11.4: Summary

11.1 Medication Orders

Different types of medication orders include routine orders, one-time orders, standing orders, STAT orders, PRN orders, and titration orders, each with specific indications for nursing practice. Routine orders are continuously followed until canceled, whereas one-time orders are for a single dose. Standing orders allow nurses to intervene promptly without waiting for provider orders, and STAT orders are administered urgently. PRN orders are used as needed for specific symptoms, and titration orders involve dose adjustments based on patient status.

The components of a medication order are crucial elements that ensure safe and effective medication administration. They include specific patient identifiers such as name and date of birth; details about the prescribed drug including its name, dosage, and route of administration; and the frequency and timing of administration. Additionally, the order must include the date and time it was written, along with the signature of the prescribing healthcare provider, to authenticate the order and ensure accountability.

11.2 Fundamental Principles of Medication Administration

To reduce the risk of medication errors, several safety measures should be implemented during medication administration. These measures include ensuring correct patient identification, checking medication orders for errors, maintaining a safe environment, and monitoring for adverse reactions. Adverse reactions are unwanted and unpredictable effects of drugs that can be influenced by various factors, including age, sex, genetics, and underlying conditions. Severe allergic reactions, such as anaphylaxis, require immediate medical attention. Drug toxicity, resulting from an accumulation of a drug in the body, can cause significant harm and must be promptly addressed. Tolerance, drug interactions, and paradoxical effects also play a crucial role in medication safety, necessitating thorough monitoring and appropriate interventions. An interdisciplinary approach involving nurses, providers, and pharmacists can further minimize errors by verifying safety at multiple checkpoints. Organizations such as the ISMP and TJC provide guidelines and standards to support these measures, including lists of high-alert medications and recommended abbreviations.

Nurses play a crucial role in ensuring patient safety during medication administration by adhering to the rights of medication administration, including confirming the right patient, drug, route, time, and dose. Additional rights recommended by the American Nurses Association (ANA), such as right reason, documentation, and response, further enhance safety and accountability. Bar Code Medication Administration (BCMA) is utilized to minimize errors by electronically confirming medication administration rights through barcode scanning. Nurses must also verify patient history, assess for drug interactions, provide education, and respect the patient’s right to refuse medication, ensuring comprehensive medication safety and adherence to ethical standards.

11.3 The Medication Administration Process

The practice of medication administration in nursing involves various routes such as oral, intradermal, subcutaneous, intramuscular, intravenous, ophthalmic, otic, nasal, inhalation, vaginal, and rectal, each requiring specific techniques for effective delivery while minimizing adverse reactions. Oral medication administration, typically via tablets or liquids, involves assessing patient safety, verifying medication orders, positioning the patient, and ensuring proper swallowing and absorption. Intradermal injections, used for skin testing and local medications, require careful site selection, skin assessment, and slow injection to create a wheal. Subcutaneous injections, commonly used for insulin and vaccines, demand aseptic technique, proper site selection, skin pinching, and slow, steady injection. Intramuscular injections, for slow drug release or digestive system bypass, necessitate aseptic technique, appropriate needle selection, muscle assessment, and aspiration to avoid blood vessels. Intravenous administration delivers medications directly into the bloodstream, requiring meticulous asepsis, vascular assessment, and monitoring for adverse reactions. Ophthalmic, otic, nasal, inhalation, vaginal, and rectal routes demand similar attention to hygiene, patient positioning, medication preparation, and administration techniques to ensure safety and efficacy, emphasizing patient education and comfort throughout the process.

Nurses are integral to the safe and effective administration of medications, ensuring optimal patient outcomes through thorough assessment, careful delegation, accurate documentation, evaluation of medication efficacy, patient education, and diligent error reporting. Assessment is conducted before, during, and after medication administration, encompassing aspects such as the patient’s ability to swallow, vital signs, and allergy checks. Delegation involves ensuring the right task, person, circumstance, communication, and supervision. Documentation is crucial for verifying medication administration “rights” and ensuring accurate records of patient responses. Nurses also play a vital role in evaluating medication efficacy and educating patients while actively reporting errors to promote patient safety and continuous quality improvement.