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The Nursing Process



                      1
Pharmacology and the
                 Nursing Process


           The Nursing Process
      is crucial for safe medication
             administration.


“Crucial = of the greatest significance in determining an
                       outcome”
                                                            2
Pharmacology and the
              Nursing Process
Nursing Process draws together all of the aspects of the patient:

Physical
Cultural
Cognitive
Spiritual
Sexual
Financial

Recognizing these aspects allows for a more holistic approach to
  patient care




                                                                    3
The Nursing Process

• A research-based organizational framework for
  professional nursing practice

• Central to all nursing care

• Encompasses all steps taken by the nurse in caring for
  a patient

• Ongoing and constantly evolving process
              Critical thinking
               Flexibility is important                4
The Nursing Process
• Assessment

• Nursing diagnosis

• Planning
  – Goals
  – Outcome criteria

• Implementation

• Evaluation
                           5
Nursing Process


Assessment

• Data collection
     -Subjective, objective
    - Accurate



                              6
Nursing Process

Nursing diagnosis

• Decision about the need/problem
     (actual or at risk for)

Three parts
• Human response to illness
• “related to”
• “as evidenced by”
                                    7
Nursing Process
Nursing diagnosis
• critical thinking
• creativity
• accurate data collection

• It is a statement about the patient’s status and
  will guide nursing interventions


                                                     8
Nursing Process

Planning
• Identification of goals
    -Must be patient-centered
• Outcome criteria
      -Must be SMART
     -have a time frame
• Prioritization
                                9
Nursing Process
Implementation

• Initiation and completion of the nursing care plan
  as defined by the nursing diagnoses and
  outcome criteria




                                                  10
Nursing Process
Evaluation

• Ongoing part of the nursing process

• Determining the status of the goals and
  outcomes of care




                                            11
The Nursing Process and
        Medication Administration
Assessment
 1. Health-                         3. Diagnostic Tests, lab values
     allergies
                                    4. Medication History
     pattern of health care             – Prescriptions
     experiences/ illnesses
                                        – OTCs
     level of education                 – Herbals
     understanding of the disease       – Responses to medications
    process                               (therapeutic and adverse
     financial support                    responses)

 2. Physical assessment –
    age and weight
    social support at home
    chronic conditions
                                                                      12
The Nursing Process and
    Medication Administration

Nursing Diagnosis
• Human response to illness (actual or risk)
        – drug therapy may only be a small part of
          the total pt picture
        – or, at times it may be an all consuming
          factor in the patient’s life

• Drug therapy is incorporated into the total
  picture
                                                     13
The Nursing Process and
   Medication Administration
Planning
   1. Identification of possible interactions
          knowledge of the prescribed medication
          over-the-counter (OTC) drugs, herbs

   2. Client and family education
          level of patient understanding of disease
          level of education

   3. Gather equipment, review procedures, safety measures
          timing and frequency of drugs
          storage of drugs
   This phase leads to the provision of safe effective
               medication administration                 14
The Nursing Process and
   Medication Administration
Implementation
  1. Maximizing therapeutic effect

   2. Minimizing adverse effects
         provide comfort measures and help pt.
         cope with the therapeutic or adverse
         effects of a drug


   3. 10 rights of medication administration

                                                 15
The Nursing Process and
    Medication Administration

Evaluation

• Monitoring the patient’s response to drug
  therapy

        1. Expected outcome
        2. Unexpected outcome



                                              16
The Five Rights of
     Medication Administration

•   Right drug
•   Right dose
•   Right time
•   Right route
•   Right patient

Medication errors are a major problem in health care
 today                                                 17
Plus Five Rights of
Medication Administration

•   Right documentation
•   Right assessment
•   Right to education
•   Right evaluation
•   Right to refuse

                            18
1. RIGHT DRUG
• Pt should receive the drug that was prescribed.

• Medication orders may be prescribed by:
  –   Physician
  –   Dentist
  –   Podiatrist (foot doctor)
  –   Licensed health care provider

• Prescription = written on prescription pad
• Drug orders = written in “order sheets” included
  in pt’s chart
                                                     19
DRUG ORDERS

Accurately written drug orders
         are part of
       patient rights




                                 20
Six Elements of a Drug Order
1. Name of the patient

2. Date order is written (start/ stop dates may be ordered)

3. Name of medication

4. Dosage includes size, frequency, and number of doses

5. Route of delivery

6. Signature of the prescriber
                                                       21
Medication Card

Bed #                                Ward



               Name of Patient

                 Medication

                 Frequency



Date ordered                     Signature



                                             22
January 16, 2012 at 3:30pm

Patient Juan Dela Cruz is admitted at Ward F bed # 2. The
  patient is hooked with 1 L D5LR at 30 gtts/min, on left
  cephalic vein. Start cefuroxime 750mg, q8h, ANST.

     F2                                            Ward F



     12                   Dela Cruz, Juan
     8
                    Cefuroxime (Zinacef) 750 mg
     4
                         q 8 h ANST (+/- )



          1/16/12                                 lmn
                                                            23
DRUG ORDERS
4 categories:

3. Standing Order
  –   Maybe an ongoing order
  –   Maybe given for a specific # of doses/days
  –   May have special instructions
  –   May include PRN orders


                                                   24
DRUG ORDERS
4 categories:

2. One-time
  – Given 1x, at a specific time




                                   25
DRUG ORDERS
4 categories:

3. PRN orders
  – Given at client’s request and nurse’s
    judgement




                                            26
DRUG ORDERS
4 categories:

4. Stat orders
  – Given at once, immediately




                                 27
DRUG ORDERS
Nursing Implications:

3. Check that the medication order is
   complete and legible.

5. Know the reason why the drug is being
   administered to client.

                                           28
3 CHECKS before drug administration:



                      •At the time of contact with the drug
                                 bottle/container



                        •Before pouring/preparing the drug




                        •After pouring/preparing the drug




                                                              29
DRUG ORDERS

4. Medication card of Kardex should include the
  date the medication was ordered and any last
  date.

  – Ex. Controlled drugs that need to be renewed q 48h
  – Anticoagulant & antibiotics renewed after 7 days
  – Cancellation of drugs when the client gpes to surgery.



                                                        30
DRUG ORDERS

5. The 1st dose, one time and “as needed”
  medication orders should be checked
  against original orders.

6. Be aware of certain drugs that sound
  alike and are spelled similarly.

                                            31
2. RIGHT DOSE
 •    Dose prescribed for a particular
                  client

Nursing Implications:
4. Calculate dose correctly. When in
    doubt, it should be calculated and
    checked by another nurse.

6.   Check references (PPDR, drug
     package insert) for recommended
     range of specific drug doses.

                                         32
3. RIGHT TIME
•   Time at which the prescribed dose
    should be administered.

Nursing Implications:

•   Administer at specific time.


                                        33
Nursing Implications:

2. Administer that are affected by foods,
    before meals.




                                            34
Nursing Implications:

3. Administer that can irritate the
        stomach with food.




4. Drug administration schedule
      maybe adjusted to fit the
     client’s lifestyle, activities,
     tolerances or preferences.

                                       35
Nursing Implications:

5. It is the nurse’s responsibility
    to check whether the client is
    scheduled for any diagnostic
         procedures that would
           contraindicate the
            administration of
              medications.




                                      36
Nursing Implications:

 6. Check the expiration
           date.

Discard the medication or
       return it to the
    pharmacy if the date
        has passed.

                            37
Nursing Implications:

7. Antibiotics should be
  administered at even
  intervals throughout a 24-
  hr period so that
  therapeutic blood levels
  are maintained.


                               38
4. RIGHT ROUTE
  • Necessary for adequate
         absorption

Nursing Implications:

1. Assess ability to swallow
  before administration.

                               39
Nursing Implications:

2. Do not crush/mix medications in
   other substances without
   consulting the pharmacist.

• Don’t mix with sweet substances
  to “trick” children.

• Don’t mix in an infant’s formula
  feeding.




                                     40
Nursing Implications:

3. Use aseptic technique when
  preparing and administering
  drugs.

Sterile technique is required
  with parenteral route.


                                41
Nursing Implications:

4. Administer at the appropriate
  site.

5. Stay with client until oral
  drugs have been swallowed.




                                   42
Nursing Implications:

6. If it is necessary to combine medication
  with another substance, explain this to the
  client.




                                            43
5. RIGHT PATIENT
•   Nurse must verify the client’s identity
    before any drug administration

Nursing Implications:
4. Verify by checking the identification
   bracelet.
    – Some institutions put the client’s photo on
      his/her health record.

                                                    44
Nursing Implications:

2. Distinguish between 2
  clients with same last
  name
  – Have warnings highlighted in
    bright color on ID tools, such
    as medication cards,
    bracelet or Kardex.


                                     45
Nursing Implications:

3. Some institutions have
  ID bracelets coded for
  allergy status.
  – Nurse must be aware of
    this policy.




                             46
6. Right Documentation
• Requires the nurse immediately record the
  appropriate information about the drug
  administered.
  – Name of drug
  – Dose and route of administration
  – Time and data of administration
  – Nurse’s initial/signature
  – Response to medication, including
    unexpected reactions, should also be
    recorded, accdg to institution policy
                                            47
48
7. Right Assessment

• Requires appropriate
 data must be collected
  before administration
       of the drug.




                             49
8. Right to Education

• Requires that client receive accurate and
  thorough information about the medication

 And how it relates to his or her particular
 situation.



                                               50
8. Right to Education
• Client teaching should
  include:
  – Therapeutic purpose
  – Possible SE
  – Any diet/lifestyle restrictions
  – Skill of administration
  – Lab monitoring


                                      51
8. Right to Education
• Coincides with the principle of
  informed consent

  – Based on the individual having
    the knowledge necessary to
    make a decision.




                                     52
9. Right Evaluation
• Requires effectiveness of the medication
  be determined by the client’s response to
  the medication

• Appropriate to determine the extent of side
  effects and adverse effects, if any.



                                              53
10. Right to Refuse the Medication
• Client can and do refuse to take a
  medication.

• It is the nurse’s responsibility to determine,
  when possible, the reason for refusal and
  to take reasonable measures to facilitate
  the client’s taking of medication.


                                              54
Nursing actions when client refuses to take
    medications:

3.   Explain the risk of refusing to take the medication,
     and reinforce the reason for the medication.

5.   When the medication is refused, this refusal
     should be documented immediately.

7.   Inform the nurse manager or health care provider
     when an omission and refusal to take medication
     pose a specific threat to the client.



                                                            55
Patient’s Rights
• In addition to the 10 medication
  “rights”……

     DO YOU THINK PATIENTS HAVE
      OTHER MEDICATION “RIGHTS”?



• What additional systems would you like to
  see in place to ensure safe drug
  administration?                             56
Association of Nursing Service
      Administrators of the Philippines, inc
                   (ANSAP)
10 Golden Rules for Administering Drugs Safely:

3.   Right drug

5.   Right drug to the right patient

7.   Right dose

9.   Right drug by the right route

11. Right drug at the right time
                                                  57
Association of Nursing Service
       Administrators of the Philippines, inc
                    (ANSAP)
10 Golden Rules for Administering Drugs Safely:

3.    Document each drug you administer.

5.    Teach your patient about the drugs he is receiving.

7.    Take a complete patient drug history
      (risk of adverse drug reactions when a number of drugs are
      taken/when pt is taking alcohol drinks)

10.   Find out if the patient has any allergies.

12.   Be aware of potential drug-drug or drug-food interactions.


                                                                   58
General Guidelines for Correct
   Administration of Medications
Preparation:

3. Wash hands before
   preparing medications.

5. Check for drug allergies,
   check the assessment hx
   and Kardex.
                                    59
General Guidelines for Correct
   Administration of Medications
Preparation:

3. Check medication order with
    health care provider’s orders,
    Kardex, medication sheets and
    medication card.

4. Check label on container 3x.

5. Check expiration date on drug
    label, card; use drug only if
    date is current.
                                     60
General Guidelines for Correct
   Administration of Medications
Preparation:

6. Recheck drug dose
  calculation with another
  nurse.

7. Verify doses of drugs that
  are potentially toxic with
  another nurse/pharmacist.
                                    61
General Guidelines for Correct
     Administration of Medications
Preparation:

8. Pour tablet/capsule into the cap of the
   drug container. With unit dose, open
   packet at bedside after verifying client
   identification.

9. Pour liquid at eye level. Meniscus, the
   lower curve of the liquid, should be at
   the line of the desired dose.

10. Dilute drugs that irritate gastric mucosa
   (aspirin, potassium) or give with meals.




                                                62
General Guidelines for Correct
   Administration of Medications
Administration:

3. Administer only those drugs
   that you have prepared.

   Do not prepare medications
   to be administered by
   another.
                                    63
General Guidelines for Correct
   Administration of Medications
Administration:

2. Identify the client by ID band, ID photo
  and name tag/band.




                                              64
General Guidelines for Correct
   Administration of Medications
Administration:

3. Offer ice chips to numb
  taste buds when giving
  bad-tasting drugs.



                                    65
General Guidelines for Correct
   Administration of Medications
Administration:

4. When possible, give bad-
  tasting medication first,
  followed by pleasant-tasting
  liquids.



                                    66
General Guidelines for Correct
   Administration of Medications
Administration:

5. Assist the client to
  appropriate position,
  depending on the route of
  administration.

6. Provide only liquids allowed
  on the diet.
                                    67
General Guidelines for Correct
   Administration of Medications
Administration:

7. Stay with the client until the medications
  are taken.




                                                68
General Guidelines for Correct
    Administration of Medications
Administration:

8. Administer no more than 2.5-3mL of
   solution IM at 1 site.

  Infants receive no more than 1 mL of
  solution IM at 1 site and no more than
  1 ml SQ.

  Never recap needles (universal
  precaution), use the “fishing method”
  instead.
                                           69
General Guidelines for Correct
   Administration of Medications
Administration:

9. When administering drugs to a group of
  clients, give drug last to clients who need
  extra assistance.




                                                70
General Guidelines for Correct
    Administration of Medications
Administration:

10. Discard needles and syringes in
  appropriate containers.

11. Drug disposal is dependent on
  agency policy.

  Controlled substances must be
  returned to the pharmacy. Some
  disposals need signature of witness.

                                         71
General Guidelines for Correct
   Administration of Medications
Administration:

12. Discard unused solutions for
  ampules.

13. Appropriately store (some
  require refrigeration) unused
  stable solutions from open
  vials.
                                    72
General Guidelines for Correct
    Administration of Medications
Administration:

14. Write date and time opened,
  and your initials on label.

15. Keep narcotics in a double-
  lock drawer or closet.

  medication carts must be
  locked at all times when a
  nurse is not in attendance.

                                     73
General Guidelines for Correct
    Administration of Medications
Administration:

16. Keys to the narcotics drawer must
  be kept by the nurse and not stored
  in a drawer or closet.

17. Keep narcotics in a safe place, out
  of reach of children and others in the
  home.

18. Avoid contamination of one’s own
  skin or inhalation to minimize
  chances of allergy or sensitivity dev’t.

                                             74
General Guidelines for Correct
   Administration of Medications
Recording:

3. Report drug error immediately to client’s
   health care provider and to the nurse
   manager.

   Complete incident report.

                                               75
General Guidelines for Correct
    Administration of Medications
Recording:

2. Charting: record the drug given,
   time, route and your initials.

3. Record drugs promptly after
   given, especially STAT doses.

4. Record effectiveness and results
   of medications administered, esp
   PRN medications.

                                      76
General Guidelines for Correct
   Administration of Medications
Recording:

5. Report to health care provider
  and record drugs that were
  refused with reason for refusal.

6. Record amount of fluid taken
  with medications in input and
  output chart.


                                     77
General Guidelines for Correct
     Administration of Medications
What to avoid during drug
   administration:

3.   Do not be distracted when
     preparing medications.

5.   Do not give drugs prepared by
     others.

7.   Do not pour drugs from
     containers with labels that are
     difficult to read/whose labels are
     partially removed/fallen off.        78
General Guidelines for Correct
    Administration of Medications
What to avoid during drug
 administration:

4. Do not transfer drugs from one
   container to another.

5. Do not give medications for which the
   expiration date has passed.

6. Do not guess about drugs and drug
   doses. Ask when in doubt.

                                           79
General Guidelines for Correct
   Administration of Medications
What to avoid during drug administration:

7. Do not use drugs that have sediment, are
  discolored, or are cloudy (should not be)

8.Do not leave prepared medications out of sight.

9. Do not give drugs id the client says he/she has
  allergies to the drug or drug group.
                                                     80
General Guidelines for Correct
   Administration of Medications
What to avoid during drug administration:

10. Do not call the client’s name as the sole
  means of identification.

11. Do not give drug if the client states the
  drug is different from the drug he or she
  has been receiving. Check the order.
                                                81
General Guidelines for Correct
   Administration of Medications
What to avoid during drug administration:

12. Do not recap needle, use universal
  precaution.

13. Do not mix drug with large amount of
  food or beverage or foods that are
  contraindicated.
                                            82

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PHARMA-THE NURSING PROCESS

  • 2. Pharmacology and the Nursing Process The Nursing Process is crucial for safe medication administration. “Crucial = of the greatest significance in determining an outcome” 2
  • 3. Pharmacology and the Nursing Process Nursing Process draws together all of the aspects of the patient: Physical Cultural Cognitive Spiritual Sexual Financial Recognizing these aspects allows for a more holistic approach to patient care 3
  • 4. The Nursing Process • A research-based organizational framework for professional nursing practice • Central to all nursing care • Encompasses all steps taken by the nurse in caring for a patient • Ongoing and constantly evolving process Critical thinking Flexibility is important 4
  • 5. The Nursing Process • Assessment • Nursing diagnosis • Planning – Goals – Outcome criteria • Implementation • Evaluation 5
  • 6. Nursing Process Assessment • Data collection -Subjective, objective - Accurate 6
  • 7. Nursing Process Nursing diagnosis • Decision about the need/problem (actual or at risk for) Three parts • Human response to illness • “related to” • “as evidenced by” 7
  • 8. Nursing Process Nursing diagnosis • critical thinking • creativity • accurate data collection • It is a statement about the patient’s status and will guide nursing interventions 8
  • 9. Nursing Process Planning • Identification of goals -Must be patient-centered • Outcome criteria -Must be SMART -have a time frame • Prioritization 9
  • 10. Nursing Process Implementation • Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria 10
  • 11. Nursing Process Evaluation • Ongoing part of the nursing process • Determining the status of the goals and outcomes of care 11
  • 12. The Nursing Process and Medication Administration Assessment 1. Health- 3. Diagnostic Tests, lab values allergies 4. Medication History pattern of health care – Prescriptions experiences/ illnesses – OTCs level of education – Herbals understanding of the disease – Responses to medications process (therapeutic and adverse financial support responses) 2. Physical assessment – age and weight social support at home chronic conditions 12
  • 13. The Nursing Process and Medication Administration Nursing Diagnosis • Human response to illness (actual or risk) – drug therapy may only be a small part of the total pt picture – or, at times it may be an all consuming factor in the patient’s life • Drug therapy is incorporated into the total picture 13
  • 14. The Nursing Process and Medication Administration Planning 1. Identification of possible interactions knowledge of the prescribed medication over-the-counter (OTC) drugs, herbs 2. Client and family education level of patient understanding of disease level of education 3. Gather equipment, review procedures, safety measures timing and frequency of drugs storage of drugs This phase leads to the provision of safe effective medication administration 14
  • 15. The Nursing Process and Medication Administration Implementation 1. Maximizing therapeutic effect 2. Minimizing adverse effects provide comfort measures and help pt. cope with the therapeutic or adverse effects of a drug 3. 10 rights of medication administration 15
  • 16. The Nursing Process and Medication Administration Evaluation • Monitoring the patient’s response to drug therapy 1. Expected outcome 2. Unexpected outcome 16
  • 17. The Five Rights of Medication Administration • Right drug • Right dose • Right time • Right route • Right patient Medication errors are a major problem in health care today 17
  • 18. Plus Five Rights of Medication Administration • Right documentation • Right assessment • Right to education • Right evaluation • Right to refuse 18
  • 19. 1. RIGHT DRUG • Pt should receive the drug that was prescribed. • Medication orders may be prescribed by: – Physician – Dentist – Podiatrist (foot doctor) – Licensed health care provider • Prescription = written on prescription pad • Drug orders = written in “order sheets” included in pt’s chart 19
  • 20. DRUG ORDERS Accurately written drug orders are part of patient rights 20
  • 21. Six Elements of a Drug Order 1. Name of the patient 2. Date order is written (start/ stop dates may be ordered) 3. Name of medication 4. Dosage includes size, frequency, and number of doses 5. Route of delivery 6. Signature of the prescriber 21
  • 22. Medication Card Bed # Ward Name of Patient Medication Frequency Date ordered Signature 22
  • 23. January 16, 2012 at 3:30pm Patient Juan Dela Cruz is admitted at Ward F bed # 2. The patient is hooked with 1 L D5LR at 30 gtts/min, on left cephalic vein. Start cefuroxime 750mg, q8h, ANST. F2 Ward F 12 Dela Cruz, Juan 8 Cefuroxime (Zinacef) 750 mg 4 q 8 h ANST (+/- ) 1/16/12 lmn 23
  • 24. DRUG ORDERS 4 categories: 3. Standing Order – Maybe an ongoing order – Maybe given for a specific # of doses/days – May have special instructions – May include PRN orders 24
  • 25. DRUG ORDERS 4 categories: 2. One-time – Given 1x, at a specific time 25
  • 26. DRUG ORDERS 4 categories: 3. PRN orders – Given at client’s request and nurse’s judgement 26
  • 27. DRUG ORDERS 4 categories: 4. Stat orders – Given at once, immediately 27
  • 28. DRUG ORDERS Nursing Implications: 3. Check that the medication order is complete and legible. 5. Know the reason why the drug is being administered to client. 28
  • 29. 3 CHECKS before drug administration: •At the time of contact with the drug bottle/container •Before pouring/preparing the drug •After pouring/preparing the drug 29
  • 30. DRUG ORDERS 4. Medication card of Kardex should include the date the medication was ordered and any last date. – Ex. Controlled drugs that need to be renewed q 48h – Anticoagulant & antibiotics renewed after 7 days – Cancellation of drugs when the client gpes to surgery. 30
  • 31. DRUG ORDERS 5. The 1st dose, one time and “as needed” medication orders should be checked against original orders. 6. Be aware of certain drugs that sound alike and are spelled similarly. 31
  • 32. 2. RIGHT DOSE • Dose prescribed for a particular client Nursing Implications: 4. Calculate dose correctly. When in doubt, it should be calculated and checked by another nurse. 6. Check references (PPDR, drug package insert) for recommended range of specific drug doses. 32
  • 33. 3. RIGHT TIME • Time at which the prescribed dose should be administered. Nursing Implications: • Administer at specific time. 33
  • 34. Nursing Implications: 2. Administer that are affected by foods, before meals. 34
  • 35. Nursing Implications: 3. Administer that can irritate the stomach with food. 4. Drug administration schedule maybe adjusted to fit the client’s lifestyle, activities, tolerances or preferences. 35
  • 36. Nursing Implications: 5. It is the nurse’s responsibility to check whether the client is scheduled for any diagnostic procedures that would contraindicate the administration of medications. 36
  • 37. Nursing Implications: 6. Check the expiration date. Discard the medication or return it to the pharmacy if the date has passed. 37
  • 38. Nursing Implications: 7. Antibiotics should be administered at even intervals throughout a 24- hr period so that therapeutic blood levels are maintained. 38
  • 39. 4. RIGHT ROUTE • Necessary for adequate absorption Nursing Implications: 1. Assess ability to swallow before administration. 39
  • 40. Nursing Implications: 2. Do not crush/mix medications in other substances without consulting the pharmacist. • Don’t mix with sweet substances to “trick” children. • Don’t mix in an infant’s formula feeding. 40
  • 41. Nursing Implications: 3. Use aseptic technique when preparing and administering drugs. Sterile technique is required with parenteral route. 41
  • 42. Nursing Implications: 4. Administer at the appropriate site. 5. Stay with client until oral drugs have been swallowed. 42
  • 43. Nursing Implications: 6. If it is necessary to combine medication with another substance, explain this to the client. 43
  • 44. 5. RIGHT PATIENT • Nurse must verify the client’s identity before any drug administration Nursing Implications: 4. Verify by checking the identification bracelet. – Some institutions put the client’s photo on his/her health record. 44
  • 45. Nursing Implications: 2. Distinguish between 2 clients with same last name – Have warnings highlighted in bright color on ID tools, such as medication cards, bracelet or Kardex. 45
  • 46. Nursing Implications: 3. Some institutions have ID bracelets coded for allergy status. – Nurse must be aware of this policy. 46
  • 47. 6. Right Documentation • Requires the nurse immediately record the appropriate information about the drug administered. – Name of drug – Dose and route of administration – Time and data of administration – Nurse’s initial/signature – Response to medication, including unexpected reactions, should also be recorded, accdg to institution policy 47
  • 48. 48
  • 49. 7. Right Assessment • Requires appropriate data must be collected before administration of the drug. 49
  • 50. 8. Right to Education • Requires that client receive accurate and thorough information about the medication And how it relates to his or her particular situation. 50
  • 51. 8. Right to Education • Client teaching should include: – Therapeutic purpose – Possible SE – Any diet/lifestyle restrictions – Skill of administration – Lab monitoring 51
  • 52. 8. Right to Education • Coincides with the principle of informed consent – Based on the individual having the knowledge necessary to make a decision. 52
  • 53. 9. Right Evaluation • Requires effectiveness of the medication be determined by the client’s response to the medication • Appropriate to determine the extent of side effects and adverse effects, if any. 53
  • 54. 10. Right to Refuse the Medication • Client can and do refuse to take a medication. • It is the nurse’s responsibility to determine, when possible, the reason for refusal and to take reasonable measures to facilitate the client’s taking of medication. 54
  • 55. Nursing actions when client refuses to take medications: 3. Explain the risk of refusing to take the medication, and reinforce the reason for the medication. 5. When the medication is refused, this refusal should be documented immediately. 7. Inform the nurse manager or health care provider when an omission and refusal to take medication pose a specific threat to the client. 55
  • 56. Patient’s Rights • In addition to the 10 medication “rights”…… DO YOU THINK PATIENTS HAVE OTHER MEDICATION “RIGHTS”? • What additional systems would you like to see in place to ensure safe drug administration? 56
  • 57. Association of Nursing Service Administrators of the Philippines, inc (ANSAP) 10 Golden Rules for Administering Drugs Safely: 3. Right drug 5. Right drug to the right patient 7. Right dose 9. Right drug by the right route 11. Right drug at the right time 57
  • 58. Association of Nursing Service Administrators of the Philippines, inc (ANSAP) 10 Golden Rules for Administering Drugs Safely: 3. Document each drug you administer. 5. Teach your patient about the drugs he is receiving. 7. Take a complete patient drug history (risk of adverse drug reactions when a number of drugs are taken/when pt is taking alcohol drinks) 10. Find out if the patient has any allergies. 12. Be aware of potential drug-drug or drug-food interactions. 58
  • 59. General Guidelines for Correct Administration of Medications Preparation: 3. Wash hands before preparing medications. 5. Check for drug allergies, check the assessment hx and Kardex. 59
  • 60. General Guidelines for Correct Administration of Medications Preparation: 3. Check medication order with health care provider’s orders, Kardex, medication sheets and medication card. 4. Check label on container 3x. 5. Check expiration date on drug label, card; use drug only if date is current. 60
  • 61. General Guidelines for Correct Administration of Medications Preparation: 6. Recheck drug dose calculation with another nurse. 7. Verify doses of drugs that are potentially toxic with another nurse/pharmacist. 61
  • 62. General Guidelines for Correct Administration of Medications Preparation: 8. Pour tablet/capsule into the cap of the drug container. With unit dose, open packet at bedside after verifying client identification. 9. Pour liquid at eye level. Meniscus, the lower curve of the liquid, should be at the line of the desired dose. 10. Dilute drugs that irritate gastric mucosa (aspirin, potassium) or give with meals. 62
  • 63. General Guidelines for Correct Administration of Medications Administration: 3. Administer only those drugs that you have prepared. Do not prepare medications to be administered by another. 63
  • 64. General Guidelines for Correct Administration of Medications Administration: 2. Identify the client by ID band, ID photo and name tag/band. 64
  • 65. General Guidelines for Correct Administration of Medications Administration: 3. Offer ice chips to numb taste buds when giving bad-tasting drugs. 65
  • 66. General Guidelines for Correct Administration of Medications Administration: 4. When possible, give bad- tasting medication first, followed by pleasant-tasting liquids. 66
  • 67. General Guidelines for Correct Administration of Medications Administration: 5. Assist the client to appropriate position, depending on the route of administration. 6. Provide only liquids allowed on the diet. 67
  • 68. General Guidelines for Correct Administration of Medications Administration: 7. Stay with the client until the medications are taken. 68
  • 69. General Guidelines for Correct Administration of Medications Administration: 8. Administer no more than 2.5-3mL of solution IM at 1 site. Infants receive no more than 1 mL of solution IM at 1 site and no more than 1 ml SQ. Never recap needles (universal precaution), use the “fishing method” instead. 69
  • 70. General Guidelines for Correct Administration of Medications Administration: 9. When administering drugs to a group of clients, give drug last to clients who need extra assistance. 70
  • 71. General Guidelines for Correct Administration of Medications Administration: 10. Discard needles and syringes in appropriate containers. 11. Drug disposal is dependent on agency policy. Controlled substances must be returned to the pharmacy. Some disposals need signature of witness. 71
  • 72. General Guidelines for Correct Administration of Medications Administration: 12. Discard unused solutions for ampules. 13. Appropriately store (some require refrigeration) unused stable solutions from open vials. 72
  • 73. General Guidelines for Correct Administration of Medications Administration: 14. Write date and time opened, and your initials on label. 15. Keep narcotics in a double- lock drawer or closet. medication carts must be locked at all times when a nurse is not in attendance. 73
  • 74. General Guidelines for Correct Administration of Medications Administration: 16. Keys to the narcotics drawer must be kept by the nurse and not stored in a drawer or closet. 17. Keep narcotics in a safe place, out of reach of children and others in the home. 18. Avoid contamination of one’s own skin or inhalation to minimize chances of allergy or sensitivity dev’t. 74
  • 75. General Guidelines for Correct Administration of Medications Recording: 3. Report drug error immediately to client’s health care provider and to the nurse manager. Complete incident report. 75
  • 76. General Guidelines for Correct Administration of Medications Recording: 2. Charting: record the drug given, time, route and your initials. 3. Record drugs promptly after given, especially STAT doses. 4. Record effectiveness and results of medications administered, esp PRN medications. 76
  • 77. General Guidelines for Correct Administration of Medications Recording: 5. Report to health care provider and record drugs that were refused with reason for refusal. 6. Record amount of fluid taken with medications in input and output chart. 77
  • 78. General Guidelines for Correct Administration of Medications What to avoid during drug administration: 3. Do not be distracted when preparing medications. 5. Do not give drugs prepared by others. 7. Do not pour drugs from containers with labels that are difficult to read/whose labels are partially removed/fallen off. 78
  • 79. General Guidelines for Correct Administration of Medications What to avoid during drug administration: 4. Do not transfer drugs from one container to another. 5. Do not give medications for which the expiration date has passed. 6. Do not guess about drugs and drug doses. Ask when in doubt. 79
  • 80. General Guidelines for Correct Administration of Medications What to avoid during drug administration: 7. Do not use drugs that have sediment, are discolored, or are cloudy (should not be) 8.Do not leave prepared medications out of sight. 9. Do not give drugs id the client says he/she has allergies to the drug or drug group. 80
  • 81. General Guidelines for Correct Administration of Medications What to avoid during drug administration: 10. Do not call the client’s name as the sole means of identification. 11. Do not give drug if the client states the drug is different from the drug he or she has been receiving. Check the order. 81
  • 82. General Guidelines for Correct Administration of Medications What to avoid during drug administration: 12. Do not recap needle, use universal precaution. 13. Do not mix drug with large amount of food or beverage or foods that are contraindicated. 82

Notas del editor

  1. DISTRIBUTE MEDICATION SHEET