Chapter 03: Medication Administration and the Nursing Process of Drug Therapy

"Rights" of Medication Administration

Safe and effective medication administration is guided by a set of principles known as the "rights" of medication administration. These ensure that each step in the process is performed correctly to minimize errors and maximize patient safety.

• Right drug: Confirm the correct medication is being administered.

• Right dose: Ensure the correct amount is given.

• Right patient: Verify the identity of the patient before administration.

• Right assessment: Assess the patient’s condition and appropriateness for the medication.

• Right route: Use the correct method of administration (e.g., oral, intravenous).

• Right time: Administer at the correct time intervals.

• Right reason: Confirm the indication for the medication.

• Right to refuse: Respect the patient’s right to refuse medication.

• Right documentation: Accurately record all aspects of medication administration.

• Right patient education: Inform the patient about the medication and its effects.

• Right evaluation: Assess the patient’s response to the medication.

Accurate Drug Administration Principles

Accuracy in drug administration is essential for patient safety and therapeutic effectiveness. Nurses must consistently apply the "rights," understand medications, and use proper techniques.

• Follow the "rights" consistently.

• Learn essential information about each medication.

• Interpret and transcribe orders accurately, using approved abbreviations only.

• Calculate and measure doses precisely.

• Use correct procedures for all administration routes.

• Verify patient identity before administration.

• Document omissions or delays as indicated by patient condition.

• Maintain up-to-date knowledge and skills.

Legal Responsibilities in Medication Administration

Nurses have legal responsibilities to ensure safe and accurate medication administration. This includes recognizing and questioning erroneous orders, refusing unsafe medications, and delegating tasks in compliance with the law.

• Safe, accurate administration

• Questioning erroneous orders

• Refusing unsafe medications

• Delegating appropriately

Medication Errors

Consequences and Common Types

Medication errors can have serious consequences, including illness, prolonged hospitalization, or death. Common errors include incorrect dosing, omission of ordered medications, and administration of unordered drugs. High-risk medications include insulin, heparin, and warfarin.

Medication Systems and Orders

Medication Systems

Healthcare facilities use various systems to manage medications and reduce errors, such as unit dose systems, computerized cabinets, bar coding, and medication reconciliation. Computerized Provider Order Entry (CPOE) is preferred for reducing transcription errors.

Medication Orders

Medication orders must include the patient’s full name, medication name (preferably generic), dose, route, frequency, date, time, and prescriber’s signature. Orders may be entered by computer, handwritten, or given verbally/telephonically (with appropriate signatures).

Drug Preparation and Dosage Forms

Forms of Medication

Medications are available in various forms for systemic or local effects, including liquids, tablets, capsules, suppositories, transdermals, and injections. Controlled-release forms (CR, SR, XL) provide sustained drug levels and should not be altered before administration.

Calculating Medication Dosages

Dosage Calculation Formula

Accurate calculation is critical. The basic formula for calculating medication dosages is:

• D = Desired dose (ordered, often in mg)

• H = Available dose (on label, often in mg per tablet/capsule/mL)

• V = Volume or unit (e.g., mL, tablet)

• X = Amount to administer

Selected Equivalent Measurements

Understanding metric and household equivalents is essential for accurate medication administration.

Routes of Medication Administration

Common Routes

Medications can be administered by various routes, each with specific indications and techniques:

• Oral (PO): By mouth

• Parenteral: Injected (includes Subcutaneous, Intramuscular, Intravenous)

• Topical: Applied to skin or mucous membranes

Injection Sites and Techniques

Subcutaneous (Sub-Q) Injection Sites

Subcutaneous injections are commonly administered in areas with adequate fat tissue, such as the upper arms, abdomen, back, and thighs. Proper site selection helps ensure effective absorption and reduces complications.

Intramuscular (IM) Injection Sites

IM injections are given into specific muscles to ensure proper absorption and minimize injury risk. Common sites include:

• Deltoid muscle: Upper arm, below the acromion process

• Ventrogluteal site: Hip area, preferred for larger volumes

• Vastus lateralis: Lateral thigh, often used in children

Intravenous (IV) Injection Sites

IV injections are administered directly into veins, commonly in the back of the hands or forearms. Proper vein selection is crucial for effective therapy and minimizing complications.

Nursing Process in Drug Therapy

Steps of the Nursing Process

The nursing process is a systematic approach to individualized patient care, including medication administration. It involves:

• Assessment: Collecting patient data, including medication history

• Nursing diagnosis: Identifying patient needs related to drug therapy

• Planning/Goal setting: Establishing measurable outcomes

• Interventions: Administering medications and other actions

• Evaluation: Assessing patient response and outcomes

Assessment: Medication History

Obtaining a thorough medication history is essential for safe drug therapy. This includes prescription, nonprescription, social, and herbal/dietary supplement use.

General and Specific Nondrug Interventions

Nondrug interventions can enhance therapeutic effects or reduce adverse effects. These include promoting healthy lifestyles, infection prevention, ambulation, and patient education.

• Promoting nutrition, fluids, exercise, rest, and sleep

• Hand hygiene and infection prevention

• Ambulating, positioning, and assisting with breathing exercises

• Applying heat or cold as needed

• Recording vital signs and other relevant data

Drug Therapy Evaluation Criteria

Evaluation involves monitoring progress toward outcomes, relief of symptoms, accurate administration, avoidance of preventable adverse effects, and patient adherence. Most outcomes are evaluated over hours or days.

Evidence-Based Practice and Herbal/Dietary Supplement Concerns

Evidence-based practice integrates scientific evidence, clinical expertise, and patient preferences for optimal care. Herbal and dietary supplements may pose safety concerns due to unknown effects, nonstandardized ingredients, and potential interactions with prescription medications.