Medication administrationMedication administration is a process that carries great responsibility in requiring that you know which medication is supposed to be given, as well as to whom, and when. Remembering the various information that you need to keep track of can be overwhelming, but it is vital that you are aware of them. We highly recommend familiarizing yourself with the seven rights of medication administration in order to protect both your patients and yourself. Show
Right IndividualMaking sure that you have the right individual is obviously a very important step in medication administration. The standard is to check with at least two other sources that you have the correct person before administering medication. The most experienced of nurses can make a mistake if tired, overworked, or managing several patients at once. Despite your level of experience, you should always verify that you are giving the right person the right medication. Right MedicationIt goes without saying that ensuring that you have the right medication is paramount for a variety of reasons. Different patients can have different medical allergies, adverse reactions, and unexpected symptoms that could lead to catastrophic results. Read the label of the medication, triple-check the patient’s charts, and make sure you are administering the correct medication for that patient. Right DoseThe right dose is incredibly important as well, as the wrong dose could lead to overdosing a patient and possibly harming them. The patient’s correct dose should be noted in their chart, and you should also know the form in which they should be receiving medication. Are they taking pills, receiving medications through IV, or swallowing liquids? These methods all require various doses. Right TimeMany medications have a specific time that they need to be administered, either due to the patient’s other medications or around their meals. Not all medications require a specific time, but it is your responsibility to know which ones do and don’t. Every time that medication is given to a patient, it should be recorded so that anyone treating them is aware of when medication was last administered. Right Route“Route” in this case refers to where and how the medication is given to a patient. While most medications are taken orally, this is not always the case. The notes surrounding the way that medications should be administered are important to keep communication clear as nurse shifts change or others administer medication. Medication can be given in several ways including rectally, vaginally, through the skin, in the eyes, in the ears, into the lungs, etc. This leaves a lot of room for error if not correctly communicated. Right DocumentationIt is the sole responsibility of the person administering the medication to properly document that administration. Without proper documentation, communication can get lost between medical professionals. Always double-check your documentation and make sure that all details are present and correct. Right ResponseLast, but certainly not least, is the response that the patient has to the medication administered. Anytime that a patient is given medication, their response should be recorded to make sure that it is known to all treating the patient. Additionally, the level to which the medication helps the patient should be recorded to keep track of what medication is working and what isn’t. Chapter 6. Non-Parenteral Medication Administration Safe and accurate medication administration is an important and potentially challenging nursing responsibility. Medication administration not only requires understanding medications, how they work, side effects, and significant nursing considerations, it also involves good decision-making skills and clinical judgment. Nurses must understand why patients take particular medications, anticipate potential med-med interactions, and assess individual patient response. Nurses are human, so naturally medication errors do happen. The Joint Commission (TJC), a non profit organization that accredits health care organizations and programs, defines medication errors as any preventable event that may cause inappropriate medication use or jeopardize patient safety (TJC, 2012). Medication errors have a substantial impact on health care in Canada (Butt, 2010) and are the number-one error in health care (Centers for Disease Control [CDC], 2018). In one study looking at drug related hospital admissions and emergency department (ED) visits, Zed et al. (2008) found that adverse drug reactions are estimated to account for more than 25% of drug-related hospital admissions and ED visits (as cited in CIHI, 2013). Of these, 68% are considered preventable. Of the patients whose ER visits were drug related, their hospital admission rates were higher and their length of stay longer when compared to patients who presented for other reasons. Studies by other researchers reveal similar and equally concerning findings about negative medication related effects on people (Baker et al., 2004; Bell et al., 2011). The cost to patients and families, as well as to the healthcare system, points to the importance of safety in relation to all phases of the medication administration process. Review Table 6.1 for principles for safer medication administration.
Administering medications in a timely fashion and according to the prescribed frequency is considered an important part of safe medication administration in terms of maintaining therapeutic drug levels and, therefore, therapeutic drug effectiveness. Traditionally, a 30 minute window on either side of a medication administration time was considered responsible practice. In a study involving acute care nurses, ISMP (2011) found that increasing patient acuity, polypharmacy, and increasing nursing workloads made it difficult for nurses to administer medications within this time frame. The resulting work-arounds done by nurses to try and avoid medication errors due to being “late” led to other, sometimes serious, errors. In response, the ISMP has challenged this 30 minute tradition and has developed guidelines for timely medication administration. The ISMP does not dictate to institutions what they must do, rather they encourage all institutions to create their own list of time critical medications. Table 6.2 reflects these new recommendations.
Technological Advances that Help Mitigate Medication Errors Computerized physician order entry (CPOE) is a system that allows prescribers to electronically enter orders for medications, thus eliminating the need for written orders. CPOE increases the accuracy and legibility of medication orders; the potential for the integration of clinical decision support; and the optimization of prescriber, nurse, and pharmacist time (Agrawal, 2009). Decision support software integrated into a CPOE system can allow for the automatic checking of drug allergies, dosage indications, baseline laboratory results, and potential drug interactions. When a prescriber enters an order through CPOE, the information about the order will then transmit to the pharmacy and ultimately to the MAR. The use of electronic bar codes on medication labels and packaging has the potential to improve patient safety in a number of ways. A patient’s MAR is entered into the hospital’s information system and encoded into the patient’s wristband, which is accessible to the nurse through a handheld device. When administering a medication, the nurse scans the patient’s medical record number on the wristband, and the bar code on the drug. The computer processes the scanned information, charts it, and updates the patient’s MAR record appropriately (Poon et al., 2010). Automated medication dispensing systems provide electronic automated control of all medications, including narcotics. Each nurse accessing the system has a unique access code. The nurse will enter the patient’s name, the medication, the dosage, and the route of administration. The system will then open either the patient’s individual drawer or the narcotic drawer to dispense the specific medication. If the patient’s electronic health record is linked to the automated medication dispensing system, the medication and the nurse who accessed the system will be linked to the patient’s electronic record. Read ISMP’s Top 10 Practical Tips about how to obtain a best possible medication history.
Medication safety is an important component of healthcare delivery. Evidence to support this is provided by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices (ISMP) Canada. The later is an independent, national, not-for-profit agency committed to the advancement of medication safety in all healthcare settings. Safer Healthcare Now! is an initiative to improve patient safety and prevent medication errors in the Medication Reconciliation process. What are the 3 checks before giving medication?WHAT ARE THE THREE CHECKS? Checking the: – Name of the person; – Strength and dosage; and – Frequency against the: Medical order; • MAR; AND • Medication container.
What must be checked before administering any medication?Assessment comes before medication administration. All medications require an assessment (review of lab values, pain, respiratory assessment, cardiac assessment, etc.) prior to medication administration to ensure the patient is receiving the correct medication for the correct reason.
What is the proper way to identify a patient before administering a medication?Patient identifier options include:. Assigned identification number (e.g., medical record number). Date of birth.. Phone number.. Social security number.. Address.. Photo.. What are the nursing responsibilities when administering medications?Nurses' responsibility for medication administration includes ensuring that the right medication is properly drawn up in the correct dose, and administered at the right time through the right route to the right patient. To limit or reduce the risk of administration errors, many hospitals employ a single-dose system.
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