Administering Medications

January 2021

Introduction

 The primary role of the nurse in drug administration is to ensure that prescribed
medications are delivered in a safe manner. Drug administration is an important
component of providing comprehensive nursing care that incorporates all aspects of the
nursing process.
 Administering medications to clients is an important nursing responsibility in all health
care setting.

RESPONSIBILITIES OF THE NURSE

 Whether administering drugs or supervising the use of drugs by their patients, nurses are
expected to understand the pharmacotherapeutic principles for all medications given to
each patient. Given the large number of different drugs and the potential consequences of
medication errors, it is an enormous task. The nurse’s responsibilities include knowledge
and understanding of the following;
 ● What drug is ordered.
 ● Name (generic and trade) and drug classification.
 ● Intended or proposed use.
 ● Effects on the body
 Contraindications.
 ● Special considerations (e.g., age, weight, body fat distribution, and individual
pathophysiological states).
 ● Side effects.
 ● Why the medication has been prescribed for this particular patient.
 ● How the medication is supplied by the pharmacy.
 ● How the medication is to be administered, including dosage ranges.
 ● What nursing process considerations related to the medication apply to this patient.
 Before any drug is administered, the nurse must obtain and process pertinent information
regarding the patient’s medical history, physical assessment, disease processes, and
learning needs and capabilities.
 Some adverse effects, however, are not preventable. It is vital that the nurse be prepared
to recognize and respond to potential adverse effects of medications.

The Rights of Drug Administration

 The traditional five rights of drug administration form the operational basis for the safe
delivery of medications. The five rights offer simple and practical guidance for nurses to
use during drug preparation, delivery, and administration, and focus on individual
performance.
  The five rights are as follows:
 1. Right patient.
 2. Right medication.
 3. Right dose.
 4. Right route of administration.
 5. Right time of delivery.
 Additional rights have been added over the years, these includes;
 the right to refuse medication
 the right to receive drug education
 the right assessment and preparation
 right documentation
 The right evaluation
 but deviations from the original five rights still account for the majority of medication
administration errors.

 If a patient refuses medication, it is the responsibility of the nurse to educate the patient
about drug benefits and risks, and to assess for fears and reasons why the patient might
refuse the medication. The nurse should notify the health care provider and document all
of the information related to these additional rights.

Right patient

 Check the name on the order against the name of the patient.
 Use two patient identifiers to verify, such as ask the client to state his or her name and
patient’s wristband to verify the name against the medication administration record

Right medication

 Know the normal dose for the medications to be administered.

 Verify medication doses if you are uncertain.
 Check the order and verify the medication against the physician’s order
 Check medication label

Right dose

 Always Check the order and question orders that the dose is out of the normal range.
 Confirm the appropriateness of the dose using a current drug reference this is to Ensure
that the prescribed dose is appropriate for the client.
 Calculate the dose carefully the dose and have another nurse calculate the dose as well,
and double check your calculations.

Right route

 Again, check the appropriateness of the route ordered to ensure that the route is safe for
the client.
  Confirm that the patient can take or receive the medication by the ordered route.
 Give medications via the prescribed route.

Right time

 Check the frequency of the ordered medication

 Double check that you are giving the ordered dose at the correct time.
 Give the medication at the prescribed time, ensuring that it is less than 30 minutes before
or after the scheduled time.
 Ensure that the medication is administered at the prescribed frequency.

Right documentation

 Document administration after giving the ordered medication.

 Chart the time, verify the route of administration, and any other specific information as
necessary e.g., the site of an injection or any lab values or vital signs that needs to be
checked before giving the drug.

Right Education

 Provide the client with information about the medication, including its name, action,
expected therapeutic response and precautions.
 Ask the client if he or she has any questions and correct any misconceptions.

Right Assessment

 Implement all assessment required before medication administration.

 Ensure that the medication is still appropriate for the client.

Right to Refuse

 Implement teaching regarding the necessity of the medication and correct client
misconceptions.
 educate the patient about drug benefits and risks, and to assess for fears and reasons why
the patient might refuse the medication. The nurse should notify the health care provider.
 Accept the client’s right to refuse medication.
 Document the clients stated reason for refusal.

Right Evaluation

 Reassess the client and compare the actual outcome with the expected outcome to
determine the medication effectiveness.
 Be alert for the nontherapeutic effects.
 Inform the physician of the non-therapeutic effects and seek new orders as needed.
 Document the client’s response to all medications in the client record.
The three checks of drug administration

 The three checks of drug administration that the nurse uses in conjunction with the
five rights help to ensure patient safety and drug effectiveness. Traditionally these checks
incorporate the following:

1. Checking the drug with the medication administration record (MAR) or the medication
information system when removing it from the medication from the storage area.

2. Checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or
connecting the IV tubing to the bag.

3. Checking the drug before administering it to the patient.

 Although the nurse is held accountable for preparing and administering medications, safe
drug practices is the responsibility of multiple individuals, the health care providers,
pharmacists, and other health care practitioners.

GENERAL PRINCIPLES OF ACCURATE DRUG ADMINISTRATION

 Follow the “five rights” consistently.

 • Learn essential information about each drug to be given (eg, indications for use,
contraindications, therapeutic effects, adverse effects, and any specific instructions about
administration).
 • Interpret the prescriber’s order accurately (ie, drug name, dose, frequency of
administration). Question the prescriber if any information is unclear or if the drug seems
inappropriate for the client’s condition.

 • Read labels of drug containers for the drug name and concentration (usually in mg per
tablet, capsule, or milliliter of solution).
 • Minimize the use of abbreviations for drug names, doses, routes of administration, and
times of administration. This promotes safer administration and reduces errors.

 • Calculate doses accurately. For medications with a narrow safety margin or potentially
serious adverse effects, ask a pharmacist or a colleague to do the calculation also and
compare the results. This is especially important when calculating children’s dosages.
 • Measure doses accurately. Ask a colleague to doublecheck measurements of insulin and
heparin, unusual doses (ie, large or small.

 Use the correct procedures and techniques for all routes of administration
 Seek information about the client’s medical diagnoses and condition in relation to drug
administration (eg, ability to swallow oral medications; allergies or contraindications to
ordered drugs; new signs or symptoms that may indicate adverse effects of administered
drugs; heart, liver, or kidney disorders that may interfere with the client’s ability to
eliminate drugs).
  Verify the identity of all clients before administering medications; check identification
bands on clients who have them.
 • Omit or delay doses as indicated by the client’s condition; report or record omissions
appropriately

 Be especially vigilant when giving medications to children because there is a high risk of
medication errors. Reasons are;
 their great diversity, in age from birth to 18 years and weight from 2–3 kilograms (kg) to
100 kg or more most drugs have not been tested in children many drugs are marketed in
dosage forms and concentrations suitable for adults. This often requires dilution,
calculation, preparation, and administration of very small doses. children have limited
sites for administration of IV drugs, and several may be given through the same site.

LEGAL RESPONSIBILITIES

 Registered and nursing assistants’ nurses are legally empowered, to give medications
ordered by licensed physicians and dentists.
 When giving medications, the nurse is legally responsible for safe and accurate
administration. This means the nurse may be held liable for not giving a drug or for
giving a wrong drug or a wrong dose. In addition, the nurse is expected to have sufficient
drug knowledge to recognize and question erroneous orders. If, after questioning the
prescriber and seeking information from other authoritative sources, the nurse considers
that giving a drug is unsafe, the nurse must refuse to give the drug.

 The fact that a physician wrote an erroneous order does not excuse the nurse from legal
liability if he or she carries out that order.
 Legal responsibilities in other aspects of drug therapy are less tangible and clear-cut.
However, in general, nurses are expected to monitor clients’ responses to drug therapy
(e.g., therapeutic and adverse effects) and to teach clients safe and effective self-
administration of drugs when indicated.

Drug Orders and Time Schedules

 Health care providers use accepted abbreviations to communicate the directions and
times for drug administration.
 A STAT order refers to any medication that is needed immediately and is to be given
only once. It is often associated with emergency medications that are needed for life-
threatening situations. The term STAT means “immediately.” The time between writing
the order and administering the drug should be 5 minutes or less.

 Although not as urgent, an ASAP order (as soon as possible) should be available for
administration to the patient within 30 minutes of the written order.
 The single order is for a drug that is to be given only once, and at a specific time, such
as a preoperative order.
  A prn order is administered as required by the patient’s condition. The nurse makes
judgments, based on patient assessment, as to when such a medication is to be
administered.

 Orders not written as STAT, ASAP, NOW, or PRN are called routine orders. These are
usually carried out within 2 hours of the time the order is written by the health care
provider. A standing order is written in advance of a situation that is to be carried out
under specific circumstances. An example of a standing order is a set of postoperative
PRN prescriptions that are written for all patients who have undergone a specific surgical
procedure.

 Some medications must be taken at specific times. If a drug causes stomach upset, it is
usually administered with meals to prevent epigastric pain, nausea, or vomiting. Other
medications should be administered between meals because food interferes with
absorption. Some central nervous system drugs and antihypertensives are best
administered at bedtime, because they may cause drowsiness. Sildenafil (Viagra) is
unique in that it should be taken 30 to 60 minutes prior to expected sexual intercourse to
achieve an effective erection.

 (Note: Sildenafil is also prescribed to hospitalized patients for pulmonary hypertension.)

The nurse must pay careful attention to educating patients about the timing of their
medications to enhance compliance and to increase the potential for therapeutic success.

 Once medications are administered, the nurse must correctly document that the
medications have been given to the patient and this documentation is completed only
after the medications have been given, not when they are prepared. It is necessary to
include the drug name, dosage, time administered, any assessments, and the nurse’s
signature. If a medication is refused or omitted, this fact must be recorded on the
appropriate form within the medical record. It is customary to document the reason when
possible. Should the patient voice any concerns or complaints about the medication, these
should also be included.

Systems of Measurement

 Dosages are labeled and dispensed according to their weight or volume. Three systems of
measurement are used in pharmacology: metric, apothecary, and household.
 The most common system of drug measurement uses the metric system of measurement.
The volume of a drug is expressed in terms of liters (L) or milliliters (mL). The cubic
centimeter (cc) is a measurement of volume that is equivalent to 1 mL of fluid, but the cc
abbreviation is no longer used because it can be mistaken for the abbreviation for unit (u)
and cause medication errors. The metric weight of a drug is stated in kilograms (kg),
grams (g), milligrams (mg), or micrograms (mcg).

 The apothecary system and the household system are older systems of measurement.
Although most health care providers and pharmacies use the metric system, these older
systems are still encountered.