Administering Medication - Pharmacology

Medication can be administered once the nurse assesses the patient and determines that the medication can be administered safely. The nurse follows implementation procedures for administering medication.

  • Check the prescriber’s medication order
  • The initial step in administering medication is to read the medication order that is written by the prescriber to make sure that the proper medication and dose is administered to the patient. The prescriber’s medication order is found in the patient’s chart.

  • Check the Medication Administration Record (MAR)
  • The medication administration record is a transcription of the prescriber’s medication order. Many times the MAR is a computer-generated document, but sometimes there will be handwritten entries in the MAR. Compare the MAR with the prescriber’s medication order to assure that the proper medication, dose, and other aspects of the medication order have been properly transcribed.

  • The nurse should check all medications prescribed to the patient even if he or she will not be administering all of the medications while taking care of the patient.
  • The MAR lists all medication that the patient receives including those already given to the patient and medication that has been discontinued. It is critical for the nurse to review all medications and not just those that will be given on the nurse’s shift because previous medications may still be active in the patient’s body. Remember that some drugs have a long half-life making them still a potential conflict with other medication days after it was administered to the patient.

  • Check the patient’s allergies
  • Although the patient’s chart might indicate that the patient does not have any allergies to medication or food, the nurse must review whether or not the patient has allergies before administering medication. Sometimes the patient may not have recalled any allergies when the patient’s history was taken, but will recall an allergy after being questioned again by the nurse.

  • Create your own medication administration worksheet
  • Although the MAR lists medications and the times they are to be administered, the patient may be scheduled for tests and procedures that conflict with the medication schedule. It is best to create a medication administration worksheet that schedules both medication and the patient’s other activities so there is one schedule for the patient.

  • Check PRN (as needed) medications
  • It is common for some medications to be administered to the patient by the nurse on an as needed basis (PRN) such as analgesics (pain medication). PRN medication isn’t scheduled on the MAR but is listed in a different section of the MAR. Therefore, the nurse must determine when PRN medication was administered and what PRN medication was administered before giving any medication. This avoids any potential interaction between medications.

PREPARING THE MEDICATION

Once the nurse is assured that the medication can be administered properly to the patient, the nurse can administer it by following these steps:

  1. Wash hands. This is the best way to prevent infection.
  2. Prepare medication that you are going to give at this time. Don’t prepare all medications at once. It is possible that someone else may have to administer the other medications. Nurses should NEVER give medication that someone else has prepared.
  3. Prepare medications in a quiet area so you are not interrupted.
  4. Double check your math when calculating doses. Have a colleague verify your calculations if necessary.
  5. Make sure that all of the patient’s medications that will be administered during the shift are in the patient’s medication drawer. Compare the contents of the patient’s medication drawer against the MAR. The medication and dose in the drawer should match the MAR.
  6. Compare the medication with that listed on the MAR. Sometimes the pharmacy substitutes a generic drug for a brand name drug. Always look up the medication in the drug manual if you do not recognize the name of the drug.
  7. Check the name of the medication three times:when you remove it from the drawer;when you prepare the medication; and before returning the medication to the drawer or disposing of the wrapper or container. If the medication is wrapped, then bring the wrapper with you to the patient’s room and check the wrapper again before administering the medication to the patient.

AT THE PATIENT’S BEDSIDE

After medication is prepared, it is taken to the patient’s room where the nurse administers the medication to the patient. In doing so, the nurse must follow precautions to assure that the medication is administered safely. Here’s how it is done:

  1. Wash your hands.
  2. Introduce yourself to the patient.
  3. Ask the patient to state his/her complete name. Don’t assist the patient by saying, “are you Mr. Jones.” The patient should say his/her name without your help if possible.
  4. Compare the patient’s name and number on the patient’s identification band against the patient’s name and number on the MAR.
  5. Ask the patient if he or she has any allergies to food or medication. The patient may be aware of food allergies such as shellfish, but unaware of allergies to medication. However, patients who are allergic to shellfish are also allergic to some medications.
  6. Examine the patient’s identification band to see if the patient has allergies. Allergies may be noted on the identification band.
  7. Assist the patient into a comfortable position to administer the medication.
  8. Ask the patient if he/she knows about the medication and why the medication is being administered. The patient’s response provides insight into knowledge the patient has about his/her condition and treatment. This gives the nurse a perfect opportunity to educate the patient about his/her condition, treatment and medication.
  9. Make sure that the patient sees the medication if it is a tablet or liquid. Stop immediately if the patient doesn’t recognize the medication as the drug the patient received previously. Recheck the order. The dose may have changed, a different medication was substituted, or there is an error in the medication.
  10. Make sure you have baseline vital signs, labs, and other patient data before administering the medication. To determine the patient’s reaction to the drug, the baseline can be compared to vital signs, labs, and other patient data taken after the patient receives the medication.
  11. Instruct the patient about side effects of the medication and take precautions to assure the patient’s safety such as raising the side rails and instructing the patient to remain in bed until the side effects subside.
  12. Stay with the patient until all the medications are swallowed. Remember that the patient has the right to refuse medication. Notify the prescriber if this occurs.
  13. Properly dispose of the medication and supplies used to administer the medication. Don’t leave the medication at the patient’s bedside unless required by the medication order.
  14. Wash hands before leaving the patient’s room.
  15. Document in the MAR that you administered the medication to the patient.

HANDY TIPS WHEN ADMINISTERING MEDICATION

Medication can taste bad. You can minimize this adverse effect by giving the patient ice chips prior to administering the medication. Ice chips numb the taste buds so the patient is unable to taste the medication.

Give bad-tasting medications first followed by pleasant-tasting liquids. This shortens the time the patient experiences the bad taste. The patient is left with the taste of the pleasant tasting medication in his/her mouth. Use the liquid form of the medication where possible because patients find it easier to ingest a liquid. Offer water after giving a medication if it is not contraindicated.

Administer medication to a patient who needs extra assistance taking the medication after you give medication to your other patients. In this way, you can devote the necessary time to assist this patient without being pressured to administer medication to your other patients.

AVOID MEDICATION ERRORS

Medication errors are the most common cause of patient injuries in a hospital. It is therefore critical that the nurse avoid situations that frequently result in medication errors. If an error occurs, assess the patient and notify the nurse in charge and the physician. Follow your hospital’s policy for preparing an incident report. Review the steps that caused the error to occur.

Here are ways to avoid common errors:

  • Avoid distractions when preparing medication.
  • Avoid conversations while preparing medication.
  • Only administer medications that you prepare.
  • Only pour or prepare medication from containers that have full labels that are easy to read.
  • Don’t transfer drugs from one container to another container.
  • Don’t pour medications directly into your hand.
  • Don’t give medications that have expired.
  • Don’t guess about medication and doses. Always ask the prescriber.
  • Don’t administer drugs that are discolored, have sediment, or are cloudy unless this is a normal state for the medication.
  • Don’t leave medications by the bedside or with visitors.
  • Keep medications in clear sight.
  • Don’t give medication if the patient says he/she has allergies to the drug or the drug group or if the patient says it does not look the same as the drug they normally take.
  • Use both the patient’s name and patient’s number on the identification band to identify the patient.
  • Don’t administer medication with food or beverages unless the medication can be given with food and beverages.

PROPERLY DISPOSE OF MEDICATION

Hospitals have strict policies that govern how unused medications and supplies used to administer medication are handled. Here are steps typically found in hospital policies.

  • Don’t recap needles.
  • Discard needles and syringes in an appropriate container that prevents others from receiving a needle prick.
  • Dispose of medication in the sink or toilet and not in the trash.
  • Return controlled substances to the pharmacy.
  • Dispose of controlled substances in the presence of another licensed healthcare worker who will sign as a witness to the disposal.
  • Discard unused solutions from ampules before discarding the ampule.

ADMINISTERING MEDICATION AT HOME

The nurse is responsible for educating the patient on how to self-medicate at home by providing the do’s and don’ts of administering the medication. The nurse must explain the following:

  • Store the medication properly. Some medication, such as insulin, must be refrigerated.
  • Always label the date and time when the medication was opened.
  • Keep the medication in a locked cabinet away from the reach of children.
  • Explain the reason the patient is taking the medication and how often the medication is given.
  • Explain what to do if the patient misses a dose.
  • Describe the signs and symptoms of the toxic effect of the medication if the patient takes more than the prescribed dose.
  • Describe the signs and symptoms of side effects and adverse reactions that might occur when taking the medication.
  • Explain negative interactions the medication might have with certain foods.
  • Develop a system for self-medication for patients who have poor eyesight and decreased mental capacity. For example, the patient can use specially marked containers for each day of the week. A relative or friend can fill those containers with the appropriate medication. The patient is then taught to open the proper container each day.
  • Give the patient a list of medication, dose, and frequency and the name of the prescriber so the patient can keep the list in a wallet or pocketbook.
  • Suggest that the patient wear a MedicAlert bracelet or other jewelry that identifies the patient as having allergies or chronic illnesses.

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