Safe Dosage

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Nursing responsibilities:

1. preparing and administering

2. evaluate responses

3. up to date knowledge base

4. maintaining skills

5. determine medication accuracy

6. reporting errors

7. safeguard and storing medications

Rights of administration

- right client

two acceptable identifiers

bar code technology

identify resident in long- term care setting

- right medication

check prescription

three checks (when you take it off the shelf, when you take it out of package, and when you are about to give it to the client

NEVER ADMINISTER SOMETHING ANOTHER NURSE PRESCRIBED

verify expiration date

consult reference

- right route

compare the label on description and then on medication

be careful with liquid medication

clarify when necessary

- right time

give within 30 min and at similar intervals

give STAT right away

Give PC 30 minutes after the meal

use your best judgement with PRN meds

- right dose

match prescription, and make sure that the dose is appropriate

- right documentation

immediately after administration to avoid administering a second dose or not giving a dose at all.

document when medication is withheld or client is omitted

Types of prescriptions:

routine: in effect until cancellation, with time frames for renewal

single: specified time, as soon as possible some times, due to circumstances

stat: immediately, one time only. usually an emergency dose

PRN: specific circumstances (high pain or temp) based on nursing judgement and client needs

standing : protocol-based, specific indications. includes multiple medications

now: similar to stat but not as urgent. administered only once within a 90 minute time frame

What is part of a prescription?

- date

- time

- client name

- medication name

- dosage

- route

- time

- frequency

- provider signature

Medication errors

- wrong medication, IV fluid, dilution

- incorrect dose, IV rate

- wrong client, wrong route, wrong time

- known allergy

- dose omission

- expired medication

- Erroneous discontinuation

Assessment and data collection

- pertinent data/ Hx

- Pre-administration data

- allergies, interactions

- complete prescription information

- accurate interpretation

Planning

- avoid distractions and rushing

- calculation, measuring

- check strength

- verify doses

- prioritize

Implementation

- follow rights of medication administration

- give client instructions

- controlled substances

- address client concerns

Evaluation

- therapeutic response

- side/adverse effects

- medication errors

IN CASE OF MEDICATION ERROR

- assess and collect data from client

- notify provider

- document event

- determine cause

INCIDENT REPORT

- time frame

- documentation

- submission

- quality improvement

- legal protection

Risk Reduction:

- medication dispensing systems

- electronic medical records

- Bar code scanning

- institute for safe medication practices

- educate about errors and prevent them

- voluntary reporting

(www.ismp.org)

some abbreviations are error- prone

- QD (once daily) versus QID (four times daily)

- HS (hour of sleep) versus HS (half strength)

- DC (discharge) versus DC (discontinuation)

confused drug names also play a part, they look alike or sound alike or both

High alert medications:

- anticoagulants

- chemotherapy

- opioids

- hypoglycemic

Tall Man Letters

- reduced confusion by mixing uppercase and lower case letters

- buPROPion vs. busPIRone

Placement of Zeros

- universal law

- place a leading zero before the decimal, but not a hanging zero after the decimal.

- helps keep dosage mistakes to a minimum

Common Abbreviations

- ER, XL, SR are different abbreviations for the way a medication passes thru the stomach, and the type of release.

- Procardia is fast release and is taken multiple times a day

- Procardia XL is slow release and is only taken once a day

THESE MEDICINES ARE NOT INTERCHANGEABLE.

Crushing Meds

- for clients who can't swallow whole pills and there is no liquid form of them

- mixed with food or small amounts of liquid

- Do not crush medications

- delayed release

- long- acting

- enteric-coated

Minimal distress

- education

- models

- safe areas

- neutral thermal environment

- explanation of noises

- privacy

- rest between procedures

- transitional items

Minimize separation issues

- comfort

- accompaniment

- touch

- promote autonomy

- orientation to facility

- alone time

- choices about accompaniment

- time structuring

- medication administration rights

Oral medications

- allow parent to administer with your supervision

- wipe excess and give to infant, ensuring entire dose is taken

- give infant a drink of juice or water

- DO NOT MIX MEDICATION IN INFANTS FORMULA

- if infant does not finish the entire bottle, you are only administering a partial dose.

help administration according to age:

Toddlers(1-2):

--familiarity with device

-- choices

-- taste

Preschoolers(3-5):

-- swallowing ability

-- decision input

-- explanations

-- therapeutic play

*Make sure the child knows that they need to take the medication now, you can mask the taste if appropriate.

*use liquid suspension or elixir before anything else.

*also check the toddler's swallowing abilities and make sure if you have to crush, it is okay with your agency

School- age children(6-12)

- swallowing ability

- decision input

- explanations

- praise

Adolescents(12-20)

- honest, detailed information

- alternatives

- questions

Calibration syringes

- precise measurements

- needleless

- can be used at home

- CAUTION- the cap is a choking hazard

Oral liquid medication

- accuracy

- small doses

- appropriate dosage devices

Oral solid medications

- solid oral forms

- chewable forms

- crushed medications

IM and Subcut administration (rarely used)

- local anesthetic

- small needle

- room temperature

- distraction

- comfort

consider

- age, size, weight, developmental level, condition

- subcut is a slower administration

- use 5/8 inch 23 or 25 gauge needle

- pinch to avoid muscle

- age appropriate sites like anterior lateral thigh or fatter region of posterior arm (for older children)

IV administration

- infusion pump

- secondary infusion

- volume-controlled administration

- for fluid restricted children and adults

- syringe pump

- IV catheter gauges

- size of vein

- type of fluid

- length

- 22- to 24- gauge

Insertion sites: anywhere there is an accessible vein but better sites are:

- forearm

- wrist

- ankle

- foot

- scalp (involve clipping hair)

Endotracheal administration

- L = lidocaine

- E = epinephrine

- A = atropine

- N = naloxone (Narcan)

Vascular access is better, because endotracheal is inconsistent

Adverse Effects

- voluntary reporting FDA

- documentation of med history

- avoid excessive and dup medications

- know indications and intended effects

- monitor therapeutic and adverse reactions

- discourage OTC meds

- perform chart reviews

- anaphylaxis and allergies