Principles of Drug Administration

Principles of Drug
Administration
ARLYN C. MENDENILLA RN,MAN

Right Client
Nurse must do:

verify client check ID bracelet & room
number
have client state his name
distinguish bw 2 clients with same last names
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Nursing responsibilities regarding
drug administration
At one time, a nurses responsibility regarding
medications focused only on the Five Rights of Drug
Administration namely give the right drug to the right
patient in the right dose by the right route at the right
time.
In drug therapy today, nurses together with the physician ,
pharmacists participate in the system check and balances
designed to promote beneficial effects and minimize
harm.
The nurse today does not concern herself with
administration of the medicine but also the consequences
of drug interaction between the drug and the patient.
Ten Rights of Accurate
Medication Administration
1. Right medication 6. Right client education

2. Right dose 7. Right documentation
3. Right time 8. Right to refuse
4. Right route 9. Right assessment
5. Right client 10.Right evaluation
Copyright 2008 by Pearson

The Five Plus Five Rights of
Drug Administration
5 Traditional Rights 5 Additional Rights
1. right client 1. right assessment
2. right drug 2. right documentation
3. clients right to
3. right dose
education
4. right time 4. right evaluation
5. right route 5. clients right to refuse
Right Client
must do:
verify client check ID bracelet & room
number
have client state his name
distinguish bw 2 clients with same last names
Right Drug
medication order may be prescribed by:
a. Physician
b. Dentist
c. Podiatrist
d. Advanced practice registered nurse (APRN)
Right Drug
Components of a drug order:
1. date & time the order is written
2. drug name (generic preferred)
3. drug dosage
4. frequency & duration of administration
5. any special instructions for withholding or
adjusting dosage
6. physician or other health care providers signature
or name if TO or VO
7. signature of licensed practitioner taking TO or VO
Right Drug
must do:
check med order is complete & legible.
know general purpose or action, dosage &
route of drug
Compare drug card with drug label three
times.
1. at time of contact with drug bottle/
container
2. before pouring drug
3. after pouring drug
4 Categories of Drug Orders:
1. Standing Order / Routine Order
ongoing order
may have special instructions to base
administration
include PRN orders
ex. digoxin 0.2 mg PO q.d., maintain blood
level at 0.5 2.0 ng/ml
Right Dose
Calculate and check drug dose accurately.
Check drug package insert or drug handbook for
recommended range of specific drugs.
Check heparin, insulin and IV digitalis doses with
another nurse.
Stock- method vs Unit-dose method
Right Route
assess ability to swallow before giving oral
meds.
Do not crush or mix meds in other substances
before consultation with physician or
pharmacist
Use aseptic technique when administering
drugs.
Administer drug at appropriate sites.
Stay with client until oral drugs have been
swallowed.
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Right Documentation
Immediately record appropriate info
Name, dose, route,time & date, nurses initial or
signature
Clients response:
narcotics
analgesics
antiemetics
sedatives
unexpected reactions to meds.
Use correct abbreviations & symbols.
Right to Education
Client teaching :
therapeutic purpose
side-effects
diet restrictions or requirements
skill of administration
laboratory monitoring
Principle of Informed Consent
Right Evaluation
Clients response to meds.
effectiveness
extent of side-effects or any adverse
reaction.
Right to Refuse
determine, when possible, reason for refusal.

facilitate pxs compliance.
explain risk for refusing meds & reinforce the reason
for medication.
Refusal shld be documented immediately.
Head nurse or health care provider shld be informed
when omission pose threat to px.
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Medication Error
What is the
definition of
medication
error ?
..any preventable event that may cause or
lead to in inappropriate medication use or
patient harm , while the medication is in the
control of health care professional, patient,
or consumer, Such events may be related to
professional practice, health care products,
procedures, and systems including :
prescribing; order communication; product
labeling; packaging and nomenclature;
compounding; dispensing; distribution;
administration; education; monitoring; and
use. (NCCMERP)
The safe and accurate
administration of medications is
one of the nurses most important
responsibilities.
Drugs are the primary means of
therapy for clients with health
problems, but a drug may have the
potential for causing harmful
effects when administered
improperly.
ALL MEDICATION ERRORS
ARE SERIOUS OR
POTENTIALLY SERIOUS!!!!!!!!
Medication Misadventures include:
1. administration of wrong medication & IV fluid.
2. incorrect dose or rate
3. administration to the wrong patient
4. incorrect route
5. incorrect schedule interval
6. administration of known allergic drug or IV
fluid
7. omission of dose or discontinuation of med or
IV fluid that was not discontinued.
Guidelines for Correct Administration of
Medications
Preparation
1. Wash hands before preparing meds.
2. Check for allergies.
3. Check medication order with physicians orders, medicine sheet, &
medication card.
4. Check label on drug container 3 times.
5. Check expiration date on drug label.
6. Recheck drug calculation with another nurse.
7. Verify doses of drugs that are potentially toxic with another nurse or
pharmacist.
8. With unit dose, open packet at bedside after verifying client
identification.9. Pour liquid at eye level.
10.Dilute drugs that irritate gastric mucosa or give with meals.
10/4/2017 23
Guidelines for Correct Administration
of Medications
Administration
11. Administer only those drugs that you have prepared.
12. Identify the client by ID band or ID photo.
13. Offer ice chips when giving bad tasting medicine.
14. Assist client to appropriate position.
15. Provide only liquids allowed on the diet.
16. Stay with client until meds are taken.
17. Administer no more than 2.5 to 3 ml of solution by
IM at one site.
10/4/2017 24
18. Infants receive no more than 1 ml of solution by
IM at 1 site & no more than 1 ml subcutaneously.
NEVER recap needles.
19. Give drugs last to client who need extra
assistance.
20. Discard needles & syringes in appropriate
containers.
21. Follow appropriate drug disposal based on
institution policy.
22. Discard unused solutions from ampules.
23. Store appropriately unused solutions from open
vials.
10/4/2017 25
Guidelines for Correct Administration of
Medications
24. Write date & time opened & initials on label.
25. Keep narcotics in a double-locked drawer or
closet. Med cart locked at all times when nurse is
not around.
26. Keys to narcotics drawer must be kept by the
nurse & not stored in drawer.
27. Avoid contamination of ones own skin or
inhalation to minimize chances of allergy.
Recording
28. Report drug error immediately to nurse manager &
physician. Complete an incident report.
29. Charting: record drug given, dose, time, route & your
initials.
30. Record drugs promptly after given, esp STAT doses.
31. Record effectiveness & results of meds given, esp
PRN meds.
32. Report to physician & record drugs that were refused
with reason for refusal.
33. Record amount of fluid taken with medications on
input & output chart.
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Behaviors to Avoid During Medication
Administration
Do not be distracted when preparing meds.
Do not give drugs poured by others.
Do not pour drugs from containers whose labels
are partially removed or have fallen off.
Do not transfer drugs from one container to
another.
Do not pour drugs into the hand.
Do not give expired medications.
Do not guess about drugs & drug doses. Ask
when in doubt.
10/4/2017 28
Behaviors to Avoid During Medication
Administration
Do not use drugs that have sediment, are discolored, or
are cloudy (& shld not be).
Do not leave medications by the bedside or with
visitors.
Do not leave prepared medications out of sight.
Do not give drugs if the px says he has allergies to the
drug or drug group.
Do not call the pxs name as the sole means of
identification.
Do not give drug if the client states the drug is different
from drug he has been receiving. Check the order.
Behaviors to Avoid During
Medication Administration
Do not recap needles. Use universal precautions.
Do not mix with large amount of food or
beverage that are contraindicated.
10/4/2017 30
Errors in medication administration often
arise due to combination of factors that are :
1. Poor communication between pharmacists and
nurses.
2. Lack of knowledge in drug administration.
3. Multiple interruptions the nurse have during preparing
medication.
4. Stress an fatigue.
5. Poor working conditions.
6. Carelessness from nurse.
Medication errors should not
happen. But they occur due to
the fact that every human
being is capable to doing
mistake here and those that
happen where you work- can
add to your knowledge and
skill.
Medication errors should not
happen. But they occur due to
the fact that every human
being is capable to doing
mistake here and those that
happen where you work- can
add to your knowledge and
skill.
Special Documentation
Circumstances
Patient refuses medication
Thoroughly record incident and reason for refusal in
nurses notes
Notify physician
Medication error occurs
Notify physician
Complete incident report
Slide 34 Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier

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Principles of Drug

ARLYN C. MENDENILLA RN,MAN

Nurse must do:

1. Right medication 6. Right client education

Copyright 2008 by Pearson

determine, when possible, reason for refusal.

Slide 34 Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier

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