Medication Administration: Safe Practices and Principles

Posted on Dec 18, 2024 in Medicine & Health

Hour Clock Conversions

• For the first hour of the day (12 Midnight to 12:59 AM), subtract 12 Hours
• Examples: 12 Midnight = 0:00, 12:35 AM = 0:35
• From 1:00 AM to 12:59 PM, no change
• Examples: 11:20 AM = 11:20, 12:30 PM = 12:30
• From 1:00 PM to 11:59 PM, add 12 Hours
• Examples: 4:45 PM = 16:45, 11:50 PM = 23:50

Definitions

• Pharmacology: A broad term that includes the study of drugs and their actions in the body
• Pharmacy: The art of preparing, compounding, and dispensing drugs for medical use
• Drug: Any chemical that affects the physiological processes of a living organism

Definitions

• Adverse drug event (ADE): Any undesirable occurrence related to administering or failing to administer a prescribed drug
• Adverse drug reaction: Any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic doses

Definitions

• Adverse effects: Any undesirable bodily effects that are a direct response to one or more drugs.
• Allergic reaction: An immunological hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication

Definitions

• Drug effects: The physiological reactions of the body to a drug
• Incompatibility: The quality of drugs or solutions that leads to a reaction resulting in chemical deterioration of at least one of the drugs when the two substances are mixed together

Definitions

• Medication error: Any preventable ADE involving inappropriate drug use by a client or health care provider; it may or may not cause patient harm
• Synergistic effects: Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone

Definitions

• Therapeutic effects: The desired or intended effect of a particular drug
• Toxicity: The condition of producing adverse bodily effects because of poisonous qualities.

Medication Administration Routes

Topical Administration

Medications applied to the skin and mucous membranes generally have local effects.

• Applied to skin.
• Rectal.
• Optic.
• Nasal.

Routes of Administration

• Oral route.
• Sublingual route
• Buccal Route
• Parenteral route

Factors in Determining Route

• Age of recipient
• Children may have difficulty swallowing; therefore, the rectal route may be used
• Severity of Condition
• If an individual is vomiting, that could affect the absorption of the medication

Qualified Staff

Who is qualified?

Person must be:

• Knowledgeable about the medication they give.
• Never give a medication if you do not know what it is for.
• Able to safely administer medications.
• Know the side effects of the medications they are giving.
• Know where and how to look up information if they do not have the knowledge.

Basic Guidelines

• Assess the patient’s history for allergies, drug-drug or drug-food interactions, and drug contraindications, and notify the physician if any exist.
• Follow Infection Control Policy during the entire process of Medication Administration.

Basic Guidelines Continued

• Always check medication expiration dates.
• Do not leave medications unattended and accessible to patients, family, or visitors.
• Remain with individuals while they take medications.

Preparation of Oral Medication

• Wash hands
• Gather equipment:
  1. Medication Sheet
  2. Medication tray
  3. Glass of water or preferred liquid
  4. Drinking straw
  5. Pill Crusher device

Administration of Oral Medication

Definition: Drugs given by the oral or gastric route are absorbed into the bloodstream through the gastric or intestinal mucosa. Usually, the patient swallows the drug.

Forms of Oral Medications

• Tablets.
• Capsules.
• Liquid drugs like syrup
• Also available as powder, granules, or oil.

Administration of Oral Medication

Purpose:

• Uses basic safety factors of drug administration in preparing and administering medications.
• Avoids client injury due to drug errors.
• Delivers medication for absorption through the alimentary tract for oral medication.

Oral Drug Administration

• Unlock the medication cart or drawer.
• Prepare one client’s medication at a time.
• Calculate correct drug dose. Take time. Double-check the calculation.
• If the client has difficulty in swallowing, grind tablets in a pill crusher until smooth. Mix it with drinks or soft food.

Liquid Medications

• Obtain the liquid medication and check the label and the med sheet for your seven rights
• Ensure the cap is secure and shake the medication
• Remove the lid and place it down “open side up”
• Hold the bottle so that the label is protected by the palm of your hand
• Check your seven rights again

Liquid Medications

• Pour the medication into the med cup at eye level
• Set the med cup on a level surface and measure the dosage from the bottom of the meniscus
• Using a tissue or clean paper towel, wipe the rim of the bottle and wipe off any spillage
• Check your seven rights again
• Recap the bottle and return it
• Liquids must not be mixed and should be given one at a time

Topical

• Gather your materials (gloves, cotton balls, gauze, washcloth)
• Wash your hands
• Review the medication administration sheets
• Determine if the individual is present
• Go to the first med sheet
• Obtain the ointment/lotion and check the label and the med sheet for your seven rights
• Prep the area as necessary
• Check your seven rights again

Topical

• Using a gloved finger or cotton ball or gauze, obtain the ointment/lotion
• Check your seven rights again
• Apply according to orders (sparingly or generously)
• No “double-dipping”
• Return the medication
• Sign for the medication
• Wash your hands

Topical/ Trans-dermal Patches

Buccal or Sublingual

• Gather your materials
• Wash your hands
• Ensure the person is present
• Obtain the medication and check the label and the med sheet for your seven rights
• Avoid touching the medication and check your seven rights again

Buccal or Sublingual

• Pour the med into the med cup and check your seven rights again
• Buccal (cheek by molars) and sublingual (under the tongue) medications are designed to dissolve quickly; therefore, use a glove if you must administer these medications
• Sign for the medications
• Wash your hands

Eye Drops and Ointments

• Gather your materials (gloves, washcloth, tissues)
• Wash your hands
• Ensure the person is present
• Obtain the medication and check the label and the med sheet for your seven rights
• Position the individual lying down on their back or in a chair with their head tilted slightly back

Eye Drops and Ointments

• Gently wash away any crust or drainage
• Check your seven rights again
• Remove the cap and set it open side up
• With your hand (gloved if necessary), use your thumb to gently pull down on the lower lid and your finger to gently pull up on the upper lid

Eye Drops and Ointments

• Resting the palm of your other hand on the cheekbone, drop the prescribed number of drops into the middle, inside of the lower eyelid.
• For ointment, drop a thin line into the inside of the lower eyelid outside to inside (ear to nose).

Eye Drops and Ointments

• Release the eyelid, the individual will blink (this helps to disperse the medication)
• Wipe off any excess
• Sign for the medication
• Wash your hands

Ear Drops

• Gather your materials
• Wash your hands
• Ensure the person is present
• Obtain the medication and check the label and the med sheet for your seven rights
• Position the individual lying down on their back or in a chair with their head tilted to the applicable side
• Check your seven rights again

Ear Drops

• Remove the cap and set it open side up
• Gently pull the earlobe up and out in an adult or down and back in a child
• Instill the required number of drops into “the black hole”
• Gently rub behind the individual’s ear for about a minute to allow time for the medication to be absorbed
• Wipe off any excess
• Sign for the medication
• Wash your hands

Nose Drops and Sprays

• Gather your materials
• Wash your hands
• Ensure the person is present
• Obtain the medication and check the label and the med sheet for your seven rights
• Have the person blow their nose if necessary

Nose Drop and Spray

• Position the individual lying down on their back or in a chair with their head tilted back (for drops) – head erect for sprays
• Check your seven rights again
• Remove the cap and set it open side up
• Instill the required number of drops or spray into “the black hole”

Nose Drop and Spray

• Maintain the head position for 30 seconds so that the medication will not flow down the individual’s throat
• Sign for the medication
• Wash hands

Rectal Suppository/Enema

Pharmacokinetics

Mode of Drug Action

Application of Pharmacokinetics to Clinical Practice

The person administering medication will:

• Know how the body handles medication
• Understand actions and side effects of drugs
• Understand the obstacles a drug faces to reach target cells

Four Components of Pharmacokinetics

• Absorption
• Distribution
• Metabolism
• Excretion

Absorption Diagram

Factors Affecting Drug Absorption

• Route of administration
• Drug formulation
• Drug dosage
• Digestive motility (the slower a person’s digestive system is, the longer it takes the body to absorb it)
• Digestive tract enzymes (will decrease or increase absorption)
• Blood flow at the administration site

Metabolism and Pharmacotherapy

• Drug becomes more active
• Drug increases metabolic activity
• Can be decreased metabolic activity in some clients
• Infants and elderly
• Clients with severe liver disease
• Clients with certain genetic disorders
• Dosages need to be adjusted in these clients

Distribution of Medications

• Involves how drugs are transported in the body
• Occurs in the blood
• Greater blood flow to the area, higher concentration of drug is delivered
• Lipid-soluble (fat-soluble) agents are not limited by barriers; therefore, they are completely distributed to body tissues

Excretion

• The primary site of excretion is the kidneys
• Ionized and water-soluble drugs are filtered here
• Drug-protein complexes are secreted into the distal tubule
• Secretion mechanism is less active in infants and older adults
• The pH of filtrate can increase excretion

Other Organs Can Be Sites of Excretion

• Respiratory system
• Glands
• Biliary system

Plasma Half-Life (t1/2) of Drugs

• Length of time needed to decrease drug plasma concentration by one-half
• The greater the half-life, the longer it takes to excrete
• Determines frequency and dosages

How Drug Reaches and Maintains Therapeutic Range

• Repeated doses of the drug are given
• Drug accumulates in the bloodstream
• Plateau reached
• Amount administered equals the amount eliminated

Loading Dose

• A higher amount of drug is given
• Plateau is reached faster
• Quickly produces a therapeutic response

Maintenance Dose

• Keeps plasma drug concentration in the therapeutic range

Purpose of Drug Administration

Drug Sources

Drug Names

Drugs

• Any chemical that affects the processes of a living organism can broadly be defined as a drug
• The study or science of drugs is called pharmacology

Knowledge of How a Drug

• Form influences its affect on the body
• Is metabolized by the body
• Acts on the body
• Is used therapeutically
• May be toxic, produce adverse effects

Drugs

• Absorption: The movement of a drug from the site of administration into the bloodstream
• Routes of administration:
  • Enteral: Oral, sublingual, buccal, rectal
  • Parenteral: Fastest route a drug can be absorbed, any route other than the GI tract, topical, transdermal
  • Inhalation: Considered a topical drug administration, drugs are delivered into the lungs as drug particles
• Distribution: The drug enters the bloodstream and is distributed throughout the body
• Metabolism: Involves the alteration of a drug into an inactive metabolite
• Excretion: All drugs are eventually removed from the body primarily by the kidneys, but the liver and bowels also play a role in the excretion of drugs.

Drugs

• Half-life: Refers to the time it takes for one-half of the medication to be removed from the body
• Onset: Of action, the time required for the drug to elicit a response
• Peak: When the med is at its most effectiveness
• Duration: How long the med will elicit a therapeutic response in the body.

Types of Therapy

• Acute therapy: Drug used for short-term acute illness
• Maintenance therapy: Drug used to prevent the progression of a disease
• Supplemental therapy: Replacement therapy supplies the body with a substance needed to maintain normal function
• Palliative therapy: To make the patient as comfortable as possible

Types of Therapy

• Supportive therapy: Maintains the integrity of body functions while the patient is recovering from an illness
• Prophylactic therapy: Drug therapy provided to prevent illness
• Empirical therapy: Drug given without a scientific basis, instead is based on experience

Monitoring

• Therapeutic index: Level of drug that will produce therapeutic effects but not toxic effects
• Patient’s condition: Current problem being treated as well as other conditions
• Tolerance: A decreasing response to a repeated drug dose
• Dependence: A physiological or psychological need for a drug

Monitoring

• Interactions: Alteration of the action of one drug by another is referred to as a drug interaction
• Additive effect: When two drugs with similar actions are given together, they can enhance the effect of one another
• Synergistic effects: When two drugs given together have a combined effect that exceeds that of the meds given individually

Monitoring

• Antagonistic effects: When the combination of two drugs is less effective than if given separately
• Incompatibility: When two parenteral drugs or solutions are mixed together and there is a chemical deterioration of one or both drugs.
• Adverse drug event: Any undesirable occurrence related to administering or failing to administer a prescribed drug

Monitoring

• Adverse drug reaction: Any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic doses

Drug Measurements and Calculations

• There are two systems of measurement used in pharmacology:
• The metric system
• Household measurements.
• It is important for the DSW to be able to convert within each of these systems and from one system to the other.

Liquids

• Under the metric system liquids are measured in:
• ml (milliliters)
• cc (cubic centimeters)
• Liters
• One (1) ml is equivalent to one (1) cc

Solids

• Solids are measured in:
• mcg (micrograms)
• mg (milligrams),
• g or gm (grams)
• kg (kilograms)

How to Convert in the Metric System

• To convert within the metric system, we simply move the decimal point to the left or to the right by three places

Factors Which Influence Drug Dosage Effects

• Many factors influence how a dose of a particular drug will affect a patient.
• Size
• Weight
• Age
• Gender
• We must consider how these factors might influence how much drug a person should receive.
• The effect(s) that drug might have on the patient.

Factors Which Influence Drug Dosage Effects

• The usual recommended adult dose of medication is based on the assumption that the person is a “normal” adult.
• “Norma” (or average) adult is said to be 5 feet 9 inches (173 centimeters) tall and weigh 154 pounds (70 kilograms).

Factors Which Influence Drug Dosage Effects

• Many people do not fit into this category.
• The following factors should be considered when patients receive drugs:
• Weight
• Obese patients may require more medication than thin patients.
• Maybe because the drug has more tissue to which it must go though
• The dosage of many drugs is calculated on a weight basis. For example, a person might be prescribed a drug that has a dosage of 5 mg of drug per kg of the patient’s body weight.

Surface Area

• A person’s height and weight are related to the total surface area of his body.
• The”norma” (average) adult has a body surface area of approximately 1.73 square meters.
• A nomogram is used to determine the surface area of a patient.
• The dosage of certain drugs are determined by the patient’s body surface area e.g. Anticancer drugs

Age

• As a rule, the very young and the elderly require less than the normal adult dose of most medications.
• Part of this requirement for less medication is due to the altered metabolism of the drug.
• Age body enzyme systems greatly influence drug metabolism
• In the infant, some enzyme systems are not yet fully developed.
• The enzyme systems of the elderly may not function as well as in the past.

Age

• Several formulas are available for calculating a child’s dose of medication
• The two most accepted methods are based upon:
• Weight (milligrams per kilogram of body weight)
• Body surface area (milligrams per square meter of surface area).

Gender

• Physiological differences between the sexes may influence the dose or the requirement for drugs.
• Females have proportionately more fat tissue than males
• Drugs, which have a high affinity (likeness) for fat, may require larger doses in females.