Medication Administration and Drug Calculations

Contents

• Review of key terms• Routes of drug administration• Legal & ethical aspects• Role & responsibility of nurses• Medication errors • Medication administration

documentation• Review

Pharmacology

• Pharmacology is the study of drugs, their properties, actions and effects on the living system.

• Pharmacokinetics - The way drugs move through the body systems.

ABSORPTION BODY

METABOLISM

EXCRETION

DISTRIBUTION

Chemical & Physiological factors affect

Factors affect

Effectiveness in functions of excretion sites affect

Sites of metabolism & factors affect

Pharmacology

Pharmacodynamics - impact of drugs on body:◦ Dose-response relationship◦ Drug receptor interaction◦ Drug receptor relationship - selectivity, affinity of

chemical, agonists, antagonists◦ Drug interactions

Key terms

What is a Drug?◦ A drug is any natural or synthetic

substance that alters the physiological function or state of a living organism.

◦Two main groups Medicinal (chemical) Non-medicinal (vitamins, herbal)

What is medication?◦A drug administered for therapeutic

effects.

Key terms

• Why do drugs have different names?

o Chemical name describes the constituents that make up its molecular structure

o Generic name given by manufacturer when fist developed, simpler then chemical name

o Trade name brand name under which manufacturer markets drug

• How do they work?o Chemical interaction between drug and body’s

cells interact with cell membrane, cell enzymes, or certain components of cell

Routes of drug administration

• Enteral - Oral, Sublingual, Buccal, Nasogastric tube, Orogastric tube, Gastrostomy tube, Jejunostomy tube, Rectal.

• Topical- skin preparations, transdermal patches, mucous membranes (eye drops, throat swabs, rectal & vaginal, bladder irrigation, nasal & throat sprays).

• Inhalations – aerosol therapy, metered dose inhalers.

• Parenteral – Intradermal, Subcutaneous, Intramuscular, Intravenous.

• Other routes - Intrathecal, Epidural, Intraperitoneal, Intrapleural, Intraosseous.

Legal & Ethical aspects

Laws• Poisons Act 1964• Drugs and Poisons and Controlled

Substances Regulations Act 1981.• Therapeutic Goods Act 1989 sets out the

legal requirements for the import, export, manufacture and supply of therapeutic goods in Australia (advertising, labelling, product appearance and appeal guidelines).

• Therapeutic Goods Administration (TGA)- regulatory agency.

• Scheduling of substances and the safe storage of therapeutic goods, are covered by the relevant State or Territory legislation.

Legal & Ethical Aspects

Three key legal principles:

1.Accountability2.Duty of care3.Negligence

Legal & Ethical Aspects

Ethical issues

• Rules and principles for right conduct• Standards of ethical practice and

conduct set by the profession

Role & Responsibilities

Prescriber: medical doctor responsible for diagnosing, charting and initiation of therapy

Pharmacist: supply, distribution,

preparation, and resource of drug information

Registered Nurse:administers medications

Over-the-Counter Medicines (OTC)

• Can buy them for self-treatment from pharmacies, supermarkets, health food stores and other retailers.

• Examples include cough and cold remedies, anti-fungal treatments, sunscreens, non-prescription analgesics such as aspirin and paracetamol.

Schedules of medicines & poisons

National classification system:• Schedule 1 Not currently in use • Schedule 2 Pharmacy Medicine• Schedule 3 Pharmacist Only Medicine • Schedule 4 Prescription Only Medicine OR Prescription

Animal Remedy • Schedule 5 Caution • Schedule 6 Poison • Schedule 7 Dangerous Poison • Schedule 8 Controlled Drug**• Schedule 9 Prohibited Substance

Prescription Medicines

• You require a doctor's prescription to buy prescription medicines from a pharmacist.

• Only authorised health care professionals can supply them, such as in a hospital setting.

• Examples include contraceptive pills, antibiotics and strong painkillers.

Role & responsibility of nurses

Check medication orders ◦Medication chart details ◦Standing orders confirmed◦Emergency or telephone order APP

documented◦Nurse initiated medications documented◦Record of medication administration

Ensuring safe practice◦Check orders◦Check drug labels◦Check patient ID◦Store as packed

Role & responsibility of

nurses

Storage of medications◦Bedside drug locker◦Pharmacy cupboard◦Imprest or medications cupboard◦DD cupboard◦Medication trolley◦Drug fridge

Rights of medication

administration

1. Right patient2. Right medication3. Right dose4. Right time5. Right route6. Right documentation

+ Right to refuse

Medication administration

• Procedure for safe drug administrationo Patient IDo Preparation- pharmacy/drug room/ bed

sideo Information o Administration o Safetyo Completion oDocumentation (drug chart, IV, FBC, Pt’s

progress notes)

ID Band

X  

The Australian Commission for Safety and Quality in Health Care has developed a national standard for patient identification bands.  This standard will become a part of accreditation standards.

Medication Errors

• Accountability, Reporting & Acting on drug errorso Report to physiciano Monitor client for adverse effectso Document in chart, client history o Report to shift in-chargeo Adverse incident formo Education to avoid future errors

Negative Effects

• Assess patient before and after medication administration and report all adverse effects:

o Side effecto Adverse reactiono Allergic reactiono Anaphylactic shocko Medication error

Medication Errors

• Defined as “deviations from a physician’s order” (Mayo & Duncan, 2004)

• Common sources of medication errors o Illegibly written orders o Dispensing errors o Administration errors

• Withholding medications o Document clearly with rationaleo Incident report if wrongly withheld

Medication Errors

• Common causes for drug errors by nurses oOrders are not clearoOrder is misreadoNurses are distracted or interrupted oNurses are tired or exhausted o Lack of adequate knowledge

Drug calculations

• Tablets Number of tablets = Required / Prescribed dose Stock dose

• LiquidsVolume = Required / Prescribed strength x Stock Volume

Stock strength

Drug calculations

• Intravenous orders

Rate/hour = Prescribed / Required Volume Hours

Drops per Minute = Prescribed / Required Volume x Drip factor of giving set

Time (in Minutes)

The drip factor of standard giving set is 20

Documentation

• Drug chart • IV orders• Narcotic/PCA orders• Patient history• Fluid balance chart• Additional Hospital requirements • Specific drug administration protocol

charts

Drug Levels

Gentamicin Levels• Specimens should be collected as one of the

following combinations:o Level 1 (GENT1) - immediately post dose, and 

Level 2 (GENT2) - 6 to 8 hours post dose, or  o A spot test (GENT), or o Pre (GENTPR) - immediately before the dose,

and post dose (GENTPO) - 30mins post dose for IV, or 1 to 1.5 hours post dose for IM.  Record dose, exact times of collection and start/finish times of infusion.

Review

• It is the role and responsibility of nurses to administer medications safely and competently.

• Drug administration is guided by codes of practice under legal and ethical frameworks in Australia.

• The fundamental rule of medication administration iso Do it right the first time, no second

chanceso Follow medication administration polices

and guidelineso Take time to check and check again

References & Resources

• Australian Nursing and Midwifery Council 2008. Code of Professional Conduct. Australian Nurses Council Inc. Canberra. ACT.

• Byrant, B., Knights, K., Salerno, E. 2007, 2nd Ed., Pharmacology for Professionals, Australia : Mosby.

• The Pharmacy Guild of Australia, March 2009,Australia’s unique medication scheduling system. Retrieved January 8, 2011 from www.guild.org.au

• Nurses & Midwives Board of Western Australia June 2010. Medication Management Guidelines for Nurses and Midwives. Retrieved June 24, 2010 from Nurses & Midwives Board of Western Australia.

• Nurses & Midwives Board of Western Australia June 2010. Medication Management Guidelines for Nurses and Midwives. Retrieved January 4, 2012 from Nurses & Midwives Board of Western Australia.

• Cohen, H., Robinson, E.S., Mandrack, M. 2003,Getting to the Root of Medication, Volume 33, Number 9 (36-45), Nursing, Commonwealth Standard, Drugs, Poisons and Controlled Substances Regulations 2006.

• Drugs and Poisons regulation Group (DPRG) January 2008, Department of Human Services (DHS), Key Requirements for Nurses Providing Acute Care (Other than Nurse Practitioners), www.health.vic.gov.au/dpu

• Mayo, A.M. 7 Duncan, D. 2004, Nurse Perceptions of medication Errors: What We Need to Know for Patient safety, Journal of Nursing Care Quality, July/September, Volume 19, number 3 (209-217), Lippincott Williams & Wilkins, Inc.

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