Medication Administration (Plan)

Compare orders at Nursing Station with MAR

5 Patient Rights of Medication Administration
1. Right Patient
2. Right Medication
3. Right Dose
4. Right Route
5. Right Time
Check MAR for patients medical, medication, and diet history. Check for
allergies and any contraindications
Analyze physical examination and laboratory data that influence medication
administration (Pain level, blood pressure, etc.)
Enter Medication Room
Gather Meds (Check 1: Verify w/ MAR!!! and check expiration dates!!!) and
proper equipment (Check expiration dates!!!)
Calculate Dosages (Determine safety of doses)
Wash hands
Prepare Meds (Check 2: Verify w/ MAR!!!) and label medications
Enter Pt. Room
o Greet Pt. (Identify yourself)
o Hand Hygiene
o Ensure bed is locked
o Raise bed to working level
o Identify Pt. confirming Wristband with MAR (At least 2 identifiers)
Name (MAR)
Record # (MAR)
DOB (MAR)
(AAOx3)
o Check patients other wrist for allergy bracelet. Ask patient if they have any allergies
o Compare names of medications on labels with MAR at patients bedside (3
rd
check with
MAR)
o Explain procedure/purpose of each medication, its action, and possible adverse effects to
patient. Allow patient to ask any questions about procedure/drugs
o Perform any necessary preadministration assessments before giving medication
o Begin med administration

1) Administering Medications Peg Tube
a. Equipment
i. 60-ml syringe
ii. Graduated container (Filled with 50 to 100 ml of tepid water)
iii. Gastric pH indicator strip
iv. Medication to be administered (Crush simple pills if they can be crushed and mix
with 15-30 ml water)
v. Straw (For mixing medications)
vi. Pill Crusher
vii. Clean Gloves
viii. Stethoscope
ix. Medicine cups (measured)
x. Towel
b. Implementation
i. Hand Hygiene and put on gloves
ii. Check affected area for swelling, redness, etc.
iii. Tell professor we turned off suction and continuous feeding 30 minutes before
medication administration
iv. Place bed in semi-fowlers position (IF NOT CONTRAINDICATED BY PTS
MEDICAL CONDITION)
v. Place a towel near patients neck in case of emesis.
vi. Check placement of tube/gastric residual. Place diaphragm of stethoscope 1.5
inches down and 1 inch to the left of Xiphoid Process. Draw 10-15ml of air with
the 60ml syringe. Connect syringe to end of tube and flush with air. Should hear
a swoosh sound. Then pull back slowly to aspirate 30ml of gastric contents.
Return all but 5 ml of aspirated contents back to stomach.
vii. Check the gastric pH of the aspirated content (gastric pH should be 4 or less)
viii. Remove bulb or plunger of syringe. Reinsert syringe into enteric feeding tube (or
medication port if Lopez Valve is in use)
ix. Flush tube with 30mls of water
x. Administer first dose of dissolved medication by pouring into syringe
xi. If given only one dose of medication, flush with 30ml of water after
administration
xii. To administer more than one medication, give each separately and flush between
medications with 15ml of water.
xiii. Follow last dose with 30ml of water.
xiv. Tell professor that we will leave patient in semi-fowlers for 30 mins. At that
time we will evaluate patients response to medications and turn suction back on.












2) Intravenous Medication Administration
a. Equipment
i. Primary Line-IV Solution or Medication (if ordered)
ii. Secondary Line-Piggyback (if ordered)
iii. Labels for IV bag(s) and Line(s)
iv. (2) 2-3ml Saline Flush Syringes (Peripheral Venous Line (PVL)
SAS = Saline Flush/ Administer Medication/ Saline Flush
(1) 2-3ml Heparin Flush Syringes(Central Venous Line(CVL)
SASH = Saline Flush/ Administer Medication/ Saline Flush/ Heparin
v. Alcohol Swabs
vi. Gloves

b. Assessment
i. IV Insertion Site:
1. Phlebitis
a. Tenderness/Pain
b. Redness
c. Swelling
d. Warm to touch
2. Infiltration
a. Tenderness/Pain
b. Swollen
c. Cool to touch
d. Pallor

c. Implementation (Primary)
i. Apply gloves
ii. Remove Primary tubing from pkg (ensure locks are on)
iii. Spike IV bag w/Primary tubing w/o contamination of tubing port
iv. Prime IV line w/o contamination of tubing port (no air bubbles)
v. Place line into pump in direction of the Pt per the device (if ordered)
vi. Wipe CVL/PVL port with Alcohol swab
vii. Aspirate using Saline Flush Syringe
1. CVL
a. If resistance stop immediately and contact Dr.
b. BLOOD
2. PVL
a. If resistance stop
b. Possible Blood/Clear/Nothing
viii. Push Saline Flush in IV port of CVL or PVL
1. If resistance Stop immediately and contact Dr.
ix. Connect Primary line to CVL or PVL
x. Configure IV Pump for Volume/Rate
xi. Start infusion
xii. Label IV Bag and Tubing
xiii. Come back every 2 hours to check for Infiltration/Phlebitis
xiv. Completion of MedsRemove tubing from CVL or PVL
xv. Flush CVL or PVL
******IF PER GRAVITY THAN STEP i to iv THAN START COUNTING YOUR DROP/MINS

d. Implementation (Secondary-Piggyback)
i. Apply gloves
ii. Remove Secondary tubing from pkg (ensure locks are on)
iii. Lower primary bag using blue hanger from package
iv. Spike IV bag w/Secondary tubing w/o contamination of tubing port
v. Connect Secondary line to Primary line
vi. Hang piggyback IV Bag above the primary
vii. Configure IV Pump for Piggyback
1. Braun
a. Stop pump
b. Select Special features option
c. Select Piggyback
d. Select Yes Continue with Primary when
completed
e. Configure Volume/Rate
f. Unlock Secondary
g. Start infusion
viii. Label IV Bag and Tubing
IF IVPB IS ORDERED WITHOUT A PRIMARY IV ALREADY INFUSING REMEMBER TO
USE A PRIMARY IV TUBING.
xiv. Completion of Meds- Remove tubing from CVL or PVL
xv. Flush CVL or PVL




3) Intramuscular Medication Administration

a. Equipment:
i. Proper syringe for amount of medication to be administered:
a. 2 to 3 ml for adults
b. 0.5 to 1 ml for infants & small children
ii. Needle size corresponds to site of injection, age of patient & body
size according to the following guides :
a. Infants & Children: 1 inch
b. Vastus lateralis (adults) : inch to 2 inches
c. Deltoid (adults): inch to 1 inches
d. Ventrogluteal (adults): to 2 inches
iii. Alcohol swab
iv. Small gauze pad
v. Vial or Ampule of Medication
vi. Clean gloves


b. Medication Administration:
i. Apply clean gloves
ii. Explain to patient that medication might cause a slight sting or
burning
iii. Keep gown or drape over body part not exposed
iv. Select appropriate site for injection
v. Palpate muscle for tenderness or hardness and inspect for any
redness or irritation
vi. Assist patient in comfortable position
vii. Relocate injections using landmarks
viii. Cleanse site with alcohol swab
ix. Uncap Needle
x. Use Z track Method to pull back skin
xi. Hold as a dart 90 degrees
xii. Inject patient
xiii. Anchor Syringe & aspirate for 5 to 10 seconds
xiv. Inject according to medication directions
xv. Remove needle & hold in upright position
xvi. Apply gentle pressure to site. DO NOT MASSAGE!!!
xvii. Apply bandage if needed.
xviii. Discard uncapped needle in sharps container
*****USE THE DELTOID ONLY FOR SMALL MEDICATION VOLUMES (0.5 to 1 ml)

4) Subcutaneous Medication Administration

a. Equipment:
i. Syringe (1 to 3 ml)
ii. Needle (25 to 27 gauge, 3/8 to 5/8 inch)
iii. Small gauze pad
iv. Alcohol
v. Medication Vial or Ampule
vi. Clean Gloves
vii. MAR

b. Medication Administration:
i. Choose appropriate injection site
a. Outer aspect of upper arms
b. Abdomen below the coastal margins to iliac crest - 2 away from
the umbilicus
c. Posterior aspects of thigh.
ii. Apply clean gloves
iii. Explain to patient that medication might cause a slight sting or burning
iv. Keep gown or drape over body part not exposed
v. Assess site of injection for signs of bruises, inflammation or edema:
vi. Injection
a. Heparin
use abdominal sites 2 away from umbilicus
b. Insulin
rotate injection site 1 inch apart from last injection
either laterally or vertically
vii. Assist patient in comfortable position
viii. Relocate previous injections using landmarks
ix. Cleanse site with alcohol swab
x. Uncap Needle
xi. Pinch skin with non-dominant hand
xii. Inject patient at a 45 degree (1 inch pinch) to 90 degree (2 inch pinch)
xiii. Anchor Syringe???
xiv. Inject according to medication directions
xv. Remove needle & hold in upright position
xvi. Apply gentle pressure to site. DO NOT MASSAGE!!!
xvii. Hold alcohol swab to site for 30 to 60 seconds
xviii. Discard uncapped needle in sharps container
xix. Stay with patient several minutes & observe for any allergic reactions

5) Intradermal Medication Administration
a. Equipment
i. 1mL tuberculin syringe with pre-attached 25 or 27 gauge needle
ii. Small gauze pad
iii. Alcohol swab
iv. Vial or ampule of skin test solution
v. Clean gloves
vi. Medication administration record (MAR)
b. Medication Administration
i. Review drug references information about expected reaction when testing
skin with specific allergen or medication and appropriate time to read site
a. TB Test; read at 48 72 hours
ii. Select appropriate injection site
a. 3 4 fingers width below antecubital space and one had width above
wrist
b. Upper back
c. If necessary use site appropriate for SubC injections
iii. Inspect skin surface over sites for:
a. Bruises
b. Inflammation
c. Edema
d. Lesions
e. discolorations of skin
iv. Cleanse site with antiseptic swab
v. Hold syringe with bevel of needle pointing up
vi. Stretch the skin
vii. insert needle at 5 15 degree until resistance is felt
viii. Advance needle through epidermis to approximately 3mm (1/8 inch) below
skin surface. Needle tip should be seen through skin.
ix. Inject medication slowly, if no resistance is felt needle is too deep; remove
and begin again
x. Note that small bleb (approximately 6mm [1/4 inch]) appears in skin surface

xi. Remove needle & hold in upright position
xii. Apply gentle pressure to site. DO NOT MASSAGE!!!
xiii. Discard uncapped needle in sharps container
xiv. Apply alcohol swab over site once needle is withdrawn