Preparing and Administering of Medications
1.1 Basic Principles of Administration of Medications
The preparation and administration of medications is a serious responsibility. Experience has shown that it is best to follow established policies and regulations pertaining to their administration. Such regulations vary depending on location, but the principles of safety do not vary. Safety regulations are effective only when they are understood and readily interpreted by those who use them. When in doubt and/or before departing from established policy, always consult with a more experienced person.
There are two medication systems presently in use today. One is the bulk drug system in which stock supplies are kept and from which individual dosages are prepared. The other is the unit dose system in which the unit dosage is prepared (and sometimes packaged) by the pharmacy. A unit dose package contains the ordered amount of a drug for a single administration in the proper form by the usual route. It is found in medicine carts. Medicine carts generally have drawers for each room on the ward, with compartments within the drawers corresponding to the bed assignment of each patient. The compartment should have a medication slip which indicates the patient's name, dosage, room and bed number, and required medication. The information may also be found on a medication Kardex as well as the patient's chart.
As the medical specialist, you must used approved hand sanitizer or perform a patient care handwash prior to preparing and administering medications.
Principles Associated with Preparing or Obtaining Medications
Although you will not usually be required to administer medications, you must master the basic rules of administration so that you will be prepared should the occasion arise.
a. Concentrate fully on the task at hand.
b. Make sure that the information on the medication card/slip is identical to the physician's written order and the label on the patient's medicine. If not, report it to your supervisor immediately.
c. Never give a medication from an unlabeled container or one on which the label is illegible. The container should be returned to the pharmacy for relabeling in accordance with (IAW) local standing operating procedure (SOP).
d. Whether preparing a dose of medication from a stock supply or obtaining medication from a unit dose package, read the label three times to ensure that the medication and dosage are correct. Read the label:
(1) As the medication is taken from the shelf or medicine cart.
(2) Before the medication is poured or taken from the package or compartment.
(3) As the stock container or empty unit dose package is returned to the shelf or medicine cart.
e. Check your drug dose calculations with your supervisor, nurse, or physician if you are not completely sure of your calculations.
f. Use appropriate measurement equipment to measure quantities as ordered. For example, use a graduated container to measure liquids.
g. Do not alter the dosage ordered for other medication. Check the order with the nurse, physician, or supervisor.
h. Use special care to return medications to their correct location. In some instances, each patient's medication is kept in a designated place on a shelf or compartment in a central storage area. Never return an unused dose of medicine to a stock bottle. It should be disposed of IAW local SOP.
i. Arrange stock supplies so that preparations for internal use are separated from those used externally.
j. Store medications according to manufacturer's specifications. For example, vitamin B12 requires refrigeration.
k. Store narcotic and abusable drugs (those dispensed under special legal regulations) and hypodermic supplies in a secure location in accordance with the local SOP.
l. Do not handle tablets or capsules. Shake the required number of tablets/capsules into the container cap and then place the medication into the container that you will take to the patient's bedside.
m. Check the container label for the expiration date. Dispose of "expired" medications IAW local SOP.
Principles Associated with Identifying the Patient
a. Positively identify the patient immediately prior to administering any medication.
b. Check his identaband or ask him to state his name. Patients have been known to answer to names other than their own.
Principles Associated with Administering Medications
Administer only the medication that you prepared or removed from the medicine cart.
b. Be familiar with the potential effects (good and bad) of any medication you administer. If in doubt, check with a nurse, physician, or pharmacist.
c. Administer medication only by the route specified on the doctor's orders. If the route is not specified or if you are in doubt about the correct route of administration of the medication, check with a nurse, physician, or pharmacist.
d. Administer the medication at the time specified on the doctor's orders.
e. Assist weak or helpless patients in taking medications as necessary.
f. Remain with the patient until he takes the medication. If the patient refuses his medication, inform your supervisor and document the incident IAW local SOP.
Monitoring the Patient
All patients must be observed after the medication is administered. The type and duration of the observation will vary with the patient and the type of medication. The patient should be observed for any specific reaction or complication that is expected from a certain medication. For example, diarrhea could be a reaction to the administration of ampicillin. If you are in doubt, ask the nurse, physician, or supervisor. If the patient has an adverse reaction to a medication, immediately inform the nurse or physician on duty. You will also observe for effectiveness of the medication, especially those given for pain relief.
Never chart a medication as having been given until it has been administered. Check the chart before giving the medication to avoid duplication.
b. Record all administrations of medications IAW local SOP.
(1) As a minimum, record the name of the drug, dosage, time and route of administration, patient's reaction or lack of reaction to the medication (if appropriate), and the name of the person who administered the medication.
(2) Correct charting helps to prevent administering a medication twice.