Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Administration of Medications 4

Focus onFocus on

PHARMACOLOGYPHARMACOLOGYESSENTIALS FOR HEALTH PROFESSIONALS

CHAPTER

Administration of Medications

4

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

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Slide 63Nebulizer Video


Safe Medication AdministrationSafe Medication Administration

• Medications have the potential to cause serious harm to the patient.

• All medication orders must come from the physician or other authorized health-care professional, per state law.

• Vigilance is needed to prevent errors and ensure quality patient care.


Principles of Principles of Drug AdministrationDrug Administration

• Assess patient health and obtain medication history and use of vitamins, herbs, or food supplements prior to giving medications.

• Determine if route of administration is suitable.

• Assess socioeconomic factors and ability to self-administer (if applicable).


Seven Rights of Drug Seven Rights of Drug AdministrationAdministration

1. Right patient2. Right drug3. Right dose4. Right route5. Right time6. Right technique7. Right documentation


Medication ErrorsMedication Errors

• Inappropriate or incorrect administration of a drug

• Medication errors should be preventable through effective system controls involving all levels of health-care workers as well as the patient.

• Some errors are caused by manufacturing mistakes.


Errors Occur in Three StagesErrors Occur in Three Stages

• Prescribing or ordering medication• Dispensing medication • Administering medication and

monitoring for side effects


Why Medication Errors OccurWhy Medication Errors Occur

• Miscommunication• Missing information • Lack of appropriate labeling by

manufacturer or pharmacist• Environmental factors • Poor management


Causes of Medication ErrorsCauses of Medication Errors

• Wrong patient• Incorrect route• Incorrect drug• Incorrect dose• Incorrect time• Incorrect technique• Incorrect information on patient chart


Manufacturing ErrorsManufacturing Errors

• The sulfanilamide disaster of 1937 is an example of formulation or manufacturing errors.

• Mislabeling, contamination, wrong drug, wrong concentration, wrong doses of drugs, counterfeit drugs, and undiscovered toxicity are other causes.


Administering Administering Medications SafelyMedications Safely

• Follow all physician orders exactly as written.

• If unsure about an order, ask for clarification.

• Administer a medication only after the order is written in the patient’s chart.

• Use the 7 rights and perform 3 order and label checks when dispensing and administering the drug.


Reducing Medication ErrorsReducing Medication Errors

• Provide adequate, trained staff.• Use standardized metric measurement

systems.• Develop consistent error-tracking

systems.• Establish clear system for review of

drug orders, ordering, dispensing, and administration.


Reducing Medication ErrorsReducing Medication Errors

• Maintain medication profiles with regularly updated allergy and reaction histories.

• Provide suitable, safe work environments.


Ensuring Safe Ensuring Safe Drug AdministrationDrug Administration

• Be sure you understand physician’s order and clarify questions about medication, dose, route of administration, and strength with physician.

• Review adverse effects, precautions, purpose, and recommended dose in pharmacology reference book such as PDR.


Routes of AdministrationRoutes of Administration

• Enteral: absorbed through GI tract– Oral– Nasogastric or gastrostomy tube– Sublingual or buccal

• Parenteral: injected– Intravenous (IV), intramuscular (IM),

subcutaneous, intradermal


Enteral Route: OralEnteral Route: Oral

• Most common, easiest, and most economical

• Contraindicated if patient is vomiting, has gastric or intestinal suction, is unconscious, or is unable to swallow

• Liquid medications are best for children.


Medications May Medications May Stain Teeth and DenturesStain Teeth and Dentures

• Advise elderly patients who have dentures to remove them before taking certain medications. Some oral liquid drugs, such as iron or iodides, may stain teeth and dentures.


Enteral Route: Nasogastric Enteral Route: Nasogastric and Gastrostomyand Gastrostomy

• Nasogastric (NG) tube: inserted through nasopharynx and into stomach

• Gastrostomy tube: surgically placed directly into stomach


Enteral Route: SublingualEnteral Route: Sublingual

• Sublingual: placed under tongue for dissolving

• Used when rapid action is desired• Examples include nitroglycerin (for

angina pectoris) and ergotamine tartrate (for migraines)


Figure 4-1 Medication given via the sublingual route.


Enteral Route: BuccalEnteral Route: Buccal

• Placed between gum and cheek for dissolving

• Forms include tablets, capsules, lozenges, and troches

• Should not be swallowed• Often used over sublingual route for

sustained-release delivery


Figure 4-2 Administration of drugs via the buccal route.


Buccal andBuccal andSublingual MedicationsSublingual Medications

• Advise patients not to drink or eat anything when buccal or sublingual medications are administered.

• Medications must dissolve completely before consuming food or drink.


Parenteral RoutesParenteral Routes

• More quickly absorbed than oral route• Irretrievable once injected• Require invasive procedure • Aseptic technique must be used to

avoid infection.


Parenteral EquipmentParenteral Equipment

• Needles: pierce the skin to allow injection

• Syringes: contain and then transfer the medication into the body through needle– Hypodermic, insulin, tuberculin

• Ampules and vials: contain medication that is then drawn into syringe for injection


Figure 4-3 The parts of a standard syringe: barrel, plunger, and shaft.


Figure 4-4 Various types of syringes, including tuberculin, insulin, and hypodermic.

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Unit-dose InjectionsUnit-dose Injections

• Available as:– Prefilled syringes that are ready to be used– Prefilled sterile cartridges and needles that

must be attached to a reusable holder (injection system) before use


Figure 4-5 Prefilled unit-dose systems.

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NeedlesNeedles

• Most are disposable and made of stainless steel.

• Special procedure needles may be reusable and need to be re-sharpened.

• Three parts of needle are:– Bevel: the slanted part at tip– Cannula (or shaft): attaches to hub– Hub: fits onto syringe


Needle CharacteristicsNeedle Characteristics

• Gauge (diameter of shaft): varies from #18 (larger) to #28 (smaller)

• Length of shaft: commonly ranges from ½ to 2 inches; determined by type of injection, patient’s weight, and muscle development


Needle CharacteristicsNeedle Characteristics

• Slant or length of bevel: longer bevels for IM and subcutaneous injections; shorter bevels for IV or intradermal injections.


Ampules and VialsAmpules and Vials

• Used to package sterile parenteral medications

• Ampules: made of clear glass; usually contain single dose of drug; usually have prescored neck that is cut open; medication is then aspirated into syringe using filter needle


Ampules and VialsAmpules and Vials

• Vials: small glass bottles sealed with rubber cap; pierced with needle to withdraw medication


Figure 4-6 Drawing medication from a vial with a syringe.

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Intradermal Injection (ID)Intradermal Injection (ID)

• Usually given in inner forearm or upper back just below epidermis into dermis

• Commonly used for tuberculin or allergy tests, or to administer local anesthetics

• Needle enters at 15-degree angle • Injection produces small wheal on skin’s

outer surface


Figure 4-7A Intradermal injection.

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Subcutaneous InjectionSubcutaneous Injection

• Usually given into upper arms, back, or abdomen

• Commonly used for heparin and insulin• 45-degree angle usually used, based on

patient’s body weight• Small volumes of medication (0.5 to

1 mL) are given subcutaneously.


Figure 4-7B Subcutaneous injection.

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Heparin InjectionsHeparin Injections

• For subcutaneous heparin injections, make sure that 0.1 to 0.2 mL of air is in the syringe to prevent heparin leakage into tissue, which can cause localized hemorrhage.


Self-administration of InsulinSelf-administration of Insulin

• Teach diabetic patients who must self-administer insulin to rotate insulin administration sites.


Intramuscular (IM) InjectionsIntramuscular (IM) Injections

• Usually given into upper arm, thigh, or hip muscles

• Commonly used for drugs that irritate subcutaneous tissue

• 90-degree angle is usually used; or Z-track method.

• 1 to 3 mL of medication can be given IM.


Figure 4-7C Intramuscular injection.

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IM Injections in Infants IM Injections in Infants and Young Childrenand Young Children

• Use shorter needles (#22 to #25 gauge, 5/8- to 1-inch) for IM injection.

• Use the dorsogluteal site for IM injection in children younger than 3 years.

• For infants 7 months or younger, use the vastus lateralis site for IM injection.


IM Injections in Older PatientsIM Injections in Older Patients

• Older patients have muscle atrophy (decreased mass).

• A shorter needle may be needed.• Carefully assess an appropriate

injection site.• Absorption of medication may occur

more rapidly than expected.


Figure 4-8A Angles and depths of injection for intradermal injections.


Figure 4-8B Angles and depths of injection for subcutaneous injections.


Figure 4-8C Angles and depths of injection for intramuscular injections.


Intravenous Injection (IV)Intravenous Injection (IV)

• Injected directly into veins, usually in arms

• Used for many types of drugs and fluids• May be administered slowly, rapidly (IV

push), by piggyback infusion, into existing IV line (IV port), into intermittent access device (heparin lock), or added to IV solution


Intravenous Injection (IV)Intravenous Injection (IV)

• IV needles are inserted into veins at a short angle to the skin.


Transdermal MedicationsTransdermal Medications

• Transdermal patches provide sustained-release administration.

• Examples include: – Nicotine– Nitroglycerin– Estrogen


Figure 4-9 Examples of transdermal patches.

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Ophthalmic RouteOphthalmic Route

• Medications are administered to the eyes using instillations or irrigations with liquids or ointments.

• Sterile technique is required.• Prescribed liquids are usually diluted to

less than 1% strength.• Eye irrigations are used to wash out

conjuctival sac.


Figure 4-10 Instillation of eye ointment.

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Figure 4-11 Instillation of eye drops.

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Otic RouteOtic Route

• Localized infection or inflammation of the ears is treated by dropping a small amount of sterilized medication into ear.

• Patient should remain lying on one side for 5 minutes to allow coating of inner ear canal with medication.


Figure 4-12 Instillation of ear medication. © Elena Dorfman.

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Nasal RouteNasal Route

• Nasal decongestants are most common nasal instillations.

• Many of these medications are OTC drugs.

• Administered with dropper or via sprays; usually while patient is supine with head tilted back


Figure 4-13 Administration of nasal medications.

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Inhalation RouteInhalation Route

• Inhalation therapy may involve the administration of medicines, water vapor, and gases such as oxygen, carbon dioxide, and helium.

• Local effects are achieved within the respiratory tract through aerosols, nebulizers, Spinhalers, or metered-dose inhalers.


Inhaled Asthma MedicationsInhaled Asthma Medications

• Commonly administered by nebulizer– Delivers fine fog or mist using atomization

or aerosolization– Atomization: larger droplets are inhaled– Aerosolization: droplets are suspended in

gas such as oxygen (the smaller the droplets, the further they can be inhaled into the respiratory system)


Figure 4-14A A girl breathes mist through a nebulizer with a bite piece in her mouth.

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Nebulizer VideoNebulizer Video

Click on the screenshot to view a video on the topic of nebulizers.

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Figure 4-14B A breath-actuated inhaler. © Dorling Kindersley.

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Figure 4-14C Inhaler with face mask. Tim Ridley © Dorling Kindersley.

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Figure 4-15 Metered-dose inhaler.

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Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Administration of Medications 4