What is the definition of a medication?
- Medication: a substance used in the diagnosis, treatment, cure, relief or prevention of health
- It can be prescription, non-prescription or herbal/complementary preparation.
What are the common medication errors throughout the process of administration?
- Ordering: order entry is the most frequent point of medication orders. Such as, drug dosing calculations, inappropriate warnings from failures in the system, omission of orders altogether.
- Transcribing: communicating order entry is highly susceptible to errors. such as incorrect concentration of medication, look alike and sound alike mistakes.
- Dispensing: considered near-misses, which occur when the provider physically obtains the wrong medication, wrong dose or wrong prep. These errors are ideally caught.
- Administering: e.g. wrong patient. Automated dispensing cabinets and bedside barcoding can be helpful .
- Monitoring: post administration= medications are monitored for side effects, toxicities and kinetic drug levels. Staff education can play a big role in preventing monitoring errors. e.g. adequate checking of blood pressure, BGL etc.
What is the role of the RN in medication administration?
- To ensure that patients are adequately prepared to administer their meds when discharged.
- to educate patients about their medications and side effects = therapeutic and non therapeutic effects which requires pharmacological, anatomy understanding.
- To ensure that medication regimes are fit for purpose, practical and sustainable = assess patients need for medication
- Assess the effects of medications in restoring or maintaining health.
Define pharmacokinetics vs pharmodynamics
Pharmacokinetics: the study of how medications enter the body, moves through the body and leaves the body
Pharmacodynamics: process in which a medication interacts with the body’s cells to produce a biologic response.
What is the: AUSTRALIA’S NATIONAL MEDICINES POLICY?
It aims to:
○ Maximise an individual’s benefit from a medication regimen
○ Achieve safe, effective use of medications to improve health outcomes.
Describe quality use of medicines (e.g. policies, definition, concepts).
- This idea stems from WHO Rational use of Medicines Policy 1985
- Australia’s response was the Australian National medicines policy which has ‘quality use of medicines (QUM)’ as a core objective.
- Key concepts of quality use of medicines:
• Wise: ensuring best possible treatment plan
• Necessary: ensuring that when medicine is needed they are managed and monitored
• Safe/effective: minimising misuse, overuse or underuse.
What are the principles of drug actions?
- Therapeutic effect : is the desired effect or result of a medicine
- Absorption: is the passage of a drug from the admin. Site into the blood stream
- Distribution: is the process of delivering medication to tissues, organs and specific site
- Metabolism: process which a drug is altered to prepare for excretion
- The excretion process removes the less active drug or its metabolites.
What are the principles of drug actions in relation to pharmacodynamics?
A drug’s half-life is the expected time it takes for the blood concentration to measure half of the original drug dose due to drug
elimination.
-Onset of action is the time the body takes to respond to a drug after administration.
-Peak plasma level indicates the highest serum (blood) concentration.
- The trough is the lowest serum level of the medication.
What are some definitions for drug actions ? e.g. side effects, adverse effects, antagonism, interactions.
- Side effects are predictable but unwanted and sometimes unavoidable reactions to medications.
- Adverse effects are severe, unintended, unwanted, and often unpredictable drug reactions.
- Toxic effects result from a medication overdose or the
buildup of medication in the blood due to impaired metabolism and excretion. - Allergic reactions are unpredictable immune responses to medications.
- Adverse Drug Reaction a harmful unintended reaction to medicines that occur at doses normally used for treatment.
- Medication interactions occur when the drug action is modified by the presence of a certain food or herb or another medication.
- Antagonism occurs when the drug effect is decreased by taking the drug with another substance.
What are the types/ routes of oral medications?
- Enteric coated - tablet for oral use coated with materials that don’t dissolve in stomach-dissolve in intestine
- Extended/sustained release-coated drug that extends release over time reduces number of doses
- Sublingual - place medication under tongue until tablet dissolves. The blood vessels under the tongue are very close to the surface.
- Buccal – place between cheek and teeth until dissolved
What are routes for medications other than oral?
Parenteral : subcutaneous, intradermal, intravenous, intramuscular, epidural etc.
topical: skin, mucous membranes, inhalation, intra ocular.
What are the types of medication orders?
Orders in Tertiary or acute care:
• Standing orders or routine medication orders e.g. 10 days with reviewed assessment
• PRN (pre re nata) orders e.g. when necessary such as pain
• Single (one-time) orders e.g. time related
• Stat (statim) orders e.g. given immediately one time
Other: -• Telephone orders • Variable dose medicines • Venous thromboembolism prophylaxis • Warfarin • Limited duration medicines • Ceased medicines • Slow release medicines and other non-standard formulations
How do you apply/administer eye and ear drops/eye ointment?
- Clean patient’s eyes first, prevent dropper contact
- Apply thin stream of ointment evenly along inner edge
- If needed clean eyes with wash cloth before
- Hold a clean tissue on the lower skin to pull down
describe how to prep for ear drops?
- straighten ear canal:
adults by pulling auricle down and back
children by pulling auricle upwards and outwards
What are the conversions of tablets and injectables?
• Tablets
Dose required = amount to be
stock strength administered
• Mixtures & Injectables
Dose required x volume = amount to be
stock strength administered (mL)
What are some reasons for not adminsitering ?
Absent, fasting, refused, vomiting, on leave, not available, withheld, self administered.
What are the steps to a telephone order?
The person receiving the order must be an authorised person in that patient care area.
all orders must be read back to the prescriber with numbers in figures and words.
the prescriber should repeat the telephone order to a second person
When a person administers medication the record on the chart comes under a telephone order section
the prescriber must confirm within 24hrs all doses administered on a verbal order
What are some distribution systems?
- Stock supply : large multidose containers. Associated with high rate medication errors. It is time consuming and costly because medications have to be dispensed separately for each client.
- Unit dose: uses portable trolleys containing a drawer with a 24hr supply container for each client. Each tablet is wrapped in foil.
- Client bedside storage: medication in a locked cupboard at a clients bedside.
What are the five rights?
5 rights:
- Right medication
- Right dose
- Right patient
- Right route
- Right time
What steps would you take to ensure that you correctly identify that you are administering the correct medication to the correct patient?
Check their date of birth , name by asking the patient and checking the medication chart if the answers match.
Check the reasoning for the medication and assess if this is correct for the patient and legal
Check the medication name with the chart of the patient and how much is being administered (converting correctly).
Do these steps prior to dispensing, after dispensing and before prescribing.
What procedures must occur with S4 and S8 drugs?
- A witness must be present for the removal of the drug, recording of it, transfer to patient, administration and discarding
- balance checks: must be carried out by an RN and another person to record each drug page the balance left over.
