Rights of Drug Administration

THE SIX RIGHTS OF DRUG establishment Right Drug M whatsoever(prenominal) do do medical specialtysss contribute similar spellings and variable concentrations. onward the boldness of the medicament, it is imperative to comp atomic number 18 the exact spelling and concentration of the electropo driveive do drugs with the medicine card or drug write and the medication container. Regardless of the drug distri besidesion system used, the drug label should be read at least three times 1. to begin with removing the drug from the shelf or whole panelling cart. 2. Before preparing or measure the actual order point 3.Before replacing the drug on the shelf or in front opening a unit dose container (just foregoing(prenominal)(prenominal) to tradeing the drug to the enduring) Right Time When scheduling the administration time of a medication, factors such as timing abbreviations, standardized times, consistency of declension take aims, absorption, diagnostic testing, and t he use of p. r. n. medications must be considered. 1. Standard AbbreviationsThe drug entrap specifies the frequence of drug administration. Standard abbreviations used as part of the drug order specify the times of administrati0n.The nurse should also represent institutional insurance policy concerning administration of medications. Hospitals often have standardized interpretations for abbreviations. The nurse must learn and utilize standard abbreviations in interpreting, transcribing, and administering medications accu setly. 2. Standardized institution TimesFor forbearing safety, certain medications be administered at specific times. This allows laboratory work or ECGs to be completed first, in order to determine the size of the conterminous dose to be administered. 3.Maintenance of Consistent Blood LevelsThe instrument for the administration of a drug should be planned to maintain consistent blood levels of the drug in order to maximize the therapeutic effectiveness. 4. Maximum Drug preoccupationThe schedule for spoken administration of drugs must be planned to sustain incompatibilities and maximize absorption. Certain drugs direct administration on an empty stomach. Thus, they are demonstraten 1hour before or 2 hours aft(prenominal)(prenominal) meals. Other medications should be given with foods to enhance absorption or reduce irritations.Still other drugs are not given with diary products or antacids. It is big to maintain the recommended schedule of administration for maximum therapeutic effectiveness. 5. Diagnostic TestingDetermine whether any diagnostic tests have been lucid for completion prior to initiating or continuing therapy. Before beginning antimicrobial therapy, assure that all culture specimens (such as blood, urine, or wound) have been collected. If a physician has staged serum levels of the drug, adjust the administration time of the medication with the time the phlebotomist is going to draw the blood sample.When compl eting the requisition for a serum level of a medication, forever make a notation of the date and time that the drug was at last administered. Timing is important if tests are not conducted at the similar time intervals in the same patient, the selective information gained are of little value. 6. P. R. N. MedicationsBefore the administration of any p. r. n. medication, the patients map should be shadowvass to ensure that the drug has not been administered by some cardinal else, or that the contract time interval has passed since the medication was last administered. When a p. rn. medication is given, it should be charted immediately.Record the response to the medication. Right Dose come off the drug dosage say against the range specified in the reference books available at the nurses station. 1. affected Hepatic or Renal FunctionAlways consider the hepatic and renal function of the specific patient who will receive the drug. Depending on the rate of drug metabolism and lane of excretion from the body, certain drugs require a reduction in dosage to prevent toxicity. Conversely, patients being dialyzed may require higher than standard doses. Whenever a dosage is orthogonal the normal range for that drug, it should be verified before administration.Once verification has been obtained, a plan explanation should be bear witnessed in the nurses notes and on the Kardex 9or drug profile) so that others administering the medication will not be repeatedly contacted with the same questions. The spare-time activity laboratory tests are used to monitor liver function aspartame aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase and lactic dehydrogenase (LDH). The blood urea normality (BUN), serum creatinine (Crs), and creatinine clearance (Ccr) are used to monitor renal function. 2.Pediatric and geriatric PatientsSpecific doses for some drugs are not yet firmly realized for the elderly and for th e pediatric patient. The nurse should question any order outside the normal range before administration. For pediatric patients, the more or less reliable mode is by proportional amount of body surface area or body weight. 3. Nausea and VomitingIf a patient is vomiting, oral medications should be withheld and the physician contacted for alternate medication orders, as the parenteral or rectal route may be preferred. Investigate the onset of the nausea and vomiting.If itbegan afterward the start of the medication regimen, thoughtfulness should be given to rescheduling the oral medication. Administration with food ordinarily decreases gastric irritation. Consult with a physician for changes in orders. Right Patient When using the medication card system, compare the anatomy of the patient on the medication card with the patients acknowledgement bracelet. With the unit dose system, compare the name on the drug profile with the individuals identification bracelet. When checking th e bracelet under either system, unendingly check for allergies, as well.Some institutional policies require that the individual be called by name as a means of identification. This practice must pass into consideration the patients mental alertness and orientation. It is much safer constantly to check the identification bracelet. 1. Pediatric PatientsNever ask children their names as a means of positive identification. Children may change beds, try to annul you, or seek attention by identifying themselves as someone else. Check identification bracelets EVERY TIME. 2. Geriatric PatientsIt is a wise policy to check identification bracelets, in addition to confirming names verbally.In a long care setting, residents usually do not wear identification bracelets. In these instances, only a person who is familiar with the residents should administer medications. Many misplays may be voided by carefully following the practices just presented. Make it a habit to check the identificatio n bracelet EVERY TIME a medication is administered. The indecent effects of administration to the malign medication to the wrong patient and the capability for a lawsuit stooge thus be avoided. Right Route The drug order should specify the route to be used for the administration of the medication.Never substitute one dosage lay down of medication for another unless the physician is specifically consulted and an order for the change is obtained. There can be a great variation in the absorption rate of the medication through various routes of administration. The intravenous route delivers the drug straightway into the bloodstream. This route provides the fastest onset, but also the greatest danger of potential adverse effects such as tachycardia and hypotension. The intramuscular route provides the next fastest absorption rate, based upon availability of blood supply.This route can be quite painful, as is the case with many antibiotics. The subcutaneous route is next fastest, b ased on blood supply. In some instances the oral route may be as fast as the intramuscular route, depending on the medication being given, the dosage form (liquids are thoughtless faster than tablets), and whether there is food in the stomach. The oral route is usually safe if the patient is conscious and able to swallow. The rectal route should be avoided, if possible, due to irritation of mucosal tissues and erratic absorption rates.In case of computer error, the oral and rectal routes have the advantage of recoverability for a short time after administration. Right Drug Preparation and Administration Maintain the higher standards of drug preparation and administration. Focus your entire attention on the calculation, preparation, and administration of the ordered medication. A drug reconstituted by a nurse should be clear labeled with the patients name, the dose or strength per unit of volume, the date and time the drug was reconstituted, the amount and type of diluent used, th e result date/ or time, and the initials or name of the nurse who prepared it.Once reconstituted, the drug should be bloodlined according to the manufacturers recommendation. entertain the label of the container for the drug name, concentration, and route of appropriate administration. CHECK the patients chart, Kardex, medication administration inscribe, or identification bracelet for allergies. If no information is found, ask the patient, prior to the administration of the administration of the medication, if he or she has any allergies. CHECK the patients chart, Kardex, medication administration record for rotation schedules of injectable or topically applied medications. CHECK medications to be mixed in one spray with a list approved by the hospital or the pharmacy for compatibility. Normally, all drugs mixed in a single syringe should be administered within 15 minutes after mixing. Immediately prior to administration, constantly CHECK the contents of syringe for clarity and the absence of any precipitate if either is present, do not administer the contents of the syringe. CHECK the patients identity EVERY TIME a medication is administered. DO approach the patient in a firm but kind manner that conveys the feeling that cooperation is expected. DO adjust the patient to the most appropriate position for the route of administration (for example for oral medications, sit the patient upright to facilitate swallowing). Have appropriate fluids ready before administration. DO remain with the patient to be certain that all medications have been swallowed. DO use every opportunity to teach the patient and family well-nigh the drug being administered. DO give simple and honest answers or explanations to the patient regarding the medication and treatment. DO use a plastic container, medicine cup, medicine dropper, oral syringe, or nipple to administer oral medications to an infant or small child. DO reward the child who has been cooperative by giving pr aise comfort and hold the uncooperative child after completing the medication administration. DO non prepare or administer a drug from a container that is not properly labeled or from a container where the label is not fully legible. DO NOT give any medication prepared by an individual other than the pharmacist. ALWAYS check the drug name, dosage, frequency, and route ofadministration against the order.Student nurses must know the practice limitations instituted by the hospital or school and which medications can be administered under what level of supervision. DO NOT return an unused portion or dose of medication to a stock supply bottle. DO NOT prove to administer any drug orally to a comatose patient. DO NOT leave a medication at the patients bedside to be taken later remain with the individual until the drug is taken and swallowed. DO NOT dilute a liquid medication form unless there are specific written orders to do so. BEFORE despatch (1) Explain the proper method of taking prescribed medications to the patient. (2)Stress the need for promptitude in the administration of medications, and what to do if a dosage is missed. (3)Teach the patient to store medications separately from other containers and personal hygiene items. (4)Provide the patient with written instruction manual reiterating the medication names, schedules, and how to obtain refills. Write the instructions in a wording understood by the patient, and use LARGE BOLD LETTERS when necessary. (5) get word anticipated therapeutic response. 6)Instruct the patient, family member(s), or significant others on how to collect and record data for use by the physician to monitor the patients response to drug and other treatment modalities. (7)Give the patient, or another responsible for(p) individual, a list of signs and symptoms that should be heralded to the physician. (8)Stress measures that can be initiated to belittle or prevent anticipated side effects to the prescribed medication. It is important to do this further encourage the patient to be complaint with the prescribed regimen.Right supporting scrollation of nursing actions and patient observations has always been an important ethical responsibility, but now it is becoming a major medicolegal consideration as well. Indeed, it is becoming known as the sixth right. Always chart the following information date and time of administration, name of medication, dosage, route, and site of administration. Documentation of drug action should be made in the regularly schedule assessments for changes in the disease symptoms the patient is exhibiting.Promptly record and report adverse symptoms ob serve up. Document health teaching performed and evaluate and record the degree of understanding exhibited by the patient. DO record when a drug is not administered and why. DO NOT record a medication until after it has been given. DO NOT record in the nurses notes that an casualty report has been completed when a medicati on error has occurred. However, data regarding clinical observations of the patient related to the occurrence should be charted to serve as a baseline for future comparisons.Whenever a medication error does occur, an incident report is completed to describe the circumstances of the event. An incident report related to a medication error should include the following data date, time the drug was ordered, drug name, dose, and route of administration. Information regarding the date, time, drug administered, and dose and route of administration should be given, and the therapeutic response or adverse clinical observations present should be noted. Finally, record the date, time, and physicians ordered given. Be FACTUAL do not state opinions on the incident report.