Week 4 Medication Flashcards
(20 cards)
Safety
Be aware that a medication error is more likely to occur at patient care transition points, such as during hospital admission, transfer from one unit to another, and discharge to home or another facility.
If a patient questions the medication, stop and reevaluate the six rights of medication administration. An alert patient or family caregiver will know whether a medication is different from those received before.
Minimize distractions and interruptions while preparing medication, including questions from staff and family, equipment alarms, and personal conversations.
Read back all telephone orders and verbal orders for verification.
Stay with the patient, and watch him or her take the medication.
Prepare medications for one patient at a time.
Administer only medications that you yourself have prepared. Do not ask another person to administer medications that you have prepared.
Double-check all medication calculations and verify them with another nurse if unsure or if indicated according to agency policy.
Question unusually large or small doses.
Record allergy information for hospitalized patients on the front of the patient’s medical record and in the medication administration record (MAR). In addition, the patient should wear a band with all allergies listed.
Encourage the health care provider to order medications that do not require splitting.
Do not crush enteric-coated, long-acting, sustained-release, or sublingual medications. Refer to the “Do Not Crush List” issued by the Institute for Safe Medication Practices (ISMP) to ensure that a medication is safe to crush.
Label all medications that require preparation and are not in their original containers. The label should include the drug’s name, strength, amount, and expiration date.
Use different syringes for enteral and parenteral medication administration.
When you administer insulin, a narcotic, a sedative, or an anticoagulant, follow current ISMP guidelines for administering high-alert medications. Be alert to look-alike/sound-alike medications.
Consult the prescriber if you have any doubts about a medication order. Clarify illegible handwriting with the prescriber.
Preparation
Perform hand hygiene before medication preparation.
Minimize distractions while preparing medications.
Make sure that the information on the medication administration record (MAR) corresponds exactly to the prescriber’s written order and with the label on the medication container.
Identify the medication’s action, purpose, and side effects, and the nursing implications for administering the drug and monitoring the patient. Ensure that the medication order has not expired.
Follow agency policy for renewing medication orders.
Double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia), and verify their accuracy with another nurse.
When preparing medications, be sure that the label is clear and legible and that the drug has been properly mixed; has not changed in color, clarity, or consistency; and has not expired.
Avoid touching tablets and capsules. Use sterile technique when preparing parenteral medications.
Keep tablets and capsules in their wrappers, and open them at the patient’s bedside. Doing so allows you to review each medication with the patient. If a patient refuses a medication, there will be no question which one was withheld.
Identify and obtain preadministration assessments (e.g., vital signs, review of laboratory results).
6 Rights of Medication administration
- Right medication: Review the Medication Administration Record (MAR) to make sure it is clear and complete. The order must include the patients full name, the drug ordered, the dosage and route of administration, and the time of administration.
- Compare drug label with MAR three times:
- Before removing drug from storage
- Before placing medication in cup or taking it to patient’s
room
- Before administering drug at beside - Right dose:
- Followed current guidelines for administering high-alert
medications
- Prepared liquid medication using a standard measuring
device
- Used a pill-splitting device to administer part of a tablet.
Discard any pill that didn’t break evenly
- Mixed crushed tablets with a small amount of food or
liquid - Right Patient:
- Ensured right patient using two identifiers - Right route:
- Ensured medication is for the right route. Consulted the
prescriber immediately if necessary - Right time:
- Followed agency’s recommended schedule for routine
medications. Gave non-time critical medications within 1
to 2 hours of the scheduled time.- For time-critical medications: Gave STAT does immediately. - Right Documentation:
- Right Medication
(1) Checked the medication label against the MAR
three times.
(2) Made sure to label prepared medication not in its
original container.
(3) Calculated dose if necessary. Double-checked all
medication calculations and asked another nurse to
calculate the dose independently. Compared
calculations and confirmed correct calculation of dose.
- Right Dose
(1) Followed current guidelines for administering highalert
medications.
(2) Prepared liquid medication using a standard
measuring device.
(3) Used a pill-splitting device to administer part of a
tablet. Discarded any pill that didn’t break evenly
(4) Mixed crushed tablets with a small amount of food
or liquid.
- Right Patient
(1) Ensured right patient using two identifiers.
- Right route
(1) Ensured medication is for the right route. Consulted
the prescriber immediately if necessary.
- Right time
(1) Followed agency’s recommended schedule for
routine medications. Gave non–time-critical
medications within 1 to 2 hours of the scheduled time.
(2) For time-critical medications:
a. Gave STAT doses immediately.
b. Gave NOW doses within 60 minutes of receiving
the order.
c. Gave “on call” drug when operating room or
treatment area requests it.
d. Gave PRN drug according to circumstances, per
the patient’s request. Checked the MAR to see when
the last PRN medication was administered to ensure
that an additional dose is appropriate.
- Right documentation
(1) Documented the medication’s name, dose, route,
time given, and any preassessments obtained,
immediately after giving the medication.
(2) Documented the patient’s response to PRN
medications.
(3) Taught the patient about his/her medication.
(4) To review your rights and responsibilities as a nurse, refer to the video skill,
“Preventing Medication Errors.”
- Disposed of sharps in a sharps container immediately.
Dispose of other supplies if necessary. - Removed clean gloves, if used, and performed hand
hygiene. - Helped the patient into a comfortable position, and placed
toiletries and personal items within reach. - Placed the call light within easy reach, and made sure the
patient knows how to use it to summon assistance. - Raised the appropriate number of side rails and lower the
bed to the lowest position. - Left the patient’s room tidy.
Follow-up
Ensure that the patient understands the purpose of each medication. Teach the patient about the medication’s side effects, and describe the criteria for calling the nurse or physician.
Evaluate the patient’s response after the administration of a PRN medication.
Documentation
Record the medication’s name, actual time of administration, dose, route, and site location if appropriate on the MAR immediately after medication administration. For paper MARs, include your initials or signature as directed by agency policy.
Do not chart medication administration until after the drug is taken by the patient. Note that some bar coding systems will document the time of administration at the point of delivery when scanned.
Document the patient’s response to PRN medications. (PRN: When nessary)
If a medication is refused, document that it was not given, the patient’s reason for refusal, and the time at which the health care provider was notified.
- When preparing to administer a new medication, what would the nurse do first to ensure the patient’s safety?
Perform hand hygiene.
Compare the written order with the medication administration record (MAR).
Inform the patient about the medication.
Review appropriate nursing considerations.
Compare the written order with the medication administration record (MAR).
- What is the most important step the nurse can take to ensure that the patient is getting the correct medication?
Assess the patient’s ability to swallow oral medications without difficulty.
Question the patient about his or her experience with this or similar medications.
Compare the medication label with the MAR three times.
Evaluate the patient’s understanding of the safety issues related to the specific drug.
Compare the medication label with the MAR three times.
- Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in medication administration?
“Does the patient need her pain medication?”
“Let me know if she complains of any nausea.”
“What is the quality of her pain now?”
“Tell her she doesn’t have an order for the drug she’s asking for.”
“Let me know if she complains of any nausea.”
The nurse may delegate to NAP the task of reporting a patient’s symptoms.
- As the nurse is administering medication to a patient, the patient states, “I’ve never seen that pill before.” What is the nurse’s most appropriate response?
Reassure the patient that the pharmacy sent the right medication.
Tell the patient that it is probably a different brand than what he takes at home and not to worry.
Tell the patient that you will review the physician’s order to clarify any discrepancies.
Tell the patient that the doctor probably ordered a new medication.
Tell the patient that you will review the physician’s order to clarify any discrepancies.
If a patient questions a medication, it is important to review the medication orders and revisit the six rights of medication administration.
- What is the nurse’s best response after noticing that the route of administration has been omitted from a medication order?
Ask which route the patient prefers.
Immediately notify the prescriber to request that the order be completed.
Refer to a current drug book to determine the most commonly prescribed route.
Contact the pharmacy to determine the most appropriate route for this patient.
Immediately notify the prescriber to request that the order be completed.
The prescriber is required to include all pertinent information on the prescription and should be notified immediately if it is incomplete.
Safety: Administering Oral Medication.
Assess the patient’s ability to swallow, and assess for the presence of a gag reflex. Follow aspiration precautions for patients who have difficulty swallowing.
Give oral medications with a full glass of water (unless restricted or contraindicated) to aid passage of the drug.
Do not divide a tablet in half unless it has been scored by the manufacturer.
Do not crush enteric-coated, long-acting, sustained-release, or sublingual medications. Refer to the “Do Not Crush List” issued by the Institute for Safe Medication Practices (ISMP).
When a liquid medication must be given by syringe, use a syringe specifically designed for oral use.
When giving medications to swallow at the same time as sublingual or buccal medications, give the sublingual or buccal medication last. Do not give additional liquids until the buccal or sublingual medication has dissolved.
Keep tablets and capsules in their wrappers, and open them at the patient’s bedside.
Observe the patient taking all medications.
Delegation: Administering Oral Medication
The skill of administering oral medications may not be delegated to nursing assistive personnel (NAP). Before delegating related skills, be sure to inform NAP of the following:
*Review the expected therapeutic effects and potential side effects
to report to you.
*Instruct NAP to inform you if the patient’s symptoms (such as
pain or itching) continue or worsen after the PRN medication is
administered.
Preparation
Check the accuracy and completeness of each medication administration record (MAR) against the health care provider’s medication order. Confirm the patient’s name, the drug and dosage, the route of administration, and the time of administration. Clarify incomplete or unclear orders with the health care provider.
Note if the patient has allergies.
Review pertinent information related to the medication, including its action, purpose, normal dose and route, side effects, time of onset and peak action, and nursing implications.
Assess for any contraindications to receiving oral medications, including NPO status, inability to swallow, nausea/vomiting, bowel inflammation, reduced peristalsis, recent GI surgery, gastric suction, and decreased level of consciousness (LOC). Notify the health care provider if any contraindications are present.
Protect the patient from aspiration by assessing his or her swallowing ability.
Review appropriate preassessment data, including physical assessment, vital signs, and lab values specific to the medications being given that may require holding medication or obtaining an order for alternative dosing.
Assess the patient’s preference for fluids, and determine if medications can be given with these fluids. Maintain fluid restrictions if prescribed.
Procedure Guideline for Administering Oral Medications
- Verify the health care provider’s orders.
- Gather the necessary equipment and supplies.
- Perform hand hygiene.
- Prepare the medication:
- Take oral medication to the patient at the correct time (see
agency policy). Give timecritical medications (i.e., STAT and
NOW doses) at the precise time ordered. During
administration, apply the six rights of medication
administration. - Administer the medication:
- For liquid medications:
- Thoroughly mix liquids before administration by shaking the
container gently. If a drug is in a unit-dose container with the
correct volume, shaking is not necessary. If the drug is in a
multi-dose bottle, remove the bottle cap from the container
and place the cap upside-down on your work surface.
- Thoroughly mix liquids before administration by shaking the
- For orally disintegrating formulations (tablets or strips): Remove the medication from the
packet just before administering it. Tear the package open carefully. Do not push the tablet
through the foil. Place the medication on top of the patient’s tongue. Caution him or her
against chewing the medication. - For buccally administered medications: Have the patient place the medication in his or her
mouth against the mucous membranes of the cheek and gums until it dissolves. - For sublingually administered medications: Have the patient place the medication under the
tongue and allow it to dissolve completely. Caution the patient against chewing or
swallowing the tablet. Caution the patient against chewing or swallowing lozenges - For powdered medications: Mix with liquids at the bedside and give the mixture to the
patient to drink. - If the patient is unable to hold medications, place the medication cup to his or her lips and
gently introduce each drug into the mouth, one at a time. Be patient and do not rush or force
medication administration. A spoon can also be used to place the pill in the patient’s mouth.
If necessary, using a gloved hand, place the medication directly into the patient’s mouth. - Stay until the patient completely swallows each medication or takes it by the prescribed
route. Ask the patient to open his or her mouth if you are not certain whether he or she has
swallowed the medication. - Help the patient return to a comfortable position.
- Dispose of soiled supplies, and perform hand hygiene.
- Place toiletries and personal items within reach.
- Place the call light within easy reach, and make sure the patient knows how to use it to
summon assistance. - To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed
to the lowest position. - Leave the patient’s room tidy.
- Document the medication administration immediately after administration, not before.
- As follow up care, keep an eye on the patient to see his or her response to the medication.
