Quiz 3 - Principles of Medication Administration and Safety Chapter 6, Enteral Administration Chapter 8

Administration of Medications by Nasogastric Tube

- Check the location of the NG tube before administering any liquid - Always flash the tube before and after administration with 30 mL of water - Perform premedication assessment - Assemble equipment before administration - flush between each medication with 5 to 10 mL of water • Prepare doses as for administration of solid. or liquid-form oral medications • Follow procedure for administering medication • DO NOT attach suction for 30+ minutes • Provide complete documentation of administration and responses to therapy Chapter 8

Sound-Alike Medications

- Most products with sound-alike names are used for different purposes - Important for nurse to know patients' diagnoses - know what medicines are used for these conditions - Manufacturers have a responsibility to avoid using brand names that are similar to those of other medicines to avoid errors (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

To minimize risk of making any type of medication error:

- avoid distractions and interruptions while accessing and preparing medications - read the medication label slowly and carefully and follow the rights of medication administration - Know the Generic and Brand Names - Be sure to understand their purposes of the medication prescribed (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

- Ephedrine - Epinephrine

- both bronchodilators and both generic names - are often confused (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

- Dopamine - Dobutamine

- differ by a very few letters - they're both generic names - both are used in emergency situations (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

Assertive Communication (ATI: Video Case Studies PN 2.0 - Hand-Off Reports)

- most effective form of communication - ensure the rights of self and clients overall goal: - Communicate with respect - Understand others - Good listening skills - Validates understanding - Eye contact SBAR becomes a part of giving a verbal report to nurse about oncoming clients - present relevant data - focus on most important information to provide optimal care - Additional clinical experience will help skills. - Effective communication fosters trust and therapeutic relationships. - Communication includes not only verbal but written word, expressions, gestures, and attitude.

- Hydroxyzine - Hydralazine

- the first 4 letters are the same - both generic names and have multiple uses - share similar dosage strengths - often appear together on an automated computer screen and on pharmacy shelves (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

Medication Reconciliation: Five-Step Process

1. Develop list of current medications being administered 2. Develop list of medications that were prescribed 3. Compare medications on the two lists 4. Make clinical decisions on the basis of comparison 5. Communicate new list to appropriate caregivers and to the patient Chapter 6 - pg 75 (medication reconciliation) slide 26

Institute for Safe Medication Practices (ISMP)

A nonprofit organization devoted entirely to promoting safe medication use and preventing medication errors; it gathers information on drug errors and suggests new, safer standards to avoid such errors. Provides list of of Errors: - High-alert medications - Error-prone abbreviations - Do-not crush medications - Look-alike, sound-alike medications (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

A nurse working on a busy unit is passing the medication room when another nurse approaches, states she is needed in another room, and asks for help administering medications to her patients. She hands the nurse two syringes and three unit-dose tablets and says they are for the patient in room 386. What does the nurse do next? a) Takes the medications and proceeds to administer them to the patient in room 386 b) Refuses to administer the medications c) Offers to take care of the other patient situation and has the nurse administer her own medications d) Reports the situation to the charge nurse of the unit

A nurse working on a busy unit is passing the medication room when another nurse approaches, states she is needed in another room, and asks for help administering medications to her patients. She hands the nurse two syringes and three unit-dose tablets and says they are for the patient in room 386. What does the nurse do next? c) Offers to take care of the other patient situation and has the nurse administer her own medications

Unit Dose System

A unit dose is a method for a single-use, pre measured containers that provide exactly one dose. The unit dose can be packaged in a vial, a blister pack, or a pre-filled syringe. Use of unit dose packaging reduces the risk of medication errors. Chapter 8

Clinical Goldmines read pg 79

CHECK the label for drug name, concentration, and appropriate route for administration CHECK the patient's chart, KARDEX, medication profile, or ID bracelet for allergies. If none found ask the patient if they have allergies CHECK the patient's chart, KARDEX, medication profile for rotation schedules of injectables or topicals CHECK medications to be mixed in one syringe with a list approved by the hospital or pharmacy (should be administered 15 minutes after mixing CHECK the patients identity using two identifiers every time a medication is given DO approach the patient in a firm but kind matter that conveys feeling that cooperation is expected DO adjust the patient to most appropriate position DO remain with the patient to be certain that all medications hav been swallowed DO use every opportunity to teach the patient and family about the drug being administered DO give simple and honest answers or explanations regarding meds and treatment plan DO use a plastic container, a medicine cup, a medicine dropper, oral syringe, or nipple to administer oral meds to infant or small child DO reward the child who has been cooperative by giving praise comfort or hold uncooperative child after completing med administration Chapter 6 - pg 79 - slides 39 - 40

Administration of Oral Medications Capsules Lozenges Tablets Orally Disintegrating Tablets

Capsules - small cylindrical, gelatin containers used to administer unpleasant tasting medications, hold dry powder or liquid medicinal agents. Timed-release capsules provide gradual and continues release of a drug Lozenges - flat disk in a flavored base, held in mouth to dissolve slowly Tablets - dried powdered drugs that have been compressed into small disk, sometimes scored or grooved. Formed in layers Orally Disintegrating Tablets - rapidly dissolve in seconds when placed on tongue (rapid onset, good for patients with Parkinsonism, Alzheimer's, or after stroke, schizophrenia) Chapter 8 - page 101-103 Dose Forms - Slide 4 - 6

Flucanazole

Common Brands: Diflucan It can treat and prevent fungal infections (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

Metronidazole

Common Brands: Metrogel, MetroCream, Nuvessa treat various infections, including certain types of vaginal infections.It can also treat skin redness and pimples caused by rosacea (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

Administration of Oral Medications Elixers Emulsions Suspensions Liquid Suspensions

Elixers - drugs dissolved in alcohol and water (when drug can't dissolve in water alone, cough medicines, and mouthwash are elixirs) Emulsions - dispersions of small drop of water in oil or small drop of oil in water. Suspensions - liquid dose forms that contain solid, insoluble drug particles dispersed in a liquid base. Should be shaken well before administration to ensure thorough mixing of particles. (antacids - Maalox and Riopan, liquid antibiotics - Cefaclor, Augmenting, erythromycin) Liquid Suspensions; Syrups - medical agents that have been dissolved in concentrated solution of sugar (sucrose) and water such as pediatric meds Chapter 8 - page 101-103 Dose Forms - Slide 4 - 6

Legal and Ethical Considerations Standards of Care

Guidelines that have been developed for the practice of nursing. These guidelines are defined by the Nurse Practice Act of each state, by the state and federal laws that regulate healthcare facilities, The Joint Commission, and by professional organizations such as American Nurses Association. Chapter 6 - pg 61 - Slide 5

How is a patient positioned for the administration of an enema? a) Supine, on the back b) Prone, on the stomach c) Left side-lying d) Right side-lying

How is a patient positioned for the administration of an enema? c) Left side-lying

Narcotic Control Systems definition

Laws regulating the use of controlled substances have been enacted in the United States and Canada and are rigidly enforced in hospitals and long term care facilities with the use of narcotic control systems Chapter 6 - pg 71 (narcotic control systems)

Medication Errors

Medication errors include... • Prescribing errors - incorrect drug selection for a patient - errors in quantity, indication - prescribing of contraindicated drug • Transcription errors • Dispensing errors • Administration errors • Monitoring errors • Adverse drug events (ADEs): Costly errors • Using CPOE, bar coding, smart pumps, and other technologies helps to prevent errors • Medication reconciliation: Five- step process Chapter 6 - pg 74 also see box 6.1 - slide 17 - 18

Situation Background Assessment Recommendation (ATI: Video Case Studies PN 2.0 - Hand-Off Reports)

Originally mandated by The Joint Comission (TJC) - Communicate with team - Capture accurate and relevant clinical data I-SBAR identify self SBAR -R receiver responds Improves verbal communication of client information for change of shift reports

High Alert Medications

Potassium injectable Insulin Narcotic (opioids) Neuromuscular blocking agents Chemotherapeutic agents Heparin Chapter 6 - pg 74-75 - slide 21 - 23

A nurse is preparing to administer furosemide 80 mg PO to a client who has edema. The nurse performs medication calculations with the provided solution of 10 mg/mL and determines the client should receive 18 mL of furosemide. The pharmacy provided a unit dose supply of a 10 mL container. Which of the following actions should the nurse take? a) Contact the pharmacy for the additional 8 mL of medication. b) Recalculate the medication dosage for verification. c) Administer the 10 mL provided by the pharmacy. d) Notify the provider of the discrepancy between the calculation and the provided dose.

Recalculate the medication dosage for verification. It is the nurse's responsibility to follow the rights of medication administration, which includes double checking any medication calculations that appear to be questionable. The nurse should identify that not only does it appear that the pharmacy has not sent enough medication for the client, but also that the calculated dose of 18 mL is questionable. The nurse should recalculate the dose to verify the amount to administer is 8 mL (ATI: Video Case Studies PN 2.0 - Look-and Sound-Alike Medication)

Seven Rights of Drug Administration

Right Drug Right Indication Right Time Right Dose Right Patient Right Route Right Documentation Chapter 6 - pg 76 -79 (seven rights of drug administration)

Seven Rights of Drug Administration (expanded)

Right Drug - drug given is the one ordered, spelling concentration, read label three times Right Indication - verify reason the pt is receiving medication, understand indication, related to medical diagnosis Right Time - timing abbreviations, standardized times, blood levels, absorption, diagnostic testing Right Dose - check drug dosage ordered against the range specified in reference books Right Patient - check identification bracelet (check two identifiers name and DOB) Right Route - order should specify what route to ne administered Right Documentation - nursing actions and patient observations (date and time, name of medication, and the dose, route, and site of administration) - do not record a medication until after it has been given Chapter 6 - pg 76 -79 (seven rights of drug administration) see slides 31 - 37

Contents of Patient Charts (expanded)

Summary Section - patients name, address, dob, attending physician, allergies, relative, insurance, etc. Consent Section - grants permission to healthcare facility and provider to provide treatment Order Section - all procedures and treatments ordered by the healthcare provider History and Physical Examination Section - recorded findings and problems to be corrected (e.g. the diagnosis notes) Progress Notes - healthcare provider, some hospitals pharmacist, dietitians, PT, RT, etc records frequent observations of patients health status (may record observations and suggestions) Nurses' Notes - Head-to-Toe, patient and family history, basis of development for individualized care plan and as baseline for comparison. term-31 Laboratory Test Record - has all the laboratory test results in one section Graphic Record - vital signs, fluid I&O, Pain Assessment Flow Sheets - condensed form for recording information for a quick comparison of data Consolation Report - when other physicians or health care professionals are asked to consult about a patient Other Diagnostic Reports - reports for surgery, scants, other diagnostic reports Medication Administration Record (MAR) or Medication Profile - list al medications to be administered nurse and pharmacist have identical information. MAR is a record of time that the medication as administered and identifies who gave it . PRN or Unscheduled Medication Record - PRN medication may be recorded on a separate sheet rather than MAR Patient Education Record - provides means of documenting the health teaching provided to the patient, family, significant others, and includes patient mastery of the content presented Additional Patient Chart Record - may included separate MARs, operative and anesthetic records, recovery room records, therapy records, insulin dosage records, blood sugar records, etc. Nursing Care Plans - Individualized plan, nursing diagnosis, critical pathway information, and physician-ordered and nurse ordered care Kardex - large index-type card usually kept in a flip file Chapter 6 - pg 62- 66 (patient charts)

Administration of Rectal Suppositories

Technique • Patient is on left side (sigmoid colon) • Patient stays in this position for 10-15 min > Procedure protocol > Seven rights > Wash hands, don gloves > If possible, ask patient to defecate prior to administering suppository > Provide privacy, drape, position on left side > Use water-soluble lubricant, insert suppository about an inch beyond internal sphincter • Dispose of gloves, wash hands • Education • Documentation Chapter 8

Medication Orders

The State Order: Generally Emergency Use, ex: "diazepam 10 mg IV stat" The Single Order: administer at a certain time but only one time ex: "Lasix 10 mg IV at 10 am; diazepam 20 mg IV to be given one time at 7 am" The Standing Order: medication is to be given for specific number of doses "Cefazolin 1 g IV q6H x 3 days; Cefazolin 1 g IV q6H x 4 doses" may also indicate drug to be administered until it is discontinued at a later date PRN Order: administer if needed, allows nurse to judge when a medication should be administered on basis of patients need, and when it can be safely administered Verbal Orders: • repeat/state back avoid whenever possible, provider must cosign and date the order within 24 hours Electronic Transmission of Patient Orders: • Many physician offices fax new orders to the area where the patient will be admitted or transferred Computerized Provider Order Entry (CPOE) systems are used to transit orders electronically Chapter 6 - pg 73 - 74 (disposal of unused medicines) - Slide 11 - 12

The nurse is in the medication room preparing unit-dose medications for patients. Before leaving the medication room, what does the nurse do? a) Places the medications as they are into a medication cup for each patient b) Empties each medication packet into a medicine cup for each patient c) Checks the label information once to be sure the drugs are correct d) Offers to help carry additional medications to a patient's room for another nurse

The nurse is in the medication room preparing unit-dose medications for patients. Before leaving the medication room, what does the nurse do? a) Places the medications as they are into a medication cup for each patient

The nurse is making rounds with a patients physician when the physician gives the nurse a verbal order for a routine medication. What does the nurse do next? a) Enters the order when the nurse returns to the desk after rounds to chart b) Refuses the order c) Does not follow the order because it is not official d) Obtains the chart and asks the physician to enter the order

The nurse is making rounds with a patients physician when the physician gives the nurse a verbal order for a routine medication. What does the nurse do next? d) Obtains the chart and asks the physician to enter the order Chapter 6 - slide 16

The nurse receives the following order: Tylenol # 3 1 tablet as needed for incisional pain. This is an example of which kind of order? a) standing b) routine c) PRN d) STAT

The nurse receives the following order: Tylenol # 3 1 tablet as needed for incisional pain. This is an example of which kind of order? c) PRN Chapter 6 - slide 15

Legal and Ethical Considerations Nurse Practice Act

The rules and regulations established by the state board of nursing for the various levels of entry (i.e., practical nursing, registered nurse, and nurse practitioner) js a solid foundation for beginning practice. • many state boards have developed specific guidelines for nurses to use when practicing nursing • nurse muse understand that thus responsibility includes accountability for one's actions and judgments during the execution of professional duties. Chapter 6 - pg 61

Which form of liquid medication contains a base of alcohol? a) Syrup b) Emulsion c) Suspension d) Elixir

Which form of liquid medication contains a base of alcohol? d) Elixir

Which medication is not appropriate to administer via an NG feeding tube? a) Scored tablet b) Suspension c) Enteric-coated tablet d) Elixir

Which medication is not appropriate to administer via an NG feeding tube? c) Enteric-coated tablet

Which method of medication administration is typically used to deliver 1 ounce of cough suppressant? a) Calibrated medication dropper b) Medicine cup c) Soufflé cup d) Teaspoon (6 t= 1 oz)

Which method of medication administration is typically used to deliver 1 ounce of cough suppressant? b) Medicine cup

Narcotic Control Systems

a standard policy that controlled substances are issued in single-unit packages and kept in a locked cabinet. • Controlled substances must be kept in a locked cabinet • Records are kept to document the dispensing of each type of medication issued • Two nurses are needed when accounting for any discarded narcotics • Discrepancies are carefully checked; if the inaccuracy is not resolved by checking the patient's chart, the pharmacy and nursing service are notified Chapter 6 - pg 71 (narcotic control systems) - Slide 10

A nurse is speaking with the provider about a client who has had a change in mental status since admission. Which of the following statements by the nurse demonstrates the use of assertive communication? a) "I am concerned about the client's rapid change in mental status." b) "This client is confused. You should have seen him by now." c) "The nurse on the previous shift probably forgot to give the client his medication." d) "The client will be okay; he is just a little disoriented." (PN Hand-Off Reports Case Study Test)

a) "I am concerned about the client's rapid change in mental status." This statement by the nurse demonstrates the use of an "I" statement, which is a form of assertive communication. The use of an ")" statement by the nurse encourages discussion about the client with the provider and emphasizes the importance of working together for the benefit of the client.

A nurse is reinforcing teaching with a newly licensed nurse about telephone reporting using the BAR acronym. Which of the following responses by the newly licensed nurse indicates an understanding of the teaching? a) "S stands for situation." b) "B stands for behavior." c) "A stands for accountability." d) "R stands for response." (PN Hand-Off Reports Case Study Test)

a) "S stands for situation." The nurse should identify that "S" stands for the "situation" of the client when providing a telephone report using the SBAR acronym Situation Background Assessment Recommendation

A nurse is providing a transfer report to an inpatient facility for a client who has atrial fibrillation. Which of the following pieces of information is the priority for the nurse to include in the report? a) "Today's INR is 2.0." b) "Ate 50% of meal at lunch." c) "Last bowel movement was 2 days ago." d) "Today's intake and output was 2200 mL" (PN Hand-Off Reports Case Study Test)

a) "Today's INR is 2.0." The greatest risk to this client is injury from bleeding, due to an increased IN as a result of being on anticoagulant therapy for atrial fibrillation; therefore, this is the priority piece of information the nurse should include in the transfer report.

A nurse is assisting with the admission of a client who has pneumonia. Which of the following medications should the nurse identify as the priority to administer? a) Clarithromycin b) Acetaminophen c) Guaifenesin d) Dextromethorphan (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

a) Clarithromycin The client who presents with community-acquired pneumonia should receive antibiotic treatment within the first 6 hr of admission. This limits complications such as sepsis and mortality. The greatest risk to this client is injury from infection. Therefore, the priority medication the nurse should administer is clarithromycin.

A nurse is preparing to administer bumetanide to a client who has heart failure. For which of the following findings should the nurse withhold the medication and contact the provider? a) Potassium 3.6 mEq/L b) BP 84/50 mm Hg c) Sodium 135 mEg/L d) Pulse rate 96/min (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

b) BP 84/50 mm Hg Bumetanide is a loop diuretic that acts to decrease circulating fluid volume. It is useful in the treatment of pulmonary edema and heart failure. The nurse should monitor the client's BP and, if the client is hypotensive, hold the medication and notify the provider.

A nurse is providing a hand-off report to another nurse for a client who is newly admitted and has Crohn's disease. Which of the following information is the priority for the nurse to include in the report? a) Diagnosed 10 years ago b) Hgb 6.8 g/dL c) Abdominal -ray prescribed d) On strict I&0 (PN Hand-Off Reports Case Study Test)

b) Hgb 6.8 g/dL The greatest risk to this client is injury from bleeding; therefore, this is the priority piece of information the nurse should include in the hand-off report.

A nurse is assisting with the admission of a client who has a history of type 2 diabetes mellitus following a CT scan with contrast to diagnose the presence of renal calculi. The nurse should expect to withhold which of the following of the client's home medications? a) Simvastatin b) Metformin c) Losartan d) Omeprazole (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

b) Metformin Metformin is a biguanide, used in the management of type 2 diabetes mellitus. It is contraindicated for the client for 48 hr following the administration of contrast media to prevent the development of acute kidney injury. The nurse should expect the provider to withhold the metformin and prescribe another medication, such as insulin, to provide glucose control in the interim.

A nurse is asked by a coworker to administer a client's dose of meperidine IM so she can attend to another client's needs. The coworker hands the nurse a syringe and tells him that she has already prepared the medication. Which of the following actions should the nurse take? a) Verify the client's identity and administer the medication. b) Offer to attend to the second client so the coworker can administer the medication. c) Contact the provider to verify the prescription prior to administering the medication. d) Ask the coworker what time the client had his last dose of meperidine. (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

b) Offer to attend to the second client so the coworker can administer the medication. The nurse should not administer a medication he did not prepare. By offering to attend to the second client, the coworker who prepared the medication can administer it to the first client.

A nurse is preparing to administer a new prescription for buspirone to a client. The client asks the nurse if this is the medication she requested to help her stop smoking. Which of the following responses should the nurse make? a) "Yes, this medication will help you with your desire to quit smoking." b) "No, but your provider must feel you need this new medication as well." c) "Let me check with your provider and make sure this is the medication he wants you to take." d) "I am not familiar with this medication. Take this dose, then I will confirm that information." (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

c) "Let me check with your provider and make sure this is the medication he wants you to take." There are many medications that either look-alike or sound-alike, and it is the nurse's responsibility to know the differences. The nurse should not administer any medication that a client is questioning in order to prevent a potential medication error. The nurse should stop and verify if this is the right medication and the right client.

A nurse is preparing to provide a hand-off report for a group of clients to the oncoming nurse. Which of the following information about the client should the nurse include in the report? a) "Mrs. Lincoln can be so difficult at times." b) "Mr. Smith is doing poorly today." c) "Mr. Jones had pain medication last at 1800." d) "Mrs. Fletcher had a bath this morning." (PN Hand-Off Reports Case Study Test)

c) "Mr. Jones had pain medication last at 1800." The nurse should include critical data related to the client's care, such as when the client last received a PRN pain medication, when providing a hand-off report.

A nurse is conducting medication reconciliation for a client who is newly admitted to the facility. Which of the following actions should the nurse take first? a) Review a list of client medications with the pharmacist. b) Investigate discrepancies in medication dosages. c) Ask the client which herbal supplements he takes. d) Reinforce education with the client. (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

c) Ask the client which herbal supplements he takes. When using the nursing process, the first action the nurse should take is to collect data from the client by completing a comprehensive review of prescribed and over-the-counter medications as well as herbal and nutritional supplements the client takes. The nurse should obtain a comprehensive list in order to identify duplications and any possible contraindications or interactions between medications.

A nurse is reviewing the medication prescriptions in a client's medical record. The dosage for one of the medications is not legible. Which of the following actions should the nurse take to clarify the prescription? a) Ask the charge nurse to assist with interpreting the dosage. b) Research the medication in a current drug handbook for the correct dosage. c) Contact the prescriber to clarify the dosage information. d) Call the pharmacist to obtain the correct dosage for this medication. (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

c) Contact the prescriber to clarify the dosage information. It is the nurse's responsibility to safely administer the client's medications. To prevent a medication error, the nurse should not attempt to interpret an illegible prescription. The nurse should contact the provider who wrote the prescription to clarify the dosage.

A nurse is preparing to administer the first dose of clarithromycin to a client who has pneumonia. For which of the following adverse reactions should the nurse monitor? a) Facial flushing b) Fever c) Cough d) Diarrhea (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

d) Diarrhea Clarithromycin can cause pseudomembranous colitis, an adverse effect of the medication, which is characterized by frequent, loose stools. The nurse should monitor for and report the development of diarrhea in the client to the provider.

A nurse is preparing to administer a medication to a client and notices that the expiration date for the medication was two days ago. Which of the following actions should the nurse take? a) Administer the medication since it has been expired for less than 72 hr b) Complete an incident report documenting that the pharmacy provided an expired medication. c) Dispose of the expired medication dose in the sharps container. d) Return the expired medication to the pharmacy. (ATI: Video Case Studies PN 2.0 - Look- and Sound-Alike Medication)

d) Return the expired medication to the pharmacy. The nurse should consider a medication that is expired to be unsafe to administer. Therefore, the nurse should contact the pharmacy to request a replacement medication and should return the expired medication to the pharmacy.

Administration of Medications by Nasogastric Tube

drugs are administered via NG tube for specific patients, using a liquid from whenever possible Chapter 8

Medication Errors (definition)

failure of a planned action to be completed as intended or use of a thong plan to achieve a goal. Chapter 6 - pg 74

Medication Reconciliation (definition)

goal of eliminating medication errors involves comparing a patient's current medication orders with a ll of the medications that the patient is actually taking (to be used during handoffs -transition of patients during care) Chapter 6 - pg 75 (medication reconciliation)

Administration of Solid-Form Oral Medications

two techniques for administrating medications 1) Unit-Dose System 2) Computer-Controlled Dispensing System • General principles apply to all distribution systems - Give the most important medications first - Do not touch the medication with your hands - Encourage liquid intake to ensure swallowing - Remain with patient while medication is taken; DO NOT leave the medication at bedside unless an order to do so exists • Discard the medication container Perform premedication assessment in all cases Chapter 8

Legal and Ethical Considerations Before administering medication, the nurse must have:

• Current license to practice • A clear policy statement that authorizes the act • A medication order signed by a practitioner • Understand the individual patients diagnosis and symptoms that correlate with the rational for drug use • Understanding why a medication is ordered (drug action), usual dosing, proper dilution, route and rate of administration, adverse effects, and contraindications Chapter 6 - pg 61 (standards of care) - Slide 7

Legal and Ethical Considerations Examples of policy statements that are related to medication administration include:

• Educational requirements for professionals who are authorized to administer medications • Approved lists of intravenous solutions and medications that the nurse can start or add to an existing infusion • Lists of restricted medications • Lists of abbreviations that are not used in documentation to avoid medication errors Chapter 6 - pg 61 (standards of care) - Slide 6

Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube

• Enteral formulas are designed to provide basic metabolic requirements and adequate nutritional intake • Prescribed enteral formula should be checked • Formula should be fully labeled • Discard unused formula every 24 hours • Follow the guidelines specific for patients receiving general nutrition via intermittent or continuous feedings • Verify tube placement, assess for residual, and initiate feeding • Flush with 30 mL water, then clamp tube • Proceed with tube feeding technique - Intermittent: Use Toomey syringe - Continuous: Use disposable feeding container and enough formula for a 4-hour period • Check gastric residual volume before next feeding; listen for bowel sounds • Provide complete documentation of administration and response to therapy Chapter 8

Disposal of Unused Medicines

• Environmental concerns regarding drugs contaminating water prompted guidelines for disposal of medications in 2007 • Do not flush prescription drugs in toilet (unless instructed by manufacturer) • If no instructions are given, throw in trash • Use drug take-back programs, which allow public to dispose of unused drugs • before throwing out an empty prescription bottle, scratch out all identifying information on the label • Controlled Substances (e.g. opiate analgesics) should be flushed down the toilet to reduce danger of unintentional use or overdose Chapter 6 - pg 72 - 73 (types of medication orders) - Slide 13-14

Discharge Medication Teaching

• Explain proper method of taking prescribed medications to the patient • Stress the need for punctuality • Teach patient to store medications separately • Provide patient with written instructions • Identify anticipated therapeutic response • Instruct patient, family members, or significant others regarding how to collect and record data • Give patient a list of signs and symptoms that should be reported to provider • Stress measures to be initiated to minimize or prevent anticipated adverse effects of prescribed medications Chapter 6

Administration of Liquid-Form Oral Medications - continued

• General principles for infants, children, and adults - Give adults and children the most important medications first - NEVER dilute medications without specific orders - DO NOT leave a medication at the bedside without an order to do so - Check an infant's ID and be certain the infant is alert • Provide complete documentation of administration and responses to therapy • Measuring techniques vary according to receptacle used • Measuring cup: Cover label to prevent smearing; place fingernail at exact level on measuring cup; read the volume at the level of meniscus • Oral syringe: Select syringe of appropriate size; draw up prescribed volume of medication from bottle or medicine cup Chapter 8

Administration of Liquid-Form Oral Medications

• General procedures are the same as with solid-form oral medications • Perform premedication assessment in all cases • Liquid medications are most commonly given to infants using a syringe or dropper • Place the syringe between the cheek and gums, halfway back into the mouth, and slowly inject medication to allow the infant to swallow Chapter 8

Contents of Patient Charts Patient Charts

• Patient's charts are legal documents • Patient's Chart or Electronic Medical Record (EMR) is primary source of information that is necessary for the patient assessment so the nurse can create and impliment plans for patients care • Nurse is responsible for lookout at all sections of the patient chart Chapter 6 - pg 61 (patient charts) - Slide 8

High Alert Medications - Steps towards Prevention

• Standardizing practices within the institution • Developing processes to make errors stand out • Developing methods to minimize consequences of errors that reach the patient • Use of technology (computer dispenses, smart pumps, barcode) • Restriction of high-alert meds from floor stock • Avoid verbal orders of high-alert drugs • Use checklist with high-alert drugs • Use both generic and brand names on MAR • Standardize drug concentrations • Perform double-checks Chapter 6 - pg 74-75 (high-alert medications) - slide 24-25

Contents of Patient Charts

• Summary Section • Consent Section • Order Section • History and Physical Examination Section • Progress Notes • Nurses' Notes • Laboratory Test Record • Graphic Record • Flow Sheets • Consolation Reports • Other Diagnostic Reports • Medication Administration Record (MAR) or Medication Profile • PRN or Unscheduled Medication Record • Patient Education Record • Additional Patient Chart Records • Nursing Care Plans Chapter 6 - pg 61 (patient charts) - Slide 9 - 10

Rectal Suppositories

• Suppositories are solid medication designed to dissolve inside a body orifice • Equipment is simple Finger cot or disposable glove Water-soluble lubricant Prescribed suppository • Perform standard premedication assessment Should not be used for patients who have had recent prostatic or rectal surgery, or rectal trauma Chapter 8

Administration of a Disposable Enema

• The dose form will be a prepackaged, disposable-type enema solution Technique begins with the seven rights • Explain procedure and check pertinent parameters Time of last defecation • Position patient on left side • Apply lubricant to rectal tube • Insert lubricated tube and insert solution • Educate • Document Chapter 8

Nurse Responsibilities

• Verification: Nurse makes professional judgment regarding medication orders Includes type of drug, usual dose, therapeutic intent, potential allergic reactions, contraindications • Transcription Nurse is responsible for verification of orders transcribed by others • Reporting variance incident report should be submitted be factual and not state opinions Chapter 6 - pg 75-76 (sound-alike medications) - slide 28

Common Methods used to Administer Oral Medications

• unit-dose /single dose packaging: provides single dose • souffle cups • medicine cups: read at eye level • medicine droppers • teaspoons • oral syringes: plastic syringes calibrated and sued to measure liquid medications • nipples with additional holes: used for infants Chapter 8 - page 103 -104 equipment - Slide 7

Sound-Alike Medications

•Most products with sound-alike names are used for different purposes •Important for nurse to know patients' diagnoses •Manufacturers have a responsibility to avoid using brand names that are similar to those of other medicines to avoid errors Chapter 6 - pg 75 (sound-alike medications) - slide 28