What nursing actions should the nurse take to administer medications safely?
Since nurses play a pivotal and hands-on role in all aspects of client care, the responsibility of ensuring client safety during medication administration often lies with them. The following sections summarize safety considerations for medication orders, medication administration, assessment/monitoring after medication administration, and documentation. Show
Safety Considerations – Medication OrdersMedications must be administered in response to an order from a practitioner or on the basis of a standing order that is subsequently appropriately authenticated by a practitioner. All practitioner orders for the administration of drugs and biologicals must include at least the following:
Safety Considerations – Medication PreparationThe following safety considerations were taken from Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon.
Safety Considerations – Medication AdministrationThe Seven RightsFor the purposes of this textbook, we will discuss the 7 RIGHTS and 3 CHECKS of medication administration. It is important that nurses always follow their hospital and regulatory College policies and guidelines. The 7 RIGHTS are:
These RIGHTS must be checked 3 times for each medication the nurse is administering. The 3 CHECKS are done at the following steps in the administration process:
Many agencies have implemented bar code medication scanning to improve safety during medication administration. Bar code scanning systems reduce medication errors by electronically verifying the “7 rights” of medication administration. For example, when a nurse scans a bar code on the client’s wristband and on the medication to be administered, the data is delivered to a computer software system where algorithms check various databases and generate real-time warnings or approvals. Studies have shown that bar code scanning reduces errors resulting from the administration of a wrong dose or wrong medication, as well as errors involving medication being given by the wrong route. However, it is important to remember that bar code scanning should be used in addition to performing the 7 rights of medication administration, not in place of this important safety process. Additionally, nurses should carefully consider their actions when errors occur during the bar code scanning process. Although it may be tempting to quickly dismiss the error and attribute it to a technology glitch, the error may have been triggered due to a client safety concern that requires further follow-up before the medication is administered. It is important for nurses to investigate errors that occur during the bar code scanning process just as they would do if an error is discovered during the traditional five rights of the medication process. Safety Considerations – Client EducationThe BCCNM Practice Standard for Medication states that “nurses educate the client about the medication they receive, including, as applicable:
The book Preventing Medication Errors by the Institute of Medicine (2007), lists the following additional key actions to include when teaching clients about the safe use of their medications:
A nurse is preparing to administer metoprolol, a cardiac medication, to a client and implements the nursing process: ASSESSES the vital signs prior to administration and discovers the heart rate is 48. DIAGNOSES that the heart rate is too low to safely administer the medication per the parameters provided. Establishes the OUTCOME to keep the client’s heart rate within the normal range of 60-100. PLANS to call the physician and report this incident in the shift handoff report. Implements INTERVENTIONS by withholding the metoprolol at this time, documenting the incident of the medication being withheld, and notifying the provider. Throughout the shift, continues to EVALUATE the client’s status after not receiving the metoprolol. While providing client teaching to a client about the medication before discharge, the nurse provides a handout with instructions, as well as a list of the current medications. What other information should be provided to the client? Note: Answers to the activities can be found in the “Answer Key” sections at the end of the book. Safety Considerations – Assessment and Monitoring of Clients Receiving MedicationsClients must be carefully monitored to determine whether the medication results in the therapeutically intended benefit, and to allow for early identification of adverse effects and timely initiation of appropriate corrective action. Depending on the medication and route/delivery mode, monitoring may need to include assessment of:
The nurse should consider client risk factors as well as the risks inherent in a medication when determining the type and frequency of monitoring. It is also essential to communicate information regarding the client’s medication risk factors and monitoring requirements during hand-offs of the client to other clinical staff. Adverse reactions such as anaphylaxis or opioid-induced respiratory depression require timely and appropriate intervention per established protocols and should be reported immediately to the practitioner responsible for the care of the client. An example of vigilant post-medication administration monitoring would be for a post-surgical client who is receiving pain medication via patient-controlled analgesia (PCA) pump. Narcotic medications are often used to control pain but also have a sedating effect. Clients can become overly sedated and suffer respiratory depression or arrest, which can be fatal. In addition, the client and/or family members should be educated to notify nursing staff promptly when the client experiences difficulty breathing or other changes that could be a reaction to a medication. Safety Considerations – DocumentationThe BCCNM outlines documentation requirements for registered nurses in the Documentation Practice Standard. Documentation is expected to occur after the actual administration of the medication to the client; advance documentation is not only inappropriate but may result in medication errors. Proper documentation of medication administration actions taken and their outcomes is essential for planning and delivering future care of the client. A nurse is preparing to administer morphine, an opioid, to a client who recently had surgery.
Note: Answers to the activities can be found in the “Answer Key” sections at the end of the book. Now that you have reviewed the safety requirements and understand that safety is a critical component of medication administration, take some time to review this medication administration checklist from Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon. This checklist is a useful resource to help you safely administer medications. Consider printing a copy for yourself to take to clinical practice. SAFE MEDICATION ADMINISTRATIONDisclaimer: Always review and follow your hospital policy regarding this specific skill.Safety considerations:
STEPSADDITIONAL INFORMATION1. Check MAR against doctor’s orders.Check that MAR and doctor’s orders are consistent.Compare physician orders and MARCompare MAR with patient wristband. Night staff usually complete and verify this check as well.
Medication calculation: D/H x S = A (D or desired dosage/H or have available x S or stock = A or amount prepared) The right patient: check that you have the correct patient using two patient identifiers (e.g., name and date of birth).Compare MAR with patient wristbandThe right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context. The right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions. The right route: check that the route is appropriate for the patient’s current condition. The right time: adhere to the prescribed dose and schedule. Check the right patient, medication, dose, route, time, reason, documentationThe right reason: check that the patient is receiving the medication for the appropriate reason. The right documentation: always verify any unclear or inaccurate documentation prior to administering medications. NEVER document that you have given a medication until you have actually administered it. 3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:
These checks are done before administering the medication to your patient. If taking the drug to the bedside (e.g., eye drops), do a third check at the bedside. 4. Circle medication when poured.Pour medication. Circle MAR to show that medication has been poured.Circle medication once it has been poured5. Positioning:
This step prevents the transfer of microorganisms. Hand hygiene with ABHRData source: Lilley, Harrington, Snyder, & Swart, 2011; Lynn, 2011; Perry et al., 2014Standards of Practice that include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing patient care. What are the nursing responsibilities when administering medications?Nurses' responsibility for medication administration includes ensuring that the right medication is properly drawn up in the correct dose, and administered at the right time through the right route to the right patient. To limit or reduce the risk of administration errors, many hospitals employ a single-dose system.
How would you ensure a safe administration of the medication?Start with the basics. Verify any medication order and make sure it's complete. ... . Check the patient's medical record for an allergy or contraindication to the prescribed medication. ... . Prepare medications for one patient at a time.. Educate patients about their medications. ... . Follow the eight rights of medication administration.. What is the most important action to take before administering any medication?Right Individual. Making sure that you have the right individual is obviously a very important step in medication administration. The standard is to check with at least two other sources that you have the correct person before administering medication.
What are the 3 checks a nurse should perform when preparing a medication for administration?WHAT ARE THE THREE CHECKS? Checking the: – Name of the person; – Strength and dosage; and – Frequency against the: Medical order; • MAR; AND • Medication container.
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