Medication Administration and Injections - Wheaton Franciscan ...

Medication Administration1

2Class ObjectivesParticipants will be able to: Describe components of a valid medicationorder State 7 rights of medication administration Identify differences between intradermal,subcutaneous, & intramuscular injections Identify sites & landmarks: intradermal,subcutaneous, & intramuscular injections

3Class ObjectivesParticipants will be able to: Select correct needle & syringe for injectionordered Explain safety & standard infection controlpractices Describe measures to minimize pain Describe pediatric and adult considerations todecrease discomfort

4Class ObjectivesParticipants will be able to: Document medications correctly in patientrecord Define adverse reactions Describe steps taken if a medication error occurs Describe anaphylaxis & steps taken if it occurs

What is required before administering amedication?1. Valid medication orderWhat do I need to know?1. Medication usage2. Major side effects/adverse reactions3. How to administer4. 7 rights of medication administration5. Wheaton’s policy on medication administration(WFMG Medications General)6. Resourced medication: Micromedex, DrugBooks, Medication Inserts

6Valid Medication Order Complete medication order to include: Date & Time Name of medication Dose of medication Route of administration Signature of providerExample: 04/17/12 10:20 am, Toradol, 25mg, IM, to begiven now. A. Gooddoctor, MD

The Seven Rights1. Right patient2. Right medication3. Right dose4. Right route5. Right time6. Right documentation7. Right to refuse7*Always document the 7 rights when administering medication

8Right PatientIdentified Patient by:Name (patient to spelllast & first name)Date of Birth (patient togive Date of Birth)NEVER use patient’s roomor MRU numberJCAHO Patient Safety Goal

9Right MedicationAll medications are checked at least threetimes prior to administration:1. When you take it out of storage2. When you are preparing it3. Before giving it to the patient

Right DoseAlways checkprovider’s orderWatch for decimalsWatch amount thatcan be placed intointramuscular site

11Right RoutePrescriber’s order must contain route,consult prescriber if missingUse only preparations intended forparenteral use for ordered injectionsBottle will state: “For Injectable UseOnly”

Right TimeMedications aretypically given“now” in clinicsettingSome cannot begiven if there ispossibility ofpregnancy

Right Documentation Document Date, Time Drug (name, dose) Route (PO, IM, SC, etc…) Site (RA, LA, RT, LT) How the patient tolerated the injection Your name and credentialsi.e. 2/1/2011 0930, Toradol 60mg IM, RT, patienttolerated well. K. Clemens, RN

Always obtain an MD/ALP’s order beforeadministering an injection!!Written/entered byprovider or a verbalorder by associateIf provider will not writeorder, associate mustrepeat order back toprovider anddocument as VORB -Verbal Order ReadBackAssociate mustwrite/enter VORB intopatient record Encounter form/Chargeticket can not be usedas medication order: Not permanent record No dosage or route No provider signature Orders must be on orderform in chart or in HAC

Order Read Back:1. Verification by recipient done through therequest of a “spell back” of unfamiliar, look-a-like&/or sound-a-like, or unclear medications.2. All numbers should be read back using words todescribe, i.e. A drug dose of 50mg should beread back as five zero.Signing the Verbal Order:1. Signed by person accepting order indicating thedate & time from whom the order was received,the order, and verification through “read back”by recipient Example: 12/24/11 1400 ….V.O.R.B. or T.O.R.B. Dr.Smith to Jane Doe, RN

Definition of Verbal ordersVerbal Orders: medical orders are given by aprovider who is in the immediate vicinity.VORB: acronym used indicating a Verbal Orderhas been Read Back to ordering provider in theimmediate vicinityTelephone Orders: medical orders given by aprovider over a telephoneTORB: acronym used indicating a TelephoneOrder has been Read Back to ordering providerover the telephone

Reminders for Verbal OrdersVerbal orders for intravenousChemotherapeutic agents are notpermittedSafest method is to have providerwrite/enter order

18InjectionsDeliver medication directly into tissues,where it quickly enters the bloodstreamInjections are given because:Not altered by gastric acidsFaster absorptionPatient’s physical/mental status may notallow the medication to be given byanother routePatient noncompliance with oralmedication

19Preparing the site Wash Hands (proper hand-washing technique) Don Gloves Choose appropriate site Clean site with alcohol using friction Allow alcohol to dry

20Angle of InjectionIntradermal 15 °Subcutaneous 45°-90°Intramuscular 90°

Intradermal Injections21 Administered into dermal layer of the skin Sites: inner forearm (away from veins) and scapularareas 25 to 27 gauge needle 3/8”, 5/8” long TB/1ml syringe

Subcutaneous injections22

Intramuscular Injection Deltoid23

Intramuscular24

Intramuscular25

Intramuscular26

Intramuscular Injection27Not recommended

Techniques for Minimizing PainEncourage patient to relax site of injectionChange needle if using an irritatingmedicationAvoid injecting into sensitive or hardenedtissueEnsure needle length reaches muscleSmallest gauge possibleBe sure skin is dry after applying antiseptic

Techniques for minimizing paincontinued…“Dart” needle quickly into muscleInject medication slowly, maintaininggrasp on syringe; do not move needleonce insertedWithdraw needle quickly after injectionUse Z-track methodEMLA cream (lidocaine/prilocaine)

Pediatric ConsiderationsVastus lateralis: preferred injection site forinfants & young childrenHave parent or associate assist holding childUse a pleasant tone & smileBe honestDistraction techniqueApply band-aidReposition child immediately after injectionGive reward

Medication Errors are related to:‣ Wrong drug, dose, route, date, time, patient‣ Expired drug‣ Omission of drug

What happens if? You make a medication error Patient reports an adverse effect You get a needle stick What you should do:• Notify provider WITHOUT DELAY!• Monitor/treat as needed• Document what patient was given in medicalrecord (do not state a Medication Error Reportwas completed)• Complete Medication Error form32

33What happens if? You have technical difficulties such as: needle dislodges – discard & start over lose medication – discard & start over get blood when you aspirate – discard &start over needle bounces off the skin – new needle

34• Go to the Tau Net toaccess the onlinereporting for allPatient/VisitorOccurrences includingMedication Errors/ ADR• Click on the link onthe left side of thepage to ReportOccurrence

35Good NewsMedication Occurrences are a part of theon-line occurrence reportItems to report-All adverse drugevents plus errors or near missesinvolving:• Wrong Patient• Wrong Drug• Wrong Dose• Wrong Time• Wrong Route• Wrong Duration• Wrong Rate• Wrong strength orconcentration• Extra Dose• DoseOmission• DocumentedAllergy• InadequateLabMonitoring• Expired Drug• InadequatePhysicalAssessment• Narcotic Discrepancy• Other (issues such aswrong frequency,order entry errors,confirmation errors,Med reconciliationerrors)

Preventing Medication Errors Follow 7 rights Read label & compare to order at least 3 times Do not allow any interruptions Double check all calculations Document as soon as medication is given Attend in-services on medicationadministration Utilize drug book/Micromedex to ensure properadministration

37Anaphylaxis Body is irritated by an allergen Allergen gets into blood stream, the body triesto fight it by having an anaphylactic reaction Anaphylaxis is a medical emergency. It cancause death if not treated as soon as possible

38Anaphylaxis signs/symptoms Chest tightness Wheezing Shortness of Breath Coughing Hoarse voice Faintness Mouth/tongue tinglingor swelling Itchy/red skin Rash Fast heartbeat

39Anaphylaxis treatment Notify provider Call 911 Call a Medical Emergency Focus on airway, breathing, circulation, andmentation

Anaphylaxis treatmentcont…40 Epinephrine: injected IM into Vastus Lateralis Place patient on back with lower extremitieselevated (maximizes perfusion of vital organs) Administer oxygen, 6 - 8 liters by face mask, upto 100 percent

41WFMG Agency MedicationAdministration and InjectionsE-Learning On-line Module