PHARMACOLOGY

THE NURSING PROCESS 3. “As evidenced by”

● Critical thinking
● Creativity
PHARMACOLOGY AND THE NURSING
● Accurate data collection
PROCESS
● It is a statement about the patient’s status
● The Nursing Process is crucial for safe
and will guide nursing interventions
medication administration.
● Crucial - of the greatest significance in
PLANNING
determining an outcome
● Identification of goals
○ Must be patient-centered
Nursing Process draws together all of the aspects
● Outcome criteria
of the patient:
○ Must be SMART
● Physical
○ Have a time frame
● Cultural
● Prioritization
● Cognitive
● Spiritual
IMPLEMENTATION
● Sexual
● Initiation and completion of the NCP as
● Financial
defined by the nursing diagnoses and
○ Recognizing these aspects allows for
outcome criteria
a more holistic approach to patient
care
EVALUATION
● Ongoing part of the nursing process
THE NURSING PROCESS
● Determining the status of the goals and
● A research-based organizational framework
outcomes of care
for professional nursing practice
● Central to all nursing care
THE NURSING PROCESS AND
● Encompasses all steps taken by the nurse in
MEDICATION ADMINISTRATION
caring for a patient
● Ongoing and constantly evolving process
ASSESSMENT
○ Critical thinking
1. Health-allergies
○ Flexibility is important
○ Pattern of healthcare
experiences/illnesses
○ Level of education understanding of
ASSESSMENT
the disease process
● Data collection
○ Financial support
○ Subjective, objective
2. Physical assessment - age and weight social
○ Accurate
support at home chronic conditions
3. Diagnostic tests, lab values
NURSING DIAGNOSIS
4. Medication history
● Decision about the need/problem (actual or
○ Prescriptions
at risk for)
○ OTCs
○ Herbals
Three parts
○ Responses to medications
1. Human response to illness
(therapeutic and adverse responses)
2. “Related to”
 PHARMACOLOGY
NURSING DIAGNOSIS 3. Right time
● Human response to illness (actual or risk) 4. Right route
○ Drug therapy may only be a small 5. Right patient
part of the total pt picture Medication errors are a major problem in
○ Or, at times it may be an all healthcare today
consuming factor in the patient’s life
● Drug therapy is incorporated into the total PLUS FIVE RIGHTS OF MEDICATION
picture ADMINISTRATION
● Right documentation
PLANNING ● Right assessment
1. Identification of possible interactions ● Right to education
○ Knowledge of the prescribed ● Right evaluation
medication ● Right to refuse
○ Over-the-counter (OTC) drugs, herbs
2. Client and family education 1) RIGHT DRUG
○ Level of patient understanding of ● Pt should receive the drug that was
disease prescribed.
○ Level of education ● Medication orders may be prescribed
3. Gather equipment, review procedures, safety by:
measures ○ Physician
○ Timing and frequency of drugs ○ Dentist
○ Storage of drugs ○ Podiatrist (foot doctor)
○ Licensed health care provider
This phase leads to the provision of safe effective ● Prescription - written on
medication administration prescription pad
● Drug orders - written in “order
IMPLEMENTATION sheets” included in pt’s chart
1. Maximizing therapeutic effects
2. Minimizing adverse effects DRUG ORDERS
○ Provide comfort measures and help - Accurately written drug orders are part of
pt. cope with the therapeutic or patient rights
adverse effects of a drug
3. 10 rights of medication administration SIX ELEMENTS OF A DRUG ORDER
1. Name of the patient
EVALUATION 2. Date order is written (start/stop dates may be
● Monitoring the patient’s response to drug ordered)
therapy 3. Name of medication
1. Expected outcome 4. Dosage includes size, frequency, and number of
2. Unexpected outcome doses
5. Route of delivery
6. Signature of the prescriber
THE FIVE RIGHTS OF MEDICATION
ADMINISTRATION
1. Right drug
2. Right dose
 PHARMACOLOGY
4 CATEGORIES (Drug orders): 5. Be aware of certain drugs that sound alike
1. Standing Order and are spelled similarly.
○ Maybe an ongoing order
○ Maybe given for a specific # of 2) RIGHT DOSE
doses/days ● Dose prescribed for a particular
○ May have special instructions client
○ May include PRN orders
2. One-time Nursing Implications:
○ Given 1x, at a specific time 1. Calculate dose correctly. When in doubt, it
3. PRN Orders should be calculated and checked by another
○ Given at client’s request and nurse’s nurse.
judgement 2. Check references (PPDR, drug package
4. STAT Orders insert) for recommended range of specific
○ Given at once, immediately drug doses.

Nursing Implications: 3) RIGHT TIME

1. Check that the medication order is complete ● Time at which the prescribed dose
and legible. should be administered
2. Know the reason why the drug is being
administered to clients. Nursing Implications:
○ 3 checks before drug 1. Administer at specific time.
administration: 2. Administer that are affected by foods, before
At the time of contact with meals.
the drug bottle/container 3. Administer that can irritate the stomach with
Before pouring/preparing the food.
drug 4. Drug administration schedule may be
After pouring/preparing the adjusted to fit the client’s lifestyle, activities,
drug tolerances or preferences.
3. Medication card of Kardex should include 5. It is the nurse’s responsibility to check
the dare medication was ordered and any whether the client is scheduled for any
last date. diagnostic procedures that would
contraindicate the administration of
Example: medications.
- Controlled drugs that need to be 6. Check the expiration date.
renewed q 48h ○ Discard the medication or return it to
- Anticoagulant & antibiotics renewed the pharmacy if the date has passed.
after 7 days 7. Antibiotics should be administered at even
- Cancellation of drugs when the client intervals throughout a 24hr period so that
goes to surgery. therapeutic blood levels are maintained.

4. The 1st dose, one time and “as needed”

medication orders should be checked against
original orders.
 PHARMACOLOGY
4) RIGHT ROUTE 6) RIGHT DOCUMENTATION
● Necessary for adequate absorption ● Requires the nurse to immediately
record the appropriate information
Nursing implications: about the drug administered.
1. Assess ability to swallow before ○ Name of drug
administration. ○ Dose and route of
2. Do not crush/mix medications in other administration
substances without consulting the ○ Time and date of
pharmacist. administration
○ Don’t mix with sweet substances to ○ Nurse’s initial/signature
“trick” children. ○ Response to medication,
○ Don’t mix in an infant’s formula including unexpected
feeding. reactions, should also be
3. Use aseptic technique when preparing and recorded, accdg to institution
administering drugs. policy
○ Sterile technique is required with
parenteral route. 7) RIGHT ASSESSMENT
4. Administer at the appropriate site. ● Requires appropriate data must be
5. Stay with the client until oral drugs have collected before administration of the
been swallowed. drug.
6. If it is necessary to combine medication with
another substance, explain this to the client. 8) RIGHT TO EDUCATION
● Requires that the client receive
accurate and thorough information
5) RIGHT PATIENT about the medication and how it
● Nurses must verify the client’s relates to his or her particular
identity before any drug situation.
administration ● Client teaching should include:
○ Therapeutic purpose
Nursing Implications: ○ Possible SE
1. Verify by checking the identification ○ Any diet/lifestyle restrictions
bracelet. ○ Skill of administration
○ Some institutions put the client’s ○ Lab monitoring
photo on his/her health record. ● Coincides with the principle of
2. Distinguish between 2 clients with the same informed consent.
last name. ○ Based on the individual
○ Have warnings highlighted in bright having the knowledge
color on ID tools, such as medication necessary to make a decision.
cards, bracelets or Kardex.
3. Some institutions have ID bracelets coded 9) RIGHT EVALUATION
for allergy status. ● Requires effectiveness of the
○ Nurses must be aware of this policy. medication be determined by the
client’s response to the medication
 PHARMACOLOGY
● Appropriate to determine the extent 10. Be aware of potential drug-drug or
of side effects and adverse effects, if drug-food interactions.
any.
GENERAL GUIDELINES FOR CORRECT
10) RIGHT TO REFUSE THE ADMINISTRATION OF MEDICATIONS
MEDICATION ❖ Preparation:
● Clients can and do refuse to take 1. Wash hands before preparing medications.
medication. 2. Check for drug allergies, check the
● It is the nurse’s responsibility to assessment hx and Kardex.
determine, when possible, the reason 3. Check medication order with health care
for refusal and to take reasonable provider’s orders, Kardex, medication sheets
measures to facilitate the client’s and medication card.
taking of the medication. 4. Check label on container 3x.
5. Check expiration date on drug label, card;
Nursing actions when client refuses to take use drug only if date is current.
medications: 6. Recheck drug dose calculation with another
1. Explain the risk of refusing to take the nurse.
medication, and reinforce the reason for the 7. Verify doses of drugs that are potentially
medication. toxic with another nurse/pharmacist.
2. When the medication is refused, this refusal 8. Pour tablet/capsule into the cap of the drug
should be documented immediately. container. With a unit dose, open the packet
3. Inform the nurse manager or health care at bedside after verifying client
provider when an omission and refusal to identification.
take medication pose a specific threat to the 9. Pour liquid at eye level. Meniscus, the lower
client. curve of the liquid, should be at the line of
desired dose.
ASSOCIATION OF NURSING SERVICE 10. Dilute drugs that irritate gastric mucosa
ADMINISTRATORS OF THE PHILIPPINES, (aspirin, potassium) or give with meals.
INC (ANSAP)
❖ Administration:
10 Golden Rules for Administering Drugs Safely: 1. Administer only those drugs that you have
1. Right drug prepared.
2. Right drug to the right pt ○ Do not prepare medications to be
3. Right dose administered by another.
4. Right drug by the right route 2. Identify the client by ID band, ID photo and
5. Right drug at the right time name tag/band.
6. Document each drug you administer 3. Offer ice chips to numb taste buds when
7. Teach your pt about the drugs he is receiving giving bad-tasting drugs.
8. Take a complete pt drug history (risk of 4. When possible, give bad-tasting medication
adverse drug reactions when a number of first, followed by pleasant-tasting liquids.
drugs are taken/when pt is taking alcohol 5. Assist the client to an appropriate position,
drinks) depending on the route of administration.
9. Find out if the patient has any allergies 6. Provide only liquids allowed on the diet.
 PHARMACOLOGY
7. Stay with the client until the medications are ❖ Recording:
taken. 1. Report drug error immediately to the client's
8. Administer no more than 2.5-3 mL of health care provider and to the nurse
solution IM at 1 site. manager.
○ Infants receive no more than 1 mL of ○ Complete incident report.
solution IM at 1 site and no more 2. Charting: record the drug given, time, route
than 1 mL SQ. and your initials.
○ Never recap needles (universal 3. Record drugs promptly after given,
precaution), use the “fishing especially STAT doses.
method” instead. 4. Record effectiveness and results of
9. When administering drugs to a group of medications administered, esp PRN
clients, give drugs last to clients who need medications.
extra assistance. 5. Report to a health care provider and record
10. Discard needles and syringes in appropriate drugs that were refused with reason for
containers. refusal.
11. Drug disposal is dependent on agency 6. Record amount of fluid taken with
policy. medications in input and output chart.
○ controlled substances must be
returned to the pharmacy. Some ❖ What to avoid during drug administration:
disposals need the signature of a 1. Do not be distracted when preparing
witness. medications.
12. Discard unused solutions for ampules. 2. Do not give drugs prepared by others.
13. Appropriately store (some require 3. Do not pour drugs from containers with
refrigeration) unused stable solutions from labels that are difficult to read/whose labels
open vials. are partially removed/fallen off.
14. Write date and time opened, and your 4. Do not transfer drugs from one container to
initials on the label. another.
15. Keep narcotics in a double-lock drawer or 5. Do not give medications for which the
closet. expiration date has passed.
○ Medication carts must be locked at 6. Do not guess about drugs and drug doses.
all times when a nurse is not in Ask when in doubt.
attendance. 7. Do not use drugs that have sediment, are
16. Keys to the narcotics drawer must be kept discolored, or are cloudy (should not be)
by the nurse and not stored in a drawer or 8. Do not leave prepared medications out of
closet. sight.
17. Keep narcotics in a safe place, out of reach 9. Do not give drugs if the client says he/she
of children and others in the home. has allergies to the drug or drug group.
18. Avoid contamination of one’s own skin or 10. Do not call the client’s name as the sole
inhalation to minimize chances of allergy or means of identification.
sensitivity dev’t. 11. Do not give drugs if the client states the
drug is different from the drug he or she has
been receiving. Check the order.
12. Do not recap needle, use universal
precaution.
 PHARMACOLOGY
13. Do not mix drugs with large amounts of E.g.
food or beverage or foods that are - Ceftriaxone - Generic Name
contraindicated. - Mesporin, Samixon, Rocephin -
Trade Name

MEDICATION ADMINISTRATION 2. Classification of Drugs

- Drugs are classified in several ways,
Administration of Medications according to their action,
● Medicine may be defined as a substance composition, their purposes and uses
used to promote health, to prevent, to etc.
diagnose, to alleviate or cure diseases. E.g.
● The safe and accurate administration of - Analgesics
medication is one of the major - Antipyretics, etc.
responsibilities of a nurse.
● The nurse must have through knowledge of 3. Preparation of Drugs
drugs that is administered by her - Medications are available in different
types of preparation.
“A fundamental rule of safe drug administration is: - The preparations may determine the
never administer an unfamiliar medication” method of administration.
E.g.
● Nurses must know generic and trade names - Capsule, Ointment, Powder,
of drugs to be administered, classification, Suppository, etc.
average dose, route of administration, use,
side and adverse effects, contraindications, 4. Dosage
and using nursing implications in - The dose is the amount of drug
administration. administered at one time.
● Essential parts of medication order. Information about the dosage and
● Abbreviations and symbols used in writing route is crucial to protect against
medication orders as per hospital policies. medication error.
● Preparation of solutions and fractional doses
● Storing of medicines 5. Effects of Drugs on the Body
● Factors of safety in the administration of ● Therapeutic Effects
medicines ○ It is the effect which is
● Rules for the administration of medicines desired or the reason a drug is
● Ethical and legal aspects prescribed.
● Nurse’s role in the administration of ● Local and Systemic Effects
medicines. ○ Local effects of drugs are
expected when they are
DRUG KNOWLEDGE applied topically to the skin
1. Names of Drugs or mucous membrane. A drug
- All the drugs will have at least two used for systemic effect must
names be absorbed into the
1.) Generic Name bloodstream to produce the
2.) Trade Name desired effect in the various
 PHARMACOLOGY
systems and parts of the PREGNANCY CATEGORY
body.
● Toxic Effects CATEGORY DESCRIPTION
○ May develop after prolonged
intake or when a medicine Category A - Studies indicate no risk to the
accumulates in the blood human fetus.
because of impaired
Category B - Studies indicate no risk to
metabolism or excretion, or animal fetus; information in
excessive amount taken. humans is not available.
○ Toxic levels of opioids can
cause respiratory depression Category C - Adverse effects reported in
animal fetus; information in
○ Antidotes available to reverse
humans is not available.
effects.
Category D - Possible fetal risk in humans
SIDE AND ADVERSE EFFECTS reported; however,
● Side effects are NON-THERAPEUTIC considering potential benefit
reactions to a drug vs. risk may, in selected
cases, warrant the use of
○ Unintended secondary effects a these drugs in pregnant
medication predictably will cause women.
○ May be harmless or serious
○ If side effects are serious enough to Category X - Fetal abnormalities reported
negate the beneficial effect of meds and positive evidence of fetal
risk in humans is available
therapeutic action, it may be
from animal and/or human
discontinued studies. These drugs should
○ People may stop taking medications not be used in pregnant
because of the side effects (An women.
example of side effect is Drowsiness,
which occurs with antihistamines) Nursing Process in Administering Drugs:
● Adverse Drug Reaction ● ASSESSMENT
○ Any reaction to a drug that is ○ The first step of the nursing process
undesirable, unexpected, and occurs is the systematic organized collection
at doses normally used for the of data about the patient.
prevention, diagnosis, or treatment of
disease. ● NURSING DIAGNOSIS
○ All adverse medication reactions or ○ Once the data have been collected,
suspected medication reactions are the nurse must organize and analyze
reported to the Physician, Nurse that information to arrive at a nursing
Manager/Charge Nurse and diagnosis
Pharmacist. An adverse reaction is
reported to the Pharmacy by filling ● INTERVENTION
out the Adverse Drug Reaction ○ The assessment and nursing
Notification Form. diagnosis of the patient’s situation
will direct specific nursing
intervention.
 PHARMACOLOGY
● EVALUATION bid Twice a day 8am, 8pm(IV) -
○ It is a part of the continual process of 10am, 10pm
pt care that leads to changes in (oral)
assessment, diagnosis, intervention.
tid Three times a 10am, 6pm, 2am
The patient is continually evaluated day
for therapeutic response.
q6h Every six hours 6am, 12nn, 6pm,
(four times a 12am
ESSENTIAL OF MEDICATION ORDER day)
● The drug order, written by the physician, has
7 essential parts of administration of drugs q4h Every four hours 6am, 10am,
(six times a day) 2pm, 6pm,
safely. The nurse should know how to read a
10pm, 2am
drug order.
● It should have the following components: q3h Every three 6am, 9am, 12nn,
1. Patients full name. hours (eight 3pm, 6pm, 9pm,
times a day) 12am, 3am
2. Date and time.
3. Drug name. q2h Every two hours 6am, 8am,
4. Dosage. (twelve times a 10am, 12nn,
day) 2pm, 4pm, 6pm,
5. Route of administration.
8pm, 10pm,
6. Time and frequency of 12am, 2am, 4am
administration.
7. Signature of physician. BASIC PRINCIPLES (SAFETY) IN
MEDICATION ADMINISTRATION
TYPES OF MEDICATION ORDERS ● 3 Checks
● STAT order ○ Obtaining the container
○ Needed Immediately ○ Removing the med
● Single order ○ Replacing the container
○ Given only once ● 7 Rights
● Routine orders 1. Right patient
○ Given within 2hrs of being written 2. Right dose
and carried out on schedule 3. Right drug
● Standing order 4. Right route
○ Written in advance carried out under 5. Right time
specific circumstances. 6. Right Frequency
7. Right Documentation

TIME OF MEANING TIME RIGHT DRUG

ABBREVIATION
● Read the physician’s orders to study the
ac Before Meals 7:30am, correct name of the drug
12:30pm, ● If the order is not clear consult the physician
7:30pm
● Make sure the drug copied correctly on the
pc After Meals 10am, 2pm, medication chart, on the nurses record
10pm ● Select the right drug from the cupboard.
Read the label of the medicine container and
Tid - with Three times a 8am, 1pm, 8pm
meals daily w/ meals
 PHARMACOLOGY
the name of the medicine in the medication ● Know the abbreviations used to designate
chart thrice. the route of administration
● Look for the colour, odour and consistency ○ E.g. I,V, IM, P,O, etc.
of the drug. Unusual characteristics of the ● Review the available forms of drug to make
drug should be questioned. sure the drug can be given according to the
● Administer medicine only from a clearly order.
labeled container. ● Make sure the pt is able to take the drug by
● Avoid conversations during preparation of the route indicated or ordered.
medicines.
● Read the physician’s orders to know the COMMON ROUTE
correct dose. ● ORAL (P.O)
● Consider the age and weight of the patient. ○ It is the most common route
This may help to find an error in physician’s ○ Most convenient route
orders. ○ The easiest and most desirable way
● Know the minimum and maximum dose of to administer medication
the medicine administered. Calculate the ○ Usually less expensive
fraction dosage correctly. ○ Inappropriate if client cannot
● Have the medicine card or written order swallow and if GIT has reduced
before you preparing drug. motility
● Know the abbreviations and symbols used. ○ Inappropriate for client with nausea
● Help the pt to take all the medicines that are and vomiting
ordered for him. ○ Drug may have unpleasant taste
○ Drug may discolor the teeth
RIGHT PATIENT ○ Drug may irritate the gastric mucosa
● An important step in administering ○ Drugs may be aspirated by seriously
medication safely is being sure the ill pt.
medication is given to the right client.
● Read the physician’s orders to make sure for Nurse’s Responsibility in Administration of Oral
whom the medicine is ordered. Drugs
● To identify the client correctly: Check the physician’s orders, check the
● The nurse check the medication diagnosis and age of the pt.
administration form against the client’s Check the purpose of medication
identification bracelet and ask the client to Check the nurses record for the time of the
state his or her name to ensure the client’s last dose given.
identification bracelet has the correct Check for any contraindications present
information. (nausea, vomiting, delirium,
unconsciousness, etc.)
RIGHT ROUTE
Check the form of the drug available
● Read the physician’s orders to determine the
Break the tablets only if it is scored
route of administration
Explain the procedure to the pt, discuss the
● Dilute the drug if indicated
need of medications.
● Know right method of giving drugs,
○ E.g. oral, parenterally, etc. Assist the pt sitting position if possible
Stay with the pt until swallow medicine
 PHARMACOLOGY
● SUBLINGUAL ○ Thickness of application
○ A drug that is placed under the ● Assessment of ear canal
tongue, where it dissolves. ● Warming of solution
○ When the medication is in capsule ● Straightening of canal for children and
and ordered sublingually, the fluid adults
must be aspirated from the capsule
and placed under the tongue. ● Nasal Instillation
○ A medication given by the ○ Assessment of nares
sublingual route should not be ○ Client instruction and
swallowed, or desire effects will not self-administration
be achieved. ● Vaginal Instillation
○ Same as oral ○ Suppositories, foams, creams
○ Drugs are rapidly absorbed in the ○ Use of gloves and applicator
bloodstream. ○ Client positioning, comfort, and
○ If swallowed, drug may be hygiene
inactivated by gastric juices. ● Eye Instillation
○ Drug must remain under the tongue ○ Drops, ointments, disks
until dissolved and absorbed. ○ Assessment of eyes
○ Asepsis
● BUCCAL ○ Positioning
○ A medication is held in the mouth ● Suppositories
against the mucous membranes of ● Use of gloves
the cheek until the drug dissolves. ● Client positioning and hygiene
○ The medication should not be ● Inhalation
chewed, swallowed, or placed under ○ The pt inhales the fumes in to the
the tongue (e.g. sustained release lungs to have local or systemic
nitroglycerine, opiates, antiemetic, effects
tranquilizer, sedatives)
○ Clients should be taught to alternate PARENTERAL ADMINISTRATION OF
the cheeks with each subsequent MEDICINE
dose to avoid mucosal irritation. ● Parenteral therapy means giving of
○ Same as oral therapeutic agents including food outside the
○ Drug can be administered for local alimentary tract.
effect ● Types of parenteral routes: Intradermal,
○ Ensures greater potency because subcutaneous, Intramuscular, Intravenous,
drug directly enters the blood and etc.
bypass the liver
○ If swallowed, drug may be Purposes:
inactivated by gastric juice ● To get rapid and systemic effect of drug
● To provide needed effect when the pt
TOPICAL ADMINISTRATION unconscious, unable to swallow due to
● Skin Applications neurological or surgical alterations.
○ Use of gloves or applicators ● To give nourishment when it cannot taken
○ Preparation of skin by mouth
 PHARMACOLOGY
Intradermal Route ○ Never use for kids less than 2 yrs old
○ Intradermal: medicine when introduced in or small children with small body
the dermis (under the epidermis) mass/muscle
○ 10-15 degree angle ○ Divide in fourths, upper/lateral
○ 0.5 mL or less of medication divide in fourths again, outside top
○ Injection into the dermis edge
○ Form a bleb or wheal ○ Position: the pt may be prone or side
○ Common site: forearm, upper back, upper lying.
dorsal aspect of the arm, and upper chest
○ Many nerves are in the dermis - painful,
burning sensation
○ TB and allergy testing most common
○ 27g needle most common
○ Slowly inject medication until wheal forms
on skin
○ Avoid scarred, blemished, hairy areas

Subcutaneous
○ Medicine introduced in to the subcutaneous
tissue
○ 45-90 degree angle
○ adipose tissue ● Vastus Lateralis
○ Tissue does not have as many blood vessels ○ The vastus lateralis is the major
as muscle so medication is absorbed slower muscle in the anterolateral thigh and
○ 1 mL max is used most often for intramuscular
○ Common sites: posterior arm, abdomen and injections in infants. By school-age
anterior aspects of the thigh and adolescence, this site may be
○ 23-25 gauge needles more painful than others because of
○ Rotate injection sites the development of the musculature.
○ “Give slowly” ○ To administer: locate the area
between the greater trochanter of the
Intramuscular femur and the knee. Divide this area
● Deltoid into thirds. Give the injection into
○ Expose upper arm and shoulder the middle third, grasping the thigh
○ Relax arm, flex elbow to find and compressing the muscle as
triangle-shaped deltoid muscle shown. The needle should be
○ Injection site in center of triangle directed on a front-to-back course.
● Dorsogluteal ● Ventrogluteal Muscles
○ Ventrogluteal, Vastus Lateralis ○ The ventrogluteal muscles make up
○ Dorsogluteal: is composed of the the other preferred site for IM
thick gluteal muscles of the buttocks. injections infants, although this is a
(Extreme caution: sciatic nerve and useful site for other age-groups as
major blood vessels) well. These muscles contain no
important nerves or vessels and are
 PHARMACOLOGY
accessible when the child is in a Right Time & Right Frequency
variety of positions. ● Administered the drug as per physician’s
○ To administer: on the anterior orders
superior iliac spine and your middle ● The nurse must know why a medication is
finger at the iliac crest. Inject the ordered for certain times of the day and
medication just below the iliac crest whether the time schedule can be altered
𝑜
using a 90 angle. ● Medication that must act a certain times are
● Gluteal Region given priority (e.g. insulin should be given
○ The gluteal muscles are very small at a precise interval before a meal)
and poorly developed in the infant ● Know the common approved abbreviation in
and young toddler. It is not administering drugs as per intuitional policy.
recommended as an injection site ● Give the medicine as ordered in relation to
until the child has been walking for the food intake (a.c (before meals), (p.c
at least one year since locomotion (after meals)
helps to develop the gluteal ● Give the medicines according to the action
musculature. expected, (e.g. sleeping pills are given at
○ Place the child supine and encourage bedtime, the diuretics are given in the
a “toe-in” position as this position morning hours).
will help relax the muscle. Palpate
the posterior superior iliac spine and Right Documentation
the head of the greater trochanter of ● Documentation is an important part of safe
the femur. Give the injection superior medication administration
and lateral to the imaginary line ● The documentation for the medication
between these landmarks. Direct the should clearly reflect the client’s name, the
needle in a straight front-to-back name of the ordered medication, the time,
course. dose, route and frequency.
● Sign medication sheet immediately after
Nurses responsibility in administration of administration of the drug.
parenteral medications ● Use the standard abbreviations on recording
● Check the physician’s orders for the type of the medications.
injections, dosage, and the route of ● Record only that medicine which you have
administration administered.
● Check the diagnosis and age of the pt’s ● Never record a medication before it is given
● Check the purpose of injections to the pt.
● Check the necessity for giving test dose ● Record the effects observed.
● Check the form of the medication available ● Record the medications that are vomited by
and the correct method of administration. the pt, refused by the pt and those drugs that
● The nurse must have the knowledge of are not administered to the pt and the reason
anatomy and physiology of the body is for not giving the medication.
essential and safe administration of
medication parenteral route. Rules of administration of medication
While preparing the drugs:
● Read the physician’s orders before preparing
the drug. No medicine should be prepared
 PHARMACOLOGY
without the doctor's orders. Verbal orders are ● Do not leave the medicine with the pt.
carried out only in emergency. ● Medication errors must be reported
● Check the medicine card against the according to the policy of the hospital.
physician’s orders. Be sure the medicine is
copied correctly on the medicine card and in Monitoring first dose of medication
the nurse’s record. Before administering the drugs:
● Avoid conversation during the preparation ● Ask if the pt has taken medication before
of medicine. ● Ask for pt allergies
● Calculate the drug dosage accurately if ● Review concomitant medicines, herbs and
doubt consult other supervisor or physician. foods
● Read the label of the medicine and compare ● Review concomitant disease states
it with the medicine card thrice: ● Review lab values
○ Before the medicine container taken ● Know right medications, dose, pt, route,
from the shelf time, and reason
○ Before pouring the drugs ● Explain to pt, medication’s name, purpose
○ Before replacing the container in and potential adverse effects.
shelf
○ Check the expiry date of the drugs During & after administration:
along with the 3 checks ● Observe for changes in clinical status,
● Make sure the medicine glasses are clean adverse reactions and allergic reactions.
and dry before the medicine is taken. ● When present, involve the family in
● When taking tablets and capsules do not monitoring the pt.
touch them with your hand. Drop the tablets ● Monitor for acute changes in clinical status,
from the container to its lid and then into the pt’s subjective and objective response.
medicine cup to be taken to the bedside. ● Adverse reactions and allergic reactions
● Once the medicine is poured out of the ● If adverse reactions are present, follow the
bottle, it should not be poured back in the hospital policy and procedure of reporting
bottle to prevent contamination of the whole adverse reactions of drugs.
medicine.
● Do not use the medicine differ in colour, Ethical and legal aspects in drug administration
taste, odour and consistency. - A moral as well as legal dimension is
● Prepare the drug just before the time of involved in the administration of
administration of medicine. Never leave the medications.
medicine tray without proper identification.
“Nurses are responsible for their actions”
During Administration:
● Observe the seven rights and three checks. ● Under the law nurses are responsible for
● Observe the symptoms of overdosage of the their own actions regardless of a written
drugs before it is administered. order. It is expected to know all nurses the
● Identify the pt correctly minimum and the maximum dose of every
● Give the drugs one by one medicine that she administer.
● Stay with the pt until he has taken the ○ If a nurses gives an inj. Pethidine
medicine completely 500 mg to a t instead 50 mg, the
● Always prepare the medicine by yourself. nurse is responsible for the harm, she
 PHARMACOLOGY
cannot justify her deed despite a any order that you considered incorrect (may
written order for the same dosage. be unclear or inappropriate)
● The nurses responsibility includes to ● Be knowledgeable about the medication that
monitor medication errors by observing you administer.
seven rights of giving medication. ● Keep the narcotics in locked place
● The nurse must follow the own institutional ● Use only medications that are in clearly
policy (leaving medicine in the bedside labeled containers.
strictly prohibited) ● Return liquid that are cloudy in color to the
pharmacy
CLIENT’S RIGHT RELATED TO ● Before administering medication, identify
MEDICATION ADMINISTRATION the client correctly
● The pt has the right to considerate and ● The nurse who prepares the drug administers
respectful care, and the right to refuse the it. Only the nurse who prepares the drug
medication knows what the drug is. Do not accept
● To be informed of the medication’s name, endorsement of medication.
purpose, action, and potential undesired ● If the client vomits after taking the
effects medication, report this to the nurse in-charge
● To refuse a medication regardless of the or physician.
consequences ● Preoperative medications are usually
● To have a qualified nurses or physicians discontinued during the postoperative period
assess medication history, including allergies unless ordered to be continued
● To be properly advised of the experimental ● When a medication is omitted for any
nature of medication therapy and to give reason, record the fact together with the
written consent for its use reason
● To receive appropriate supportive therapy in ● When the medication error is made, report it
relation to medication therapy immediately to the nurse in-charge or
● To not receive unnecessary medications physician. To complement necessary
measures immediately. This may prevent
Medication Safety Guidelines any adverse effects of the drug.
● Medications are not given without a ● Each nurse should know the common dose,
physician's written orders. maximum dose, how to compute dosage if
● Do not administer a drug about which any necessary.
doubt exists, check further with the ● Do not leave the medication at the bedside.
physician. Stay with the client until he takes the
● Labels must be clear if not returned to the medications.
pharmacy. ● Prepare medications for one pt at a time.
● A nurse not to pour medication from one ● Do not label the medicine by pt room
bottle to another, not to put a medicine back number or bed number.
into a bottle, nurses are not authorized to ● Know and follow institutional policy and
re-label medication bottles, Medication procedures
which loses its label or which lacks a legible ● Look up what you do not know
label shall be returned to the pharmacy. ● Chart carefully
● Nurses who administer the medications are ● Listen to the pt “I never took that before”
responsible for their own actions. Question and the like
 PHARMACOLOGY
● Check, double - check when a dose seems WHERE CAN MEDICATION ERROR
high OCCUR?
● The unit dose cart should be moved up to ● medication error error may be related to
the door of the pt room with drawer side professional practice, health care products,
towards the room during administration. procedures, and systems, including
● Narcotics are to be checked by every shift, prescribing, order communication, product
and the narcotic cabinet must be locked. labeling, packaging and nomenclature,
● Follow the universal safeguards in compounding, dispensing, distribution,
administration of medications administration, education, monitoring, and
● Always check pt ID before administering use.
medications.
● Chart the medication after administration, if MEDICATION MANAGEMENT PROCESSES
it is not charted, it is not done ● Prescribing
● Chart if any nursing action done before ○ Wrong Dose
administering (apical heart rate, B.P) ○ Wrong Drug
● Check for the expected effect (therapeutic) ○ Wrong Route/From
of the drug. Did side effects or adverse ○ Allergy
effects occur and perform indicated nursing ○ Drug interaction
actions. Record observations. ● Transcribing
○ Wrong Dose
Patient & Family Education ○ Wrong Drug
● Names dose and action of the drug ○ Wrong Route
● Time of administration ○ Wrong Time
● Special storage and preparation of the drug ○ Wrong Patient
● Specific OTC drugs and alternate ● Dispensing
● Special comfort and safety reasons ○ Wrong Dose
● Specific points about drug toxicity ○ Wrong Drug
● Specific warning about drug ○ Wrong Route
discontinuation. ○ Wrong Time
○ Wrong Patient
MEDICATION SAFETY ○ Incorrect Labelling
○ Primary Catch for allergy, drug
MEDICATION ERROR interaction
● A medication error is any preventable ● Administering
event that may cause or lead to ○ Wrong Dose
inappropriate medication use or patient ○ Wrong Drug
harm while medication is in the control of ○ Wrong Route
the health care professional, patient, or ○ Wrong Time/Omitted
consumer. ○ Wrong Patient
○ “MEDICATION ERROR: simple ○ Incorrect Labelling
mistake can be LETHAL”
 PHARMACOLOGY
MEDICATION ERROR (ME) REPORTING ○ Oxycontin - Oxynorm
SYSTEM (MERS) ○ Dopamine - Dobutamine
Purpose: ○ Adrenaline - Atropine
To obtain information on the occurrence of ○ Noradrenaline - Adrenaline
medication errors
To maintain a database on medication errors HOW TO PREVENT ERROR?
To analyse the report ● Double checking the drug
To propose remedial actions and monitor the (dispensing/administering)
situations ● (Pharmacist) Contacting the prescribers in
case of any clarification regarding the
To minimize the reoccurrence of such errors
prescription
(DO NOT ASSUME)
Contributing Factors of ME
● Becoming familiar with LASA medications
● Staff Factors
● Separating LASA medications from one
● Task & Technology
another
● Medication related
● Using Tall Man Lettering
● Work & Environment
● Installing warning system to staff -
Computer alerts or warnings on stock bottles
ERROR-PRONE ABBREVIATION
● MMF - MTF
HIGH ALERT MEDICATIONS (HAMS)
● HCT - HCTZ - HCQ
● Drugs that bear a heightened risk of causing
● CBZ - CPZ
significant patient harm when they are used
● IVIg vs Human Albumin
in error.
● Although mistakes may or may not be more
HOW TO PREVENT ERROR?
common with these drugs, the consequences
Use generic names for drug. Avoid trade
of an error are clearly more devastating to
names.
patients.
Avoid using abbreviations
● Those that are most likely to cause
Write clear instructions significant harm to the pt, even when used
Use leading zero before decimal point as intended.
Avoid trailing zero after decimal point ● Those medications with the highest
Avoid verbal orders percentage of, or potential for, medication
Identify patient drug allergies errors and/ or sentinel events and that carry a
high risk for abuse, errors or other adverse
LOOK ALIKE SOUND ALIKE MEDICATION outcomes.
(LASA)
Medication that are: When a Medication Error Occurs. Organization
● Visually similar in physical appearance or Wide System weaknesses are often Identified in:
packaging ● How information is collected and
● Name of the medications that have spelling communicated
similarities ● How colleagues interact
● How patients and staff are educated
SOUND ALIKE MEDICATIONS ● How organizational culture and physical
○ Clotrimazole - Co-trimoxazole environment are managed.
 PHARMACOLOGY
● How staff is provided to carry out patient ● REPORTING takes place when two or
care functions. more people share information about client
● How staff learns about system errors and care, either face to face or by telephone.
their causes, and
● How pt’s are safeguarded from harm.
● Pt information PURPOSES OF CLIENTS RECORD CHART
● Drug Information
● Communication related to medications 1. Communication. Provides efficient and effective
● Drug labelling, packaging & nomenclature method of sharing information.
● Drug standardization, storage & distribution 2. Legal Documentation. It is admissible as
● Medication delivery device acquisition, use, evidence in a court of law.
and monitoring 3. Research. Provides valuable health-related data
● Environmental factors for research.
● Staff competency & education 4. Statistics. Provides statistical information that can
● Pt education be utilized for planning people’s future needs.
● Quality process & risk management 5. Education. Serves as an educational tool for
students in health discipline.
CONCLUSION 6. Audit & Quality Assurance. Monitors the quality
● Medication error is common and is causing of care received by the client and the competence of
preventable human suffering and financial health care givers.
cost 7. Planning Client Care. Provides data which the
● Remember that using medications to help pt entire health team uses to plan care for the client.
is not risk-free activity 8. Reimbursement. Provides the basis for decisions
● Interdisciplinary interactions go a long way regarding care to be provided and subsequent
toward preventing errors reimbursement to the agency, to cover
● Know your responsibilities and work hard to health-related expenses.
make medication use safe for your pt’s.
TYPES MEDICAL RECORD

● Components of medical record:

DOCUMENTATION AND ○ Patient identification & demographic
REPORTING data
○ Present complains
● Documentation as Communication ○ Informed consent for treatment &
○ Reporting and recording are the procedure
major communication techniques ○ Admission nursing history
used by healthcare providers. ○ Family history
○ Physical examination finding
● DOCUMENTATION serves as a ○ Medical history
permanent record of client information and ○ Tentative history
care. ○ Medical diagnosis
○ Therapeutic order
○ Treatment given
○ Medical progress notes
 PHARMACOLOGY
○ Supportive care given ● State the reason for the error.
○ Reports of diagnosis studies ● Sign and date the correction.
○ Final diagnosis
○ Patient education Elements of Effective Documentation
○ Summary of operative procedures W/Correcting a documentation error
○ Discharge plan and summary
○ Any specific instructions Abbreviations and Symbols
● Always refer to the facility’s
Types of Nursing Records approved listing.
● Admission nursing assessment ● Avoid abbreviations that can be
● Nursing care plan misunderstood.
● Kardexes
● Pertinent information about patient Organization
● Medication with date of order & time ● Start every entry with the date and
of administration time.
● Daily treatment & procedures ● Chart in chronological order.
● Flow chart ● Chart medications immediately after
● Graphic record (TPRBP) administration.
● Fluid balance record ● Sign your name after each entry.
● Medication
● Skin assessment record Accuracy
● Progress notes ● Use descriptive terms to chart
exactly what was observed or done.
Elements of Effective Documentation ● Use correct spelling and grammar.
● Use of Common Vocabulary ● Write complete sentences.
● Legibility
● Abbreviations and Symbols Documenting a Medication Error
● Organization
● Accuracy Document in the nurses’ progress notes:
● Documenting a Medication Error ● Name and dosage of the medication
Confidentiality ● Name of the practitioner who was
● Factual notified of the error
● Complete ● Time of the notification
● Current ● Name of the practitioner who was
● Organized notified of the error
● Nursing interventions or medical
Use of Common Vocabulary treatment
● Improves communication and ● Client’s response to treatment
lessens the chance of
misunderstanding between members Confidentiality
of the health team. ● The nurse is responsible for protecting the
Legibility privacy and confidentiality of client
● Print if necessary. interactions, assessments, and care.
● Do not erase or obliterate writing.
 PHARMACOLOGY
Factual Common ward records
● A factual record contains descriptive, ● Patient clinical records
● objective information about what a nurse ● Staff attendance record
sees, hears, feels & smells. ● Staff leave record
● An objective description is the result of ● Staff patient assignment record
direct observation & measurement. ● Student attendance and patient assignment
record
Complete ● Ward indent record
● The information within a recorded entry or a ● Ward inventory record
record must be complete, containing ● Equipment maintenance record
appropriate and essential information. ● Ward incidence record
● Infection surveillance record
Current ● Ward quality indicator record
● Timely entries are essential in a patient’s ● Ward diet supply record
ongoing care. Delays in documentation leads ● Emergency drug and crash card record
to unsafe patient care. ● Patient admission/discharge/shift record
● Health organizations use military time to
avoid misinterpretation of AM & PM. Methods of Documentation
● Following activities should enter timely ● Narrative Charting
○ Vital signs, ● Source-Oriented Charting
○ Pain assessment, Administration of ● Problem-Oriented Charting
medication & treatment, ● PIE Charting
○ Preparation for diagnostic test or ● Focus Charting
surgery, ● Charting by Exception (CBE)
○ Change in patient’s status & who ● Computerized Documentation
notified, Admission, transfer, ● Case Management with Critical Paths
discharge or death of the patient,
○ Patient’s response to treatment Narrative Charting (TRADITIONAL CLIENT
RECORD)
Organized
● Communicate information in a logical order. ● Describes the client’s status, interventions
● It is effective when notes are concise, clear, and treatments; response to treatments is in
& to the point story format.
● Narrative charting is now being replaced by
TYPES OF RECORDING other formats.

● Patient clinical records Five Basic components of a Traditional Client

● Individual staff records Record
● Ward records
● Administrative records with educational ● Admission sheet
value ● Physician’s order sheet
● Medical history
● Nurse’s notes
 PHARMACOLOGY
Source-Oriented Charting PIE Charting
● Each person or department makes notations ● P: Problem statement
in a separate section/s of the client’s chart. ● I: Intervention
● Narrative recording by each member ● E: Evaluation
(source) of the health care team on separate
records. Example:
● Most Traditional ● P: Patient reports pain at surgical incision as
● Different disciplines chart on separate forms 7/10 on 0 to 10 scale
● Each reader must consult various parts of ● I: Given morphine 1 mg IV at 23:35.
the record to get a complete picture ● E : Patient reports pain as 1/10 at 23:55.
● Records become bulky
○ For example the admission Focus Charting (PAR)
department has an admission sheet, ● A method of identifying and organizing the
nurses use the nurses’ notes, narrative documentation of all client
physicians have a physician notes, concerns.
etc.... ● Uses a columnar format within the progress
notes to distinguish the entry from other
Problem-Oriented Medical Record (POMR) recordings in the narrative notes (Date &
NURSE’S or narrative notes (SOPIE format) Time, Focus, Progress note)
● Uses a structured, logical format called
S.O.A.P. ○ DATA- SUBJECTIVE OR
○ S - SUBJECTIVE. WHAT PT OBJECTIVE THAT SUPPORTS
TELLS YOU. THE FOCUS (CONCERN)
○ O - OBJECTIVE. WHAT YOU ○ ACTION - NURSING
OBSERVE, SEE. INTERVENTION
○ A - ASSESSMENT. WHAT YOU ○ RESPONSE - PT. RESPONSE TO
THINK IS GOING ON BASED ON INTERVENTION
YOUR DATA.
○ P - PLAN. WHAT YOU'RE GOING Ex:
TO DO. ● D - COMPLAINING OF PAIN AT
INCISION SITE , PS: 7/10
CAN ADD TO BETTER REFLECT NURSING ● A - REPOSITIONED FOR
PROCESS COMFORT. DEMEROL 50 MG IM
● I - INTERVENTION (SPECIFIC GIVEN.
INTERVENTIONS IMPLEMENTED) ● R - STATES A DECREASE IN
● E - EVALUATION. PT RESPONSE TO PAIN, “FEELS MUCH BETTER.”
INTERVENTIONS.
● R - REVISION. CHANGES IN
TREATMENT. Charting by Exception (CBE)
● Uses flow sheets to record routine care. ● The nurse documents only deviations from
● SOAP entries are usually made at least pre-established norms (document only
every 24 hours on any unresolved problem. abnormal or significant findings).
● Avoids lengthy, repetitive notes.
 PHARMACOLOGY
Computerized Documentation Usually include the following data:
● Increases the quality of documentation and ● Personal data
save time. ● Basic needs
● Increases legibility and accuracy. ● Allergies
● Facilitates statistical analysis of data. ● Diagnostic tests
● Daily nursing procedures
Case Management Process ● Medications and intravenous (IV) therapy,
● A methodology for organizing client care blood transfusions
through an illness, using a critical pathway. ● Treatments like oxygen therapy, steam
● A critical pathway is a multidisciplinary inhalation, suctioning, change of dressings,
plan or tool that specifies assessments, mechanical ventilation.
interventions, treatments and outcomes of ● Entries are usually written in pencil. This
health related problems a cross a time line. implies the kardex is for planning and
communication purposes only.
FORMS FOR RECORDING DATA
● Kardex FLOW SHEETS
● Flow Sheets ● The information on flow sheets can be
● Nurses’ Progress Notes formatted to meet the specific needs of the
● Discharge Summary client. (e.g.: graphic sheets for vital signs,
intake & output record, skin assessment
KARDEX record).
● Is used as a reference throughout the shift
and during change-of-shift reports. NURSES’ PROGRESS NOTES
○ Client data (e.g. name, age, ● Used to document the client’s condition,
admission date, allergy) problems and complaints, interventions,
○ Medical diagnosis and nursing responses, achievement of outcomes.
diagnoses
○ Medical orders, list of medications DISCHARGE SUMMARY
○ Activities, diagnostic tests, or ● Client’s status at admission and discharge.
specific data on the pt. ● Brief summary of client’s care.
● Provide a concise method of organizing and ● Interventions and education outcomes.
recording data about a client, making ● Resolved problems and continuing need.
information readily accessible to all ● Referrals.
members of the health team ● Client instructions.
● It is a series of flip cards usually kept in
portable file REPORTING
● It is a way to ensure continuity of care from ● Verbal communication of data regarding the
one shift to another and from one day to the client’s health status, needs, treatments,
next. outcomes, and responses
● It is a tool for change-of-shift report. But ● Reporting is based on the nursing process.
endorsement is not simply reciting content
of kardex. Health care needs of the client is
still primary basis for endorsement.
 PHARMACOLOGY
Types of Reporting ● Legibility
● Summary / Hand-Off Reports ● Permanence
● Walking Rounds Reports ● Correct spelling
● Incident or Occurrence Reports ● Signature
● Telephone Reports and Orders ● Accuracy
● Sequence
Summary / Hand-Off Reports ● Appropriateness
● Commonly occur at change of shift (or when ● Completeness
client care is transfers to another health care ● Conciseness
provider). ● Accepted terminology

Incident or Occurrence Reports CORRECTING ERRORS

● Used to document any unusual occurrence ● If you spill something on the chart, do not
or accident in the delivery of client care. discard the note. Recopy , put original and
copied sheets in the chart. Write “copied” on
Telephone Reports and Orders copy.
● Provide clear accurate and concise ● Do not scribble out charting
information ● Avoid using “ERROR” or “WRONG
PATIENT” when making corrections.
GENERAL DOCUMENTATION ● Follow your facilities policy
● Ensure that you have the correct client ● DO NOT Alter Charting. It is a legal
record or chart. document.
● Document as soon as the client encounter is ○ Correct errors by drawing a single
concluded to ensure accurate recall of data. horizontal line through the error
● Date and time of each entry. ○ Write the word error above the line,
● Sign each entry with your full legal name then sign your signature
and with your professional credentials. ○ No ink eradication, erasures or use of
● Do not leave space in between entries. occlusive materials.
● If an error is made while documenting, use a
single line to cross out the error, then date, YOU MUST KEEP ACCURATE AND UP TO
time and sign the correction DATE RECORDS OF MEDICATION
● Never change another person’s entry even if ● Medications are the property of the person
it is incorrect for whom they are prescribed, however,
● Use quotation marks to indicate direct client providers are required to keep records of
responses. medicine used, ensure that medication
● Document in chronological order reviews are taking place regularly and that a
● Use permanent ink record is kept in the person's care plan.
● Document all telephone calls that you ● All records should be clear, legible, in black
received that are related to the client's case. ink and signed.
● Each provider should have in place policies
Minimizing legal liability through effective and procedures which describe:
record keeping ○ Ordering of medicines (where
● Date & time relevant).
● Timing
 PHARMACOLOGY
○ Receipt of medicines (where provided on a medicine label. Click on each
relevant). of the reading for more information and for
● providers need to keep records of the initials further learning and a refresher of previous
and signature of all staff. learning.
● That are in any way involved with the care
and administration of medication. Giving Medicine Safely
● Local recording systems must provide an
accurate audit trail from prescription to ENSURE YOU USE MEDICATION
administration or disposal. CORRECTLY
● By using medication correctly, we can
MEASUREMENT: ensure an individual receives the correct
● Medication comes in different strengths. medication,
● Always check you have the correct dosage. ● The correct dose
● Check the medication sheet, label and ● Administered by the correct route
container. ● At the correct time, With agreed support and
● To maintain an accurate recording system, respect for the individual’s dignity and
everyone must understand how drugs are respect
named, how drugs are measured and what is
provided on a medicine label. Click on each USING THE MEDICATION
of the headings for more information and for ADMINISTRATION RECORD (MAR.)
further learning and a refresher of previous Check:
learning. ● Individuals name, date of birth,
address/postcode
NAMING DRUGS ● Ensure the MAR is correct and up to
● Drugs often have two names. date, showing any allergies, GP, their
● One is the approved or generic name, the phone number, pharmacy plus phone
other is the proprietary or brand name. no., start date of medication, and
● This can cause confusion, as medication can completion date where appropriate.
appear to have changed. ● The date and time of the dose given
● Always check the generic name against the and the initials of the person giving
medication sheet. the medication to the individual
● The medicine has the proprietary or brand ● All medications must be checked in
name, for example RESTORIL and an for quantity ordered, and then stored
approved or generic name, for example appropriately
temazepam. ● Some medications must be given,
before food, with food or after food,
What’s on a medicine box label check the advice on the MAR
● What’s in the box – medicine name –
Dispensing Chemist – Strength of Medicine
– When to take – Who the medication is for
– Special Instructions – Date Dispensed
● To maintain an accurate recording system,
everyone must understand how drugs are
named, how drugs are measured, and what is
 PHARMACOLOGY
SUPPORT THE USE OF MEDICATION If medication is given to the wrong person:
● Call a GP; give exact circumstances,
ALL STAFF MUST EXERCISE information about what was given, etc.
RESPONSIBILITY WHEN ADMINISTERING ● Listen to advice.
MEDICATIONS ● Act upon advice.
● Ensure that no action or omission is made ● Record detailed circumstances in daily
which would be detrimental to the interests, records.
condition or safety of people who use ● Observed the person closely.
services. ● Check the British National Formulary for
● Act a manner promoting and safeguarding possible side effects.
the interests and wellbeing of people who ● Communicate this to staff i.e. upon
uses services. handover.
● Maintain and improve people’s own level of ● Advise your emergency on-call manager if
competence. you are unable to inform your line manager.
● Acknowledge any limitations in knowledge
and competence, declining any duties and We have already learned that medication can
responsibilities they are unable to perform in sometimes lead to complications and these
a safe manner until given proper instruction images represent some of the many ways that
to fulfill the task. medicines can be administered, but what should
you do if something does go wrong?
If medication is missing from a blister pack:
● Check that it has not already been given. ● All incidents should be fully investigated,
● Check that it has not moved into the next the results documented and every possible
day. action taken to prevent the mistake
● Check that it has not been signed for. happening again.
● Check that the blister is intact. ● Report immediately to your line manager
● If you are sure that the medication has not and follow directions given.
already been administered, take medication ● Report immediately to the prescriber/GP/
from the end of blister. pharmacist and follow directions given.
● Be sure to record what action you have ● If a serious error is made, the person may
taken following local policy and procedure. need hospital treatment.
● Contact the pharmacy for replacement. ● Document the error fully.
● When any error in administering medication
If a person vomits after taking medication: occurs, local procedure must be followed
● Do not give them more medication. immediately and should include the steps
● Record detailed circumstances in daily Chris will outline when clicked.
records.
● Contact qualified staff for advice. SUPPORT THE USE OF MEDICATIONS
● Observe the person and contact their GP if ● There are no official codes for the
necessary. Communicate this to staff i.e. completion of a MAR or guidance as to
upon handover. what they should be.
● If vomiting occurs regularly, discuss with ● it is up to the care organization to decide
their GP. what information is recorded.
 PHARMACOLOGY
● Typically, they might include the examples SELF ADMINISTRATION
shown ABOVE, but the MAR should have a ● When a person wishes to self-administrate
key which identifies code. he or she:
○ Will need a lockable cabinet in
WHAT YOU HAVE LEARNT which to store their medication.
● We have already learned that medication can ○ Must have a key to the cabinet.
sometimes lead to complications. ○ Must give written consent stating
● These images represent some of the many that they are self-administering their
ways that medicines can be administered. own drugs.
● What should you do if something does go
wrong SELF MEDICATION
● As we now know, within person-centred
WHAT YOU MUST ALWAYS DO AND KNOW planning, people are encouraged to
● Always wash your hands before administer their own medication and
administering medications maintain personal independence.
● Giving medication must always be a ● We should also recognize that
non-touch technique self-administration is not an ‘all or nothing’
situation.
MEDICATION SIDE EFFECTS ● These two examples highlight the flexibility
● The most common side effects are: that might be required to facilitate a degree
○ Nausea of self-administration.
○ Vomiting ● If an individual cannot present their own
○ Diarrhea prescription at the pharmacy because of a
○ Constipation disability, this does not mean that they will
○ Headache be incapable of exercising control over their
○ Dry mouth medicines.
○ Rash ● A person can still exercise some control
over medication provided that staff assist the
ADVERSE MEDICATION REACTIONS person taking their medication.
● An adverse reaction is a serious physical ● Active participation is another way of
side effect to a medicine and may include: working that recognizes an individual’s right
○ Swelling of the hands, face and body to participate in the activities and
○ Reddening of the skin relationships of everyday life, as
○ Sweating independently as possible. Click on the more
○ Blotches information button to see how a person is
○ Feeling of faintness regarded as an active partner in their care or
○ Difficulty with breathing support, rather than a passive recipient.
○ Any of these symptoms indicate a ● Some people might keep and use their
medical emergency – they are inhalers, but not their medicines.
potentially very serious symptoms ● A person might be able to manage his or her
and if they occur, expert medical medicines, providing that care worker assists
help must be sought immediately. them.
● As we now know, within person-centred
planning, people are encouraged to
 PHARMACOLOGY
administer their own medication and Toxic Dose
maintain personal independence. We should - Amount of drug that cause harmful effect.
also recognize that self-administration is not
an ‘all or nothing’ situation. Lethal Dose
- Amount of substance that will cause death.
ACTIVE PARTICIPATION
● A person who might be unable to Single Dose
self-administer can still actively participate - To be taken at one time
and exercise some control over medication.
● If he or she has capacity to collect their own Daily Dose
prescription and take it the pharmacy, he or - Amount to be taken in a 24 hours period.
she will also have the right to choose where
the prescription is dispensed. Maintenance Dose
● Active participation is another way of - Amount to be taken to maintain the
working that recognizes an individual’s right therapeutic effective dose.
to participate in the activities and
relationships of everyday life, as Loading Dose
independently as possible. - First dose given to achieve maintenance
drug level quickly.

POSOLOGY & DOSAGE

SYSTEM OF MEASUREMENT
CALCULATIONS
1. Metric System
- Most widely used system of
Posology
measurement
- The pharmacological study of drug dosage
- A decimal system based on the
- The study of dosage quantity and
power of ten
prescription
- Units:
- Gram (weight)
Usual Recommended dose
- Liter (volume)
- The amount of drug that will ordinarily
- Meter (length)
produce the effect for what is intended
2. Apothecary system
Minimum Dose
- Uses Roman numerals to express
- The smallest dose of drug that produces
quantity
therapeutic effect.
- Old system of measurement
- Uses:
Maximum Dose
- Minim = liquid
- The largest dose that can safely
- Grains = solid
administered.
3. Household system
Example:
- Not as accurate as metric system due
Acetaminophen 10 to 15 mg/kg/dose
to lack of standardization of spoons,
cups and glasses
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- Teaspoon (tsp) = liquid
- Pound (lb) = solid

● mL - milliliter
● cc - cubic centimeter
● gm - gram
● mg - milligram
● gr - grain
● mEq - milliequivalent
● mcg - microgram