10 GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY 1. Administer the right drug. 2.

Administer the right drug to the right patient. 3. Administer the right dose. 4. Administer the right drug by the right route. 5. Administer the right drug at the right time. 6. Document each drug you administer. 7. Teach your patient about the drugs he is receiving. 8. Take a complete patient drug history. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks.) 9. Find out if the patient has any drug allergies. 10. be aware of potential drug - drug or drug-food interactions. To protect your patients and your license, follow these guidelines for avoiding medication errors GENERAL RULES IN MEDICINE ADMINISTRATION Know and observe the RIGHTS IN MEDICINE ADMINISTRATION . 1. Right medication 2. Right dose 3. Right patient 4. Right manner and route 5. Right time 6. Right documentation 7. Right assessment 8. Right drug history 9. Right evaluation 10. Right to refuse to medication 11. Right Order 12. Right client education 13. Right approach 2. Check doctors order of medicine/drug at least 3x before administering the said drugs to the patient. 3. If written order is not clear as to meaning, not legible or complete or not signed by the doctor, consult the Physician who order that medicine; if he/she is not on duty, refer it to the resident on duty. 4. Receiving verbal orders/phone calls/text order should be minimized as much as possible. If and when there are such orders, let the physician signed in the doctors order within 24 hours. 5. Make certain that all equipment/supplies are functional, sterile/clean and dry. 6. Use hypo tray/medicine tray when giving medicines with medicine card available in the tray. Do not touch oral pills or tablets with your bare hands. 7. Always check the patency of NGT before giving drugs through NGT with precaution such as putting the patient on moderate high back rest and let it be at least 30 mins. 1 hour in that position. 8. Change and/or remove medicine card if there is a new order with indication on the medication sheet. 9. Never leave the medicine on patients bedside table. See to it that all medicines are taken by the patient before leaving him/her. 10. Any change in color, odor or consistency of drugs should not be use without consulting the Senior Nurse/Supervising Nurse/Chief Nurse/Physician. 11. Wrap a dark cloth or paper to an IVF with incorporation of vitamins/drugs. 12. Medicines/drugs that should be refrigerated should be put in a refrigerator. 13. Never give medicines through IV infusion if it is out of vein. 14. Never allow Nursing attendants to give medicines especially through IV infusion. 15. Never allow a patient or a watcher to carry or give medicines to another patient 16. Never follow cough syrups with water nor dilute cough syrups as it minimizes the soothing effect of the syrup on the mucous membrane. 17. Any medicine/drugs given to the patient must be duly signed by the NOD who administer the medicine in the medication sheet after it has been administered. If medicines are not available or is not given, write NA in the medication sheet as well as meds that are refused to be given/taken by the patient must be signed by the patient in the doctors order sheet. Never record a medicine as given until the patient has actually taken it. 18. Notify the Senior Nurse/Physician if patient refused to take the medicine or if any drug is not administered. 19. Never give any drugs in oral form to an unconscious or delirious patient. Inform first the physician if the patient cannot tolerate oral meds. 20. For Pediatric patients, dissolve tablets first and give it slowly using a spoon or a dropper. 21. Observe the patient carefully for any side effects/drug action/toxic effects and notify the Resident on duty immediately. 22. Use only standard abbreviation in recording. 23. Follow the dilution of drugs according to hospital standards.

Routes of Drug Administration

ORAL Advantage

Disadvantage

Drug Forms for Oral Administration a. Solid- Tablet capsule, pills, powder b. Liquid-syrup, suspension, emulsion, elixir, milk, or other alkaline substances Syrup- sugar-based liquid medication

Suspension- Water based liquid medication: shake the bottle before use of medication to properly mix it. Emulsion- oil-based liquid medication Elixir- alcohol based liquid medication. After administration of elixir allow 30 minutes. To elapse before giving water this will allow maximum absorption of the medication Special Consideration / Precaution

1. enteric coated tablets should never be crushed before administration 2. Suspension should not be administered IVF 3. do not administered enteric coated tablet or any drugs with antacid, milk or any alkaline substance 4. In case the patient vomits after administering the drug, notify the doctor and never administer the drug again.

SUBLINGUALAdvantage
.

Disadvantage

BUCCAL Advantage Disadvantage It has to be retained for several of minutes under the tongue until dissolved and absorbed.

TOPICAL/PERCUTANEOUS- application of the medication to a circumference area of the body. Include dermatological medications, irrigation and instillation. Wash hands and pat dry the area before administration If the pt has wounds practise surgical asepsis Before applying the medication, removed the previously applied drugs Wear gloves/ used tongue depressor when applying the drug A. Dermatologic: skin (lotion, liniment, ointment, paste and powder) B. Ophthalmic: indicate to treat the eye infection, eye irritation, glaucoma, includes instillation and irrigation 1. Instillation-to provide an eye medication that the client requires. 2. Irrigation- to clear the eye of noxious or other foreign materials. Position the client either from lying or sitting position. Instil at maximum 2 drops at a time and wait for 5 min if additional drops need to be administered, instruct client to close gently and do not rub. C. Ear/Otic Administration- also includes installation and irrigation 1. installation- to soften earwax, to reduce inflammation, to relieve pain 2. Irrigation- to remove cerumen or pus, to apply heat, to remove foreign body D. Nasal nasal instillation usually are instilled for their astringent effect (to shrink swollen mucous membranes), to treat infection of the nasal cavity. Examples, decongestants, steroids Before administration , have the patient blow the nose Position the patient in supine After administration keep the head tilted for 5 min, used alternate nares when daily uses to prevent irritations.

E. Inhalation used to induce anaesthesia, treat respiratory disorder. used of nebulizers, metered-dose inhalers (MDI) F. Vaginal Used of suppositories, jelly, tablets, phizaries, cream Advantage Vaginal Irrigation is the washing of the vagina by liquid at low pressure or it is also called douche. Empty the bladder before the procedure Instillation: Back lying position with knees flexed and hips rotated laterally Irrigation: back lying hips are higher than the head and shoulder The high of irrigation is 12 inches/30 cm (enema is 12-18 inches) Remain for 5-10 minutes if vaginal suppositories, cream, foam, jelly or irrigation. G. Rectal: indicate for medicines with unpleasant taste/noxious. Advantage Disadvantage Dosage absorption is unpredictable Has limited used Drug forms: Disadvantage

Suppository needs to be refrigerated Used gloves for insertion Have client lie on left side and breathe to the mouth to relax the sphincter. Insert suppository until a sensation that something has grab it away- indication that the suppository is inserted pass the internal anal sphincter.

PARENTERAL: the administration of medication by using a needle. Types: 1. Intradermal 2. Intramuscular 3. Subcutaneous 4. Intravenous 5. Intra arterial6. Intra osseousIntradermal injection: the administration of the drug into the dermal layer of the skin beneath the epidermis. used for skin testing/ allergy testing Site: inner lower arm, upper chest and back beneath the scapula Used left arm for tuberculin test, used right arm for all kinds of test Needle gauge is 25, 26 Bevels up 10-15 degrees angle Inject a small amount enough to make a wheel or bleb Do not massage the bleb (encircle the bleb using blue or black pen) Subcutaneous: drugs administered subcutaneously are as follows: vaccines, preoperative medications, narcotics, insulin and heparin. Sites: upper arm, abdomen, anterior thigh, scapula area. Needle gauge is: 21-23 Position for obese 90 degrees, thin 45 degrees. Heparin do not aspirate and do not massage may cause hematoma For insulin do not massage site the site to prevent rapid absorption and preventing hypoglycaemia. For other medication aspirate first before injecting. Intramuscular Injection: Large volume of medication, Rapid absorption because muscle have many capillaries, Used when administering irritating medication in the tissue Needle 20-23 (1, 1 , 2)depending on the viscosity of medication Inject the medication slowly to allow tissue to accumulate volume. Sites of Intramuscular Injections 1. Ventrogluteal site (Von Hochsteter site) Uses of gluteus medius Position the client in prone or side lying. When in prone position, curl toes inward. When inside lying position, flex the knee hip, this ensure the relaxation of of the gluteus muscles and minimize discomfort during injection. To locate the site place the heel of the palm to the trochanter , point the index finger toward the anterior superior iliac spine, and then abduct the middle (third) finger. Triangle formed by the index finger, the third finger and the crest of the ilium is the site. 2. Dorsugleteal site

Uses gluteus medius Position the client similar to ventrogluteal The site should not be used to infant under 3 years old(gluteal muscle are not well develop) To locate the site, the nurse draws an imaginary line by dividing the buttocks into 4 quadrants. The upper outer quadrant is the site of injection. Palpate the crest of the ilium to ensure that the site is high enough.

Alert: avoid hitting the sciatic nerve, major blood vessel or bone by locating the site properly; may caused paralysis 3. Vastus Lateralis Recommended site for injection for infants Located at the middle third of the lateral aspect of the thigh Assumes back lying or sitting position Rectus Femoris Located at the middle third, anterior aspect of the thigh Deltoid Site Not used often for IM To locate: palpate the lower edge of the acromion process and the midpoint on the lateral aspect of the arm that is inline with the axilla. This is approximately 5 cm (2 inches) or 2 to 3 fingerbreadths below the acromion process.

4. 5.

Variation of IM injection (Z-track technique) Used for iron preparation. To seal the drug deep into the muscles to prevent from staining the skin. Retract the skin laterally, inject the medication slowly. Hold retraction of skin until the needle is withdrawn. Do not massage the site of injection to prevent leakage of medication into subcutaneous tissue. Intravenous (Venipunctured): insertion of a needle into a vein, based on the physician's written prescription. The needle is attached to a sterile tubing and a fluid container to provide medication and fluids. Direct IV, IV push, IV infusion Most rapid route of absorption of medications. Larger doses of medication can be administered Types of IV fluids 1. Isotonic solution. Has the same concentration as the body fluids. Example: D5w, NaCl 0.9%, Plain Ringer solution. 2. Hypotonic: Has lower concentration than the body fluids(swell or burst) NS (NaCl 0.45%) 3. Hypertonic: Has higher concentration than the body fluids (will shrink or crenate) D10W, D50W, D5LR, D5NM,D5NS Complication of IV infusion 1. Infiltration: the needle is out of the vein, and the fluids accumulate in the subcutaneous tissues. Assessment: Pain, swelling, skin is cold at needle site, pallor of the site, flow of IV site decreses or stop Nursing intervention: Change the site of the needle, Apply cold compress. This will relieve pain, promote vasoconstriction and reduce swelling. 2. Circulatory Overload: Assessment: Headache, Flushed Skin, Rapid Pulse, Increased BP, Weight Gain, Pulmonary Edema, SOB, Shock Nursing Intervention: Slow Infusion to KVO, Place patient in high Fowlers position, Administer diuretics and bronchodilators as ordered. 3. Drug Overload: the patients receive excessive amount of fluids containing drugs Assessment: Dizziness, Shock, Fainting Nursing Intervention: Slow infusions to KVO, Notify Physicians 4. Superficial Thrombophlebitis: is the inflammation of the vein. It is the due to overdose of a vein, irritating solution or drugs, clot formation, large bore catheters. Assessment: Pain along the course of vein, vein may feel hard and cordlike, Edema and redness at the needle insertion site, arms feel warmer than the others. Nursing Intervention: Change IV site every 72 hours, Use large veins for irritating fluids, Apply warm compress 5. Air Embolism: Air manages to get into the circulatory system; 5ml of air or more causes air embolism. Assessment: Chest, shoulder or back pain, Hypotension, Dyspnea, cyanosis, decrease LOC Nursing Intervention: Do not allow IV bottle to Run Dry, Turn client to left side, in T-burg position. 6. Nerve Damaged: May result from tying the arm to thigh Assessment: Numbness of the fingers and hands Nursing Intervention: massage the area and move arms through ROM, Open and close hands several times, 7. Speed Shock: May result from administration of IV push medication rapidly. Assessment: to avoid speed shock and possible cardiac arrest give most IV push medication over 3-5minutes.

DOSAGE AND CALCULATIONS A. Equivalents Common Household and Measurements

Common Household and Measurements 1 quart 4 cups 1 pint 2 cups 1 cup 8 ounces 1 tea cup 6 ounces 1 tbsp 3 tsp; 15-16 ml 1 tsp 60 qtts; 4-5 ml Apothecary Measurements 60 minims 8 fluid Ram or 16 fluid ounces O) 2 pints 4 quarts B. Important Formula 1 fluid Ram 1 fluid onces 480 minims 1 pint (pt or 1 quart (qt) 1 gallon (C) Metric Measurements Unit of volume (Liter - L) 1 m. (millimeter) 0.001L-(1/1000) 1 cl (centiliter) 0.01 L (1/100) 1 dl (deciliter) 0.1 L (1/10) 1 decaliter 10 L Units of weights (Gram-G or gm) 1 mcg. (microgram) 0.000001 G (1/10000000) 1 mg (milligram) 0.001 G. (1/1000) 1 cg (centigram) 0.01 G. (1/100) 1 dg (decigram) 0.1 Gm (1/10) 1 kg (kilogram) 1000 Gm Units of length (Meter-m) 1 mm (millineter) 0.001 m (1/1000) 1cm (centimeter) 0.01 (1/100) 1 dm (decimeter) 0.1 m (1/10) 1 hectometer 100 meters Other units equivalents 1 G (gram) 1 gr (grain)`` 1 mg (milligram) 1 ml (millimeter) mcgtts; 1G 1 L (liters) 1 oz. (ounces) 1 kg. (kilogram) 1 lb. (pound) 15 gr 69 mg 1000 mcg 1 cc; 15 gtts; 60 1 qt.; 4 qt.; 4000 ml 30 G.; 30 ml; 30 cc 2.2 lbs 16 oz.

1. Solid Medications:

Desired/stock = quantity
Example: paracetamol 50 mg. S=250 mg 50mg/250X tab = .2 mg 2. Liquids Medications Desired/Stock X dilution=Quantity of drugs 3. IV fluid Rates

a. gtts/min = volume in cc x gtt factor Number of Hours X 60 Mins b. cc/hr = Vol. in CC number of Hr c. Duration in Hours = volume in cc cc/hr

4. Conversion of Temperature a. O C to o F = (O C X 1.8) + 32 b. o F to O C = (o F - 32) (0.55) (Note: 1.8 is 9/5) (Note: 0.55 is 5/9) 5. Paediatric Doses a. Clarks Rule Wt. In lbs x usual adult dose = safe child dose 150 b. Frieds Rule Age in month x usual adult dose = safe Childs dose 150 c. Youngs Rule Age in years X usual adult dose = safe childs dose Age in two years + 12