To provide safe drug administration, the nurse should practice the “rights” of drug administration. They are: 1. The right client 2. The right drug 3. The right dose 4. The right time 5. The right route
Experience indicates that five additional rights are essential to professional nursing practice; 1. The right assessment 2. The right documentation 3. The client’s right to education 4. The right evaluation 5. The client’s right to refuse
The right client needs to be ensured by checking the wrist band, and by checking a second piece of identification. This could be a picture on the chart, or a case number that is both on his chart and wristband. This must be done before any medication is administrated. The right drug means that the client receives the drug that was prescribed by a physician (MD), dentist (DDS), podiatrist (DPM), or an advanced practice nurse with the license to write prescriptions (APRN). The use of computerized systems to record medications has helped to decrease medication errors, because nurses are not trying to read written forms of the prescriptions. Dr.’s can electronically add a new medication order to a pt. chart from any location.
If there is a phone order or verbal order it must be cosigned by the prescribing physician within 24 hours.
The components of a drug order are as follows:
· Date and time the order is written
· Drug name (generic is preferred)
· Drug dosage
· Route of administration
· Frequency and duration of administration (e.g, x 7 days, x 3 doses)
· Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness, or laboratory results
· Physician or other health care provider’s signature or name if TO or VO
· Signatures of licensed practitioners taking TO or VO. If any of these components are missing, the entire order is incomplete and the medication should not be given. To avoid error, the nurse must check the bottle against the order for the medication three different times. 1) at the time of contact with bottle or container,2) before pouring the drug, 3) and after pouring the drug.
Drugs given for the first dose, one-time or PRN medication should always be checked against the original order.
Beware of medications that sound alike, and read the labels carefully. For example, Percocet contains oxycodone and acetaminophen. Percodan contains oxycodone and aspirin. Percodan should not be given to someone who has an adverse reaction to aspirin. Nursing implication includes the following: 1. Check that medication order is complete and legible 2. Know why the client is receiving the medication 3. Check the drug label three times before administration 4. Know the start date that the drug was ordered and the ending date The following are the four categories of drug orders: 1. Standing orders 2. One-time (singe dose) 3. PRN 4. STAT (at once) The right dose is the dose prescribed for a particular client. The nurse is responsible for questioning any dose that looks too high or too low. Always consult a peer or pharmacist if the dosage appears incorrect. Beware of pediatric doses that are based on body weight. Weights can change daily so regular assessment of dosages is crucial. The nursing implications include the following: 1. Calculate the drug dose correctly. For some medications, two nurses are needed to sign off on a new order such a heparin and insulin. 2. Check the PDR, American hospital formulary, drug package insert, or other drug references for recommended range of specific drug doses.
The right time is the time at which the prescribed dose should be administered.
Nursing implications include the following: 1. Administer drugs at the specified times. Drugs may be given 0.5 hour before or after the time prescribed if the administration interval is > 2 hours. See company policy. 2. Administer drugs that are affected by foods, before meals (e.g. tetracycline). 3. Administer drugs that can irritate the stomach (gastric mucosa) with food such as aspirin or potassium. 4. The drug administration schedule can sometimes be flexible in order to accommodate the client’s activities for the day or preferences. 5. It’s the nurses responsibility to be aware of test’s or procedures that are taking place that may affect the medication administration. (e.g, fasting blood tests, endoscopy) 6. Check the expiration date on medications and return to pharmacy if expired. 7. Antibiotics need to be given evenly over 24 hours as opposed to T.I.D The right route is necessary for adequate or appropriate absorption.
The following are the nurse’s implications with regard to route: 1. Assess clients ability to swallow before administering p.o . 2. Do not crush or mix medications into other substances before consultation with the pharmacy. Do not mix meds into sweetened juices for kids or add to formula for babies. Follow all med administration guidelines for that specific drug. 3. Use aseptic technique when administering drugs. Use sterile technique when administering parenteral meds. 4. Administer drugs to appropriate sites. 5. Stay with client until p.o meds have been swallowed. 6. If it’s necessary to combine a medication with another substance, explain this to the client.