Nursing Procedure 5.8

• Preparing Medication From a Vial

Obtains medication from a vial, using aseptic technique, for administration by a parenteral route.

• Doctor's order
• Computerized medication administration record (or manual record if computerized record not available)
• Barcode or electronic client and medication identification scanner, if available
• Vial with prescribed medication
• Appropriate-size syringe and needle for type of injection and viscosity of solution
• Extra needle
• Alcohol swabs
• Medication label or small piece of tape
• Medication tray
• Access pin and sterile cap (for needleless system and multidose vials)
• Pen

Assessment should focus on the following:

• Appearance of solution (clarity, absence of sediment, color indicated on instruction label)
• Vial label for expiration date of drug
• Medication allergies or sensitivity to latex (if latex gloves used)

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include:

• Client received correct amount, type, and dose of medication.
• Client relates procedure for medication preparation with multiuse vials without contaminating remaining medication.

Special Considerations in Planning and Implementation

General

If medication requires reconstitution, follow guidelines on vial. Maintain sterility of syringe, needle, and medication while preparing the drug. Figure 5.8 identifies the parts of a syringe and needle assembly that must be kept sterile. When using a needleless system, replace the needle with an access pin with a sterile cap to allow frequent withdrawal of medication. Although exposure to a contaminated needle by the nurse is unlikely at this point in the medication administration procedure, using a needleless system minimizes the nurse's risk of a needlestick injury.

Geriatric

For older clients who have difficulty remembering, use devices that remind them when to take medications, such as calendars and daily medication dispensers. For clients with visual deficits, note whether client is able to withdraw an accurate amount of solution from the vial. Determine support person who can prepare medication for client as needed.

Home Health

Assess area in which client or family member will be preparing drug for adequacy of lighting. Instruct client to discard used needles, syringes, and empty vials by dropping into large coffee can with hole cut in lid. Urge client to store that can in a safe place (away from children) until it becomes full, then transfer it to the garbage. Instruct client to secure clean needles and syringes in a locked container or cabinet to prevent unauthorized use.

Delegation

As a basic standard, medication preparation, teaching, and administration are done by a licensed registered or vocational nurse. Some drugs may be given by registered nurses only. Policies vary by agency and state. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. BE SURE TO NOTE SPECIFIC AGENCY POLICIES FOR A GIVEN ROUTE AND DRUG BEFORE DELEGATING ADMINISTRATION!

[Outline]

• Desired Outcomes
• Special Considerations in Planning and Implementation
  • General
  • Geriatric
  • Home Health
  • Delegation

Were desired outcomes achieved? Examples of evaluation include:

• Desired outcome met: Client received correct amount, type, and dose of drug.
• Desired outcome met: Client accurately related the procedure for aseptically preparing dose of medication from a multidose vial without contaminating remaining medication.

The following should be noted on the client's record:

• Name of medication
• Date and time medication was prepared
• Dosage prepared
• In addition, if the medication is a controlled substance, follow agency policy and procedure for recording medication in Controlled Substance Record Book. Note any amount of the controlled substance that was wasted, the name of the nurse preparing the controlled substance, and the name of the nurse witnessing use and, if appropriate, witnessing the discarding of the wasted amount.