Chapter 51: Administering Oral and Noninjectable Medications
What can a medication error involve?
- CORRECT drug given to the WRONG patient - WRONG drug given to the CORRECT patient - WRONG dose administered - WRONG documentation placed in patient's chart
What does proper documentation include for a reaction to any medication?
- Date - Time - Type of reaction - Medication administered to reverse the reaction or restore function - Airway support (when applicable) - Level of care (office interventions, transfer to emergency department, hospital admission, etc.) - Outcome of interventions - Instructions provided to the patient and family member for further observation
What does a correct and complete medication order include
- Full name of the patient (including middle names, initials, Jr./Sr.) - Name of medication - Dosage - Route of administration - Frequency, or how often the medication is ordered (ensure patient understands) - Date and time order is written - Specific instructions - Signature of the prescriber (prescriber signs, but the person administering makes sure the order is complete and accurate) *FOR ALL DOUBLE CHECK*
What do immunizations require in addition to the regular documentation items?
- Name of manufacturing pharmaceutical company - Lot number - Serial number (if applicable) - Container's expiration date
What does appropriate documentation include?
- Patient's name - DOB - Medication name; amount, site, and route; time administered; any reactions observed - Patient education provided - Ordered by (provider or other legal prescriber) - For immunizations, also include manufacturer, lot number, serial number, and expiration date - If conditions were not met or any variances made
QID, qid
4 times daily
Intra-arterial
Administered into a artery
Right documentation
All information regarding the rights should be documented in complete detail in the patient's record, along with any adverse events and instructions provided to the patient regarding being alert for reactions and what steps to take if a reaction occurs
Ophthalmic
Applied directly into the eyelid or lacrimal opening in the corner of the eye; medication in the form of ointment or drops.
Topical
Applied directly to skin
Transdermal
Applied directly to skin; an adhesive patch placed on the skin, containing time-released medication
How do you achieve the desired affect with topical ointments?
Apply as prescribed
Right patient
Ask patient to cite full name as well as one other identifier from the chart (ex. birth date, age, address, etc.); DO NOT ask "yes" or "no" questions
Inhalation
Breathed in through nose or mouth; spray or metered aerosol device
Oral
By mouth; swallowed in solid or liquid form
Right dose
Carefully reading medication order
Right route
Carefully reading medication order (e.g., topically, transdermal, orally, injection); also, considering - Age - General physical condition - Body size or mass - Gender - Other medical problems - Other medications taken
Right medication
Check medication order and verify medication at least three times prior to administration, and a final time following administration: 1. When preparing 2. When bringing the medication to administer 3. Prior to administering 4. Following administration
What are advantages of oral medications?
Convenient, easily stored, more economical, lower risk, less expense, easy to self-administer at home
Vaginal
Delivered directly by manual insertion or applicator into the vaginal vault in the form of ointment or dissolvable tablet
Intravenous
Delivered into a vein by injection or infusion
Otic
Delivered into the ear canal
Intrathecal
Delivered into the spinal canal by injection or infusion
How is the route a drug is administered decided?
Depending on the rate of absorption desired, distribution, biotransformation (how the body converts the drug into a form it can use), and elimination
Right time
Determining time patient last ate and checking the expiration date of the medication
Medication orders
Direct and complete instructions composed by the provider or other licensed practitioner for administering medications to a patient - generally entered into in the electronic record as a permanent part of the patient's chart
What does the person administering the order do at the end?
Electronically sign their name with credential, followed by date and time the order was given
In what form are medications given to patients by the inhalation method?
Gases, sprays, fluids, or powders - which are then mixed with liquid to be used with equipment that will produce a medication-containing mist or vapor that can be breathed into the respiratory tract
Intradermal
Given by shallow-angle injection just under dermis of skin
Intranasal
Given through the nares
Right technique
How the medication is administered (e.g., the skill in giving different types of injections, the manner in which you apply a topical preparation, or in which the way you administer an inhalation treatment to a patient)
What medications are parenterally but not injectables?
Inhalation, nasal, ointment, otic, rectal, topical, transdermal, urethral, and vaginal
Intramuscular
Injected into muscular tissue for delayed absorption
Subcutaneous
Injection just below cutaneous layer of the skin
Rectal
Inserted directly into the rectum; usually in the form of an ointment or dissolvable tablet
Oral medications
Intended for absorption through the alimentary canal or digestive system
Which agency has made a "Do Not Use" list of abbreviations?
Joint Commission
Drops
Liquid solution applied directly to eyes, ears, nose, or in the mouth for infants and small children
What are the most common medical errors?
Medication erros
What happens when a medication error occurs?
NEVER try to cover it up - notify the prescriber or supervising practitioner at once to determine what steps need to be taken. Most errors only require monitoring by some might require emergency intervention
Can you document a medication for anyone else or have anyone else record a medication you administer?
NO
How often should oxygen tanks be checked?
On a daily basis, and maintained as recommended by the manufacturer or providing company
What routes are MAs permitted to administer medications?
Oral, inhaled, topical, rectal, vaginal, urethral, and injectable
Parenteral
Other than by mouth; intended for absorption outside the digestive system
What forms do oral medications come in?
Pills, tablets, capsules, caplets, lozenges, syrups, sprays, and other liquids
Buccal
Placed between the cheek and gum for absorption through mucous membranes in the mouth; solution, gel, or dissolvable tablet
Sublingual
Placed under tongue for fast absorption; dissolvable tablet or gel
When following provider's order in giving medications to patients, always...
Prepare, administer, and record the medication as soon as possible before beginning any other new tasks
qns
Quantity not sufficient
VAERS (Vaccine Adverse Event Reporting System)
Reporting system for adverse events and products problems with vaccines
What are the Seven Rights?
Seven elements that MUST be considered when administering medication: 1. Right PATIENT 2. Right MEDICATION 3. Right DOSE/AMOUNT 4. Right ROUTE/METHOD 5. Right TIME/SCHEDULE 6. Right DOCUMENTATION 7. Right TECHNIQUE
What forms do topical medications come in?
Sprays, lotions, creams, ointments, paints, salves, wet dressings, and transdermal patches
What are the most prevalent methods of delivering rectal medication?
Suppositories and enemas
Prior to ANY medication to ANY patient, what should the MA follow?
The Seven Rights of medication administration
Where do health care providers report certain adverse events that occur following vaccination?
The Vaccine Adverse Event Reporting System (VAERS)
What is recorded after medication is administered?
The date and time and that it was give as ordered, followed by an electronic signature complete with credential
What happens if the medication order is incomplete or unclear?
The order will not be carried out until it is clarified
What should MAs not do regarding the preparation and administration of medications?
They should NOT prepare medications for someone else to administer, or give medications that have been prepared by someone else
What should you advise patients to do along with provider's order for metered dose inhaler?
Use only as directed, notify provider if medication isn't providing relief/symptoms worsen, perform good oral hygiene, and only use the medication for the stated number of doses on the canister
Intraosseous
Used in emergencies to deliver drugs directly into the bone marrow; not a commonly used route but used in emergencies when other routes are unavailable
What is included in recording medication information in the patients chart?
WHO - who ordered the medication and who should take it WHAT - what medication was administered and how much (strength and dose) WHEN - the time and date administered WHERE - the route of administration, as well as site and appearance following injection WHY - reason for medication and printed patient information
When do nebulizers work better than metered-dose inhalers?
When patients are unable to use the latter, such as small children
p
after
pc
after meals
PRN, prn
as needed
ad lib
as needed or desired
a-
before
ac
before meals
BSA
body surface area
po
by mouth
CAPS
capsules
comp
compound
Sig, sig
directions, dispense number
DC, DISC, disc, d/c
discontinue
DAW
dispense as written
When provider is present and gives order verbally (discouraged), always...
double-check specific medicine, the dose, the expiration date, and other necessary details with the provider again just prior to administration
elix
elixir
Q or q followed by number
every 2, 3, etc. hours
qh
every hour
Qam
every morning
EENT
eye, ear, nose, throat
fl
fluid
GI
gastrointestinal
GU
genitourinary
hr
hour
STAT, stat
immediately
inj
injection
IM
intramuscular
IV
intravenous
am
morning
noc
night
NPO, npo
nothing by mouth
pt
patient
Rx
prescription
qs
quantity sufficient
TID, tid
three times daily
BID, bid
twice daily
c-
with
s-
without
w/o
without
