THE ROLE OF THE NURSE IN DRUG ADMINISTRATION Patient’s Rights Patient’s Rights Because of the risks involved in drug administration patients have the right.

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Patient’s RightsPatient’s Rights

Because of the risks involved in drug Because of the risks involved in drug administration patients have the right administration patients have the right to:to:

- be informed of the name, purpose, - be informed of the name, purpose, action & potential side effects of drugsaction & potential side effects of drugs

- refuse a medication regardless of the - refuse a medication regardless of the consequencesconsequences

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Patient’s Rights (con’t)Patient’s Rights (con’t)

- receive labelled medications safely - receive labelled medications safely in accordance with the five (5) rightsin accordance with the five (5) rights

- be adequately informed of the - be adequately informed of the experimental nature of any drug and experimental nature of any drug and sign a written consentsign a written consent

- not receive unnecessary - not receive unnecessary medicationsmedications

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

The nurse is also responsible for The nurse is also responsible for ensuring that they have the ensuring that they have the knowledge to ensure the correct knowledge to ensure the correct administration of drugs. This includes administration of drugs. This includes pharmacology, anatomy and pharmacology, anatomy and physiology, and legal issues.physiology, and legal issues.

WHAT CONSTITUTES A LEGAL WHAT CONSTITUTES A LEGAL MEDICATION ORDERMEDICATION ORDER

Medication charts are legal Medication charts are legal documents and must be completed documents and must be completed accurately and unambiguously in accurately and unambiguously in order to ensure that patients receive order to ensure that patients receive safe and optimal drug therapy. safe and optimal drug therapy.

WHAT CONSTITUTES A LEGAL WHAT CONSTITUTES A LEGAL MEDICATION ORDERMEDICATION ORDER

Medication Charts should be written Medication Charts should be written legibly in the prescriber’s own legibly in the prescriber’s own handwriting and include:handwriting and include:

Patient’s surname, first name, medical Patient’s surname, first name, medical record number (MRN), ward/clinicrecord number (MRN), ward/clinic

- if a patient ID label is used it must be - if a patient ID label is used it must be affixed to every medication chart and affixed to every medication chart and signed for verification by the prescriber signed for verification by the prescriber

WHAT CONSTITUTES A LEGAL WHAT CONSTITUTES A LEGAL MEDICATION ORDERMEDICATION ORDER

Drug name (generic), dosage form, Drug name (generic), dosage form, strength and dose requiredstrength and dose required

Complete, clear and unambiguous Complete, clear and unambiguous directions for each item – directions directions for each item – directions should be written in plain English should be written in plain English (only approved abbreviations may be (only approved abbreviations may be used) used)

WHAT CONSTITUTES A LEGAL WHAT CONSTITUTES A LEGAL MEDICATION ORDERMEDICATION ORDER

Prescriber’s printed name, signature Prescriber’s printed name, signature and date of order - the prescriber’s and date of order - the prescriber’s full signature and date of order must full signature and date of order must be written for EACH DRUG orderedbe written for EACH DRUG ordered

Weight should be provided for any Weight should be provided for any drug dosed by weight. drug dosed by weight.

WHAT CONSTITUTES A LEGAL WHAT CONSTITUTES A LEGAL MEDICATION ORDERMEDICATION ORDER

N.B. Each medication order must be N.B. Each medication order must be legible, complete and unambiguous so legible, complete and unambiguous so that the correct patient is administered that the correct patient is administered the correct drug at the appropriate the correct drug at the appropriate dose. A nurse cannot administer the dose. A nurse cannot administer the drug and a pharmacist cannot drug and a pharmacist cannot dispense a drug to a patient unless all dispense a drug to a patient unless all details are correct and complete.details are correct and complete.

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

Every registered nurse is legally responsible Every registered nurse is legally responsible for the correct administration of drugs. This for the correct administration of drugs. This includes the five “rights” of administration:includes the five “rights” of administration:

• Right patient Right patient • Right drug Right drug • Right dose Right dose • Right route Right route • Right timeRight time

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Right PatientRight Patient

– check the patient name & hospital check the patient name & hospital number against the chart & I.D. band.number against the chart & I.D. band.

– ask the patient to state his/her name, & ask the patient to state his/her name, & their date of birth (D.O.B)their date of birth (D.O.B)

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Right DrugRight Drug Identify the drug from the M.O.’s order. Clarify Identify the drug from the M.O.’s order. Clarify

with the M.O. if in doubt. with the M.O. if in doubt. Check the drug three times:Check the drug three times: - before removing it from the trolley or shelf- before removing it from the trolley or shelf - when the drug is removed from the container- when the drug is removed from the container - before the container is returned to storage- before the container is returned to storage - check the expiry date of the drug- check the expiry date of the drug

Check the drug with another RN for S4 & S8 drugsCheck the drug with another RN for S4 & S8 drugs

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Right DoseRight Dose - check the dose, read the container label, - check the dose, read the container label,

calculate the dose & check with a RN if calculate the dose & check with a RN if necessarynecessary

- use proper measuring devices for liquids, - use proper measuring devices for liquids, do not crush tablets or open capsules do not crush tablets or open capsules unless directed to by the pharmacist. (do unless directed to by the pharmacist. (do not crush enteric coated tablets).not crush enteric coated tablets).

- if a drug is required in another form you - if a drug is required in another form you may get it from the pharmacy.may get it from the pharmacy.

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Right RouteRight Route

- make sure the M.O.’s order is clear & - make sure the M.O.’s order is clear & only give the medications by the only give the medications by the route designated.route designated.

- know the abbreviations for the - know the abbreviations for the different routes.different routes.

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• Right TimeRight Time

- check the time interval ordered by - check the time interval ordered by the M.O. & give the medication at the M.O. & give the medication at the prescribed time.the prescribed time.

- drugs should be given within 20 - drugs should be given within 20 minutesminutes

of the prescribed time.of the prescribed time.

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

• AllergiesAllergies

Check if your patient:Check if your patient:

1. has any known drug allergies1. has any known drug allergies

2. has had any previous adverse drug 2. has had any previous adverse drug

reaction reaction

THE ROLE OF THE NURSE IN DRUG THE ROLE OF THE NURSE IN DRUG ADMINISTRATIONADMINISTRATION

Another responsibility of the nurse is to Another responsibility of the nurse is to monitor the effect of the drugs that monitor the effect of the drugs that are administered to a client, i.e.are administered to a client, i.e.

- whether the drug had the required - whether the drug had the required effecteffect

- little or no effect or- little or no effect or

- if any adverse reactions occurred.- if any adverse reactions occurred.

Terms and DefinitionsTerms and Definitions

• Drug InteractionsDrug Interactions

• The combined effect of two (2) or more The combined effect of two (2) or more drugs acting simultaneously. Each drug may drugs acting simultaneously. Each drug may have either a positive or negative effect on have either a positive or negative effect on the working of the others, i.e. they may be the working of the others, i.e. they may be

• antagonisticantagonistic- lessening the effectiveness of - lessening the effectiveness of another druganother drug

• synergisticsynergistic- enhancing or improving the - enhancing or improving the effectiveness of another drugeffectiveness of another drug

Terms and DefinitionsTerms and Definitions

• Adverse Reactions Adverse Reactions

-- unwanted and/or unintended effects unwanted and/or unintended effects of the administration of a drug.of the administration of a drug.

May be: Iatrogenic May be: Iatrogenic

Drug sensitivity/allergy Drug sensitivity/allergy

Terms and DefinitionsTerms and Definitions

• Adverse Reactions (con’t)Adverse Reactions (con’t)

Iatrogenic disease- caused Iatrogenic disease- caused unintentionally by drug therapy, unintentionally by drug therapy, i.e.induced by medical practitioners.i.e.induced by medical practitioners.

Terms and DefinitionsTerms and Definitions

• Adverse Reactions (con’t)Adverse Reactions (con’t)

Drug sensitivity/allergy - occurs in an Drug sensitivity/allergy - occurs in an individual who has been previously individual who has been previously exposed to the drug and has exposed to the drug and has developed antibodies. Drug allergies developed antibodies. Drug allergies can be manifested in a variety of can be manifested in a variety of symptoms ranging from minor to symptoms ranging from minor to serious.serious.

Terms and DefinitionsTerms and Definitions

• Adverse Reactions (con’t)Adverse Reactions (con’t)

- the reaction can occur immediately - the reaction can occur immediately after the client received the after the client received the medication, or be delayed for hours medication, or be delayed for hours to days.to days.

- some of the signs and symptoms - some of the signs and symptoms are skin rash, urticaria (itching), are skin rash, urticaria (itching), nausea and vomiting.nausea and vomiting.

Terms and DefinitionsTerms and Definitions

ANAPHYLAXISANAPHYLAXIS

A life-threatening immediate A life-threatening immediate reaction is called anaphylaxis. There reaction is called anaphylaxis. There is respiratory distress, sudden severe is respiratory distress, sudden severe bronchospasm, and cardiovascular bronchospasm, and cardiovascular collapse. It may result in death if not collapse. It may result in death if not treated immediately.treated immediately.

NAMES OF DRUGSNAMES OF DRUGS

Drugs can have three types of Drugs can have three types of names:names:

a. chemicala. chemical

b. genericb. generic

c. trade/brand/proprietaryc. trade/brand/proprietary

NAMES OF DRUGSNAMES OF DRUGS

a.Chemical name:a.Chemical name:

- a very precise description of the - a very precise description of the drug’s chemical composition, drug’s chemical composition, identifying the drug’s atomic and identifying the drug’s atomic and molecular structure.molecular structure.

- this name is of significance to the - this name is of significance to the pharmacist.pharmacist.

NAMES OF DRUGSNAMES OF DRUGS

b.Generic name:b.Generic name:

- the name assigned by the - the name assigned by the manufacturer who first develops the manufacturer who first develops the drug. Often the generic name is drug. Often the generic name is derived from the chemical name.derived from the chemical name.

- the official name is the name by - the official name is the name by which the drug is identified in the which the drug is identified in the official publication.official publication.

NAMES OF DRUGSNAMES OF DRUGS

c.Trade/ Brand/ Proprietary name:c.Trade/ Brand/ Proprietary name:

- is selected by the drug company - is selected by the drug company selling the drug and is copyrightedselling the drug and is copyrighted

- a drug can have several trade - a drug can have several trade names when produced by different names when produced by different manufacturersmanufacturers

NAMES OF DRUGSNAMES OF DRUGS

e.g. Chemical name= Acetylsalicylic acide.g. Chemical name= Acetylsalicylic acid

Generic name = AspirinGeneric name = Aspirin

Trade names include Aspro, DisprinTrade names include Aspro, Disprin

Be aware that in different countries generic Be aware that in different countries generic and trade names will also differ, e.g. in and trade names will also differ, e.g. in Australia & the United States one drug has Australia & the United States one drug has the generic names of paracetamol & the generic names of paracetamol & acetaminophen, i.e. Panadol/Tylenol.acetaminophen, i.e. Panadol/Tylenol.

Categories/Classifications Categories/Classifications of Drugsof Drugs

Drugs can be classified from different perspectivesDrugs can be classified from different perspectives

e.g. drugs may be classified by -e.g. drugs may be classified by -

(a) body systems(a) body systems

i.e. drugs affecting the respiratory systemi.e. drugs affecting the respiratory system

drugs affecting the cardiovascular systemdrugs affecting the cardiovascular system

OROR

(b) the symptom relieved by the drug, or the (b) the symptom relieved by the drug, or the clinical indication for the drug i.e. analgesic, clinical indication for the drug i.e. analgesic, antibiotic antibiotic

COMMOM ABBREVIATIONS USED IN COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequencyMEDICATION ORDERS/frequency

• MANEMANE• MIDIMIDI• NOCTENOCTE• BDBD• TDSTDS• QIDQID• STATSTAT• PRNPRN

• morningmorning• middaymidday• NightNight• twice a daytwice a day• three times a daythree times a day• four times a dayfour times a day• give immediatelygive immediately• when required when required

when necessarywhen necessary

COMMOM ABBREVIATIONS USED IN COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequencyMEDICATION ORDERS/frequency

• acac

• pcpc

• q.h.or 1/24q.h.or 1/24

• q2h or 2/24q2h or 2/24

• q4h or 4/24 q4h or 4/24

• before mealsbefore meals

• after mealsafter meals

• every hourevery hour

• every two hoursevery two hours

• every four hoursevery four hours

COMMOM ABBREVIATIONS USED IN COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/routeMEDICATION ORDERS/route

• BUCBUC• O/P.OO/P.O• S/LS/L

• IDID• IMIM• IMIIMI

• SCSC

• inside cheekinside cheek• oral/per oraloral/per oral• sublingalsublingal (under the tongue)(under the tongue)• intradermalintradermal• intramuscularintramuscular• intramuscular intramuscular

injectioninjection• subcutaneous subcutaneous

COMMOM ABBREVIATIONS USED IN COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/routeMEDICATION ORDERS/route

• SCISCI

• IVIIVI• IVTIVT

• NEBNEB• PRPR• TOPTOP• VAGVAG

• subcutaneous subcutaneous injectioninjection

• intravenous injectionintravenous injection• intravenous therapyintravenous therapy

• nebulisernebuliser• per rectumper rectum• topical/skintopical/skin• vaginalvaginal