Medication Orders
What are some physiologic changes associated with aging that influence medication administration and effectiveness?
altered memory, decreased visual acuity, decrease in renal function, resulting in slower elimination of drugs and higher drug concentrations in the bloodstream for longer periods, less complete and slower absorption from the gastro tract, increased proportion of fat to lean body mass, which facilitates retention of fat-soluble drugs and increases potential for toxicity, decreased liver function, which hinders biotransformation of drugs, decreased organ sensitivity, which means that the response to the same drug concentration in the vicinity of the target organ is less in older people than in young people, altered quality of organ responsiveness, resulting in adverse effects becoming pronounced before therapeutic effects are achieved, decrease in manual dexterity due to arthritis and/or decrease in flexibility.
What is a prn order?
as needed order, permits the nurse to give medication when, in the nurses judgment, the client requires it. The nurse must use good judgment about when the medication is needed and when it can be safely administered.
What should a nurse do prior to giving any medication?
assess a clients health status and obtain medication history, to obtain baseline data by which to evaluate effectiveness of med. Extent of assessment depends on the clients illness/current condition, intended drug, route.
How can medication orders be given?
written order, telephone, and verbal are acceptable for some agencies.
What is the process of administering medications?
Check order and MAR, wash hands, prepare medication, identify client; check for allergies, inform client; teach about medication, administer medication; offer water, Provide other interventions as needed, Wash hands, record medication administration, evaluate clients responses 30-45 minutes after administration.
Why do nurses receive computer printouts of a clients medications instead of a copy of the PCP's order?
method avoids error and saves nursing time.
What does the third check of medication admin consist of?
Recheck the label on the container (vial, bottle, or unused unit-dose medications) before returning to its storage place. or Check the label on the medication against the MAR before opening the package at the bedside
Who is a drug order written on a clients chart by?
a primary care provider or a nurse receiving a telephone or verbal order from a pcp.
What is the nurses responsibility in relation to administering injections to children?
acknowledge that the child will feel some pain; denying this fact only deepens the child's distrust; afterwards the nurse or parent can cuddle and speak softly to the infant and give the child a toy to dispel the child's association of the nurse only with pain.
What are the parts of a prescription?
client name, address, sometimes age, date on administration, the Rx symbol (meaning take thus), Medication name, dosage, strength, route, dispensing instructions for pharmacist, Ex: Dispense 30 capsules, Directions for administration to be given Ex: one tab w/meals, refill and/or special labeling Ex: Refill x1, Prescribers signature
What does a Medication Administration record include?
clients name, room, bed number, drug name and dose, times and methods of administration, date order was prescribed and date it expires.
When the nurse judges a PCP ordered medication inappropriate what actions are required?
contact the pcp and discuss rationale for med being wrong, document: when the pcp was notified, what was conveyed to the pcp, and the pcp response, If the pcp cannot be reached, document all attempts to contact them and the reason for withholding meds, (facility policy dictates whether or not to contact another physician), If someone else gives the med, document data about the clients condition before and after med, if an incident report is indicated clearly document factual info.
What happens once the drug order is signed by the pcp?
copied by a nurse or clerk to a Kardex or medication administration record (MAR)
When your assigned client receives new medication orders what should be done?
double check the transcribed information with the pcp's order to ensure client safety.
What are the essential parts of a drug order?
full name of client, date and time the order is written, name of drug to be administered, dosage, frequency, route, signature of the person writing order
When an order is not signed?
has no validity and the ordering physician or nurse practitioner needs to be notified.
What is a stat order?
indicates the medication is to be given immediately and only once.
Two common problems older adults have with medication are?
lack of transportation to obtain and inadequate finances to purchase. Nurse can provide referrals to available resources when these concerns arise.
How can the nurse allay client fears about their medications?
listening carefully to clients concerns and giving correct information.
What does the signature of the ordering pcp on the order form mean?
makes the drug order a legal request.
What is a standing order?
may or may not have a termination date. may be carried out indefinitely until an order is written to cancel it, or it may be carried out for a specified number of days. In some agencies, they are automatically canceled after a specified number of days and must be reordered.
What are some medication dispensing systems?
medication cart, medication cabinet, medication room, automated dispensing cabinet.
When are medications scheduled as being given at the right time?
medications given within 30min/1hour before or after the scheduled time.
Nursing students are prohibited from?
taking phone and verbal medication orders.
Why is the nurse advised to stay with older clients until they have swallowed their medication?
older people are bewildered by the prescription of several medications and may passively accept their medications from nurses but not swallow them, spitting out tablets, or capsules after the nurse leaves the room. Others may be suspicious of the medications and actively refuse.
What is a single order?
one time order; medication is to be given once at a specified time.
What are the problems older adults have related to medications associated with?
physiologic changes, past experiences, established attitudes towards medications.
What does Institute for Healthcare Improvement (IHI) state?
poorly communicated information at admission and other health care transition positions is responsible for as many as 50% of all medication errors in hospitals.
What should the nurse do when an order is ambiguous, unusual, or contraindicated by the clients condition?
question the PCP.
What does the first check of medication admin consist of?
read the MAR and remove the med from the clients drawer. Verify that the clients name and room number match the MAR, compare the label of the med against the MAR, If the dosage does not match the MAR determine if you need to do a math calculation, Check the expiration date of the med.
What are the ten rights of Medication Admin?
right medication, right dose, right time, right route, right client, right client education, right documentation, right to refuse, right assessment, right evaluation
What written rule do prescribers often follow when prescribing medications for older adults?
start slow and go slow.
What are four common medication orders?
stat, single, standing, and prn.
Unless the order is a standing order it should?
state the number of doses or the number of days the drug is to be administered.
Why shouldn't milk or orange juice be used to mask the taste of medications for children?
the child may develop unpleasant associations and refuse that food in the future.
What increases the possibility of error?
the number of medications taken at once whether self administered at home or in a hospital.
What are acceptable identifiers for identifying a client?
the persons name, assigned identification number, telephone number, photograph, other person specific identifier, wrist band in hospitals. Do not ask the patient "are you Mr. Jones?" instead say "Please state your name."
What does the Institute for Healthcare Improvement (IHI) define medication reconciliation as?
the process of creating the most accurate list possible of all medications a patient is taking, including drug name, dosage, frequency, and route and comparing that list against the physicians admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital.
How many times should medication be checked before administration?
three.
What is the nurses responsibility in relation to clients refusal of medication?
to ensure that the client is fully informed of the potential consequences of refusal and to communicate the clients refusal to the health care provider.
What is the purpose of clients maintaining a list of current medications?
to help improve communication and avoid potential errors in medication administration.
Another safety issue that affects the nurse is?
to make sure that clients receive the appropriate medications and dosages on admission, during transfer, and at discharge.
Instructions about medications should include?
when to take, what effects to expect, and when to consult a pcp.
What does the second check of medication admin consist of?
while preparing the medication (pouring, drawing up, or placing unopened package in a medication cup) look at the medication label and check against the MAR