Fundamentals session 4:

Fundamentals

Medical administration

9/1/15

 

Medication orders

  • who can write them: LIP
    • NP, CRNA, MD, DO
  • Allergies!!
  • Nurses cannot receive an order
    • metric
    • suffixes
    • include brand

 

do not use illegal abbreviations

  • similar to others and can be confused

 

people that can take an order

  • pharmacist
  • pt
  • nurse
  • Not CNA

types of orders

  • written
  • verbal
  • telephone
    • RB x1 = read back once (closed loop communication)

 

Don’t be afraid to clarify the order

  • if you didn’t document it you didn’t do it.

 

writing techniques

  • 0.1 mg, 0.01 mg, 0.03mg
  • 1mg not 1.0 mg

 

pediatric doses dependent on weight

  • weighed upon admission

 

PRN – as needed

BID – twice a day

TID – Three times a day. every 8 hours.

MARS – medication administration record sheet

PO – by mouth

 

titrate by dose not time

  • 1-2 doses every 6 hours
    • the one to two portion of that statement is the titration variability

 

Standing order – nurse can refer to as needed (PRN)

  • O2, aspirin, chest pain.
  • is effective because you don’t have to wait for the orders.

 

STAT orders – immediately – within 10 mins

  • Metoprolol 5 mg IVP STAT
  • usually chest pain

 

Provider’s role

  • Allergies!!!
  • write order from diagnosis
  • treatment plan
  • Appropriate medical treatment

 

Med admin Assessment:

    • Med record
      • MARs for last dose and time
    • Diet and fluid
      • NPO?
    • Lab volues  
      • Serum drug levels
      • s/s
      • drug effects
      • system functions
      • know baseline and trend

 

  • Physical assessment ie. blood sugar for insulin, BP for antihypertensives, Assess system before drug affects it
  • can they swallow?
  • GI working?
  • MM mass sufficient for IM dose?
  • VS if drug will affect

 

 

  • Assessment of knowledge and compliance
    • pt’s knowledge of, purpose, TP effects
    • pt can refuse.
      • find out why not
      • be aware of language.

 

Safe Medication admin practice

  • always know why you are giving a drug
  • Tall man lettering – emphasize the differentiating qualities of two similar words
  • appropriate dose
  • changes in the ordered doses
  • double check calculations
  • talk to patient
  • double check Med concentration
  • do not assume route
  • check name band
    • name alert
    • double identifiers!!
    • barcode technology
  • right time
    • 30mins before or after scheduled time
    • with/without food
  • right documentation
    • hospital policy
    • assessment for med
    • flow sheets
    • injection location and route

Med administration Process

  • critical thinking
    • there is a lot of stimulus

Always contact the LIP if the order is unclear

 

You can only split scored tablets NCLEX answer  

 

high alert meds

  • insulin
  • anticoagulation medication

 

double check

  • need for med
  • IV pump setting

 

Medication Reconciliation

  • Three steps
    • Verification
    • Clarification
    • Reconciliation
      • creating an accurate list for when dose occurred

Errors in cognition

  • confirmation bias
  • inattentional blindness

 

how are errors caught

  • 48% prescribing

 

Error occurs

  • notify pt and Prescriber
  • Monitor pt
  • complete report

 

Medication diversion

  • Nurses taking meds from patients for themselves
  • Report to Manager  

 

Nurse practice act

  • colorado
  • responsible for actions
  • prepare and give your own meds

 

Use the smallest syringe that is possible for highest accuracy

insulin syringe

  • Measure insulin in units
  • one ml
  • orange on both ends
  • ONLY FOR INSULIN!

 

Smaller gauge needle is a larger bore

hub of needle is the side that connects to the syringe

you do not need a needle to draw medication from a vile

Heparin injected subQ for DVTs

 

Intramuscular injections

  • 19-25 gauge
  • faster than subQ
  • longer needle
  • 90 degrees
  • deltoid
  • lateral quadriceps
  • ventrogluteal

Slowest to fastest absorption

  • ID subQ, IM, IV

 

IV

  • fast
  • know how fast the med can be pushed
  • flush the tubing first
  • continuous infusion
    • longer period of time
    • intermittent
      • piggyback
      • medicated
  • bolus less than five minutes

 

Know you tubes

  • different infusion rates or types

 

topical medications

  • skin
  • eyes
  • nasal
  • ear instillation
  • vaginal instillation
  • rectal instillation

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s