Y khoa - Dược - Chapter 53: Medication administration

53Medication Administration53.1 Describe rules and responsibilities regarding drug administration and the initial preparation for the drug administration.53.2 List the rights of drug administration.53.3 Recognize the correct equipment to use for administering medications.Learning Outcomes53.4 Carry out the procedures for administering oral medications.53.5 Carry out procedures for administering parenteral medications.53.6 Carry out procedures for administering parenteral medications by other routes.Learning Outcomes53.7 Relate special considerations required for medication administration to pediatric, geriatric, and pregnant patients.53.8 Outline patient education information related to medications. 53.9 Implement accurate and complete documentation of medications.Learning OutcomesIntroduction Drug administration Given correctly ~ restores healthGiven incorrectly ~ condition can worsenMedical assistant mustUnderstand fundamentals of drug administrationKnow your scope of practicePreparing to Administer a DrugFor common drugs know UsesContraindicationsInteractionsAdverse effects Be alert to any change in patient’s condition that could affect drug therapyPreparing to Administer a Drug (cont.)Drug and drug allergiesKeep an accurate medication list in the patient recordAsk about drug allergies at every appointmentPreparing to Administer a Drug (cont.)Administration siteCheck site of administrationBe sure there are no contradictions to using the sitePreparing to Administer a Drug (cont.)Patient conditionAssess overall conditionReview drug list Be sure dose is appropriate Patient consent formAnswer questionsHave signed before administering injectionGeneral Rules for Drug AdministrationGive only drugs the doctor orders Wash your handsPrepare in a well-lit areaFocus on taskAvoid distractionsGeneral Rules for Drug AdministrationTriple check medicationWhen taken from storage container and matched to MARWhen preparedBefore administration General Rules for Drug Administration (cont.)Calculate the dose carefullyDo not leave a prepared drug unattended Do not administer a drug you did not prepareVerify patient identityGeneral Rules for Drug Administration (cont.)The physician must be in the officeHave patient remain in officeInstruct patientGeneral Rules for Drug Administration (cont.)If patient refuses the medicationDiscard properlyDocument Report medication errors Document after administering medicationApply Your KnowledgeWhat does “triple check” include?ANSWER: The medication needs to be checked 3 times:1st check – when you remove it from the storage area and match it to the MAR2nd check – when you prepare it3rd check – before you close the storage container or  just before you administer the medication to  the patientRights of Medication AdministrationBasic rightsRight patientRight drugRight doseRight routeRight timeRight documentationAdditional rightsRight reasonRight to knowRight to refuseRight techniqueRights of Medication Administration (cont.)Right PatientAsk patient for name and date of birthCheck against recordRight DrugCheck ordered drug name against labelCheck expiration dateLook up drug if unfamiliarPerform a triple checkRights of Medication Administration (cont.)Right dose Read label Calculate accuratelyRight route Matches route orderedCan be administered by route orderedRights of Medication Administration (cont.)Right timeRight documentationImmediately following administrationCorrect informationRights of Medication Administration (cont.)Right reason Right to know – patient educationRight to refuseReport to physicianDocument Right technique – know the correct techniqueApply Your KnowledgeHow do you properly identify the patient before administering a drug?ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.Right!You must be able to give drugs safely by any route In the medical office Buccal or sublingual medicationsOther routes based on scope of practiceDemonstrate use of inhalersTopical drugsDrug Routes and EquipmentMedications by MouthOral administrationSlower absorption Tablets, scored tablets, capsules, lozenges, and liquidsContraindications NauseaComatoseUnable to swallowPatient educationMedications by MouthBuccal or sublingual administrationBuccal – placed between the cheek and gumSublingual – placed under the tongue Faster absorption; bypasses GI tract Gold star Answer!Apply Your KnowledgeWhy is it important to be able to administer medications by a variety of methods?ANSWER: You may be asked to administer drugs by any of an number of different routes.Why is absorption faster when drugs are administered sublingually or buccally?ANSWER: The drug is absorbed directly into the bloodstream bypassing the GI tract.Medications by InjectionParenteral administrationAny route other than through the GI tractRapid drug actionSafety risksRapid administrationExposure to blood-borne pathogensMedications by Injection (cont.)NeedlesParts GaugeLength ~ select forType of injectionPatient sizeAmount of fatty tissueInjection siteMedications by Injection(cont.)SyringesBarrel ~ calibrated cylinderPlunger ~ forces drug through barrelNeedlestick prevention safety deviceNeedleNeedlestick prevention safety deviceSyringe hubBarrelPlungerTrailing ring Leading ringForms of Packaging for Parenteral DrugsCartridge Ampule Vial Liquid or powder ~ reconstitute with diluentSingle or multiple dosesMedications by Injection (cont.)Intradermal (ID)Into upper layer of skinUsed for skin testsSubcutaneous (subcut)Provides slow, sustained release and longer duration of action1 mL or lessRotate sites To diagramEpidermisDermisSubcutaneous tissueMuscleIntramuscularSubcutaneousIntravenousEpidermis and dermisSubcutaneous tissueMuscleMedicationZ-track MethodMedications by Injection (cont.)Intramuscular (IM) More rapid absorptionLess irritation of tissueZ-track methodTo diagramIM injections – choose sites carefullyVentroglutealIliac CrestDeltoid muscleClavicle Vastus lateralis (mid-portion)Medications by Injection (cont.)Medications by Injection (cont.)Intravenous (IV) Directly into veinGiven by IV infusionDrug is dissolved into a solutionSlow drip into a veinRapid onset of actionSudden adverse reactions possibleTo diagramApply Your Knowledge___ prevents drug from leaking  into subcutaneous tissue___ used to administer skin tests___ small bottle with rubber  diaphragm ___ can administer a larger amount  of medication___ provides a slow, sustained release inside diameter of needle provides an almost immediate  effectANSWER:Super!MatchingIntramuscular injectionGaugeSubcutaneous injectionIntradermal injectionVialIV injectionZ-track methodGDEACBFOther Medication Routes Inhalation Administered through the mouth or nose Read package insert Topical Direct application of a drug on the skin Some forms ~ creams, lotions, ointmentsTransdermal systemOther Medication Routes Urethral administration – local effectVaginal Local effect Suppositories most common formDouches ~ administer liquid medicationsRectal – suppositories or enemasApply Your KnowledgeList parenteral routes other than an injection.ANSWER: Other parenteral routes include:Inhalation TopicalUrethral VaginalRectalGreat job!Special ConsiderationsPediatric patients Drug effects are less predictableRequire dosage adjustments and careful measurements of dosesSpecial Considerations (cont.)Pediatric patients Observe pediatric patients closely for adverse effects and interactionsAdministration sites and techniques differPatient education ~ parents vs. childSpecial Considerations (cont.)Pediatric patients Oral medications ~ use calibrated dropper or spoonInjectionsSitesRestraining methods Special Considerations (cont.)Pregnant patients – check drug references for safety during pregnancyPatients who are breast-feedingCheck drug references for safety during lactationMay need to supplement with formulaApply Your KnowledgeWhy are drug effects less predictable in children?ANSWER: Drugs are absorbed, distributed, metabolized, and excreted differently in children than adults.Fantastic! Patient Education about MedicationsOver-the-counter drugsMay not produce therapeutic effectMay be dangerous in combination with other substancesMay mask or aggravatesymptomsMay have more thanone active ingredientPatient Education about Medications (cont.)Prescription drugsWhen and how to take the medicationDrug safety precautionsHow to read a prescription labelSpecial instructionWarnings Patient Education about Medications (cont.)Drug-drug interactionsTypes Effects may be increasedEffects may be decreasedOne drug may be increased by anotherLead to adverse reactionsCheck patient drug usePatient educationPatient Education about Medications (cont.)Food-drug interactionsAlter the therapeutic effectInterfere with body’s use of nutrientsPatient educationBe specific about foods to avoid and whenExplain what to expect if interaction occursDescribe what to doPatient Education about Medications (cont.)Adverse effectsMay be mild to life-threateningElderly or patient with kidney and liver disease ~ more susceptible Patient educationTake as instructedRecognition of significant adverse effectsReport to physicianPatient Education about Medications (cont.)Complete medication listPrescription and OTC drugsSupplements and herbalsPast and present use of recreational drugs and alcoholPatient education Tell all of their doctors about their medicationsKeep an up-to-date list with dosagesPatient Education about Medications (cont.)Patient compliance – patient educationHow and when to take each drugHow long to take each drugHow to identify possible adverse effectsPatient Education about Medications (cont.)Patient compliance – patient educationWhat to do with old medicationHow to store drugsWhen to call the doctorApply Your KnowledgeWhat should you instruct the patient about regarding drug administration?ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly.Bravo!Charting MedicationsEntries – accurateBe consistent with charting methods usedTips Have the right chart, document in right placeChart directly from physician’s orderBe specificDo not leave gaps or skip linesCharting Medications (cont.)Tips (cont.)Correct errors in proper mannerDo not use ditto marksWrite neatly; enter carefully in EHRUse approved abbreviations and symbols If unsure, ask supervisorApply Your KnowledgeWhen charting that you gave the patient a subcutaneous injection, you wrote intravenously by mistake. What should you do?ANSWER: If you make an error, do not erase it. Draw a line through intravenously. The mistake should still be visible, so do not black it out. Initial it and then chart “subcut”.IMPRESSIVE!In Summary53.1 Before administering a medication, you should check the patient for allergies and also evaluate any drug-drug interactions. You should check all injection sites for abnormalities. Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary.53.2 The rights of drug administration include the right patient, right drug, right dose, right route, right time, right documentation, right reason, right to know, right to refuse, and right technique.In Summary (cont.)53.3 Drugs may be administered for either local or systemic effects. Table 53-2 outlines the many drug administration routes.53.4 Oral medications typically are swallowed and absorbed through the digestive tract. Sublingual medications go under the tongue, and buccal medications go between the cheek and gum.53.5 The three most common injection routes are ID, subcut, and IM. IV is less frequently used in a medical office. All injections are given using aseptic technique. In Summary (cont.)53.6 Other medication routes include inhalants (respiratory), topical (including transdermal), urethral, vaginal, and rectal.53.7 Certain special considerations must be made when caring for pediatric, pregnant, and breastfeeding patients. Pediatric patients require extreme care when calculating doses. Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential. In Summary (cont.)53.8 Patients should be educated about why, when, and how they should take medications. This includes instruction to ensure patient compliance. Patients should also be instructed about the dangers of medication combinations, the importance of reporting an adverse effect, and maintaining a complete medication list.53.9 Documentation of medication administered should occur immediately after the given and should include the name, date, time, medication administered, dose, route, location, lot #, and how the patient tolerated it.End of Chapter 53Words are the most powerful drug used by mankind.~Rudyard Kipling