Pharm Chapter 7: Responsibilities and pronciples of drug administration

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Responsibilities of health care practitioner:
Adequate, up-to-date information
Wisdom and judgment to assess, evaluate, and plan
Skill in delivery
Patient education
Responsible Drug Administration
Unfamiliar drugs should never be administered
Moral, ethical, and legal responsibilities
Must document medications given and education provided
Resources: PDR, AHFS Drug Information, USP/DI, package inserts, and pharmacists:
must be consulted before admin of a drug in order to become familiar with its desired effect, potential side effects, precautions and contraindications, and possible interactions with other drugs or foods.
Responsibility for safe administration of medications requires:
complete planning for patient care, including prior assessment, interventions, and evaluations of the results of drug therapy. Also, training to develop skills in the delivery of meds. Goal is to maximize the effectiveness of the drug with the least discomfort to the patient. Sensitivity to the unique needs of each patient is encouraged. Awareness of difficulty swallowing or impaired movement that coul affect admin of meds.
Assessment
taking a complete history, including all medical conditions, allergies, and all other meds in use, including OTC drugs, vitamins, and herbal remedies. Also, careful observation of patient's vital signs, posture, skin temp and color, and facial expressions before and after drug admin.
Interventions
require judgment in timing, discontinuing medicine if req'd, and taking steps to conteract adverse reactions, as well as knowing what and when to report to the physician.
Planning effective drug therapy
evaluation and documentation of results play a vital role for all HC providers, including the physician, in planning effective drug therapy.
Patient education
essential part of the safe admin of meds. Patients must understand the importance of taking the med in proper dosage, on time, and in the proper way, in order to benefit from drug therapy. Info must be in their language, both verbally and written instructions as well as demonstrations of techniques when indicated. If the med admin requires extra equipment or has multiple steps, a return demonstrtion should be req'd.
moral, ethical, and legal responsibilities
some rules and regulations vary with the institution, agency, or office. When in doubt, consult those in authority- supervisors or administrators/ and/or policy and procedure books. Doc on the patient's record is always req'd for all meds given. In addition, controlled substances given must also be recorded in a narcotics record.
Medication Errors
Occur in all health care settings
How:
Drug given to wrong patient
Incorrect drug given
Incorrect route or wrong time
Incorrect dose
Improper documentation
Medication errors are reported from:
acute care facilities; the risk is greater.
Increasing the number of meds an individual receives:
increases the risk of interactions and adverse side effects; also increases risk of error.
reducing error of med admin
meticulous care in preparation and admin of meds.
Medication mistakes
must be reported immediately to person in charge so corrective action can be taken for the patient's welfare. Patient's record should reflect the corrective action for justification in legal proceedings. Incident reports are legally required.
Honesty
best policy; ONLY policy for moral, ethical, and legal reasons.
First, do no harm
includes prevention of med errors and also reporting of medication errors so corrective steps can be taken.
USP has established:
Medication Errors Reporting program (MER).
Agency for Healthcare Research and Quality (AHRQ)
federally certified the Institute for Safe Medication Practices (ISP) as a Patient Safety Organization (PSO) to operate a national error-reporting program for both vaccine and medication errors. Health practitioners and the public should be encouraged to report errors to ISMP since a PSO confers both privilege and confidentiality to the information reported. Error reporting by health care professionals and hospitals is necessary to develop safety alerts and quality improvement programs.
medication reconciliation
method used to compare the medications a patient is taking to the medications ordered by the patient's physician. This comparison is done every time there is a change in the patient's care. Ex: med reconciliation is done whenever a patient is admitted, transferred, or discharged. Prevents medication errors caused by omissions, duplications, errors in doses, or med interactions. (The Joint Commission Oct. 2012).
According to TJC, med reconciliation consists of 5 steps:
develop a list of current medications
develop a list of meds to be prescribed
compare the meds on the two lists
make clinical decisions based on the comparison
Communicate the new list to appropriate caregivers and to the patient.
Principles of administration:
cleanliness- always wash hands before handling meds and be sure preparation area is clean and neat
organization- be sure meds and supplies are in the appropriate area in adequate supply; when stock drugs are used, they should be reordered immediately.
preparation area- should be well lighted and away from distracting influences.
Guidelines to review before administering meds are called:
Six Rights of Medication Administration
Six Rights of Medication Administration
right medication
right amount
right time
right route
right patient
right documentation
Right medication page 91
confirm you have the right medication by carefully comparing the name of the drug prescribed (on physician's order sheet, prescription blank, medication record, or medicine card) with the label on the package, bottle, or unit-dose packet (meds with each dose separately sealed in an individual paper, foil, plastic, or glass container). Never give me when the name on the med is obscured in any way. Some drugs have names that sound or look similar. Accuracy can be facilitated by placing the unit-dose packet next to the name of the drug ordered on the patient's record while comparing the drug ordered with the drug on hand. Right and responsibility to question the physician and/or pharmacist is there is any question about the drug because of handwriting, misspellng, inappropriateness, allergies, or interactions. Never give meds that someone else has prepared. never leave meds at the bedside unless specifically ordered by the physician. If patient is unable to take a med when you present it, the med must be returned in an unopened packet, to the patient's drawer in the med cart or med room. never open the unit-dose packet unless the patient is prepared to take the medicine.
Right amount page 92
drug dosage must be copared very carefully with the dose listed on the label of the package, bottle, or nit-dose packet. The three different systems of measurement (household, apothecary, and metric). Important to consult a talbe of equivalents if necessary to convert from one system to another. drug calculations are infrequent with unit-dose packaging. if it's necessary to compute calculations, such calculations must be checked by another trained health care practitioner, pharmacist, or physician to verify accuracy. be careful when the dose is expressed in decimals or fractions. Always recheck the dose if less than 1/2 tablet or more than two tablets or more than 2mL for injection is req'd. An unusual dosage should alert you to the possibility of error. Those who admin meds have the right and responsibility to question any dosage that is unusual or seems inappropriate for the individual patient. Drug action is influenced by the condition of the patient, metabolism, age, weight, sex, and psychological state. the HC practitioner has the responsibility to report the results of careful assessment and observations in order to assist the phsyician in prescribing the right dosage for each patient. An important part of patient education includes complete instructions about the improtance of preparing and taking the right amount of medicine prescribed by the physician.
Right time page 92
time for admin of meds is important part of drug dosage, which includes the amount, frequency, and number of doses of medication to be administered. For maximum effectiveness, drugs must be given on a prescribed schedule. Physician's order specifies the number of times per day the medicine is to be administered. Some meds need to be maintained at a specific level in the blood and are prescribed at regular intervals around the clock. Some meds (antibiotics) are more effective on an empty stomach and prescribed before meals (ac). Meds that are irritating to the stomach are ordered pt (after meals). Drugs that cause sedation are more frequently prescribed at hour of sleep. If the physician does not prescribe a specific time for admin, the HC practitioner arranges and appropriate schedule, taking into consideration the purpose, action, and side effects of the medication. Patient education includes instruction about the right time to take specific meds and why.
Right Route page 93
route of admin is important because of its effect on degree of absorption, speed of drug action, and side effects. many drugs can be administered in a variety of ways. they physician's order specifies the route of admin. Those administering medications have the right and responsibility to question the appropriateness of a route based on assessment and observation of the patient/ Change of route may be indicated because of the patient's condition (nausea, vomitting, difficulty swallowing). Route of admin may not be changed without the physician's order.
Right patient page 93
the patient who is to receive the med must be identified by used of certain techniques to reduce the chance of error. In health care facilities, the patient's wrist ID band should be checked first, and then the patient should be called by name or asked to state her name, before administering the medication. In the ambulatory care setting, the patient can be asked to giver name and date of birth; this can be verified with the chart before administering meds. If the patient questions the medication or the dosage, recheck the order and the medicine before giving it.
Right documentation page 93
Every medication given must be recorded on the patient's record, along with dose, time, route, and location of injections. Unusual or adverse patient reactions must be noted. If the med is given on a PRn basis, notation should also be made on the patient's record of the effectiveness of the medication. The person administering the med must also sign or initial the record after admin (the polocy of each facility determines the exact procedure to be followed). The accuracy of medication documentation is very important legal responsibility. patients' records are examined in court, and the accuracy of medication documentation can be a critical factor in some legal judgments.
Also includes recording of narcotics administered on the special controlled substances record kept with the narcotics. If narcotics are destroyed because of partial dosage, cancellation, or error, two health care practitioners must sign as witnesses of the disposal of the drug. ( policy about documentation of narcotics may vary with agency).
Safe and effective admin of meds summary:
involves current drug information; technical and evaluation skills, and moral, ethical, and legal responsibilities. Guidelines include the Six Rights of Med Admin. HC practitioner has the right and responsibility to question any medication order that is confusing, illegible, or inappropriate and the right to refuse to admin any med that is not in the best interests of the patient. Welfare of the patient is the primary concern in the admin of meds.
MedWatch
The FDA issued a form in 1993 to assist health care professionals in reporting serious, adverse events or product quality problems associated with meds, medical devices, or nutritional products regulated by the FDA. EX: dietary supplements or infant formulas. Even the large, well-designed clinical rials that precede FDA approval cannot uncover every problem that can come to liht once a product is widely used. Ex: drug could interact with other drugs in ways that were not revealed during clinical trials. Reports by HC professionals can ensure the safety of drugs and other products regulated by the FDA.
In response to the voluntary reports from the healthcare community, the FDA has issued warning, made labeling changes, req'd manufacturers to do postmarketing studies, and ordered the withdrawal of certain products from the market. such actions can prevent injuries, suffering, disabilities, congenital deformities, and even deaths.
You are not expected to establish a connection or even wait until the evidence seems overwhelming. Agency's regulations will protect your identity and the identities of your patient and your facility. MedWatch can help the FDA better monitor product safety and take swift action to protect you and your patients. Encouraged to regard voluntary reporting as part of your professional responsibility.