You are on page 1of 35

THE ROLE OF THE

NURSE IN
DRUG ADMINISTRATION
&
PREVENTING
MEDICATION ERRORS

PATIENTS RIGHTS
There are risks involved in the drug
administration, therefore,
patients have the right to:

be informed of the name, purpose, action


& potential side effects of drugs

refuse a medication regardless of the


consequences

receive labelled medications safely in

accordance with the five (5) rights of drug


administration

be adequately informed of the

experimental nature of any drug and sign


a written consent

not receive unnecessary medications

WHAT CONSTITUTES A LEGAL


MEDICATION ORDER

Medication charts are legal


documents and must be completed
accurately and unambiguously in
order to ensure that patients receive
safe and optimal drug therapy.

Medication Charts should be written


legibly in the prescribers own
handwriting and include:

Patients surname, first name, medical


record number (MRN), ward/clinic

- if a patient ID label is used, it must be


affixed to every medication chart and
signed for verification by the prescriber

Drug name (generic), dosage form,


strength and dose required

Complete, clear and unambiguous

directions for each item


directions should be written in plain
English (only approved abbreviations
may be used)

Prescribers printed name, signature

and date of order - the prescribers


full signature and date of order must
be written for EACH DRUG ordered

Weight should be provided for any


drug dosed by weight.

Each medication order must be


legible, complete and unambiguous
so that the correct patient is
administered with the correct drug
at the appropriate dose. A nurse
cannot administer the drug and a
pharmacist cannot dispense a drug
to a patient unless all details are
correct and complete.

THE ROLE OF THE NURSE IN DRUG


ADMINISTRATION
Every registered nurse is legally responsible
for the correct administration of drugs. This
includes the Five Rights of Administration:

Right Patient
Right Drug
Right Dose
Right Route
Right Time

RIGHT PATIENT
check the patients name & hospital
number against the chart & I.D. band.
ask the patient to state his/her name, &
their date of birth (D.O.B)

Important
Check if your patient:
1. has any known drug allergies
2. has had any previous adverse drug
reactions
3. has been assessed for her pregnancy
status

RIGHT DRUG
Identify the drug from the M.O.s order.
Clarify
with the M.O. if in doubt.
Check the drug three (3) times:
- before removing it from the trolley or shelf
- when the drug is removed from the
container
- before the container is returned to storage
Check the expiry date of the drug/s

Important
Check for Drug Interactions

Antagonistic - lessening the effectiveness


of another drug
Synergistic - enhancing or improving the
effectiveness of another drug

Check for Food Interactions


There are medications that requires dietary
restrictions.

The generic and brand name should


match those on the prescription.
Generic name - the name assigned by the
manufacturer who first develops the drug. Often
the generic name is derived from the chemical
name.
Trade/ Brand/ Proprietary name
- is the name selected by the drug company
selling the drug and is copyrighted
- a drug can have several trade names when
produced by different manufacturers

Example:
Generic name = Aspirin
Trade names available = Jusprin, Disprin
Be aware that in different countries
generic and trade names will also differ,
e.g. in Australia & the United States one
drug has the generic names of
paracetamol & acetaminophen, i.e.
Panadol/Tylenol

Watch out for Look-alike and Sound-Alike


Drug Names!
Some Common Drugs that are Look-alike and
Sound-Alike:
Accupril Accutane
alfentanil fentanyl
Allegra Viagra
azithromycin erythromycin
Betagan Betagen
Capitrol - Captopril

ciprofloxacin ofloxacin
clonidine quinidine
clotrimazole co-trimazole
Desoxyn digoxin
Diatab Diatabs
dobutamine dopamine
Eurax Urex
folic acid folinic acid
fosphenytoin phenytoin
guiafenesin guanfacine
Lamasil Lomotil

losartan valsartan
mebendazole methimazole
metoprolol misoprostol
naloxone naltrexone
Panadol pindolol Plendil
ranitidine rimantadine
salbutamol salmeterol
Tobradex Tobrex
tretinoin trentine
Verelan - Virilon
Zantac - Zyrtec

RIGHT DOSE
- check the dose, read the container label,
calculate the dose & check with another
RN if necessary
- use proper measuring devices for liquids,
do not crush tablets or open capsules
unless directed by the pharmacist
- if a drug is required in another dosage
form, you may get it from the pharmacy.

Important
Knowledge of the different dosage forms is
essential in giving the right dose to the
patient so that the intended therapeutic
effect of the drug will be achieved.
Example:
Tablets maybe effervescent, sublingual,
buccal, chewable, enteric coated, etc
Other liquid dosage forms should be
shaken well before administration like oral
suspensions and oral emulsions

RIGHT ROUTE
- make sure the M.O.s order is clear & only
give the medications by the route
designated.
Knowledge of the different dosage
forms is also important in giving the
medication in the right route.
- know the common abbreviations used for
the different routes.

COMMON ABBREVIATIONS USED IN

MEDICATION ORDERS FOR DIFF. ROUTES

BUCC buccal/ inside cheek


PO per orem/ by mounth
SL sublingually/ under the tongue
IN/NAS - intranasal
ID - intradermal
IM intramuscular
SC/SQ/Subq subcutaneous

COMMON ABBREVIATIONS USED IN

MEDICATION ORDERS FOR DIFF ROUTES

IP intraperitoneal
IV intravenous
IVP intravenous push
IVPB intravenous piggy back
PR per rectum / rectally
TOP - topical
VAG - vaginal

RIGHT TIME
- check the appropriate time of the day,
time interval, and frequency, ordered by
the M.O. &
give the medication at the prescribed
time.
- drugs should be given within 20 minutes
of the prescribed time.

COMMON ABBREVIATIONS USED IN

MEDICATION ORDERS
a.c. - ante cibum - before meals
BDS, b.d.s. - bis die sumendum - twice daily
b.i.d., b.d. - bis in die - twice daily
EOD -every other day
h.s. hora somni at bedtime
mane mane in the morning
noct nocte at night
p.c. post cibum after meals
p.r.n., PRN - pro re nata - as needed, when
necessary

q quaque - every, per


q.1 h, q.1 - quaque 1 hora - every 1 hour
(can
replace "1" with other numbers)
q.d.s. - quarter die sumendus - 4 times a day
s.o.s., si op. - sitsi opus sitif - there is a need
stat statim- immediately
t.i.d., t.d. - ter in die - 3 times a day
t.d.s., TDS - ter die sumendum - 3 times a day
1/24 every hour
2/24 every two hours
6/24 every six hours
8/24 every eight hours

Error-Prone Abbreviations,
Symbols, and Dose Designations
g microgram - mistaken as mg - Use mcg
AD, AS, AU - right ear, left ear, each ear Mistaken as OD, OS, OU
(right eye, left eye, each eye)
Use right ear, left ear, or each ear
OD, OS, OU - right eye, left eye, each eye
Mistaken as AD, AS, AU
(right ear, left ear, each ear)
Use right eye, left eye, or each eye

BID, BD twice a day mistaken as BT (bedtime)


Use twice a day
HS half strength mistaken as bedtime
hs at bedtime mistaken as half strength
Use half-strength or bedtime
IU - International unit - mistaken as IV
- Use units
o.d. or OD - once daily - mistaken as right eye
(OD-oculus
dexter)
- Use daily

Trailing zero after decimal point (e.g., 1.0

mg)**
- mistaken as 10 mg if the decimal point is
not seen
- Do not use trailing zeros for
doses
expressed in whole numbers
1 mg
Naked decimal point (e.g., .5 mg)**
- mistaken as 5 mg if the decimal point
is
not seen
- Use zero before a decimal point when
the dose is less than a whole unit
0.5 mg

Abbreviations such as mg. or mL. with a

period following the abbreviation


- The period (.) is unnecessary and could
be mistaken as the number 1 if written
poorly
- Use mg, mL, etc. without a terminal
period

@ - at - mistaken as 2 - Use at
- hour - mistaken as a zero
(e.g., q2 seen as q 20)
- Use hr, h, or hour

Place adequate space between the drug


name, dose, and unit of measure
Inderal40mg mistaken as Inderal 140mg
Inderal 40 mg
10mg m is mistaken as a zero or two
zeros
10 mg
Use Complete Drug Names
HCl - mistaken as potassium chloride
(The H is misinterpreted as K)
MgSO4 mistaken as Morphine Sulfate
MSO4 mistaken as Magnesium Sulfate

AZT Zidovudine (Retrovir) mistaken as


Aztreonam
PCA Procainamide mistaken as Patient
Controlled
Analgesia
Nitro drip - nitroglycerin infusion
-mistaken as sodium nitroprusside
infusion