medication administration. automated medication administration equipment pyxis suremed medserve

Medication Administration

Automated Medication Administration Equipment

PyxisSureMedMedServe

Essential Components of a Medication Order

Client’s NameMedical Record

Number, Room/Bed #Date & time of orderName of MedicationDosage of MedicationRoute Frequency of

administrationMD’s signature

Six “Rights” of Medication Administration

Right Patient (check name band, ask client their name)

Right MedicationRight Dose Right RouteRight Time (frequency)Right Documentation* Client’s also have the right

to refuse (say no) to medication

The Nurse’s Responsibility for Medication Administration

Assess whether the client can tolerate the meds

Administer meds accurately & timely

Monitor for side-effectsKnow contraindicationsClient teachingPractice the “Six Rights”(stressed in clinical)

Evaluation (effectiveness & client response)

Types of Oral Medications

TabletsCapsulesSublingualBuccalElixirsEnteric Coated

Precise & Safe Medication Administration

Rectal MedicationsProvide for privacyExplain procedure to clientPlace client in Sim’s positionApply clean glovesLubricate tip, round end inserted firstEncourage client to relax , deep breatheInsert past sphincter, towards umbilicusHave client remain on side at least five

mins. (hold buttocks together etc.)

Rectal Medication Administration

Ophthalmic Medications

Place HOB down or low Fowler’s

Provide Kleenex for clientHave client look towards

ceilingInstill meds in

conjunctiva (if gtts)If ointment, apply ribbon

from inner to outer canthus

Know od, os, ou routes

Topical & Inhalation MedicationsOintments (absorbed via mucous

membranes, skin)Inserted (vaginal)Instilled (ear/nose gtts)LotionsSprays (nasal)Pastes (absorbed through skin)Inhalation (nebulized treatments, MDI)

Topical Ointments

Otic Medications

MDI Medications

Medications via NGT/EFT

Determine whether med comes in elixir formCrush all except for EC meds and mix with water

or other liquid medicationsStop feedings, clamp tube, apply syringe,

unclamp tube, flush tube with approx. 30cc waterClamp tube, remove syringe, pull plunger from

barrel, reattach barrel, pour meds through barrelAdd water as necessary to keep things flowing

smoothlyAfter all meds have been given, flush with 30cc

water, clamp tube, remove syringe, start feedings

DocumentationAlways record:

Date, time & your initials or signature, title (R. Otten, SN,CSUF )

Medication, route (site) and actual time given

Reason why med was omitted (ie. refused)

Client’s response to the medication

Medication Administration Records (MARs)

Nursing Considerations for Injection Sites Assess for adequate tissue & muscle availability/client body wt.

Assess where previous injections have been administered

Assess client restrictions Assess for quantity & quality of medication to be administered

Parts of a Needle & Syringe

Syringe: Barrel Plunger Tip

Needle: BevelShaftHub

Types of Syringes

Tips of Syringes

Luer-Lok

Non Luer-Lok

Pre-Filled Systems

Assembling the Device

Scoop Method

Safety Devices

Needless Systems

Three Types of Injections

Intradermal - Injected into dermal skin layers (Allergy tests, PPDs, etc.)

Subcutaneous - Injected into subcutaneous

tissues (Heparin, Insulin) Intramuscular - Injected into deep muscles (narcotic analgesics, iron)

Intradermal Injections

Given in small doses (i.e.. 0.1cc) Common sites include: RFA, LFA Use 1cc syringe with 26-27 gauge

needle, 1/4 - 5/8 inch long Administer with needle at 5-15 degree

angle with bevel of needle up Check for “bleb” or “wheal” Document site in medication

book/nurses’ notes

Intradermal Injections

Subcutaneous Injections Given in doses of 0.5cc - 1.5 cc Common sites include: deltoid, abdomen Deltoid landmarks: Find Acromium

Process and go 4 to 6 finger-lengths below Rotate sites to minimize tissue damage Use Insulin/TB syringe for these meds For other SQ meds use 1-3 cc syringe, 25-27 gauge needle, 3/8-5/8 inch length Insert needle 45-90 degrees

Deltoid Injections

Vastus Lateralis Injections

Site well-developed in both adults & children, lacks major blood vessels/nerves

Landmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect).

Good for clients with position restrictions

Intramuscular Injections

Vastus Lateralis

Dorsogluteal Injections

Rarely used due to Sciatic nerve risk

Less accessible than other sites (i.e. requires side-lying or turned further)

Landmark: Find Greater Trochanter & Iliac Crest, draw quadrants and administer in upper two quadrants

Dorsogluteal Injections

What other site is used for IMs?

VentroglutealGood for deep injectionsAway from blood vessels and nervesZ-trackThick, viscous medsAntibioticsLarge volumeIrritating

What if……when giving an IM injection, the aspirate comes back with blood.

What is the correct procedure and why?

Preparing NPH & Regular Insulin

Swab tops of both vialsInject desired units of air into NPH vial, remove needle and then inject desired units of air into Regular vial

Invert Regular vial and withdraw desired units of insulin (no bubbles)

Insert needle into NPH vial, invert and withdraw desired units of insulin

Regular & NPH Insulins

Mixing Insulins

NPH

Insulin

Regular Insulin

Remember !!!

If an IM injection requires the administration of > 3cc of medication, divide the medication up into two equal doses and

administer in different sites.

Remember !!!

Always double-check Insulin & Heparin

amounts/doses with another licensed

person(RN/LVN/INSTRUCTOR)