Using Principles of Medication Administration

Nursing Procedure 5.1

Using Principles of Medication Administration

Avoids client injury due to drug errors
Ensures adherence to basic safety factors of drug administration in preparing and administering medications

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
Medication to be administered
Medicine cart or medication tray
Drug reference resource—PDA or other electronic resource or drug book
Nonsterile gloves
Pen

Optional Equipment (depending on route of administration)

Syringes with appropriate-size needles
Alcohol swabs
Medication cups
Cup of water
Drinking straw
Medication labels
Calculator
Lubricant
Medicine dropper
Needleless system equipment (e.g., access pins, caps, adapters, adaptive tubing)

Assessment should focus on the following:

Clarity and legibility of doctor's order
Correct identification of client, drug, dosage, route, time
Preassessment and postassessment data related to use of the drug (e.g., pain status, vital signs, urine output, related laboratory results, pattern of bowel elimination, mental status, other body systems assessments)
Client tolerance to drug, if previously administered
Age and weight of client
Client ability to take drug in its current and recommended form
Client knowledge about the drug—purpose, how to take, effects, and what to report
Lighting in medication preparation area
Medication allergies or sensitivity to latex (if latex gloves used)

Nursing diagnoses may include the following:

Acute pain related to back injury
Deficient knowledge related to lack of exposure to information about prescribed medication therapy

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include the following:

Client reports a decrease in level of pain from level 5 to level 2.
Client verbalizes correct information about medication therapy and dosing procedure.

Special Considerations in Planning and Implementation

General

Consult a drug reference manual or pharmacist for information on drugs with which you are unfamiliar. Instruct client and family to monitor for side effects and possible reactions to medications.

Pediatric

Infants and children often require very small doses of medications. Using a syringe instead of a medication cup provides the most accurate measurement of liquid medications.

Home Health

See Display 5.1 for home health considerations.

Delegation

As a general standard, only licensed nurses may administer medications. In most agencies, drugs administered by intravenous (IV) route may be administered only by registered nurses. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. POLICIES VARY BY AGENCY AND STATE, HOWEVER. BE SURE TO CONSULT SPECIFIC AGENCY POLICIES FOR DELEGATION OF DRUG ADMINISTRATION FOR A GIVEN ROUTE OR DRUG. Registered nurses generally administer IV push medications and medications given through central line catheters and PICC lines. IV sedation drugs are given by registered nurses. In many facilities, selected IV piggyback medications and peripheral IV saline flush solutions may be given by licensed vocational nurses. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. BE SURE TO CHECK AGENCY POLICY BEFORE DELEGATING ANY DRUG ADMINISTRATION TO OTHER PERSONNEL!

[Outline]

Desired Outcomes
Special Considerations in Planning and Implementation

Action		Rationale
1	Perform hand hygiene.	Reduces microorganism transfer
2	Gather equipment and unlock medication cart or cabinet.	Promotes efficiency
3	Compare medication administration record to doctor’s order, adhering to the five rights of drug administration; use these principles throughout preparation and dministration. Use barcode scanning, if available, for all methods of client and drug identification.	Promotes safety; avoids client injury related to wrong dose, drug, route, time, or client
	Note: DO NOT USE the client’s room number as a client identification check. Check for the right:	Reduces the chance of administering drug to the wrong client; the client should be identified in such a manner that matches the client to the drug or treatment, not the location
	Client—includes visually or electronically scanning to check name, identification number, and prescribing doctor’s name on the order, medication administration record, and client identification band. Also includes electronic drug scan, which is matched to client for identification. Verify that the electronic identification is complete. **DO NOT bypass final safety checks: that is, DO NOT give a client a drug and then scan labels and identification labels afterwards.
	Drug—includes ascertaining that generic names are compatible with brand names (if both are used) and that the client has no allergies to ingredients of ordered medications; checking drug labels with medication administration record or electronic medication record and electronic scanning of drug labels and medication administration record, if available.
	Route—includes checking drug label to ascertain if medication can be administered by ordered route and checking that route recorded on medication administration record or electronic medication record corresponds to the doctor’s order.
	Time—includes checking that medication administration frequency (e.g., “every 12 hr” or “three times a day” [t.i.d.]) is compatible with times (e.g., 6 AM and 6 PM or 10 AM, 2 PM, and 6 PM) listed on medication administration record or electronic medication record.
	Dosage—includes determining that dosage ordered is within usual dosage range for route of administration, weight, and age of client; checking dosages on drug labels for compatibility with dosages written on medication administration record or electronic medication record (includes checking drug labels with medication administration record or electronic medication record and electronic scanning of drug labels and medication administration record, if available); and performing accurate dosage calculations.
4	Notify doctor if client has allergy to any ordered medication.	Prevents client injury resulting from allergic reactions
5	Focusing on one medication at a time, begin label checks by comparing the actual drug labels to the order, as transcribed on the medication administration record; if using a medication administration record, begin at the top and systematically move down the page; if using a computer or scanner, scan or focus on one drug at a time.	Promotes systematic preparation; prevents error in preparation by adhering to the five rights of medication administration
6	Compare drug labels to the orders on the medication administration record or computer and determine if dosage calculations are necessary.	Verifies correct medication; ensures preparation of correct dose
7	Perform calculations using one of the formulas in Display 5.2. Use a calculator or computer calculated formulas, as available, with smart medication technology. Whether performing calculations manually or with a basic calculator or smart technology, IF YOU ARE UNCERTAIN OF THE ACCURACY OF YOUR CALCULATIONS, CHECK WITH ANOTHER NURSE.	Provides safety check
8	Check the label on each medication:	Prevents administration of wrong drug to client or administration of drug to wrong client
	Before removing drug from drawer or storage area
	Before pouring or drawing up medication (or once medication is in hand, if unit dose)
	Before replacing multiple-dose containers on shelf (or before removing your hands from the drug once it is on the medicine tray, if unit dose)
9	Recheck medication administration record for appropriate client identification or scan client’s armband as scanner system requires.	Ensures that nurse is focusing on right client record
10	Using aseptic technique, pour or draw up each medication after second label check (Fig. 5.1); use guidelines in Table 5.1 when preparing drugs for various routes of administration.	Reduces risk of contamination; ensures accurate measurement of drug
11	Place each drug on medication tray after checking label a third time and before proceeding to prepare the next drug. If using scanner system to give medications at bedside, administer medication after scanning drug and client.	Provides third label check
12	Recheck medication record or computer with each drug on tray.	Provides safety check
13	Place all administration equipment on tray.	Ensures organization of proper equipment for administration
14	Lock medication cart or cabinet.	Adheres to institution accreditation guidelines

Were desired outcomes achieved? Examples of evaluation include:

Desired outcome met: Client reports decrease in pain level from level 5 to level 2.
Desired outcome met: Client accurately stated purpose of medication and dosing regimen for self-administration.

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

Medication ordered
The right client and the right drug, route, time, and amount of medication
Any reaction to medication
Client's tolerance to medication
Any reports of pain or discomfort

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆