Medication Administration
Medication Administration understanding is important for recognizing medication reconciliation, and mastering pediatric dosage calculations. These essential skills are for ensuring optimal patient outcomes. This section delves into critical topics such as reducing medication errors through evidence-based practice, utilizing Automated Medication Dispensing Systems (AMDS), and applying critical thinking in drug delivery. We will also explore the six rights of medication administration—an essential framework for safe nursing practice.
By the end of this section, you should know about:
- The importance of pharmacology in nursing
- Pharmacokinetics: Basis of Medication Actions
- Evidence-based practice: reducing medication errors
- Pediatric Dosage Calculations
- Medication Administration Dispensing System (AMDS)
- The role of the nurse in medical reconciliation
- Critical thinking and knowledge in drug delivery
- Six different rights to drugs
Let’s Take a closer look at them.
The importance of pharmacology in nursing
Nurses play a critical role in safe medication administration, which requires a detailed understanding of scientific concepts. This includes medicine, chemistry, bacteriology, and human physiology. In addition, they must have a good understanding of the legal aspects of healthcare, including prescriptions, and ensure that medicines are administered in a safe and correct manner. Knowledge of drug actions and side effects is essential to monitor patient response and deliver optimal care.
Chemical Manuals and Standards in Medication Administration
Federal Regulations: The government controls the safety of drugs in the US through laws such as the Pure Food and Drug Act, which ensure that drugs are free of impurities the Food and Drug Administration (FDA) plays an important role in overseeing safety, effectiveness and chemical prescriptions. The FDA also regulates the sale and distribution of controlled substances. Programs like MedWatch allow health care providers to report adverse events and improve patient safety.
State and local laws: In addition to state laws, states have their own laws that sometimes cover substances that are not regulated in the state, such as alcohol and tobacco. Local government agencies also play a role in the control of certain types of drugs. Health care organizations are required to comply with both federal and state regulations, and often implement strict policies, such as automatic drug cessation after a certain period of time
Nurse Practice Act and Legal Responsibility in Medication Administration
National Nursing Practice Acts (NPAs) define a nurse’s responsibilities and workload. These acts are broad enough to allow flexibility in practice but are intended to protect the public from unqualified or inadequately trained personnel. Nurses are legally obligated to follow specific guidelines when administering opioids and other controlled substances. Violation of this law can carry severe penalties including fines, imprisonment and loss of license. Hospitals and healthcare organizations have specific policies to manage drug use, including proper storage, proper paperwork and waste disposal procedures.
Pharmacological Concepts in Medication Administration
Chemical nomenclature: Drugs typically have three types of nomenclature: the chemical name, which includes a description of the molecular structure; a generic, official name (e.g., acetaminophen for Tylenol); and trade name, which is the brand name used by the manufacturers. Nurses should be cautious when administering medications, as similar names can lead to confusion and error. Resources like the Institute for Safe Medical Practices (ISMP) help identify drug names that are often confusing.
Classification and Approach: Drugs are classified on the basis of effect or its clinical symptoms. For example, asthma medications are often classified as beta2-adrenergic agonists. Some drugs come in many forms, such as aspirin, which is used as an analgesic, antioxidant, and antibiotic. A variety of drugs, including lotions, lotions, lubricants, and lotions, each affect how the drug is absorbed and delivered.
Side effects: Unintended effects of a medication that are generally mild and commonly occur alongside the desired therapeutic effect.
Prescriptions: Written or electronic orders from a healthcare provider authorizing the use of specific medications for a patient.
Pharmacokinetics: Basis of Medication Actions
Absorption: The absorption of a drug and the process by which the drug enters the bloodstream after administration. Various factors such as route of administration, drug solubility, blood flow to the administration site, body surface area, and lipid solubility affect absorption Intravenous drugs (IV) is absorbed most rapidly and absorption of oral drugs applied to the skin obtained.
Distribution: After absorption, medications are distributed throughout the body to the tissues and organs. Factors like circulation, membrane permeability, and protein binding influence how and where the medication reaches its target site. Moreover, impaired circulation, such as in patients with heart failure, can delay the effectiveness of medications by slowing distribution to the intended areas.
Metabolism: Once a medication reaches its site of action, it is metabolized, typically in the liver, into a less active form to be excreted. Liver function is vital in this process, as reduced liver function can lead to slower metabolism and medication accumulation, increasing the risk of toxicity.
Excretion: Finally, medications are excreted from the body through organs like the kidneys, liver, and lungs. The excretion process depends on the chemical composition of the medication. For example, gaseous substances exit through the lungs, while lipid-soluble medications are excreted through sweat glands. Impaired organ function can slow excretion, which may require adjustments to medication dosages.
Drug excretion process in Medication Administration
The body uses a variety of detoxification mechanisms, ensuring that chemicals and metabolites are eliminated. When drugs are taken from the body through the mammary glands, there is a risk of continuing breastfeeding infants. This highlights the importance of examining drug safety for breastfeeding mothers. Another route of elimination is the gastrointestinal (GI) route where drugs produced by the liver enter the bile and are transported to the intestines Here factors affecting peristalsis such as laxatives are either inactive or inactive can result in faster or delayed drug release.
The kidneys are the primary excretory organs, and some drugs are excreted unchanged in the urine. Adequate fluid intake (approximately 50 mL/kg/hr) is essential for normal renal function and drug elimination. Renal disorders can lead to decreased clearance and accumulation and toxicity of drugs, so that dosage adjustments by health care providers will be required.
Medication Interactions in Medication Administration
Drug interactions occur when the effects of one drug are altered by the presence of another. These interactions can increase or decrease the efficacy of drugs, or alter absorption, metabolism, or elimination. Synergistic effects occur when two drugs are combined to produce greater effects than when used separately. For example, alcohol potentiates anticonvulsants, antidepressant barbiturates, and sedative painkillers. In some cases, such interactions are desirable, such as the combined use of diuretics and vasodilators to manage hypertension rather than drugs alone.
Timing of Medication Dose Responses
Timing of administration greatly affects effectiveness. Intravenous drugs enter directly into the bloodstream and work immediately, whereas oral drugs take longer to be absorbed. Each drug has a therapeutic range, defined as a blood concentration between the minimum effective concentration (MEC) and the toxic concentration. The dose is carefully adjusted to maintain a constant therapeutic dose. For agents such as vancomycin, peak doses are measured to ensure efficacy and monitor trough levels to avoid toxicity. Consistent dosing, especially for chronic conditions, helps keep doses consistent, which is important for effective treatment.
Routes of Administration
Drugs can be administered in different ways depending on the type and the condition of the patient. The oral route is the most common and mild, although it starts off slow. It rapidly passes through the mucous membrane via the sublingual buccal route. Oral routes such as intravenous, intramuscular, and subcutaneous medications facilitate absorption but may cause nausea or vomiting. Topical inhalation techniques are used for local effects, while systemic effects can occur with transdermal patches or intraocular devices. Advanced techniques, such as bone marrow transplantation, are used in specific clinical settings and often require specialized training.
Safe Medication Administration
Safe dosing depends on adherence to prescribed dosages and schedules. To avoid non-therapeutic or side effects, long-term critical medications should be administered within 30 minutes of the appointment, whereas non-time-critical medications allow for a wider window if it is 1-2 hours and nurses need to understand the pharmacokinetics of the drugs in order to adjust the timing of administration to patient needs. Educating patients about the medication regimen using familiar terms ensures compliance, which enhances treatment outcomes. Organizations often implement evidence-based guidelines and double-check systems for high-risk medications to reduce medication errors and increase patient safety.
Absorption: The process by which a drug enters the bloodstream after being administered, either through the skin, gastrointestinal tract, or other routes.
Intraocular: Medication administered directly into the eye, often used for treating eye conditions.
Medication error: A preventable event that leads to inappropriate medication use, potentially harming the patient.
Medication interaction: When one drug affects the activity of another drug, either enhancing or reducing its effectiveness, or leading to harmful effects.
Trough: The lowest concentration of a drug in the bloodstream, typically measured just before the next dose is administered.
Synergistic effect: When two or more medications work together to produce a combined effect greater than the sum of their individual effects.
Sublingual: A method of administering medications under the tongue, where the drug is absorbed directly into the bloodstream through the mucous membranes.
Subcutaneous: An injection administered into the layer of fat and tissue just beneath the skin, often used for insulin or vaccines.
Pharmacokinetics: The study of how the body absorbs, distributes, metabolizes, and eliminates drugs.
Peak: The time after drug administration when the drug’s concentration in the bloodstream is at its highest.
Injection: The process of administering a substance (e.g., medication) through a needle and syringe, typically into the body via various routes (e.g., intramuscular, intravenous).
Intramuscular (IM): An injection given deep into a muscle, where the medication is absorbed into the bloodstream more slowly than intravenous administration.
Evidence-based practice: reducing medication errors
Patient safety issues in healthcare gained national attention with the publication of To Err Is Human: Building a Safer Health System by the Institute of Medicine (IOM) in 1999. This report revealed alarming statistics, and they count that about 98,000 hospital deaths each year are caused by medical errors—car accidents, breast cancer; AIDS, workplace injuries and deaths Despite overdose, inpatient prescribing errors are estimated to cost more than $3.5 billion annually (CDC, 2012).
Nurses play an important role in patient safety, especially during the critical phase of medication administration. Safe administration of medications has become a major focus of nursing research, emphasizing the need for nurses to accurately estimate dosage and understand the role of health care team members in prescribing and internal delivery and emphasis on rigorous thinking and evidence-based practice under error reduction.
PICO Question in Medication Administration
Does the use of electronic medication ordering (CPOE), automated medication dispensing systems (AMDs), and bar code medication administration (BCMA) reduce medication error reduction compared to routines we do about it?
Collection of evidence in Medication Administration
Prescribing errors are often the result of problems in the ordering or dispensing of medications. Studies have confirmed that technologies such as CPOE, AMD, and BCMA significantly reduce medication errors in a variety of settings. However, this technology is not foolproof and should be integrated into nursing services along with qualified personnel to improve safety.
Practice in Medication Administration
Implementation plan: Involvement of health professionals, including nurses, in planning the integration of new drug delivery technologies is essential.
Maintaining Happiness: Technology reduces errors but does not eliminate them. Nurses must adhere to medication administration protocols at all times.
Workload and staffing considerations: Increased nursing workload and inadequate physician support contribute to errors. Staff ensures staffing levels match patient seriousness and hard work.
Hospital statistics
Nurses must have a strong understanding of mathematical concepts to accurately calculate dosages, mix solutions, and measure intake/output. This includes modifying measurement systems, implementing calculation methods, and ensuring safe dosages are administered to children.
Change strategies
In the metric system: To convert milligrams to grams, divide by 1,000 (move the decimal three places to the left). Multiply by 1,000 from liters to milliliters.
Between systems: Use equity tables to convert between metric systems and household systems.
Solution: A liquid preparation where a drug is dissolved in a solvent, typically water or saline.
Metric system: A decimal-based system of measurement used in healthcare for accurately measuring medication doses, fluids, and other substances.
Pediatric Dosage Calculations
Children are vulnerable to drug errors due to limited dosage, immature body systems, and lack of communication. Doses are usually calculated by weight (mg/kg) or body surface area (BSA). Basic safety measures include weighing children in kilograms, using precision weighing devices, and double-checking calculations with another health care provider.
Guidelines for the treatment of medications in children
Always calculate dose based on weight or BSA.
Use a small syringe for the exact dose.
Round carefully, usually in just a few to the nearest thousand.
Determination of 24-hour dose limits compared to recommended standards.
Role of the health practitioner
Physicians, nurse practitioners, or physician assistants dispense medications, and often use electronic systems such as CPOE to reduce errors associated with incomplete and illegible orders Verbal telephone orders are accepted at strict guidelines requiring timely confirmation, documentation, and signature by the prescriber.
Oral/telephone ordering best practices
Use “read-back” for confirmation.
Instruct the patient clearly and give full details of the order.
Follow company policies for correspondence and co-signers.
Unit dose system
The unit-dose system is a storage and dispensing system of drugs used in healthcare settings. Medicines are dispensed individually, pre-filled to reduce medication errors and ensure proper inventory control.
Doctors generally prepare medications in single bottles, which nurses dispense to patients.
In many programs, medications are stored in 24-hour dispensing carts organized by patient name and room. These are regularly refilled by pharmacists or pharmacists.
Controlled substances are stored separately in secure locked containers. This helps prevent misuse and ensures proper inventory tracking.
This program reduces medication errors, reduces warehouse inventory, and improves patient safety by improving the workflow for nurses and physicians.
Medication Administration Dispensing System (AMDS)
AMDS uses networked computer systems to manage medication administration, ensure proper medication adherence, and patient safety.
Access to the system and sometimes security measures such as biometric identification (e.g. fingerprint scans) are required to access the system.
Nurses interact with AMDS to select the appropriate medication and dosage, after which the system administers the medication and records the event in the patient’s electronic health record (EHR).
AMDS is often combined with legally administered medications (BCMAs). This system scans the barcode on the patient’s ID card, medication and nurse ID card to ensure that the right medication is dispensed to the right patient.
Benefits: Reduces medication errors by ensuring accuracy, improved safety, and improved overall efficiency.
The role of the nurse in administering medications
Nurses play an important role in the safe administration of medications. Key responsibilities include:
Ensures proper medication is ordered and prepared.
Assessment of the patient’s ability to self-administer medications.
Medications are accurately administered and checked for side effects or complications.
Patient education is also part of the nurse’s role. Nurses should educate patients and families about appropriate medication dosage, side effects, and medication use at home.
Provision of Services: Nurses should not administer nursing assisted personnel (NAP) medications and should ensure that medication therapy is appropriately integrated into all patient care.
Drug errors and prevention
Medication errors occur when medication is not administered incorrectly, whether in the wrong dosage, timing, route, or timing
Preventive measures include:
To prepare medicines for each patient.
Follow the six opportunities of drug supply: right patient, right drug, right dose, right time, right method, right documentation.
Double-testing high-risk drugs and using two indicators for patients.
Avoidance of drug administration.
Prompt reporting of errors and consideration of their causes.
By following appropriate procedures, through the use of technologies (such as AMDS and BCMA), errors can be prevented by ensuring successful communication between healthcare professionals.
Reporting and Chemical Safety
Advances in health information have greatly improved drug safety. Examples include:
Computer systems with networks that provide real-time access to medication orders, reducing the risk of error.
Automated medication dispensing systems (AMDS) and electronic medication administration records (eMAR) assist in medication tracking, reconciliation, and error prevention.
Barcoding technology ensures accurate dispensing of medicines by linking patients, medicines and healthcare providers.
Medication reconciliation: This is especially important when patients experience a transition in care, such as during admission or discharge. Ensures accurate prescriptions and helps identify potential contradictions or dangerous interactions.
Medical error reports and near misses
Near misses should also be reported. These are situations where the error is caught before it reaches the patient, but there was still a potential loss.
Incident reporting tracks events, allowing companies to analyze patterns and implement corrective actions to prevent future errors.
Reporting medication errors is critical to patient safety and quality improvement. These reports help healthcare teams learn from mistakes and improve policies and procedures.
Medication harmonization protocol in Medication Administration
The goal of medication matching is to ensure that the medication the patient is currently taking matches the medication ordered in the new care setting.
The steps involved are:
Obtain, Check, and Record: Accurately collect all medications taken by the patient, including prescriptions and medication descriptions.
Compare: Review the patient’s home prescription and compare it to the current order to ensure accuracy.
Medication reconciliation: The process of reviewing a patient’s medications to ensure that all prescribed medications are correct, complete, and safe, particularly during transitions of care.
The role of the nurse in medical reconciliation
Nurses are an integral part of the medication reconciliation process. They must communicate with the healthcare team and the patient to ensure that a complete and accurate prescription is maintained throughout the patient’s care journey.
Nurses should be alert when patients change in care settings (e.g., admission, discharge, or transfer) to prevent medication errors.
The integration of systematic systems such as unit-dose systems and AMDS into health information data goes a long way toward safer medication delivery. Nurses follow established procedures and continuously monitor for errors, participate in medication preparation, and educate patients about appropriate medication use to minimize errors and provide patient care developed.
Critical thinking and knowledge in drug delivery
Ensuring safe and effective care requires a detailed understanding of physiology, medicine, child development etc. Knowledge of body physiological processes such as how potassium affects muscle function, nurses be able to predict the effects of medications on a patient’s body eg Nurses must also understand the principles of child development in order to administer medications well children, recognizing that children can associate medication with negative experiences. Knowledge is especially important when using unknown drugs. If a nurse is unfamiliar with the drug, they should consult reliable sources such as pharmacists, or make sure to check the literature before proceeding.
Experience in Medication Administration
As nursing students gain experience in clinical settings, they enhance their neuropsychological skills in medication administration. However, medication administration goes beyond physical activity alone – the nurse must consider the patient’s temperament, knowledge, and physical/mental state. This comprehensive understanding is essential to ensure the safety and efficacy of drug delivery.
Attitudes Towards Medication Administration
Nurses must take a disciplined, systematic approach to ensure the safety of medication administration. Taking sufficient time to read the patient’s medical record, thoroughly reviewing medications, and the six rights of the medication regimen (right medication, right dose, right patient, right approach, appropriate timing, and appropriate documentation) are all important elements of nurse behavior toward medication administration. Nurses must be fully accountable for their actions, ensure that each medication is correct, and that the patient or caregiver understands how to safely administer medication when needed. Interventions to ensure medication use safely if a nurse determines that the patient cannot safely deliver on his own the hypothesis must be developed.
Professional Standards in Medication Administration
Health organizations and the nursing profession set standards for medications to ensure their safety. These standards, defined by the American Nurses Association (ANA), guide nurses to exercise the six rights of dispensing. For example, phenytoin (Dilantin) for epilepsy has dosing restrictions based on the unit’s ability to monitor patients’ heart rate and rhythm Nurses should be aware of these restrictions and consult with healthcare professionals to communicate effectively to avoid administering unsafe chemicals.
Six different rights to drugs
Medication compliance: Always check for medication conflicts with a physician’s order, either manually or electronically through a computerized physician order entry (CPOE) system. Nurses should triple-check the medication label against the Medication Administration Record (MAR)—before administering, adjusting the dose, at the patient’s bedside and if there is any uncertainty, nurses should and a highly skilled health professional or pharmacist verifies the product.
Right Dose: The exact dosage is important. Nurses should monitor for dosing or changes, especially for medications involving drug breakdown. If the drug is ordered in a strength that does not conform to the standard unit dosing schedule, nurses should check the correct dosage prior to administration. Incorrect dosage errors often arise in situations such as drug disintegration, and care must be taken when preparing drugs.
Correct patient: Always use at least two patient identifiers (such as name and medical record number) before administering medication to prevent medication errors. The Barcode Medication Administration (BCMA) system can be used in some institutions to significantly reduce errors by scanning patient fingerprints, medications, and nurse badges.
Different rights to drugs
Correct Method: Medication orders must specify the correct method of administration. If the drug is administered incorrectly, it can reduce its effectiveness or cause harm. Nurses should double-check that the prescribed method matches that listed in the MAR.
Timeliness: Medications should be administered within the prescribed intervals. Nurses need to know when to administer a medication, and ensure that it is administered at the right time to maximize the therapeutic effect.
Proper Documentation: Proper documentation is important. The MAR must include the exact name, dosage, route, and timing of the medication. Any patient refusals, medication changes, or errors should also be documented.
By using critical thinking, building knowledge, gaining experience, and maintaining a positive attitude, nurses can ensure safe and effective medication delivery to patients. Compliance with the Six Rights of Dispensing helps reduce medication errors by ensuring that the right patient is given the right medication in the right dosage, at the right time, in the right way , with the appropriate documentation.
Critical aspects of medication administration
There are several critical aspects of medication administration. The six rights that healthcare professionals must follow to ensure patient safety. These six rights are:
Right Medication: This refers to confirming that the correct medication is administered. It includes checking the medication order against the Medication Administration Record (MAR), verifying the medication’s label, and ensuring proper identification of the medication when preparing it. It’s important for nurses to consult the healthcare provider if there are any questions or discrepancies with the medication orders.
Right Dose: Nurses should ensure that the correct dosage is administered by verifying medication calculations or conversions. Using standard measurement devices and avoiding the splitting of pills or improper crushing of tablets is essential for accurate dosing. Special care should be taken when medications are split or crushed, ensuring that only safe practices are followed.
Right Patient: Medication errors often occur when a patient receives the wrong drug. Nurses must use at least two patient identifiers (such as name and medical record number) to confirm the identity of the patient before administration. Barcoding systems, such as Barcode Medication Administration (BCMA), can further reduce the risk of errors by ensuring proper patient identification.
More Rights
Right Route: Ensuring that the correct route of administration is followed is critical. If there is uncertainty about the route of administration, the nurse should consult with the healthcare provider. Special attention should be given when preparing medications, especially when the oral medication is in a syringe, as mistakes can lead to serious consequences, such as administering an oral medication intravenously.
Right Time: Nurses must understand the timing and scheduling of medications to ensure they are given within the correct timeframe. For example, medications like insulin may need to be given precisely before a meal, while antibiotics require timely administration to maintain therapeutic levels. Understanding the difference between time-critical and non-time-critical medications is important for safe practice.
Right Documentation: Accurate documentation is vital for patient safety. Nurses must document the medication administered, including the name, dose, time, and route, immediately after the administration. Proper documentation ensures that the next healthcare provider knows what has been given and prevents errors from occurring. Inaccurate or incomplete documentation can lead to serious medication errors.
Therapeutic effect: The intended, beneficial effects of a medication in treating a specific condition or disease.