NURSING RESPONSIBILITIES IN DRUG ADMINISTRATION
· Medications must be kept in an orderly manner in a place where they are not freely accessible to patients or to the public and where they are protected from air, moisture & light. Only medicines that are properly labeled must be retained. Instructions regarding storage, refrigeration & expiration dates should be carefully observed.
· Controlled substances (narcotics) should be kept under lock and keys and appropriate records should be kept regarding their use.
· No medications should be given without a proper medical order from a physician clearly indication the medication, doe, route and schedule.
· A medication card is filled out for each drug indicating the date, the patients room number, drug name, dose, route schedule, and duration of administration. The nurse who transcribes the order to the medication card would initial it. The identity of the medication should be carefully checked when it is taken from the storage, when it is prepared and when the container is returned to the shelf.
· Medication in the solution or suspension should be shaken well to ensure homogeneity before a quantity is removed from the container in filling a drug order. Care should be taken to wipe the rim of container in taking solutions.
· Know the drug to be given in terms of nature, action, usual dosage, indication and contraindications, mode of action, side effects, physical characteristics and why it is particularly given to the patient.
· Be careful with the same sound. Know abbreviations of the drug.
· Gather all necessary equipment before starting preparation of medication.
· Do not converse with anyone (as much as possible) while preparing the medication. Allow no interruptions.
· Read and check label on medication three times.
a) Before taking from the shelf.
b) Before pouring or measuring.
c) Before returning to the shelf.
· Avoid touching medications especially tablets or pills.
· Do not return excess medicine to the bottle to avoid contamination.
· Always keep medicine card and medicine tray together.
· Arrange prepared medications according to dispensing and other factors.
· Never leave medicine cupboard or shelf unlocked.
· When preparing the medications, do not use the following:
a) Medications from unmarked container with illegible labels.
b) Medications that are cloudy or have changed of color.
c) Medications that have sediment at the bottom unless the medication requires shaking before use.
· Identify the patient carefully using all precautions. Check the bed cards; look at the identification bands, call the patient by name or ask the patient to state his name. Remember the five rights of medications, right dose, right patient, right time, and right route of administration.
· With rare exceptions, patients have the right to know the name and action of the drug they are taking, and they have the right to refuse a medication, medications that are refused must be changed and the reason for refusal must be recorded.
· Provide the correct adjunctive nursing measure.
· Give medications within 30 minutes of the time ordered except for preoperative medications, which must be given exact time ordered or medications that are ordered to be given hourly or every 2 hours (e.g. eye medication, prior to surgery).
· If a patient vomits after taking an oral medication report the fact to the responsible nurse and state the names of all medications. With-hold the medication. Often the physician re-orders the same drug by a different route, for example subcutaneously or intramuscularly.
· Special precautions must be observed for certain drugs. Most agencies requires that two qualified nurse double-check the dosages of anticoagulants, insulin, digitalis preparations and certain IV medications. Check agency policies.
· After medication has been administered, record it on the patient’s chat. The recording should include the time, the name of the drug, the dosage, the method of administration and any related data. Some agencies require that the method of administration be specified if it is other than oral, the oral route is usually not specified in the record.
· Evaluate the effectiveness of a medication of suitable time after its administration. For example, the effectiveness of an intramuscularly injected analgesic can be evaluated 10-20 minutes after administration.
· Medications are usually discontinued before surgery, and the physician writes new orders after the surgery. New orders are generally given drugs to a newly admitted patient, takes at home or when a patient is transferred to another service within an agency. Check agency policies.
· When medications are intentionally omitted; e.g. before surgery or a diagnostic test, record the omission and the reason on the patient’s chart. It may also be necessary to notify the prescriber.
· Medication error sometimes occurs. When an error is made, report it immediately to the responsible person so that corrective measure can be implemented promptly. Errors are usually documented on an unusual incident form that becomes a part of the agency’s file.
The nurse who prepared the medicine should be the one to administer and record. Never allow a patient to carry or bring medicine to another.