- push air bolus in & listen over the stomach if you hear a griggle

2) Elevate HOB to at least 30 DEGREES to decrease risk of aspiration
3) Prevent clogging by:
- Pills have to be crushed –> usually give liquid
- Before & After meds flush tube with 20-45mL of water
- If clogged, trouble shoot –> usually required reinsertion of tube

Question 16

What are examples of Topical meds (applied to skin or mucous membrane)?

Answer 16

• Transdermal (patches)
• Ophthalmic (eyes)
• Otic (ear)
• Nasal (nose)
• Intravaginal (vagina)
• Rectal (rectum)

Question 17

What are examples of Parenteral meds (bypass the digestive tract)?

Answer 17

• Intradermal –> PPD/TB skin test
• Intramuscular (IM) –> about 10-20 mins absorption
• Subcutaneous (Subcut)
• Intravenous (IV) –> IV push or bolus, IV fluids, IV piggyback

Question 18

What are the disadvantages and advantages of giving parenteral meds?

Answer 18

Advantages:
- fast-absorbing
- Have a more predictable dose
- Can use for patients who are unresponsive, nauseous & vomiting

Disadvantages:
- breaking the skin barrier
- uncomfortable
- costs more

Question 19

What are the 2 examples of oral absorption ?

Answer 19

Absorbs directly into the mucous membrane of the mouth.
- Bypass the First Pass Effect of the liver
- Make sure their mouth is moist enough for it to absorb
- Sublingual
- Buccal

Question 20

What are the recommendations when administering Ophthalmic meds?

Answer 20

• Don’t let the tip touch the eyes
• Wait 3-5 mins between each drop
• Open lower eyelid to the sac, put the drop to the sac, & press on tear duct with tissue

Question 21

What do you need to know when giving ear drops?

Answer 21

• Adult & children over 3 y/o: pulling UP & back
• Children younger than 3 y/o: pulling DOWN & back

Question 22

What do you need to know about Rectal meds?

Answer 22

• Don’t over handle them because they might start to disintegrate
• WEAR gloves
• Use lubrication so that it can pass thru the internal sphincter

Question 23

When handling controlled substances, what are nursing responsibilities ?

Answer 23

1. Shift counts (2 RNs)
2. Counts when removing medications (1 RN)
3. Discrepancies (2 RNs)
4. Witnessing partial dose wastes of controlled substances (2 RNs)

Question 24

Which 2 sites should you administer an intramuscular injection into when the total volume is 2mL??

Answer 24

Vastus lateralis and Ventrogluteal!!!
(IM Deltoid can only hold 1 mL)

Question 25

How many mL can IM Deltoid holds?

Answer 25

1mL or less ONLY!! if it's more than 1mL, then use Ventrogluteal & Vastus lateralis

Question 26

What's the time window for time critical and non-time critical when giving medications to patients?

Answer 26

Time critical: 30 mins window - Separate from other medications & give it close or exactly at the right time. Non-time critical (like routine meds): 1 hour window (30 mins before the due time & 30 mins after the due time) - Can be given a little earlier or late without harm

Question 27

How do you select a syringe size?

Answer 27

Go a little bit bigger than the total volume/round up - If it's 3.5ml --> round up to 5ml syringe - 2--> round up to 3 ml - .5 --> round up to 1 ml

Question 28

What are the delegation considerations?

Answer 28

- Nurses must administer meds - Nurses can ask UAPs to watch for potential side effects and report their occurrence to the nurse - UAPs should be instructed to notify the nurse if the patient condition worsens - UAPs can provide perineal care after med admin - UAPs to let the nurse know if patient complains of discomfort or pain at IV site