Drug Administrati

on

Drug Administrati

on

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By: MYLA KISON, RN, MANBy: MYLA KISON, RN, MAN

Drug NomenclatureDrug Nomenclature• Chemical name — identifies drug’s

atomic and molecular structure• Generic name — assigned by the

manufacturer that first develops the drug• Official name — name by which it is

identified in official publications USP and NF

• Trade name — brand name copyrighted by the company that sells the drug

• Chemical name — identifies drug’s atomic and molecular structure

• Generic name — assigned by the manufacturer that first develops the drug

• Official name — name by which it is identified in official publications USP and NF

• Trade name — brand name copyrighted by the company that sells the drug

Drug PreparationsDrug Preparations• Oral

– Capsule, pill, tablet, extended release, elixir, suspension, syrup

• Topical– Liniment, lotion, ointment, suppository,

transdermal patch

• Injectable

• Oral – Capsule, pill, tablet, extended release,

elixir, suspension, syrup

• Topical– Liniment, lotion, ointment, suppository,

transdermal patch

• Injectable

Drug ClassificationsDrug Classifications• Body system• Symptoms relieved• Clinical indication

• Body system• Symptoms relieved• Clinical indication

Mechanisms of Drug ActionsMechanisms of Drug Actions• Drug-receptor interaction — drug

interacts with one of more cellular structures to alter cell function

• Drug-enzyme interaction — combines with enzymes to achieve desired effect

• Acting on cell membrane or altering cellular environment

• Drug-receptor interaction — drug interacts with one of more cellular structures to alter cell function

• Drug-enzyme interaction — combines with enzymes to achieve desired effect

• Acting on cell membrane or altering cellular environment

Pharmacokinetics Pharmacokinetics • Absorption — drug is transferred from

site of entry into bloodstream• Distribution — drug is distributed

throughout the body• Metabolism — drug is broken down

into an inactive form• Excretion — drug is excreted from the

body

• Absorption — drug is transferred from site of entry into bloodstream

• Distribution — drug is distributed throughout the body

• Metabolism — drug is broken down into an inactive form

• Excretion — drug is excreted from the body

Factors Affecting Drug AbsorptionFactors Affecting Drug Absorption• Route of administration• Drug solubility• pH• Local conditions at site of

administration• Drug dosage• Serum drug levels

• Route of administration• Drug solubility• pH• Local conditions at site of

administration• Drug dosage• Serum drug levels

Adverse Effect of MedicationsAdverse Effect of Medications• Iatrogenic disease• Allergic effects• Toxic effects• Idiosyncratic effects• Drug interactions

• Iatrogenic disease• Allergic effects• Toxic effects• Idiosyncratic effects• Drug interactions

Signs and Symptoms of Drug Allergy

Signs and Symptoms of Drug Allergy

• Rash• Uticaria• Fever• Diarrhea• Nausea• Vomiting• Anaphylactic reaction

• Rash• Uticaria• Fever• Diarrhea• Nausea• Vomiting• Anaphylactic reaction

Variables Influencing Effect of Medications

Variables Influencing Effect of Medications

• Developmental considerations• Weight• Sex• Genetic and cultural factors• Psychological factors• Pathology• Environment, timing of administration

• Developmental considerations• Weight• Sex• Genetic and cultural factors• Psychological factors• Pathology• Environment, timing of administration

Types of Medication OrdersTypes of Medication Orders• Standing order — carried out until

cancelled by another order• Prn order — as needed• Stat order — carried out immediately

• Standing order — carried out until cancelled by another order

• Prn order — as needed• Stat order — carried out immediately

Parts of the Medication OrderParts of the Medication Order• Patient’s name• Date and time order is written• Name of drug to be administered• Dosage of drug• Route by which drug is to be

administered• Frequency of administration of the drug• Signature of person writing the order

• Patient’s name• Date and time order is written• Name of drug to be administered• Dosage of drug• Route by which drug is to be

administered• Frequency of administration of the drug• Signature of person writing the order

Medication Supply SystemsMedication Supply Systems• Stock supply• Individual supply• Medication cart• Computerized medication system• Bar coded medication cart

• Stock supply• Individual supply• Medication cart• Computerized medication system• Bar coded medication cart

Systems of MeasurementSystems of Measurement• Metric — meter (linear), liter (volume),

gram (weight)• Apothecary — less convenient and

concise; basic unit or weight is grain• Household — least accurate system;

teaspoons, tablespoons, teacup and glass used

• Metric — meter (linear), liter (volume), gram (weight)

• Apothecary — less convenient and concise; basic unit or weight is grain

• Household — least accurate system; teaspoons, tablespoons, teacup and glass used

Metric System ConversionsMetric System Conversions• To convert larger unit to smaller unit,

move decimal point to right.• To convert smaller unit to larger unit,

move decimal point to left.– 1 kilogram = 1000 grams– 1 gram = 1000 milligrams– 1 milligram = 1000 micrograms

• To convert larger unit to smaller unit, move decimal point to right.

• To convert smaller unit to larger unit, move decimal point to left.– 1 kilogram = 1000 grams– 1 gram = 1000 milligrams– 1 milligram = 1000 micrograms

Three Checks of Medication Administration

Three Checks of Medication Administration

• Read the label:– When the nurse reaches for the container

or unit dose package– Immediately before pouring or opening

medication– When replacing the container to the

drawer or shelf

• Read the label:– When the nurse reaches for the container

or unit dose package– Immediately before pouring or opening

medication– When replacing the container to the

drawer or shelf

Five Rights of Medication AdministrationFive Rights of Medication Administration

• The nurse should give:– The right medication – To the right person– In the right dosage– Through the right route– At the right time

• The nurse should give:– The right medication – To the right person– In the right dosage– Through the right route– At the right time

Controlled Substances Required Information

Controlled Substances Required Information

• Name of patient receiving narcotic• Amount of narcotic used• The hour narcotic was given• The name of physician prescribing

narcotic• Name of the nurse administering

narcotic

• Name of patient receiving narcotic• Amount of narcotic used• The hour narcotic was given• The name of physician prescribing

narcotic• Name of the nurse administering

narcotic

Oral MedicationsOral Medications• Solid form — tablets, capsules, pills• Liquid form — elixirs, spirits,

suspensions, syrups

• Solid form — tablets, capsules, pills• Liquid form — elixirs, spirits,

suspensions, syrups

Administration of Oral MedicationsAdministration of Oral Medications• Oral Route — having patient swallow

drug• Enteral route — administering drug

through an enteral tube• Sublingual administration — placing

drug under tongue• Buccal administration — placing drug

between tongue and cheek

• Oral Route — having patient swallow drug

• Enteral route — administering drug through an enteral tube

• Sublingual administration — placing drug under tongue

• Buccal administration — placing drug between tongue and cheek

Administration of Parenteral MedicationsAdministration of Parenteral Medications

• Subcutaneous injection — subcutaneous tissue

• Intramuscular injection — muscle tissue• Intradermal injection — corium (under

epidermis)• Intravenous injection — vein• Intraarterial injection — artery• Intracardial injection — heart tissue• Intraperitoneal injection — peritoneal cavity• Intraspinal injection — spinal canal• Intraosseous injection — bone

• Subcutaneous injection — subcutaneous tissue

• Intramuscular injection — muscle tissue• Intradermal injection — corium (under

epidermis)• Intravenous injection — vein• Intraarterial injection — artery• Intracardial injection — heart tissue• Intraperitoneal injection — peritoneal cavity• Intraspinal injection — spinal canal• Intraosseous injection — bone

Sites for Intramuscular Injections

Sites for Intramuscular Injections

• Ventrogluteal site• Vastus lateralis site• Deltoid muscle site• Dorsogluteal site

• Ventrogluteal site• Vastus lateralis site• Deltoid muscle site• Dorsogluteal site

• Route of administration• Viscosity of the solution• Quantity to be administered• Body size• Type of medication

• Route of administration• Viscosity of the solution• Quantity to be administered• Body size• Type of medication

Criteria for Choosing Equipment for Injections

Criteria for Choosing Equipment for Injections

Preparing Medications for InjectionPreparing Medications for Injection• Ampules• Vials• Prefilled cartridges

• Ampules• Vials• Prefilled cartridges

Topical Administration of Medications

Topical Administration of Medications

• Vaginal• Rectal• Inunction• Instillation• Irrigation• Skin application

• Vaginal• Rectal• Inunction• Instillation• Irrigation• Skin application

Medical Record DocumentationMedical Record Documentation• Each dose of medication, give as soon

as possible after it is given• Intentional or inadvertent omitted

drugs• Refused drugs• Medication errors

• Each dose of medication, give as soon as possible after it is given

• Intentional or inadvertent omitted drugs

• Refused drugs• Medication errors

THE HIGH RISK ENVIRONMENT OF HEALTH CARE“THE PERFECT SET UP FOR MAKING MISTAKES”

high volumeprescription

high volumeMD orders

high volumepatients

high speedemergencies

high stress, overworkedmedical staff

highly sensitiveimpatient patients

high turnovermedical staff

illegible, unclear orders

MD

high variety, myriadcases, symptoms

Type of Medication ErrorsType of Medication Errors

• Inappropriate prescribing of the drug• Extra, omitted, or wrong doses• Administration of drug to wrong patient• Administration of drug by wrong route or rate• Failure to give medication within prescribed time• Incorrect preparation of a drug• Improper technique when administering drug• Giving a drug that has deteriorated

• Inappropriate prescribing of the drug• Extra, omitted, or wrong doses• Administration of drug to wrong patient• Administration of drug by wrong route or rate• Failure to give medication within prescribed time• Incorrect preparation of a drug• Improper technique when administering drug• Giving a drug that has deteriorated

LOOK-ALIKE SOUND-ALIKE PRODUCT NAMES

HYDROXYZINEHYDRALAZINE

FORADILTORADOL

PLAVIXPAXIL

LOSECLASIX

ULTRACETULTRACEF

ACCUPRILMONOPRIL

SERZONESEROUEL

ZYRTECZYPREXA

CELEBREXCEREBYX

ACTRAPIDACTRAPHANE

SINECODSINEMET

DANGEROUS ABBREVIATIONS-INSTRUCTIONS

10U100.5 mg

5 mg

D/C (discharge)D/C (discontinue)HCl

KCl

µgmg

5.0 mg50 mg

every Mondayevery morning1:10,000 mg/mL

1:1,000 mg/mLX (yes)X (no)

0.01 mg0.001 mg

LOOK-ALIKE PRODUCTS AND PACKAGING

HEPARIN

10ml

INSULIN

10mlsuppository

oralcapsule

water alcohol

A B

cephalexin dolfenal

KCl distilledwater

SIMILAR-LOOKING CONTAINERSFOR DRUGS AND NON-DRUGS

drugsoap

fixative poison

THE HIGH RISK ENVIRONMENT OF HEALTH CARE“THE PERFECT SET UP FOR MAKING MISTAKES”

potent drugslook-alike, sound-alike drugs, chemicals, fluids

potent body fluids

high risk, irreversibleprocedures

dangerousequipment

infectiousenvironment

potent chemicalsKCl

use of invasive devices

Medication ErrorsMedication Errors• Check patient’s condition immediately;

observe for adverse effects.• Notify nurse manager and physician.• Write description of error on medical

record and remedial steps taken.• Complete special form for reporting

errors.

• Check patient’s condition immediately; observe for adverse effects.

• Notify nurse manager and physician.• Write description of error on medical

record and remedial steps taken.• Complete special form for reporting

errors.

THE HIGH RISK ENVIRONMENT OF HEALTH CARE“THE PERFECT SET UP FOR HIDING MISTAKES”

collegial silence incoherent, inarticulate patients

incomplete, error-prone documentation

multiple handoffs

MANAGER MANAGER

ADMINISTRATOR

MANAGER MANAGER

MED. DIRECTOR

dual management

disease canmask medical error

punitive culture

IR

most errors are near misses, slight effects

hierarchicalculture

1 million hospitalized patients in the U.S.16 doses of medication daily each

16 million doses per day2% medication rate

320,000 medication errors daily

A Medication Error Story

A Medication Error Story

Nurse borrows medication fromanother patient

HIS for ordering medications

is broken

Tube system for obtaining medications

is broken

Nurse gives the patient

a medication to which heis allergic

Patient arrests and dies

Reason

Patient Teaching Patient Teaching • Review techniques of medication

administration.• Remind patient to take the medication

as prescribed for as long as prescribed.• Instruct patient not to alter dosages

without consulting physician.• Caution patient not to share

medications.

• Review techniques of medication administration.

• Remind patient to take the medication as prescribed for as long as prescribed.

• Instruct patient not to alter dosages without consulting physician.

• Caution patient not to share medications.

11 Golden Rule’s in giving medications

11 Golden Rule’s in giving medications

1. Administer the right Drug 2. Administer right drug to right patient 3. Administer with right dose 4. Administer Right drug with right route 5. Administer right drug at right time 6. Document each drug you administer 7. Teach your patient about the drug he is receiving.8. Take a patient complete pt. drug history 9. Find out if the patient has any drug allergies10.Be aware of potential drug to drug , and Drug to food

reactions,11.The right of the patient to refuse medications.

1. Administer the right Drug 2. Administer right drug to right patient 3. Administer with right dose 4. Administer Right drug with right route 5. Administer right drug at right time 6. Document each drug you administer 7. Teach your patient about the drug he is receiving.8. Take a patient complete pt. drug history 9. Find out if the patient has any drug allergies10.Be aware of potential drug to drug , and Drug to food

reactions,11.The right of the patient to refuse medications.

suppositoryoral

capsulesuppositoryoral

capsule

potent drugspotent drugs

Clarifying Orders Clarifying Orders

• Illegible • Incomplete • Incorrect Route or dosage • Not expected of patients current

diagnosis.

• Illegible • Incomplete • Incorrect Route or dosage • Not expected of patients current

diagnosis.

Know your Medications Know your Medications • Mode of action & the purpose of

medication • Side effects or contraindication of

medication • Antagonist of medication • Safe dosage range of medication • Interaction with other medication • Proper administration technique

• Mode of action & the purpose of medication

• Side effects or contraindication of medication

• Antagonist of medication • Safe dosage range of medication • Interaction with other medication • Proper administration technique

Principle in Size of Needle Principle in Size of Needle

• The higher the number the smaller the gauge of the needle.

• The smaller the number the bigger the size of the lumen.

• The higher the number the smaller the gauge of the needle.

• The smaller the number the bigger the size of the lumen.

Degrees of Insertion Degrees of Insertion

• Intramuscular – 72 to 90 degrees• Subcutaneous – 45 degrees• Intradermal- 10 to 15 degrees

• Intramuscular – 72 to 90 degrees• Subcutaneous – 45 degrees• Intradermal- 10 to 15 degrees

Subcutaneous Subcutaneous

• Subcutaneous injection should not contain no more that 1 ml in an insertion site .

• The normal angle of insertion is 45 to 90 degrees

• Subcutaneous injection sites: Abdomen, scapula, thigh, upper back, upper dorso gluteal region.

• Subcutaneous injection should not contain no more that 1 ml in an insertion site .

• The normal angle of insertion is 45 to 90 degrees

• Subcutaneous injection sites: Abdomen, scapula, thigh, upper back, upper dorso gluteal region.

Intramuscular Intramuscular

• Intramuscular injection should not contain no more than 3 to 5ml,the smaller the muscle being injected ,the smaller the amount should be.

• Injection sites: Vastus lateralis, Ventrogluteal, deltoid , dorso gluteal.

• Insertion site selection depends on:• Amount of medication/ Viscosity of

medication/ Age of pt & Development of muscle tissue , preference of pt. or nurse.

• Intramuscular injection should not contain no more than 3 to 5ml,the smaller the muscle being injected ,the smaller the amount should be.

• Injection sites: Vastus lateralis, Ventrogluteal, deltoid , dorso gluteal.

• Insertion site selection depends on:• Amount of medication/ Viscosity of

medication/ Age of pt & Development of muscle tissue , preference of pt. or nurse.