rule right of medication administration.pptx

rule right of medication administration.pptx

• 1.
  The rights/ rulesin medication administration • Right patient • Right drug • Right route • Right time • Right dose • Right documentation • Right reason • Right assessment data • Right education • Right response
• 2.
  • Nurses mustadminister numerous drugs daily in a safe and efficient manner. The nurse should administer drugs in accord with nursing standards of practice and agency policy. The safe storage and maintenance of an adequate supply of drugs are other responsibilities of the nurse. • The nurse documents the actual administration of medications on the medication administration record. The MAR is a medical record form that contains the drug’s name, dose, route, and frequency of administration
• 3.
  Right patient • Themedication must be administered to the patient for whom it is prescribed. • Administering a medication to the wrong patient is a common error. • Verify the identity of the patient using at least two identifiers. Check the medication card/record against the patient’s name, bed and other patient’s identification. Ask the patient to tell you his/her name. • For unconscious patients or children, use an identification tag and ask patient relatives.
• 4.
  2. Right drug •When administering a medication, the nurse should check the label written on the container against the MAR at least three times before giving the drug. The nurse should: 1. Check the label when removing the drug container from the client’s medication drawer. 2. Check the drug when removing the amount of medication ordered from the container. (expiry date, color, consistency, name) 3. Check the drug at the bed side before administering the medication to the patient. • The nurse should give only medications that the nurse has prepared and checked. The nurse who administers the medication is the responsible party should an error occur. If a client questions a medication to be administered, the nurse should never ignore the question. Clients are active participants in their care and usually know when a medication is different from that usually taken.
• 5.
  3. Right route •Numerous errors have been reported involving the correct medication being administered to the correct patient but by the incorrect route. • For example enteral and parenteral medication are confusion in peadiatric population because liquid medication are frequently given in orally. Syringe for enteral and parenteral should be leveled clearly. • The nurse’s responsibilities in maintaining the right route are: • Read the physician’s order carefully to ensure the route of administration • Know abbreviation for methods e.g. I/V, I/M, P/O • If any error occurs, it should be immediately reported to the ward sister and the physician
• 6.
  4. Right time •Medications must be administered at the correct time to ensure therapeutic serum levels. Administering the medication at the wrong time is therefore one type of error. • Nurse should give a medication ordered pc (after meals) within 30 minutes after a meal when the patient has a full stomach. You give a STAT medication immediately. • Some medications must be given at a certain time for proper therapeutic effect; e.g. Insulin is normally given ½ hour before meal. Lasix is given in morning and afternoon only. A drug should not be given more than a half-hour before or after the scheduled time (according to organizational policy).
• 7.
  • Administering medicationsat the right time also involves preparing the medication at the appropriate time. Medications should not be prepared many hours (or even one hour) before they are administered, unless the manufacturer recommends this. Intravenous infusion of Phenytoin, for example, must begin within one hour after preparation.
• 8.
  5. Right Dose •Nurses must be cautious when reading the patient’s medication chart. A decimal point in the wrong place could result in either one tenth or ten times the correct dose being administered • In one case, a nurse administered 5mls of morphine 20mg/ml, instead of 5mg. The patient was given 100mg of morphine and consequently died. • The nurse must know how to reduce the risk of error by correctly calculating doses and having them double checked before administration. Formula, Dose ordered * Quantity in hand = volume to be given Dose available • After calculating dosages, prepare the medication using standard measurement devices. Use graduated cups, syringes, and scaled droppers to measure medications accurately • we cannot crush all medications. Some medications, such as time-released or extended-release capsules, have special coatings to keep the medication from being absorbed too quickly.
• 9.
  6. Right documentation •When a nurse administers a medication, he or she must sign the medication chart. This provides evidence that the medication has been administered to the patient. • Signing the medication chart before the medication has been administered is a risk, as the patient may refuse their medication or, in some cases, forget to take them. Similarly, failing to sign when a medication has been administered creates the risk that another nurse may assume that it has not been administered, and repeat that dose. • Documentation should include the medication’s generic name, dose, time, route, reason for administration and the effect achieved. • Document the patient's responses to medications, either positive or negative, in the nursing notes. Notify the patient's health care provider of any negative responses to medications, and document the time, date, and name of the health care provider you notified in the patient's chart.
• 10.
  7. Right reason •When a nurse is administering a medication, he or she must ensure it is prescribed for the appropriate reason. For example, it is not appropriate to administer an antibiotic for a viral infection, nor an antiviral for a bacterial infection. • Similarly, administering a sedative to a patient who already appears sedated may be harmful. • When a nurse is administering a medication, he or she should state to the patient the action of the medication and the reason for which it is prescribed.
• 11.
  8. Right assessmentdata: collect appropriate assessment data related to mechanism of action and therapeutic data is necessary. 9. Right education: assessment of the patient prior knowledge is important before giving education. Provide right education regarding purpose, dosing, administration information, costing information to patient and visitors.
• 12.
  10. Right response •Once a medication is administered, the nurse should monitor the patient to it medication has the desired effect or response. • This right of medication administration involves an evaluation of the effectiveness of the medication’s intended purpose which is crucial for some high-risk medications such as anti- arrhythmic and insulin. • Monitoring for the right response for example could involve assessment of the patient’s blood glucose level, vital signs or other physiologic parameters such as urine output.
• 13.
  Ways of preventingmedication errors: • Identification of the cause of medication error. • Check the label of each medication 3 times before giving the medicine • Read medication labels carefully (because most products come in similar container, colors and shape). • Question administration of multiple tablets or vial for single dose ( because most doses are 1 or 2 tablets or capsules or single dose vial, incorrect interpretation of order may result in excessively high dose). • Be aware of medications with similar name.
• 14.
  Ways of preventingmedication errors Contd… • Check decimal point (because some medications come in quantities that are multiples of one another; for e.g., caumadin in 2.5 mg and 25 mg tablets). • Question sudden and excessive increase in doses • When new or unfamiliar medication is ordered consult resource.
• 15.
  Ways of preventingmedication errors Contd.... • Do not administer medication ordered by nick name or unofficial abbreviation. • Do not attempt to decipher illegible handwriting (because there is chance of misinterpretation). • Identifying the patient: (complete patient name, date of birth, medical record number) (at least two identifier) • Do not confuse equivalents (because when in hurry the nurse may misread equivalents; e.g., milligram instead of milliliter). • The nurse who prepares the medication also administer the drug and records the drug administration.
• 16.
  • Ensure thatthe right medications given to the right patient in the right dose through the right route at the right time for the right reason based on the right (appropriate) assessment data using the right documentation and monitoring for the right responses by the patient with right education, ensuring that patient receive accurate and through information about the mediation and considering the right to refuse, acknowledging that patients can and do refuse to take medication (Elliot&liu,2010; Macdonald, 2010; Kee et al.,2012).
• 17.
  Role and responsibilitiesof nurses during medication administration • The administration of medications to patients requires knowledge and a set of skills that are unique to nursing. Responsibilities of medication administration include assessing the client’s ability to self administer medications, determining whether a client should receive a medication at a given time, administering medications correctly, and monitoring the effects of the prescribed medication. Safe and accurate medication administration is an important and potentially challenging nursing responsibility. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety.
• 18.
  • Be vigilantwhen preparing medications. • Check for allergies • Use two patient identifiers at all times. Always follow agency policy for patient identification. • Assessment comes before medication administration. • Be diligent in all medication calculations. • Avoid reliance on memory; use checklists and memory aids. • Communicate with your patient before and after administration. • Avoid workarounds.
• 19.
  • Ensure medicationhas not expired. • Always clarify an order or procedure that is unclear. • Report all near misses, errors, and adverse reactions. • Be alert to error-prone situations and high-alert medications. • If a patient questions or expresses concern about a medication, stop and do not administer it. • Plan medication administration to avoid disruption: – Dispense medication in a quiet area. – Avoid conversation with others. – Follow agency’s no-interruption zone policy.
• 20.
  • Prepare medicationsfor ONE patient at a time. • Follow the Nine RIGHTS of medication preparation. • Perform hand hygiene. • Check room for additional precautions. • Introduce yourself to patient. • Complete necessary focused assessments, lab values, and/or vital signs, and document on MAR. • Patient and family education about proper medication administration.
• 21.
  Thank you