1757988438Medication Administration NEW.ppt2(1).pptx

تتهاون الله يسلمك يا رب العالمين والصلاة والسلام مرحبا سهم ↔ ↔

1. Medication Administration

2. Basma Abdelhakeem Amer Prepared by

3. GoaL To empower the staff with knowledge, skills and positive attitude toward medication administration

4. The medication Is a substance used in the diagnosis, treatment, relief, or prevention of health alterations.

5. Factors Affecting Drug Action

6. Factors Affecting Drug Action Age. Weight. Psychological. Gender. Time of Administration.

7. The seven rights of medication administration

8. The ten rights of medication administration The right medication. The right dose. The right patient. The right route. The right time. The right documentation. The right of the patient to refuse the medication. The right Assessment The right Evaluation The right Education

9. Routes of Drug Administration Enteral : drug placed directly in the GI tract. Oral : swallowing per mouth (P.O). Sublingual : placed under the tongue. Tubal : Gastric tube administration . Rectum : Absorption through the rectum.(on side) Others : (topical & drops & inhalation)

10. Parenteral IM: intramuscular ( Vastus Lateralis & Deltoid muscle& Dorsogluteal ). SC: subcutaneous (outer surface of upper arm &around umbilicus& Thighs). ID: intradermal (ventral forearm ). IV: intravenous(with in the vein).

11. cont .-----

12. IM INJECTION

13. Purpose of injection To get a rapid and systemic effect of the drug. To help in quick absorption than oral out. To provide means of administration for medication that cannot be given orally or I/V. To provide the needed effect even when the child is unconscious /very small or un able to swallow/when peripheral line is not accessible.

14. Choosing the site to administer medication- Site determination depends on . Stage of patients’ development. Body builds. Physical condition.

15. Site of IM injection

16. VASTUS ATERALIES The nurse locates the vastus lateralis site by placing one hand above the knee and one hand just below the greater trochanter at the top of the thigh /He or she then inserts the needle into the lateral area of the thigh.

17. Rectus femoris site The rectus femoris site is in the anterior aspect of the thigh, in the middle third of the thigh

18. Dorsogluteal site The dorsogluteal site is the upper outer quadrant of the buttocks, This site is avoided in clients younger than 2 years because their muscle is not sufficiently developed.

19. deltoid musule Take 2 fingers and place them at the top of the shoulder, At the end of the second finger in the middle of the muscle is where the injection can be made.

20. Ventrogluteal Site Place palm on hip (greater trochanter), with fingers point to the ground, and make a very large “V” with your pointer finger and middle finger. In the middle of the “V” is where the injection can be done.

21. Guidelines for solution Amount, Needle length, for IM injections

22. Solution Amount   Vastus lateralis Deltoid Ventrogluteal Dorsogluteal Infant 0.5ml Not recommended Not recommended Until 7months then0.5ml Not recommended Toddler 0.5-1ml 0.5ml 1ml Not recommended Preschooler   1ml 0.5ml 1.5ml Not recommended School age 1.5-2ml 0.5-1ml 1.5-2ml 1.5-2ml

23. Reducing Injection Discomfort Change the needle before administering a drug that is irritating to tissue. Select a site that is free of irritation. Numb the skin with an ice pack before the injection. Insert and withdraw the needle without hesitation. Instill the medication slowly . Apply pressure to the site during needle

24. Complications associated with IM injections Local trauma. Neuropathy. Local irritation, pain, Local discomfort, and redness at the site. Infection, abscess, cellulites, and tissue necrosis. Bleeding and arterial puncture. Muscle fibrosis. Permanent damage to radial nerve resulting in paralysis. Permanent damage to sciatic nerve resulting in paralysis.

25.   How to calculate flow rate ? To find the number of milliliters to be given per hour: Total solution –––––––——––––––––– No. of hours to run ═ mL/ hour

26. To find drops per minute:   mL × drop factor ––––––––––––––––––––– hr ×60 minutes = drop/minute

27. The use of the semi-prone position has the advantage that any surplus adipose tissue falls naturally downwards and allows clear identification of the injection site .

28. Instruction for medication safety 1-Check doctors order in MAR. 2-Check for unfamiliar medications. 3-Check drug sheet every 24hrs. 4-Labeling of each drug. 5-Discard any used iv fluids within 24 hrs. - .

29. 6-Send any discontinued drugs to the pharmacy. 7-Prepare the needed equipment in clean tray. Double check medication with another nurse. 8- 9-Check medication right 10-Hand washing and wear gloves

30. . . 11-Explain procedure to the patient 12-Prepare medication. 13-Keep patient privacy. 14-put patient in comfortable position

31. 15-Assessment of medication sites(redness- tenderness-hematoma) 16-Give medication in appropriate site with appropriate technique. 17-Return patient to comfortable position. 18-Documentation(date-time-route-dose-any side effects& signature)

32. Medication Label Medication Name Medication Strength Medication Use Expiration Date Medication Information

33. Medication orders *Once daily ( OD,Q24 hrs ) *Twice daily ( BID,Q12 hrs ) *Three times daily ( TDS,Q8 hrs ) *Four times daily ( Q6 hrs ) *Give now only ( STATE) *Continuous during 24hrs (INFUSION rate …..)

34. High Alert Medication Are drugs that causing significant patient harm when they are used wrongly.

35. Examples of High Alert Medication * Arrest trolley medications :- ( Atropine-Adrenaline-Noradrenaline-Dex25%) * Electrolytes :- (Kcl-Mg-Nahco3-Ca) * Narcotics :- (morphine-pethidine-fentanyle)

36. Cautions of high alert medications *Must be in separated container. * Must be labeled by red label . . *Must be locked * Must not be stored in patient care area except (ICU-OR-ER) . . * Restrict access to high alert medications

37. Cautions cont: *Must be prepared at the same time of taking from cupboard. * Any remaining medications must be discard *Double check the medication with another nurse. - *Narcotics: 1- Double locked . 2 -Separated narcotic prescription used. 3 -Special log book used.

38. Sound & look-alike medications Lanoxin ( antiarrhythmic ) Laxin (laxative) DepriVAN (general anesthesia) DepreBAN(antidepressant) Debocaine(lidocaine(local anesthesia) Depakine (anticonvulsant) * Sound-alike *It is a confused drug name. * Examples : -

39. Sound & look-alike medications cont: Mediathetic 5mg(Sedative) Haemokion ( vit K) Sodium bicarbonate(NaHco3) Magnesium sulphate(Mg) Diuretic) ) Lasix 20mg Primpran (anti emetic) Atrovent Combivent *Look-alike: *It is a confused drug shape. - * Examples :

40. How to prevent sound&look-alike med errors *Must be separated and clearly labeled . *Make sure of drug name during preparation and before giving medications. *Double check must be done. *In case of verbal or telephone order ( read back- write down & confirm) .

41. Medication Error

42. Medication Error It is any event that may cause or lead to inappropriate medication use or patient harm .

43. Causes of medication error Poor communication between nurses and pharmacists. Lack of knowledge in drug administration. Multiple interruptions the nurse during preparing medication. Verbal order. Stress or fatigue.

44. Types of medication errors - *Nursing errors: 1 -Wrong labeling . 2 -Wrong dose. 3 -Missed dose. 4 -double dose 5 -No signature. 6 -Lost medications. 7 -Wrong administration.

45. Types of medication errors cont: *Prescribing errors: 1- Bad hand writing. 2- Writing in wrong place. . 3- Incomplete prescriptions 4- Modefing&D.C without . Sig,date or time. 5 -Wrong Prescribing.

46. Types of medication errors cont: * Pharmacy errors:- 1- Look-alike medications. 2- Sound -alike medications. 3- Wrong labeling 4- Wrong dispensing. 5- No signiture.

47. Prevention of medication error Don't administer any drug without a doctor's order. Check the label to identify a drug. Don't rely on the drugs color, shape, or location of the medication. No verbal order Except in emergency

48. Prevention of medication error Check the label with the patient medication administration record (MAR) three times. Check the drug name. if you have any doubts about the spelling, call the doctor or pharmacist Drug written clearly .

49. * Ask another nurse or a pharmacist to double check your dosage. *Sound & look-alike medications should be separated. *Don't give drugs another nurse has prepared. *Use appropriate documentation to prevent errors.

50. I hope you understand well

51. THANK YOU