INTRODUCTION TO

MEDICATION
ADMINISTRATION
HOLD ON TO YOUR SEAT WE HAVE A
LOT TO LEARN
DRUG LEGISLATION:

 Prescribers must follow federal and state

laws

 All drugs for legal use are

controlled/enforced by whom?
 Law protects?
DRUG LEGISLATION:

 Controlled Substances Act of 1970

 What does this law control?

 What drugs are included?

 Under this federal low, prescribers who dispense

controlled substances must register with the DEA
every 3 years
DRUG LEGISLATION:
 Controlled Substances Classifications:
 Schedule I
 Describe:

 Schedule II
 Describe:

 Schedule III
 Describe:

 Schedule IV
 Describe:

 Schedule V
 Describe:
MEDICATION ORDER
 Overview:
 A drug that is prescribed is referred to as a medication or
medicine order

 Those involved in the medication/medication order

processes are:

 HCP, NP or PA: responsibilities?

 Pharmacists

 Nurses:
COMPONENTS OF A MEDICATION ORDER
 Name of the patient (may be on the bottom or top of physician order, be
sure the name is on the order)

 Date and time the order is written

 Name of the medication (may be in generic or brand)

 Dose

 Route the medication is to be administered

 Time and frequency: exact times or number of times per day

 Signature of prescribing Dr.

COMPONENTS OF A MEDICATION ORDER

 If need be, could you identify an order that

needs clarification or that is incomplete?

What is missing?
Lasix 40 mg now
Lanoxin 1 tab PO daily
TYPES OF ORDER SETS:

 Routine or Standard order

 Let’stalk specifics:
 Physician prescribes/orders according to patient
needs. Usually written out by physician.

Example: Lanoxin 0.25 mg PO daily.

TYPES OF ORDER SETS:

 Standings orders:
 Written for specific circumstances

 For example:
TYPES OF ORDER SETS:
 Orders can be classified according to how the orders
are received:
 Written orders:

 Telephone order:

 Verbal order:

Of these which is best from a legal standpoint?

Other words, which one has a decrease potential for error?
 WHEN RECEIVING VERBAL OR TELEPHONE
ORDERS:
 When it comes to a telephone order of verbal order,
protect your license-
 write it down exactly as you hear it
 repeat back to physician & document 100% read back
 follow six/seven rights of mediation administration
 carefully document all appropriate information about
administration have physician co-sign within 24 hrs.
TYPES OF ORDER SET REVIEW:

 Can you differentiate between routine/standard

order and a standing order?
THE MEDICATION ORDER:

 Routine/scheduled medication even a

procedure
 What does this mean

Example: Lanoxin 0.25 mg PO daily.

THE MEDICATION ORDER:
 Single/one-time order:
 Let’s talk specifics

 Pay attention to orders: if order does not specify

frequency, verify
 Why?

Example: Lasix 80 mg IVP now or x1, or today

THE MEDICATION ORDER:

 Stat order:
 Specifics:

Example: NTG gr 1/150 SL stat

THE MEDICATION ORDER:
 PRN orders (as needed)
 Specifics:
 Must also include in the order the same criteria as all
other orders i.e. time frame/frequency i.e. q 6 hours
 PRN is not frequency and only indicates as needed

 Usually includes PRN and what reason the nurse is to

give i.e. nausea or pain or temp > 101

 Word of caution:

Example: Hydrocodone 10 mg PO q 4 hours PRN pain

PRESCRIPTION

 A prescription is a written order

A prescription is written on a specific form
 With controlled substances a specific type of prescription
pad is required

 Prescriptions are NOT needed for OTC drugs

 In the acute care setting prescriptions are NOT part

of the patient chart
PARTS OF A PRESCRIPTION
 physician's name
 address
 phone
 DEA #
 pt name, address
 Date
 Superscription-
 Inscription -
 Subscription-
 sig (signatura)-
 signature blanks--
 Refills or REPETATUR 0123 prn-
 Reading
Medication Labels
DRUG NAMES

Trade or Brand name -

Generic or official name -

DRUG DOSAGE & STRENGTH

 Dosage: the amount of the drug available by

weight and unit of measurement (mg, mcg, etc)

 Strength: solid form within a liquid

(100mg/1ml) or solid form per tab, % per tube
DRUG FORM

 Form in which the drug is prepared by

the manufacturer

 Provide some examples of form:

DRUG ROUTE

 Indicates how the drug is to be administered

 Example:
DRUG AMOUNT/QUANTITY

 Total amount or volume in the container

DIRECTIONS

 Drug administration instructions or how to mix

medication
 DRUG MANUFACTURING INFORMATION
 Manufacturer’s name

 Expiration date

 Special instructions for storage

 Lot number (what is this?)

 Control numbers
 National Drug Code (NDC) number / Bar code
 Code identifying one of two official national lists of approved drugs, either the USP
(United States Pharmacopeia) or NF (National Formulary)

 Contraindications
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
Brand Name: Lot #:
Generic Name:
Dosage Strength: Expiration date:
Form:
Amount: Directions:
Manufacturer:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
DOES SOMETHING LOOK DIFFERENT HERE?
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
BRAND NAME: LOT #:
GENERIC NAME:
DOSAGE STRENGTH: EXPIRATION DATE:
FORM:
AMOUNT: DIRECTIONS:
MANUFACTURER:
NDC:
SAFE MEDICATION
ADMINISTRATION
LEGAL IMPLICATIONS:

 Who can administer medications?

NURSE RESPONSIBILITIES

 Whatare the nurse’s legal

responsibilities when administering
medications?
NURSE LEGAL RESPONSIBILITIES

 Maintain competence:

 Know your patient:

 How exactly will you know your patient?
 Discussion

 Determine if the medication is accurate:

NURSE LEGAL RESPONSIBILITIES

Be knowledgeable:
 Drug names

 Drug class

 How the drug works

 Indication/use
INDICATION FOR USE
Analgesic antidote contraceptive
Anesthetic antidote decongestant
Antacid antiemetic diuretic
Antianxiety antihistamine expectorant
Antiarrhythmic antihypertensive hemostatic
Antibiotic anti-inflammatory hypnotic
Anticoagulant antineoplastic
hypoglycemic
Anticonvulsant antipyretic laxative
Antidepressant antitussive sedative
Antidiarrheal bronchodilator vasodilator
vasopressor
NURSE LEGAL RESPONSIBILITIES
Be knowledgeable:
 Side/adverse/toxic effects, precautions, contraindications
 Side effect

 Adverse Reaction

 Toxic effect

 Allergic effect

 Interaction

 Compatibilities

 Contraindication
NURSE LEGAL RESPONSIBILITIES
Be knowledgeable:
 Drug dosage
 Determined by what factors?

 Safe Dosage
 Initial dose
 Average dose
 Maintenance dose
 Maximum dose
 Therapeutic dose
 Divided dose
 Unit dose
 Cumulative dose
 Lethal dose
 Toxic dose
 Minimum dose
NURSE LEGAL RESPONSIBILITIES

Be knowledgeable:
 Expected response
 Idiosyncratic effect

 Drug tolerance vs Dependence

 How to prepare medication

 How to administer the medication (route)
NURSE LEGAL RESPONSIBILITIES

 Evaluate response of the medication

 Report all medication errors and reactions

 Discussion

 Storing and safeguarding medications

 discussion
SIX RIGHTS OF MEDICATION ADMINISTRATION

 Right patient
 How would you identify the patient?
 How many times?

 Right drug
 How
 Must know about the med; where would you find
info about a medication?
 Right dose
 Important to ensure you have correct dose (check
order to label, 3 times)
SIX RIGHTS OF MEDICATION ADMINISTRATION

 Right route

 Right time
 Must be administered within 1 hour of designated
time (30 min before; 30 min after)

 Right documentation
 Do NOT DOCUMENT anything you did not give
 ADDITIONAL RIGHTS OF MEDICATION
ADMINISTRATION
 Right reason
 Right response

 Right to refuse
MEDICATION ERRORS
 Best to prevent:
 Follow the Institute for Safe Medication for
Practice Guidelines www.ismp.org
 Observe approved and unapproved abbreviations
designed by JC
 Pay attention to names of meds, how they look
 Use caution taking verbal or telephone orders
 Use caution with high alert medications: have a
colleague check your med and dose
MEDICATION ERRORS

 Prevention:
 Learn to pay attention to the look alike drugs:
use Tall man letters

 Use the correct placement of zero’s

 Beaware of suffixes and abbreviations with

meds
 i.e. ER, XL, SR may indicate delayed, long acting
MEDICATION ERRORS

 What constitutes a med error?

MEDICATION ERROR

 Should a medication error occur what should

be done?
BASIC SAFETY GUIDELINES

 Be familiar with facility system for dispensing of

meds
 Check each order carefully: compare original
order with MAR
 Important to note if there are any excessive or
duplicate medications
 Be completely familiar with the drug you are
giving before you give it
BASIC SAFETY GUIDELINES

 Anticipate adverse events when starting or

stopping therapy

 Regularly monitor liver and kidney function

 Know when there are therapeutic levels that need
monitoring
BASIC SAFETY GUIDELINES

 Patient teaching is extremely important

 Inform the patient of potential side effects
 teach any restrictions like foods or drugs that may
cause interactions
 Teach about OTC use: need to check with physician
prior to using
 Teach about follow up labs tests, regular visits
BASIC SAFETY GUIDELINES

 NEVER give a medication if there is any

question about the order or if a patient
questions you or has concerns

 Know the circumstances in which you may be

allowed to hold a drug
 NPO, perimeters set
 Something to consider when administering Insulin
BASIC SAFETY GUIDELINES

 NEVER give a med you did NOT prepare; never

allow someone else to give a med you prepared

 Never leave a med unattended once you have

prepared it

 Always check expiration date

BASIC SAFETY GUIDELINES

 When giving a PRN always check when the last

dose was given and response

 Never give a drug if normal appearance is

altered

 Practice medical asepsis

BASIC SAFETY GUIDELINES

 When administering PO meds: stay with the

patient until you are certain med has been
swallowed
 Do not leave at the bedside

 ALWAYS check for allergies

 Perform three checks prior to giving

BASIC SAFETY GUIDELINES

 When pouring liquid med hold at eye level,

palm the label, read the lowest level of the
meniscus
 Ifgiving 10 mL or less must draw up in a syringe for
accuracy (med cup just not accurate in small
doses)
 Do not contaminate cap of bottle; place inside
up
BASIC SAFETY GUIDELINES
 In case of medication error: take action
immediately
 AsSN check with instructor first before filling out
any incident reports or forms of any kind

 Prevent distractions

 Avoid needle sticks by following needle

precautions (do not recap used needles)
BASIC SAFETY GUIDELINES

 Keep all medications not being prepared

secure
 Be sure the medication is the correct strength
and form
 Heparin comes in several strengths: 10 units, 100
units etc
 Some meds can be formulated in immediate acting
and long acting
BASIC SAFETY GUIDELINES

 High alert medication should be check by

colleague
 Ex: insulin, K+, heparin, pedi medications
 Use the correct supplies i.e. insulin syringe for
insulin
 If the patient brings own medications from
home know the policy in securing them and or
use