1- What are the
two patient Identifiers used before medication
Administration?
Use 2 identifiers.
- Ask patient to identify himself/herself.
- When available, use technology (for example, bar-code
system).
2- What are are
the rights of medication administration?
In the past, there was “5 Rights of Medication
Administration: right patient, right drug, right route, right
time, and right dose.” Medical practices have changed to include a
few more rights.
10 Rights of Medication Administration
1. Right
Patient
- Make sure you are giving the right medication to the right
person.
- If you are at home and giving medication to a family member,
make sure you check the bottle and giving the right prescription to
the right person.
- If you work in the medical field, always ask the patients name,
check an ID band, and check the medication bottles to compare
before giving a medication.
2. Right
Medication
- When your doctor prescribes a medication, there will be a
prescription label on the bottle.
- It isn’t safe to just grab any bottle and take any pill.
- Even pharmacies can make mistakes.
- Check your pills and your prescription label carefully to make
sure you have the right medication.
- Check the label every time you grab your bottle to take a
dose.
- Most pill bottles are easily mixed up because they look so much
alike.
- Also, never store a different medication in an empty pill
bottle that was used for something else.
3. Right
Dosage
- This is one of the most important in the 10 rights of
medication administration.
- Before you leave the doctor’s office, ask how much of the
medication you should take.
- Then if you are unsure after you leave, talk to the
pharmacist.
- When you get home do not “play” with dosages.
- Do not break pills in half or take more or less than the doctor
wants you to.
- Check to see if it takes more than one pill to make your right
dosage.
4. Right
Route
- If your doctor gives you pill form and you can’t swallow, you
may need to ask for liquid form of the medication.
- This is especially important for children that cannot swallow
pills yet.
- Check to see if the medication is given by suppositories
(rectal or vaginal) and only use topical creams and lotions on the
skin.
5. Right
Time
- If your doctor orders a medication at HS, this means take it at
bedtime.
- Some bedtime medications can make you sleepy.
6. Right
Documentation
- At home you should keep a journal of the meds you take, what
time you took them and how much you took.
- If you give yourself injections, write down the injection site
since most injection sites should be rotated.
7. Right Client
Education
- Know the side-effects of the medications you and your loved
ones are taking.
- Let them know what they are and have them tell you if they feel
an unwanted reaction to the medication.
- The same thing goes for nurses in the hospital, let your
patients know what to expect from the medication: side-effects,
benefits, and reactions that might happen.
8. Right to
Refuse
- At home or in the hospital, people taking medications have the
right to refuse medications.
- If someone tells you they don’t want to take something, simply
dispose of the medication and call the doctor to let them
know.
- Nurses must legally document a refusal of medication.
9. Right
Assessment
- Have a copy of the patient’s medical history.
- Medications like blood pressure medications always warrant a
quick blood pressure check before giving a blood pressure
medication.
- Ask the doctor what number is too low to give the
medication.
10. Right Evaluation
- Make sure you check for drug allergies and interactions between
different medications.
- Doctors and pharmacists don’t always catch them and we need to
be a third set of eyes.
- At home, it is important to keep a drug guide so you can check
prescriptions against each other.
3- What are the
components of a medication order?
Orders Include:
- Drug name (generic name, followed by brand name when
appropriate)
- Metric dose/strength
- Objective, organization-determined measures are associated with
medication doses that vary based on the degree of the presenting
symptom (e.g., morphine 2 mg IV every 3 hours for severe pain;
morphine 1 mg IV every 3 hours for moderate pain)
- Criteria for dosing adjustments due to renal impairment or age,
and/or an order to consult pharmacy to make necessary dosing
adjustments
- Frequency (and duration if appropriate)
- Route of administration
- Indication (or a prompt/column for the prescriber to specify
the indication)
- Types, frequency, and details regarding necessary patient
assessments, as appropriate (e.g., blood pressure, neurological
assessment, quality and rate of respirations, pulse oximetry) to
monitor the effects of therapy
- Drug administration precautions
- Specific drugs to discontinue during therapy (e.g., enoxaparin
when initiating IV heparin; insulin if enteral feedings are being
held)
- Instructions to address known potential emergencies (e.g.,
antidote available, when to administer the antidote or call the
prescriber)
4- How is
insulin mix and which insulin needs to be drawn first
?
How to Mix Insulin
Purpose of mixing insulin: To prevent having to
give the patient two separate injections (hence better for the
patient).
Most commonly ordered insulin that are mixed: NPH
(intermediate-acting) and Regular insulin
(short-acting).
Important Points to Keep in Mind:
- Never mix Insulin Glargine “Lantus” with any other type of
insulin.
- Administer the dose within 5 to 10 minutes after drawing up
because the regular insulin binds to the NPH and this decreases its
action.
- Check the patient’s blood sugar and for signs and symptoms of
hypoglycemia to ensure they aren’t hypoglycemic …if patient is
hypoglycemic hold the dose and notify md for further orders.
Steps on How to Mix Insulin
1. Check the doctor’s order and that you have the correct
medication
Doctor’s order says: “10 units of Humulin R and 12 units of
Humulin N subcutaneous before breakfast daily”
You’re giving a total of 22 units (10 Regular
& 12 NPH)
As the nurse, it is important to know the peak times of the
insulin you are giving because this is the most likely time the
patient could experience HYPOGLYCEMIA.
- Regular insulin has an onset of 30 minutes, peak 2
hours, and duration of 8 hours
- NPH insulin has an onset of 2 hours, peak 8
hours, and duration of 16 hours
2. Wash your hands and don gloves!
3. Roll the “cloudy” insulin vial in between the palms of the
hands to mix the ingredients because if you don’t mix the contents
it can alter how much cloudy insulin you are actually drawing up.
DON’T SHAKE the vial because this will cause air bubbles!
4. Clean off tops of vials with alcohol prep
for 5 to 10 seconds.
5. Remove cap from syringe.
6. Inject 12 units of air into the Humulin-N vial & then
remove syringe from vial.
7. Inject 10 units of air into the Humulin-R vial & turn
bottle upside down (while syringe still inserted into the bottle)
and then withdraw 10 units of clear insulin…REMOVE SYRINGE.
8. Insert syringe into Humulin-N and turn bottle upside down and
remove TOTAL UNITS NEEDED by pulling the plunger to 22 units (this
will equal removing 12 units of Humulin-N)
9. Recap the needle using the one-hand scoop technique…if not
using immediately.
5- Why is
necessary to prime an IV line before giving the
medication?
- At the beginning of an infusion, all IV sets are primed to
avoid delivering air through the line. After the IV bag is spiked
with the IV administration set, the IV solution/fluid flows through
the tubing to remove the air.
- Depends on the drug and how the drug is mixed by the pharmacy.
Usually, the mixed IV medication bag is sent to the patient care
area as is, no tubing attached. Then the nurses will prime the IV
administration set when it’s ready to be given. In this case, the
solution used for priming is the drug. Some pharmacy will prime the
tubing with saline before they add the medication to the IV bag and
sends the IV medication bag/tubing to the patient care area with
the tubing pre-primed with saline. This is usually the case when
the drug ordered is a cytotoxic or hazardous drug.
6- For how long
are IV line good for and what are the risk if they are not attended
to properly?
|
IV line change |
| No additives in infusion |
Every 7 days |
| Additives in infusion |
Every 7 days |
| Lipid or lipid containing parenteral nutrition |
Every 24hrs |
| Blood products |
Upto 12hrs |
i) Infection:
- Skin-based bacteria may enter through insertion site
- Local cellulitis or systemic bacteraemia are possible.
ii) Phlebitis: Vein irritation
- Due to the presence of the catheter/fluids or medication
- Chronically ill patients requiring multiple and recurrent IV
access.
iii) Infiltration/Extravasation: delivery of
fluids or medications into surrounding tissue
If Infiltration/extravasation occurs...
- Immediately stop the infusion and disconnect the tubing as
close to the catheter hub as possible.
- Remove the catheter without placing pressure on the site.
- Elevate the affected limb.
- Apply either ice packs or warm compresses to the affected area,
depending on the drug that extravasated.
- Continue to assess and document the appearance of the site and
associated signs and symptoms. Some signs, such as erythema and
ulceration, may be delayed for 48 hours or more after the
extravasation.
- For neonatal extravasation refer to RCH guideline Neonatal
Extravasation
- Plastics team to review the patient
- Document the date and time of the infusion when extravasation
was noted, the type and size of catheter, the drug administered,
the estimated amount of extravasated solution, and the
administration technique used.
- Document the patient's signs and symptoms, treatment, and
response to treatment. Include the time you notified the patient's
primary care provider and the primary care provider's name.