Medication Rights
1. Right Drug/Medication
2. Right Client/Patient
3. Right Route
4. Right Dose
5. Right Frequency/Time
6. Right Assessment
7. Right Approach
8. Right Education
9. Right Evaluation
10. Right Documentation
11. Right to Refuse
12. Right Principle of Care
13. Right Prescription
14. Right Nurse Clinician
Drug-drug interactions ..
Drug-drug interactions (DDIs) are one of the commonest
causes of ADRs and these manifestations are common in the
elderly due to poly-therapy. In fact, poly-therapy increases
the complexity of therapeutic management and thereby the
risk of clinically relevant drug interaction. Poly-therapy may
determine the “prescribing cascade,” which occurs when an
ADR is misunderstood and new potentially unnecessary
drugs are administered; therefore the patient is at risk to
develop further ADRs.
BASIC GUIDLINES/GENERAL INSTRUCTION
A.BEFORE ADMINISTRATION (DURING PREPARATION OF
DRUG)
•Patient must be correct identified by using 2 identifiers ;complete
name and file number checked against the ID .do not identify patient
using room or bed number .
•To the maximum extent possible ,only administer medications you
have personally prepared .
•Gather or review assessment data that may influence drug
administration .this may include vital signs,lab data ,drug serum etc.
•Do not administer medication from containers that are unmarked
or illegible .do not give medications that have changed color
.appearnce ,or from which the container is broken or crusted.
Cont
• Check the label of the containers thrice before
preparing the drug .
-before the medication container is taken from the shelf.
-before pouring the drug
-before replacing the container in shelf .
-check the expiry date of the drug.
• Always use a calibrated measures while preparing
the drug .
• Shake the liquid medication before pouring it into
the ounce glass ;pour it away from the label.
Cont
• Wipe the mouth of the bottle ,close it tightly and
replace it at the proper place .
• When taking tablets or capsule do not touch them
with hands ,drop them from the container to its lid
and then to the medication cup .
• Do not put back the medicine once it is taken out of
the container .
• Prepare the drug just before the time of
administration and do not leave the drug in the
medicine tray without proper identification .
Cont
B.DURING ADMINISTRATION
▪ Observe 14 right of administration of drugs .
C.AFTER ADMINISTRATION :
❑Record only the medicine ,which you have
administered .
❑Record the date ,time ,name and dose of the drug
administered.
❑Never record a medicine before it is given
❑Record the effect observed –the local or systematic
effect ,its side –effect or toxicity ,any complication.
Parts of syringe
Parts of an Insulin Syringe
subcutaneous injection
1. A subcutaneous injection is a
methodofadministering medication. ... In this type
of injection, a short needle is used to inject a drug
into the tissue layer between the skin and the
muscle. Medication given this way is usually
absorbed more slowly than if injected into a vein,
sometimes over a period of 24 hours.
2. A subcutaneous injection is a method of
administering medication. Subcutaneous means
under the skin
Location of injection
• The location of injection is important for subcutaneous
injections. The drug needs to be injected into the fatty
tissue just below the skin. Some areas of the body have
a more easily accessible layer of tissue, where a needle
injected under the skin will not hit muscle, bone, or
blood vessels.
• The most common injection sites are:
• Abdomen: at or under the level of the belly button,
about two inches away from the navel
• Arm: back or side of the upper arm
• Thigh: front of the thigh
Cont...
• Medication: Vials of liquid medication can be single-use or
multiuse. Vials can also be filled with a powder to which
liquid needs to be added.
• Syringes: The needles are short, at 5/8 inches long. The
thickness of the needle is usually 25 or 27 gauge. There
may be other options for doses more than 1 mL or for
children or people with visual impairments.
• Auto-injector pen: Some medications are available in a
“pen” with a short single-use needle screwed onto the end
of a pen-shaped, multiuse vial. The amount of medication
needed is then dialed in at the end. As mentioned earlier,
emergency medications like epinephrine can also come in
this form
complication
• As with any injection procedure, infection at
the site of injection is a possibility. Signs of
infection at the injection site include:
• severe pain
• redness
• swelling
• warmth or drainage
IM INJECTION
• An intramuscular, or IM, injection is a
procedure used to insert medications into the
muscle tissue. Some medication cannot be
taken by mouth because digestive juices can
alter their effects. Others can be very irritating
when they go into fatty tissues or veins. IM
injections insert medication deep into the
muscle, where there is an adequate supply of
blood. This facilitates fast absorption and
leads to better effects and outcomes.
SITES OF IM INJECTION
• The dorsogluteal injection site is in the upper
outer quadrant of the buttock. Be careful to
identify the correct location because
permanent damage to the body can occur if
the injection reaches the sciatic nerve that is
close by.
• The ventrogluteal injection site is located in
the upper side of the hip. It is the preferred
site for most IM injections given to adults.
CONT..
• The deltoid injection site is one to two inches below
the shoulder region. Many adult vaccinations are
administered at this site.
• There are two IM injection sites located in the leg.
The vastus lateralis is located mid-thigh on the outer
side of the leg. The rectus femoris is also located
mid-thigh, but on the anterior that is 1 and a 1/2
inches or longer is appropriate for someone who has
a large body mass, while a needle that is 1/2 - to 1-
inch long is appropriate for someone with a smaller
body mass
The dorsogluteal injection site is in the upper outer quadrant of the buttock. Be careful to identify the correct location because permanent damage to the body ca
The ventrogluteal injection site is located in the upper side of the hip. It is the preferred site for most IM injections given to adults.
The deltoid injection site is one to two inches below the shoulder region. Many adult vaccinations are administered at this site.
There are two IM injection sites located in the leg. The vastus lateralis is located mid-thigh on the outer side of the leg. The rectus femoris is also located mid-thi
ADVANTAGES
• Intramuscular injections have
other advantages too. The muscles have a
plentiful supply of blood, which helps ensure
that the body absorbs the medication quickly.
The tissue in the muscles can also hold more
medication than fatty tissue. Doctors
administer most injectable vaccines into the
muscles
CONT..
• 1. Simple and Accessible
The method is simple and very accessible. When injections cannot be administered
by doctors or no one trained is around, it is difficult to administer intravenous or
even the subcutaneous injections. Intramuscular injections are much easier to
administer. Most people can easily access their thigh muscles. One can even access
the deltoid or the gluteus muscle.
• 2. Unaided Administering
There are medical devices available that make administering intramuscular
injections easier but one doesn’t have to use them. With some intravenous
injections and subcutaneous injections, you would depend on some medical
devices. You don’t need to find a vein or the exact depth of the fat inside the skin.
• 3. Imperative for Many
Intramuscular injections are necessary to administer some vaccines and many
drugs including immunoglobulins. You cannot administer these as subcutaneous or
intravenous injections. Intramuscular injections can supply a larger volume of the
drug or fluid. The intake is much more since muscles have a larger capacity than
the veins. Since the medicine is not directly getting into the bloodstream, there is a
sustained release which can have a desired effect in certain cases. Not everyone or
every condition benefits from an instant release of a medicine into the
bloodstream.
DISADVANTAGES
• 1. Can be Ineffective
Intramuscular injections can be futile if the exact site where it is
administered is not conducive to the ready absorption of the drug.
Absorption is anyway poor with intramuscular injections, especially
when compare with intravenous injections, so wrong choice of site
can easily lead to wastage.
• 2. Side Effects
Intramuscular injections have quite a few side effects. General
discomfort is quite common. One may also experience severe pain
where injected, numbness and tingling are common too, swelling
and redness would certainly occur if the administration was not
gentle, there can be drainage at the site, bleeding is possible and
there can be allergies depending on the drug as well as the person’s
vulnerability to various allergens.
COMPLIOCATION
• Complications with IM include muscle
atrophy, injury to bone, cellulitis, sterile
abscesses, pain, and nerve injury .
Procedure
Z-track method
• The Z-track method is a type of IM injection
technique used to prevent tracking (leakage)
of the medicationinto the subcutaneous
tissue (underneath the skin). ...
This zigzag track line is what
Prevents medicationfrom leaking from the
muscle into surrounding tissue.
Special consideration during parental
injection
special consideration parentral injection.docx
IV INJECTION
• Intravenous fluid regulation is the control of the
amount of fluid receive intravenously, or through
bloodstream. The fluid is given from a bag connected
to an intravenous line. This is a thin tube, often called
an IV, that’s inserted into one of veins.
• intravenous injection an injection made into a vein. I
ntravenous injections are used when rapid absorption
is called for,when fluid cannot be taken by mouth, or
when the substance to be administered is too irritatin
g to be injected into the skinor muscles. In certain dia
gnostic tests and x-
ray examinations a drug or dye may be administered i
ntravenously.
PURPOSE
There are several reasons why you might need to have fluids
administered intravenously. For instance, some treatments rely on IV
delivery. These include:
• rehydration after becoming dehydrated from illness or excessive
activity
• treatment of an infection using antibiotics
• cancer treatment through chemotherapy drugs
• management of pain using certain medications
• Fluids for such treatments consist of water with electrolytes,
sugar, or medications added in concentrations that depend on
need.
• The rate and quantity of intravenous fluid given depends on
medical condition, body size, and age. Regulation ensures the
correct amount of fluid drips from a bag down the IV into vein at
the correct rate. Complications can result from receiving too much
too quickly, or not enough too slowly.
SITE OF IV INJECTION
Types of intravenous fluid regulation
There are two ways to regulate the amount and
rate of fluids given during intravenous therapy:
1. Manually and
2. Using an electric pump
SPECIAL CONDARATION FOR IM
INJECTION
• Ensure the patient’s position for injection is not contraindicated by a
medical condition (e.g., circulatory shock, surgery).
• Always wear gloves to administer injections. Although policy may vary
from place to place, the CDC recommends wearing gloves if there is
potential for contact with blood and body fluid.
• If required by agency policy, aspirate for blood prior to administering an
IM medication.
• Upon injection, if a patient complains of radiating pain or a burning or a
tingling sensation, remove the needle and discard.
• Take all necessary steps to avoid interruptions and distractions when
preparing and administering medications.
• If a patient expresses concern or questions the medication, always stop
and explore the patient’s concerns by verifying the order.
• NEVER recap needles after giving an injection. Apply the safety shield
and dispose in the closest sharps container.
CONT.
• Ensure the patient’s position for injection is not contraindicated by a
medical condition (e.g., circulatory shock, surgery).
• Always wear gloves to administer injections. Although policy may vary
(for example, if you are in an acute setting compared to a community
setting), the CDC recommends wearing gloves if there is potential for
contact with blood and body fluids.
• If required by agency policy, aspirate for blood prior to administering an
IM medication.
• Upon injection, if a patient complains of radiating pain, burning, or a
tingling sensation, remove the needle and discard.
• Take all necessary steps to avoid interruptions and distractions when
preparing and administering medications.
• If a patient expresses concern or questions the medication, always stop
and explore the patient’s concerns by verifying the order.
• NEVER recap needles after giving an injection. Apply the safety shield and
dispose in the closest sharps container.
SPECIAL CONSIDERATION FOR IV
INJECTION
• From TNI BOOK
Cont...
• CLINICAL PROCEDURES FOR SAFER PATIENT
CARE.docx
Ethical and legal aspects in drug
administration.
• A moral as well as legal dimension is involved in the
administration of medications.
• “Nurses are responsible for their actions”
• Under the law nurses are responsible for their own actions
regardless of a written order. It is expected to know all nurses
the minimum and the maximum dose of every medicine that
she administer. If a nurse gives an Inj.pethadine 500mg to a
patient instead 50mg , the nurse is responsible for the harm,
she cannot justify her deed spite of a written order for the
same dosage.
• The nurses responsibility includes to monitor medication
errors by observing seven rights of giving medication.
• The nurse must follow the own institutional policy(leaving
medicine in the bedside strictly prohibited)
CLIENT’S RIGHT RELATED TO
MEDICATIONADMINISTRATION ,CONT
• The patient has the right to considerate and respectful
care, and the right to refuse the medication,
• To be informed of the medication’s name, purpose, action,
and potential undesired effects,
• To refuse a medication regardless of the consequences
• To have a qualified nurses or physicians assess medication
history, including allergies
• To be properly advised of the experimental nature of
medication therapy and to give written consent for its use
• To receive appropriate supportive therapy in relation to
medication therapy
• To not receive unnecessary medications.
Medication safety guidelines
• Medications are not given without physician’s
written orders.
• Do not administer a drug about which any doubt
exists, check further with the physician.
• Labels must be clear if not return to pharmacy.
• A nurse not to pour medication to one bottle to
another, not to put a medicine back into bottle,
Nurses are not authorized to re-label medication
bottles, Medication which loses its label or which
lacks a legible label shall be return to the
pharmacy
CONT.
• Nurse who administer the medications are responsible for
their own action. Question any order that you considered
incorrect (may be unclear or inappropriate)
• Be knowledgeable about the medication that you
administer
• Keep the Narcotics in locked place.
• Use only medications that are in clearly labeled containers.
• Return liquid that are cloudy in colour to the pharmacy
• Before administering medication, identify the client
correctly
• The nurse who prepares the drug administers it.. Only the
nurse prepares the drug knows what the drug is.
• If the client vomits after taking the medication, report this
to the nurse in-charge or physician.
CONT.
• Preoperative medications are usually discontinued during the
postoperative period unless ordered to be continued.
• When a medication is omitted for any reason, record the fact
together with the reason.
• When the medication error is made, report it immediately to
the nurse in-charge or physician. To implement necessary
measures immediately. This may prevent any adverse effects
of the drug.
• Each nurse should know the common dose, maximum dose,
how to compute dosage if necessary.
• Do not leave the medication at the bedside. Stay with the
client until he takes the medications.
• Prepare medications for one patient at a time.
• Do not label the medicine by patient room number or bed
number .
CONT.
• Know and follow institutional policy and procedures
• Look up what you do not know
• Chart carefully
• Listen to the patient “I never took that before’’ and the like
• Check ,Double – check when a dose seems high.
• Narcotics are to be checked by every shift, and the narcotic cabinet must
be locked
• Follow the universal safeguards in administration of medications.
• Always check patient ID before administering medications.
• Chart the medication after administration, if it is not charted , it is not
done.
• Chart if any nursing action done before administering( apical heart rate, B.P,
)
• Check for the expected effect(therapeutic) of the drug. Did side effects or
adverse effects occur perform indicated nursing actions . Record
observations.
Patient & Family Education
• Name dose and action of the drug.
• Time of administration
• Special storage and preparation of
the drug
• Specific OTC drugs and alternate
• Special comfort and safety reasons
• Specific points about drug toxicity
• Specific warning about drug
discontinuation.
• ADVANCED TECHNIQUES INJECTION
Modern injection systems reach very
high injection pressures, and utilize
sophisticated electronic control methods.
Epidural
• definition of epidural : an injection of a local
anesthetic into the space outside the dura
mater of the spinal cord in the lower back
region to produce loss of sensation especially
in the abdomen or pelvic region.
EPIDURAL
1. Patient preparation
• Nurse Prehydration
• Non-particulate antacid Monitors Position Preparation Emergency equipment, O2
2.Procedure
1.Informed consent
2.Monitoring during analgesia induction :
B P/1–2 m for 15 m
verbal communication
Maternal HR.
FHR
3.Hydration: 500 to 1000 mL of L R
4. Position: lateral decubitus or sitting
5. The epidural space: identified with a loss-of- resistance
6. E catheter is threaded 3–5 cm into the E space.
7.Test dose: 3 mL of 1.5%lidocaine with 1:200,000 epinephrine is injected after careful
aspiration& after uterine contraction {minimizes the chance of confusing tachycardia
that results from labor pain with tachycardia from IV injection of the test dose}.
8. If the test dose is negative: one or two 5-mL doses of 0.25%bupivacaine are injected to
achieve a cephalad sensory T10 level.
Cont..
Assess the block: After 15–20 m loss of sensation to cold or
pinprick.
• No block : Catheter is replaced.
• Block is asymmetrical: Catheter is withdrawn 0.5–1.0 cm
Additional 3–5 mL of 0.25%bupivacaine is injected.
• Block inadequate: Catheter is replaced.
Position: lateral or semilateral position {avoid aortocaval
compression}.
Observation
▪ Maternal BP: /5–15 min.
▪ FHR: continuously.
▪ Level of analgesia& intensity of motor block: hourly.
Cont..
• Intrathecal administration is a route
ofadministration for drugs via
an injection into the spinal canal, or into the
subarachnoid space so that it reaches the
cerebrospinal fluid (CSF) and is useful in spinal
anaesthesia, chemotherapy, or pain
management applications.
CONT..
• Intraosseous infusion (IO) is
the process of injecting
directly into the marrow of
a bone. This provides a non-
collapsible entry point into
the systemic venous system.
This technique is used to
provide fluids and
medication when
intravenous access is not
available or not feasible.
CONT.
• Intraperitoneal
injection or
IP injection is
the injection of a
substance into
the peritoneum
(body cavity). It
is more often
applied to
animals than to
humans.
