 Consider

The Drug Administration clients experience with

medications or health care system, previous
Process hospital
 Check vital signs (establish baseline)
ASSESSMENT  List meds client is taking or how they can or
 Drug history (allergies, prescription, drugs when
taken, over the counter drugs used)  List knew medication ordered
 Medical history (biographical data, lifestyle  Use holistic framework - identify emotional,
and beliefs, sensory and cognitive status) physical, cognitive, cultural and social
 Physical examination economic factors impacting drug therapy
and nursing process
Assessment of Client
 Collects objectives an objective data: client,
drug, and environment PLANNING CARE: IDENTIFYING GOALS
 Use current drug handbook / text / AND OUTCOME CRITERIA
reference / licensed pharmacist  Prioritized the nursing diagnosis
 Create a medication profile  Specify objective, measurable, realistic
goals
Assessing Drug History of Client  Establish a time period for achievement of
 OTC meds (e.g. aspirin, vitamins, dietary outcomes
supplements, NSAIDS, laxatives, antacids,  If order is in question - do not give - call
minerals, elements) physician for clarification or further
 Prescription Medications (e.g. birth control instructions
pills, hormone replacements, drugs for
sexual dysfunction)
 Street Drugs (e.g. marijuana, cocaine, PCP NURSING DIAGNOSIS
LSD illegal narcotics i.e. oxytocin)  Health maintenance, altered.
 Herbal and homeopathic substances  Knowledge deficit.
 Problems with drug therapy in the past (e.g.  Management of therapeutic regimen,
allergies, adverse effects, diseases or ineffective.
injuries, organ pathology)  Physical mobility, impaired.
 Growth and development issues as related  Sensory or perceptual alterations.
to the client's age and specific expectations  Swallowing impaired.

THE INTERVIEW PROCESS NURSING INTERVENTIONS

 Establish a therapeutic relationship with Primary nursing interventions related to
client medication management are:
 Use open ended questions (avoid “yes” or P Assessment
“no” answers) P Administration
P Teaching
Questions/Content of Questions Should
Include:
 Oral intake of client: how does client IMPLEMENTATION
tolerate fluids  Requires constant communication and
 Swallow problems collaboration with client and health care
 Laboratory/diagnostic tests value e.g. team
Renal, liver panels, hgb/hct., protein,  Follow the “Eight Rights”:
albumin levels. 1. Right Patient
2. Right Medication
3. Right Dose
 4. Right Route
5. Right Time 2. Right Patient
6. Right Documentation Ask the name of the client and check his/her ID
7. Right Reason band before giving the medication. Even if you
8. Right Responds know that patient’s name, you still need to ask
just to verify.
Client or Patient's Rights with Regards to
Medication 3. Right Dose
1. Right to a “double check” Check the medication sheet and the doctor’s
2. Right to proper storage or order before medicating. Be aware of the
documentation difference between an adult and a pediatric
3. Right to accurate calculation and dose.
preparation
4. Right to careful checking of transcription 4. Right Route.
of orders Check the order if it’s oral, IV, SQ, IM, etc.
5. Client safety - use of correct
administration procedures 5. Right Time and Frequency.
6. Right to close consideration of special Check the order for when it would be given and
situations e.g.: difficulty with swallowing, when was the last time it was given.
client with ng tube or who is
unconscious 6. Right Documentation.
7. Right to having all measures taken to Make sure to write the time and any remarks
prevent and report med errors if they on the chart correctly.
occur
8. Right to individualize or complete client 7. Right History and Assessment.
teaching Secure a copy of the client’s history to drug
interactions and allergies.

EVALUATION OF DRUG THERAPY: AN 8. Drug approach and Right to Refuse.

ONGOING PART OF THE NURSING Give the client enough autonomy to refuse the
PROCESS medication after thoroughly explaining the
 Monitor client responses to the drug effects.
 Monitor expected and unexpected
responses 9. Right Drug-Drug Interaction and
 Monitor therapeutic (intended effects), side Evaluation.
effects, adverse effects and toxic effects Review any medications previously given or
the diet of the patient that can yield a bad
interaction to the drug to be given. Check also
the expiry date of the medication being given.
Ten Rights of Medication
Administration 10. Right Education and Information.
Provide enough knowledge to the patient of
what drug he/she would be taking and what are
1. Right Drug
the expected therapeutic and side effects.
The first right of drug administration is to check
and verify if it’s the right name and form.
Beware of look-alike and sound-alike
medication names. Misreading medication Medication Orders
names that look similar is a common mistake. Reviewing Pertinent Data Prior to
These look-alike medication names may also Medication Administration
sound alike and can lead to errors associated
with verbal prescriptions.
Prior to the administration of medications, the
nurse must check and validate the medication Medication orders are often transcribed by
order, and also apply their critical thinking skills hand onto a medication administration record
to the ordered medication and the status and (MAR) or Medex, when the facility is not using
condition of the client in respect to the computerized order entry.
contraindications, pertinent lab results,
pertinent data like vital signs, client allergies, The client's allergies are determined, all
and potential interactions of the medication that contraindications for the medication as based
is to be given. on the client's health problems and disease
conditions are determined, pertinent diagnostic
A complete medication order must include the laboratory results such as checking the client's
client's full name, the date and the time of the prothrombin time and partial thromboplastin
order, the name of the medication, the ordered time prior to the administration of heparin,
dosage, and the form of the medication, the client data like a blood pressure and a pulse
route of administration, the time or frequency of rate prior to the administration of an
administration, and the signature of the antihypertensive medication and digoxin, for
ordering physician or licensed independent example, are assessed and any possible
practitioner's signature. interactions with other medications, foods and
alternative and over the counter preparations
The four general types of medication orders are assessed in order to determine whether or
are stat orders, single orders, standing orders not the medication should be administered.
and prn orders. Stat medication orders are The doctor must be notified whenever the
administered immediately and only once; single nurse has any concerns or problems with these
orders are also given only once but not things.
necessarily immediately; a standing order is an
order for a medication that will be given at
specific times until it is discontinued by a
doctor's order or by default when a facility's
3 Medication Label
policy states that all standing orders are Checks done during preparation for
automatically discontinued after 7 days unless medication administration
the physician has reordered the medication. A
prn order indicates that the ordered medication Definitions
is only given when a specified condition, like o Administration - setting up and giving
pain or nausea, is present. medications.
o Frequency – how often a medication
All incomplete, questionable and/or illegible
must be given.
orders must be questioned and validated by
o MAR – medication administration
the nurse transcribing the order before it is
record.
administered to the client. This questioning and
o Route – how a medication is given.
validation requires that the registered nurse
use, integrate and apply their critical thinking o Time – when the medication is
and professional judgment skills. Automated scheduled on the MAR.
order entry using a computer eliminates some
medication order errors including those that WHAT ARE THE THREE CHECKS?
result from illegibility of handwriting and Checking the:
ordering a medication with which the client is – Name of the person;
allergic to, however, nurses should never – Strength and dosage; and
assume that this is the case. For example, – Frequency against the:
medications that have sound alike names and  Medical order;
medications that are similar in terms of their  MAR; and
correct spelling can remain at risk even when  Medication container.
computerized, automatic order entry is used.
The Three Checks must be used every time Right Form. Confirm that the form of medicine
medications are given. that has been dispensed, matches with the
specified route of administration
Safe medication administration is not an
accident. It must be a well-planned process Right Action. Ensure medicine is prescribed
that is used each and every time: for the appropriate reason, and state to
When setting up or administering medications patient / parent / carer, the action of the
avoid distractions and interruptions. medication and why it is prescribed.

Never give medications by “memory.” Use the Right Documentation. Sign, date all
Six Rights and Three Checks every time. documentation recording the administration of
the medicine in medicines administration chart.
Avoid “auto-pilot” - think about what you are The chart must only be signed to record a
doing. medicine has been administered once the
medicine administration has been witnessed.
Double check anytime there is concern or a
question about a medication. Right Response. Observe the patient for
adverse effects, assess patient to determine
that the desired effect of the medicine has
Ten Rights of Safe been achieved.

Medication Administration
Right Patient. Be certain of identity of patient
by verifying the identification wristband, name
and date of birth on the medicine chart.

Right Reason. Understand the intended

purpose of the medicines to be administered.

Right Medicine. Name of medicine to be

administered must correspond with generic or
brand name of prescribed medicine.
Must have been stored correctly, properly
packaged and within its expiry date.
Must check, both by asking patent and
checking allergy box on the kardex, whether
patient has a known and recorded allergy to
the prescribed medicine.

Right Route. Administer medicine via

prescribed route and site

Right Time. Administer medicine at prescribed

time and prescribed intervals

Right Dose. Confirm that the dose of medicine

being administered is exactly the dose
prescribed.