👩‍⚕️Foundations of Nursing Practice Unit 13 – Medication Administration

Key Concepts

• Medication administration involves providing medications to patients as prescribed by healthcare providers
• Nurses play a critical role in ensuring safe and effective medication administration
• Medications can be classified based on their therapeutic effects, such as analgesics, antibiotics, and antihypertensives
• The five rights of medication administration include right patient, right drug, right dose, right route, and right time
  • Verifying these rights helps prevent medication errors and ensures patient safety
• Pharmacodynamics refers to the study of how medications affect the body, while pharmacokinetics focuses on how the body processes medications
• Adverse drug reactions (ADRs) are unintended and harmful responses to medications that can range from mild to severe
• Medication reconciliation involves comparing a patient's current medication orders to all the medications the patient has been taking to avoid discrepancies and potential adverse effects

Types of Medications

• Prescription medications require a healthcare provider's order and are regulated by law
  • Examples include antibiotics (amoxicillin), antihypertensives (lisinopril), and opioid analgesics (oxycodone)
• Over-the-counter (OTC) medications can be purchased without a prescription and are used to treat minor ailments
  • Common OTC medications include acetaminophen, ibuprofen, and antihistamines (diphenhydramine)
• Controlled substances are medications with a high potential for abuse and are strictly regulated by the government
  • These include opioids (morphine), benzodiazepines (diazepam), and stimulants (methylphenidate)
• Complementary and alternative medications (CAM) are not typically prescribed by healthcare providers and may include herbal remedies, vitamins, and minerals
• Medications can be further classified based on their mechanism of action, such as beta-blockers, ACE inhibitors, and proton pump inhibitors
• Some medications require special handling or storage conditions, such as refrigeration or protection from light

Routes of Administration

• Oral administration involves taking medications by mouth, either in the form of tablets, capsules, liquids, or suspensions
  • This is the most common and convenient route of administration
• Parenteral administration involves delivering medications directly into the body through injection or infusion
  • Subcutaneous injections are given into the fatty tissue beneath the skin (insulin)
  • Intramuscular injections are given into the muscle tissue (vaccines)
  • Intravenous administration involves delivering medications directly into the bloodstream through a vein (antibiotics, fluids)
• Topical administration involves applying medications directly to the skin or mucous membranes
  • Examples include creams, ointments, patches, and eye drops
• Inhalation involves breathing in medications through the mouth or nose (asthma inhalers, nebulizers)
• Rectal and vaginal administration involve inserting medications into the rectum or vagina (suppositories, creams)
• The route of administration is determined by factors such as the medication's properties, desired onset and duration of action, and patient preferences

Medication Safety

• Medication errors can occur at any stage of the medication use process, from prescribing to administration
• Common types of medication errors include wrong dose, wrong drug, wrong route, wrong time, and wrong patient
• Strategies to prevent medication errors include using barcode scanning, double-checking calculations, and following the five rights of medication administration
• Allergies and drug interactions can cause serious adverse reactions and must be carefully assessed before administering medications
  • Nurses should review the patient's allergy history and check for potential drug interactions using reliable resources
• High-alert medications, such as insulin, anticoagulants, and opioids, carry a higher risk of causing significant harm if used incorrectly
  • These medications require special safeguards and protocols to minimize the risk of errors
• Proper storage and handling of medications are essential to maintain their potency and prevent contamination
  • This includes following recommended temperature ranges and expiration dates
• Patient education is crucial for promoting medication safety and adherence
  • Nurses should provide clear instructions on how to take medications, potential side effects, and when to seek medical attention

Dosage Calculations

• Accurate dosage calculations are essential for safe medication administration
• The metric system is used for most medication calculations, with common units including milligrams (mg), grams (g), and milliliters (mL)
• Dimensional analysis is a problem-solving method that involves setting up a series of fractions to convert between units and calculate the desired quantity
  • For example, to calculate the number of tablets needed for a 30 mg dose when the available tablets are 10 mg each: $\frac{30 \text{ mg}}{1 \text{ dose}} \times \frac{1 \text{ tablet}}{10 \text{ mg}} = \frac{3 \text{ tablets}}{1 \text{ dose}}$
• Dosage calculations often involve working with ratios and proportions to determine the correct amount of medication based on the patient's weight or body surface area
• Pediatric and geriatric patients require special considerations when calculating dosages due to differences in body composition and organ function
• Nurses should always double-check their calculations and have another healthcare professional independently verify the dosage before administration

Administration Techniques

• Proper hand hygiene and aseptic technique are essential for preventing the spread of infection during medication administration
• Oral medications should be administered with a sufficient amount of water or other appropriate liquid to aid in swallowing and absorption
  • Some medications, such as enteric-coated tablets or sublingual tablets, have specific administration instructions that must be followed
• Injectable medications require careful preparation and technique to ensure sterility and prevent complications
  • This includes using the correct needle size and injection site, aspirating to check for blood return, and massaging the site after injection
• Intravenous medications must be administered using sterile equipment and technique to prevent catheter-related infections
  • Nurses should assess the IV site for signs of infiltration, phlebitis, or extravasation and take appropriate action if complications arise
• Topical medications should be applied using clean technique and in the appropriate amount to cover the affected area
• When administering medications via feeding tubes, nurses must verify tube placement, flush the tube before and after administration, and use liquid formulations when possible

Documentation and Reporting

• Accurate and timely documentation of medication administration is a legal and professional responsibility of nurses
• The medication administration record (MAR) is the primary document used to record each dose of medication given to a patient
  • The MAR should include the medication name, dose, route, time, and the nurse's initials or signature
• Nurses should also document any relevant assessments, such as pain scores or vital signs, before and after medication administration
• Adverse drug reactions, medication errors, and near-misses must be promptly reported to the appropriate healthcare team members and through the organization's incident reporting system
  • This allows for timely intervention and analysis to prevent future occurrences
• Controlled substance administration requires additional documentation, such as witnessing waste and maintaining accurate inventory counts
• Verbal orders for medication administration should be documented and signed by the prescribing provider within a specified timeframe
• Nurses should communicate any concerns about medication orders, patient response, or administration difficulties to the healthcare team to ensure continuity of care

Legal and Ethical Considerations

• Medication administration is governed by federal and state laws, as well as professional standards of practice
• The Controlled Substances Act regulates the manufacture, distribution, and dispensing of controlled substances to prevent diversion and abuse
• Nurses must maintain patient confidentiality and protect patient privacy when handling and discussing medication information
  • This includes following HIPAA regulations and organizational policies regarding the secure storage and transmission of patient data
• Informed consent is required before administering medications, and patients have the right to refuse treatment
  • Nurses should educate patients about the benefits, risks, and alternatives to medication therapy to support informed decision-making
• Ethical principles, such as beneficence (promoting patient well-being), non-maleficence (avoiding harm), and justice (fair distribution of resources), guide medication administration practices
• Nurses must advocate for patients and address any concerns about inappropriate or unsafe medication practices
  • This may involve questioning orders, reporting errors, or escalating issues to higher levels of authority when necessary
• Cultural competence and sensitivity are essential when administering medications to diverse patient populations
  • Nurses should consider factors such as language barriers, religious beliefs, and health literacy when providing medication education and support