RNB 11302

PHARMACOLOGY

PRINCIPLES OF DRUG
ADMINISTRATIONS

Pn. Tuminah
 LEARNING OUTCOMES
At the end of the lesson the student should be able to :
• State the nursing process in serving medication;
• identify the methods of drug order;
• state the role of nurses in serving medication;
• discuss the ’10R’ of drug administration;
• state the general guidelines in medication administration;
• identify important considerations during medication
administration.
 Introduction
• Medication safety is very important in the provision of
patient care
• The “10 Rights” are important to followed in each time
of medication administration
• Regardless of the route for the drug enters the body, the
same practices and principles of medications need to
apply
 THE NURSING PROCESS
• It is an organizational framework for the practice of
nursing
• Systematic & orderly in order to avoid potential error
• Central to all nursing care
• Steps of the nursing process
 Assessment
 Nursing diagnosis
 Planning
 Implementation
 Evaluation
 THE NURSING PROCESS
Assessment
• Take medication history - use of OTC drugs, hormone,
herbs,
• Assess the patient’s understanding about illness including
past experience
• Conduct a physical assessment
• Obtain information about social network & resources –
alcohol & caffeine intake
• Check specific prescription/medication after assessment
 THE NURSING PROCESS…cont
• Elements in drug prescriptions;
Patient’s name
Date order was written
Name of medications
Dosage (include size, frequency, number of dose)
Route of delivery
Signature of the prescriber
 THE NURSING PROCESS…cont
Diagnosis & Planning
• State relevant nursing diagnosis
 Noncompliance related to drug regimens
 Deficient knowledge on illness and treatment
• Identify desired learning outcomes of nursing
intervention
• Focus on:
Why the drug is needed
How the drug will be administered
Adverse effects
Other nursing measure to enhance desired outcomes
 THE NURSING PROCESS…cont
Implementation
• It is the actual administration of the drugs – use general
guide of “10 R” in giving medications
• Ensure cleanliness of your hands, work area & supplies
• Ensure adequate lighting
• Decrease environmental distractions

Evaluation
• Evaluation is the comparison of actual client outcomes
with expected outcomes
• Always return to assess the patient’s response to the
medication
THE MEDICATION DELIVERY SYSTEM

1. Ward stock system

2. Individual prescription order system (3-5 days
supplies)
3. Computer controlled dispensing system
4. Unit dose system - single unit packages of drugs
(topping-up of medication) by using medication trolley
5. Narcotic control system
 THE METHODS OF DRUG ORDER
Stat Order
• Used for emergency situation
• It is administered IMMEDIATELY

Single Order
• Administered only one time

Standing Order
• A written instruction issued by a doctor
• Authorizes paramedics or registered nurses have rights
to administer specified medicines & some controlled
drugs
• To be given until discontinued date
THE METHODS OF DRUG ORDER…cont
Renewal Order
• Must be written and signed by doctor in order to
continue drug administration
PRN Order
• Means administer when necessary
• Eg. Maxalon 1 tab prn OR Pcm 2 tab tds/prn
Verbal Order
• Orders given via phone & need 2 nurses to listen the
verbal order
• Nurse have to repeat the verbal order
• The nurse is responsible to enter the verbal orders
accurately on the chart
• The doctor must sign the chart within 24 hours
 THE METHODS OF DRUG ORDER…cont
Prescription of medication
• Prescription must be prescribed by a registered medical
practitioner
• Should be clearly written, typed or computer generated,
and be indelible and dated
• If a drug replaces a previously prescribed drug then the
outdated one must be cancelled, signed and dated
 THE METHODS OF DRUG ORDER…cont
Component in drug prescription
• Date and time the order is written
• Drug name & formulation – tab/cap/syr/susp/inj
• Drug dosage – gm/mg/mcg/ml
• Route of administration – oral/IV/IM/SL
• Frequency and duration of administration (e.g, x 7 days,
x 3 doses)
• Any special instructions for withholding or adjusting
dosage based on nursing assessment, drug effectiveness,
or laboratory results
• Physician or other health care provider’s signature
If any of these components are missing, the entire order
is incomplete and the medication should not be given
14
The Role of Nurses in Serving Medication
• Aware of their responsibilities in giving drugs & be
accountable for any mistakes
• Familiar with the act, additional regulations formulated
by health authorities as well as policies & procedures of
their hospitals
• Know the medication being administered
• Know the correct technique of administration
• Know patient-related factors that may affect the
method of administration – age, developmental stage,
weight, physiological & mental status, education level &
past physical history
 The role of nurses in serving
medication…cont
• Know the agency policy on administering drugs by any
technique
• Know the client’s rights in relation to medication
administration
• Use each steps of the nursing process in medication
administration:
 Assessment
 Nursing diagnosis
 Planning
 Implementation
 Evaluation
10 RIGHTS OF DRUG
ADMINISTRATION
 10R’s OF DRUG ADMINISTRATIONS
1. RIGHT PATIENT
2. RIGHT MEDICATION
3. RIGHT DOSE
4. RIGHT TIME
5. RIGHT ROUTE
6. RIGHT EDUCATION
7. RIGHT TO REFUSE
8. RIGHT ASSESSMENT
9. RIGHT EVALUATION
10.RIGHT DOCUMENTATION
 1. RIGHT PATIENT
• Always check patient’s identification (bracelet)
• Ask patient to state their name by themselves
• Compare medication order to identification bracelet
and patient’s stated name
• Verify patient’s allergies with chart and with patient
 2. RIGHT MEDICATION

• Carefully check the prescription

• Check the medication label with the physician’s orders
 2. RIGHT MEDICATION…cont

• Perform "Three Checks" on the label

1st check – when taking the container from its
location (drawer/refrigerator) & compare the
medication with patient’s medication administration
record (MAR)
2nd check – when checking the expiry date & present
of sediment
3rd check- before administering the medication to
patient
• Never administer medication prepared by another person
• Never administer medication that is not labeled
 2. RIGHT MEDICATION…cont

• For multiple drug doses that need to be used at other

times – ensure the drug’s name, strength of the solution,
date preparation, initials is written in the container & it
stored properly

Part of drug label

 3. RIGHT DOSE
• It is how much of the medication need to give the
individual at one time
• The dosage is identified from the doctor’s order
• Verify that dosage is within appropriate dose range
• To ensure of the right dose:
 Be familiar with the various measuring device – medicine cup,
syringe
 Recheck any mathematical calculation with other nurse if
necessary & focus on decimal points that may lead to overdose -
e.g 0.2mg vs 2.0mg
 Check label for medication concentration
 Do not divide unscored tablet
 Not administer tablet that have been broken unevenly along
the scoring
 3. RIGHT DOSE…cont
• To determine the dose, you need to know the strength of
each medication. E.g. paracetamol is 500 mg
• Need extra caution with dosage amount for paediatric &
elderly patient as they are more sensitive to medications
 4. RIGHT TIME
• Verify schedule of medication with order – date, time &
specific period of time
• Check last dose of medication given to patient
• Medication is scheduled at specific time to;
Achieve maximum therapeutic effectiveness
Prevent giving medication too close together or too
far apart
Maintain constant blood level of drugs that are given
several times a day
• Administer medication within 30 minutes of scheduled
time
 5. RIGHT ROUTE
• Verify medication route with medication order before
administering
• If no route stated – need to clarify with the doctor
• Do not assume the route of administration
• Common route for administration:
Local effect GI tract Injection
Intra-articular (cavity Buccal / submucosal Intramuscular
joint)
Intra-cardiac Oral Intraosseous
Intradermal Sublingual Intratracheal
Intrathecal (spinal fluid) Rectal Intravenous
Inhalation Subcutaneous
 6. RIGHT EDUCATION
• Inform patient of medication being administered
 the desired effects of medication
 the side effects of medication
• Ask patient if they have any known allergies to medication
• Example; “ Ms Lim , this is Tablet Atenolol 50mg. This
medication is to control hypertension. Your blood pressure
is 150/90mmHg. Therefore, you need to take this
medication. The side effects of this medication are
dizziness, nausea, vomiting. If you feel dizzy after taking
the medication, please inform the nurse immediately. Are
you clear?”
 7. RIGHT TO REFUSE

• The legally responsible party (patient, parent, family

member, guardian, etc.) for patient’s care has the right
to refuse any medication
• Inform responsible party of consequences of refusing
medication
• Verify that responsible party understands all of these
consequences
• Notify physician that ordered the medication and
document notification
• Document refusal of medication & reason report
 8. RIGHT ASSESSMENT
• Properly assess patient and tests to determine if
medication is safe and appropriate.
• If deemed unsafe or inappropriate, notify ordering
physician and document notification.
• Document that medication was not administered & the
reason that dose was skipped.
• Example;
Before administering the anti-hypertensive drugs, the
nurse needs to take the blood pressure
Before administering the tablet Potassium Chloride,
the potassium level in the blood needs to be
monitored closely
After medication
has been
administered…
 9. RIGHT EVALUATION
• Assess patient for any adverse side effects
• Assess patient for effectiveness of medication
• Compare patient’s prior status with post medication
status
• Document patient’s response to medication
• Example;
After administering the anti-hypertensive drugs, the
nurse evaluate the effectiveness of the drugs by
taking the blood pressure.
After administering the drugs, the nurse evaluate
whether the side effects of the drugs happen to the
patient
 10. RIGHT DOCUMENTATION

• Never document before medication is administered

• Document;
Medication
Dosage
Route
Date and Time
Signature and credentials
Signature of other nurse checking medication
 General Guidelines in Medication
Administration
• Perform hand hygiene
• Verify patient and check doctor’s order
• Check for a history of allergies
• Perform necessary observations and measures, e.g;
Assessing apex beat before administration of digoxin
BP before giving antihypertensive drug
• Prepared the dosage as prescribed
• Do not touch the tablets/capsule with your hand
• Check 10 R’s before serving medication
 general guidelines in medication
administration…cont
• Explain the purpose and anticipated side effect of
medication
• Identify the correct patient by asking his/her name
and checking ID band
• Check medication 3 times:
when taking out the medication from it location
during preparation of medication
before serving the medication to patient
 General Guidelines in Medication
Administration…cont
• For oral medication
Ensure patient has swallowed the medication
Raised the head of bed – aid patient in swallowing
If the patient vomits within 20-30 minutes after taking
medication – do not re-administer, inform the doctor &
document
• For injection
Always identify anatomical landmarks
Rotate injection site
• If patient refuses medication - do not force it & write the
reason of refusal & informed physician
 general guidelines in medication
administration…cont
• If medication need to omit - document the reason of
omitting & report to the physician
• Never leave a medication tray or cart unattended
• Document in the medication chart after medication is
served
• Evaluate effectiveness of the medication at the time it is
expected to act
• Always assess the patient’s response to the medication -
report any abnormalities or adverse effect
 Important Considerations of Medication
Administration
• If you do not pour it, do not give it
• If you give it, chart it
• Do not chart for someone else or have someone else
chart for you
• Do not transport or accept a container that is not
labeled
• Do not put down an unlabeled syringe; keep it in your
hand or label it before you put it down