jana heŘmanovÁ administration of medications icm ii, 24 february 2014

ICM II, 24 February 2014

JANA HEŘMANOVÁ

Administration of medications


What does it involve?

Prescribing – MD, nurse practitioner, medical student

Administering – RN, health care assistant, NA, radiology assistant, MD

Taking – the patient

What’s missing? Who’s missing?Dispensing – clinical pharmacist,

pharmacology assistant


What is a medication?

a substance given to a person (or animal) with the aim to cure disease, relieve symptoms, prevent disease or help with diagnosis


What’s in the picture?


Forms of medications

Solid Powder, tablets, capsules, coated tablets, lozenges

Semisolid Suppositories, creams, ointments, gels, patches

Liquid Solutions, suspensions, syrups, elixirs, drops,

mouth wash

Inhalants/sprays


Routes of administration

Enteral By mouth p.o. Rectal p.r.

Parenteral Intradermal i.d. Subcutaneous s.c. Intramuscular i.m. Intravenous i.v. Intraarticular i.a.

Intraosseal i.o. Intrathecal i.t.

Topical Skin Nose Ear Vaginal Intrauterine

Inhalation – sprays, inhalers, nebulization


Let’s play a game!

Can you name the forms and methods of administration?

http://www.sporcle.com/games/Ellix/give-it-to-me-straight-doc

http://www.sporcle.com/games/Ellix/give-it-to-me-straight-doc


What are the roles of the persons involved?

MD Know the patient – medical history, other drugs taken,

allergies, weight, height, dietary habits, activities

Know the drug – recent developments, references, dosing, available products (positive list)

Write legibly, follow the prescription guidelines

Inform/educate the patient

Monitor the effects of medications


Pharmacist Check the order

Consult with doctor if in doubt

Check for possible incompabilities

Inform the patient

Educate the medical and nursing staff


Nursing staff Read the order carefully

Consult with MD when in doubt

Know the medication, consult when giving new drugs

Identify the patient!

Follow the administration guidelines

Document


The patient Compliance – to what extent does the patient follows

the doctor’s orders, recommendations, treatment regime Compliance is influenced by many factors – age, level of

patient information, side effects, food interference, doctor – patient communication, patient’s expectations, impact on ADL, leisure activities

Communication – honest, open


Increase the compliance - For the little ones


Hooray for the apps!


Prescription guidelines – be complete!

Name of the drugForm of the drugStrength of the drugRoute of administrationDoseTime/frequency

Ibalgin tbl. 400 mg p.o. 1 – 1 - 1


Complete


Not so complete


Specifics

Antibiotics – use exact times for timed adm Chemotherapy – dose prescribed by BSA

(body surface area)Infusions – define the drip rate or length of

administration PRN orders – define criteria for adm., the

maximal daily doseDefine measurable goals/target effect in

specific meds such as insulin, hypertensives, etc.


Wrong Right

Paralen 1 – 1 – 1

Unasyn 1,5 g a 6h i.v.

Novalgin 1 amp i.m. prn

Actrapid 50U/50ml FR 1-10ml/hr

Paralen 500 mg tbl. 1–1–1 p.o.

Unasyn 1,5g/100 ml FR i.v. give over 30 min at 12-18-24-6

Novalgin 1amp (5ml) i.m. by VAS over 3, max a 6 hours

Actrapid 50U/50ml FR continuously 1 – 10ml/hr according to glycemia (goal 3,5 – 6,5mmol/l)

Examples of prescription


Prescription guidelines – be legible!


…and clear


Administration guidelines

According to doctor’s orderDo not transcribe orders (might differ within

countries)Prepare at bedsideFrom original container (might be problematic with

patient’s meds brought to the hospital)Avoid giving all daily doses at one timeUse protective equipment when giving chemotherapyDo not give when exspiration over

Follow the “5 Rights” rule


The 5 Rights of Medication Administration

Right patientRight drugRight time and frequency administrationRight doseRight route of administration


The 6th Right - documentation


Monitoring the effects


Medication errors

“A preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer”

“Any error in the prescribing, dispensing, or administration of a drug whether there are adverse consequences or not”

National Coordination Council for Medication Error Reporting and Prescription


The most common causes of medication errors

Missing patient informationMissing drug informationIllegible, incomplete, misheard orderLook alike/sound alike, faulty drug identificationDrug storage or delivery problemsDrug delivery device problemsEnvironmental, staffing, workflowLack of staff education, patient education,

physician’s knowledgeFailure to monitor closely


Sentinel events related to medication errors

Medication not givenMedication given to wrong patientWrong rate of administrationWrong dose/concentration/formWrong time of administrationWrong route of administrationWrong medication


Prevention of medication errors

Prescription related Good patient history Be legible, type or print orders Use computerized prescription systems Know the drugs Avoid abbreviations (PRN, AZT, FeSO4) Always use zero, e.g. 0.5 mg, never .5 mg Be aware of LASA (Lasix - furosemide, Losec – omeprazol,

Amiloride, Amlodipine) Follow guidelines for verbal orders (only in emergency,

always follow with written order, read back the order to the physician, document immediately, never use verbal orders for chemotherapy or high alert drugs)


Prevention of medication errors

Administration related Identify the patient! Check for allergies Double-check dosage calculation of high alert drugs

by another staff member (insulin, KCl, chemotherapy) Store LASA separately Store high alert drugs separately, label properly Prepare medication at bedside Minimize interruptions


Label safely


Store safely


Real life clinical stories

1. Warfarin order 11/2 – 11/2 – 0 (What was the meant dose? What dose was given?)

2. Verbal order of 500ml 10% G to run at 100ml/hr for the patient with critical hypoglycemia (Doctor fell asleep, did not follow with written order. Dose too low, what could have happened?)

3. Wrong rate of insulin infusion (10 x faster) due to mistake with managing the i.v. lines, poor work organization (What are the risks? What should change?)


Summary…let’s go to the movies

Administering oral medications

http://www.youtube.com/watch?v=xofnnPS2KyY




Safety of the patient first!

Assess..Diagnose…Treat…Monitor…Communicate

jana heŘmanovÁ administration of medications icm ii, 24 february 2014

Documents

complete icm

nebulization icm

diagnosis icm

pharmacology assistant

nursing staff icm

little ones icm

patient whats

mouth wash inhalantssprays