NURSES ROLE IN DRUG THERAPY

BY PUAN HASLINDA BINTI DAN NURSING BLOCK 2008/2009

OBJECTIVES
At the end of this lecture, the students should be able to;

understand the legal aspect related to drug therapy/ administration discuss the routes of drug administration understand the important steps in drug administration discuss how the health professionals can prevent medication error

Drugs administration
Key

element of nursing care important role of nurses

Most

DRUGS @ MEDICATIONS
~ substances prescribed by practitioner to help in the treatment, relief, or cure of the cause of patients health alteration or in the prevention of such alteration.

Safety of the medicines

Drugs/ medicines Help alleviate symptoms and restore health therapeutic effects Not without risk and may cause lesser/ greater harm Harmful effects referred as Adverse Drug Reactions (ADRs) ex. Chloramphenicol blood disorder

Team Members in Drugs administration

Participate in ensuring safe and effective medication administration

Physician - prescribes the drug Pharmacist - dispense the medication as prescribed by physician

Cont.

Nurse - responsible to prepare and serve/ administer the medication Patient - the person who take the drugs

Safe Medication Chain

PHYSICIAN PHARMACIST

PATIENT

NURSE

Last link

Legal Aspect in Nursing

Relationship between nursing practice and law Includes standard of care, patient rights, informed consent, malpractice liability, patient safety, documentation and confidentiality

Cont.. Legal Aspect

Nurses can be held liable for negligence or malpractice

Liability implies a legal obligation for which the nurse can be held responsible and accountable

Elements of Liability for Malpractice

To prove liability for negligence or malpractice, each 4 elements must be proven;

Duty - nurse responsibility, standard of care Breach of duty failure to meet SOC Causation when failure results in harm to pt Damage pt suffered an actual harm or injury

Potential Liability related to drug administration

Medication error

Patients safety
44,000 to 98,000 Americans die each year because of medical error. 28% of them preventable, Prescription error being the most common cause .
To Err is Human: Building A Safer Health System Report by Institute of Medicine

Examples of medication error;

Failure

to question medication orders that are unclear

Failure

to adhere to established procedures in medication administration to recognize ADRs

Failure Lack Lack

of familiarity with medication

of communication in verbal or written medication orders

Medication Management
Pharmacology a study of the effects of drugs on living organisms Drug names chemical and generic Drug forms tablets, capsule, suspensions etc Drug actions mechanism of action, therapeutic effect, interactions, pharmacokinetics Types of order standing order, daily, bd, tds, qid, PRN, Stat Routes of administration

Routes of Administration
Topical Oral Sublingual Inhalers Parenteral

Transdermal Eye/ ear medication Vaginal medications Rectal medications

Topical drugs
Applied directly to the skin surface and absorbed through the epidermis into dermis Includes lotions, pastes, ointments, creams, powders, shampoo and aerosol sprays Most are used for local effects

Oral medications
The safest, convenient, least expensive method For conscious patient and able to swallow Available in many forms; tablets, capsules, syrup, elixirs, oils, liquids, suspensions and granules Pt with nasogastric tube need to mix the crushed tablets/ liquid medications

Sublingual

Certain drugs are given sublingually or buccally to prevent their destruction or transformation in the stomach or small intestine Drugs act quickly because the oral mucosas thin epithelium and abundant vasculature allow direct absorption into bloodstream Place drug under pts tongue and instruct the patient to keep it until dissolves and not to chew/ swallow

Inhalers

Includes metered-dose inhaler (nebulizer), turbo-inhaler, nasal inhaler Produce local and systemic effects The mucosal lining of respiratory tract absorbs the inhalant Common: bronchodilators used to improve airway patency and facilitate mucous drainage

Parenteral/ Injections
Intradermal injection subcutaneous (SC) injection intramuscular (IM) injection intravenous (IV) injection

given using sterile technique

continue

Intradermal injection: small volumes ( 0.5ml), as in allergy or tuberculin testing Subcutaneous injection: into adipose tissue, eg. Insulin injection

continue..

IM injections: deep into muscle tissue, provides rapid systemic action and absorption, large doses (up to 5ml) IV injection: directly into a vein, allows rapid drug administration, achieve peak levels in the bloodstream

Transdermal
An adhesive patch applied to the skin Deliver constant, controlled medication directly into blood stream for systemic effect Contraindication skin allergies/ reactions Example: transdermal nitroglycerin

Others
Eye/ ear medications: drops and ointments Vaginal medications : suppositories, creams and ointments Rectal medications: suppositories, ointment

Guidelines for Drugs Administration

5 RIGHTS

Right patient Right drug Right doses Right route Right time Right documentation

Right Patient

Correctly identify patient by; - asking him/ her to state their full names - check ID band Pt understand what they are being given and why

Right Drug
Correctly identify medication by; - check the label written on the container The reason the medication is being given make sense Are there any contraindication / allergic? Medication in good condition expiry date, broken down/ damage, change colour

Right Dose

Unit dose system Careful calculation, unit conversions Double check policy Use appropriate measurement devices cups, syringes etc Careful prepare crushed medications to prevent overdosage or underdosage

Dose = (dose needed/ dose in hand) X dose unit

Right Route
Specified in written order Consult the prescribing doctor when route indicated differs from recommended Injecting medication that designed to be adm. orally can cause ADRs eg abscess at injection site

Right Time
Responsible for knowing why medication is ordered on a certain schedule Should not be given more than half-hour before or after the schedule time Must be given at certain time for proper therapeutic effects eg. Insulin given at set time before meals

Right Documentation
IF IT WAS NOT DOCUMENTED, IT WAS NOT DONE Initial the medication record after the pt has taken the drug If pt refuse to take medication, nurse must indicate that a dose was missed and notify physician

Components of Drug Order

Date and time order Name and forms of medication Dose of medication Route of administration Frequency of administration Signature of prescribing physician

MAKLUMAT ASAS NAMA: NO. PEND: WAD: MAKLUMAT LAIN DIAGNOSIS: UMUR: BERAT BDN: TARIKH MASUK: NO.KATIL: ALERGIK KPD UBAT: REKOD PENGUBATAN
Rx

JABATAN FARMASI HOSPITAL USM KUBANG KERIAN, KELANTAN CARTA PENGUBATAN

Tarikh Masa

. TARIKH: .. T/TGN & NAMA DOKTOR

IV Ampicillin 250 mg QID

Calculation 250 mg/ 500 mg x 4 ml = 2 ml

Post administration Assessment monitor therapeutic effects, sign and symptoms of reactions (ADRs) Intervention - report to prescriber, treat the sign & symptom, documentation Evaluation of effectiveness

HOW TO PREVENT MEDICATION ERROR ???



Complete and clearly written order Never take verbal and telephone orders Correct drug route and dose dispensed by pharmacist Use unit dose system, computerized prescription, bar code system Updated and easily accessible drug information Policy guide and protect from litigation Safest environment - < distraction, pressure