Administer and MonitorSchedule 8 Medications

WorkshopPresented by Colleen

Reeve

Medications

Drugs are substances that bring about a chemical change in the body

When used for therapeutic purposes

Diagnosis Treatment Cure Relief or prevention of health

condition

Nurse’s Role

As the person administering medications you have a number of responsibilities

Key ones includes Being aware of

The action of the medicationThe therapeutic effectsNon-therapeutic effectsThe reason it has been prescribed

Medication Preparations

Variety of forms for administration.Choice may depend on a number of

reasons Absorption rate required Difficulties that may be

experienced with swallowingDrug side-effectsPatient preferences

Routes of Medication

Most convenient and acceptable method for patients to receive medication is orally

May be administered a number of other ways.

Drug Schedules The assigning of Drugs and Poisons into one of

eight schedules is in accordance with the Standard for the uniform scheduling of drugs and poisons published by the Australian Health Ministers’ council. The decision on which drugs go into which group is done by the National Drug and Poisons Schedule Committee for inclusion in the relevant state or territory legislation. The Queensland Act being the Therapeutic Goods Act 1989 (Section 52B).

The classifications are made according to potency, addictive qualities and suitability for ingestion by humans or animals.

Pharmacology

The two main areas of pharmacology that specifically relate to your practice are;

Pharmacokinetics

and Pharmacodynamics

Pharmacokenetics

How the body handles a drug over a period of time. It deals with the absorption, distribution, biotransformation and excretion of drugs.

These processes influence the effectiveness of the drug – to be effective it must be available at the site of action in the correct concentration.

WHAT THE BODY DOES TO THE DRUG

Pharmacodynamics

Pharmacodynamics is the process by which specific drug doses produce biochemical or physiological changes in the body.

Adverse Drug Reactions

The definition described by the World Health Organisation for an adverse drug reaction is

‘ any response to a drug which is noxious, unintended and occurs at doses used for prophylaxis, diagnosis and therapy’.

Adverse Drug Reactions

While drugs may be prescribed to cure or alleviate a particular problem, because of the intricate workings of the body systems, the response to these drugs can spill over to areas where the effect is not advantageous.

A term that is commonly used to refer to these is Side–effects

Adverse Drug Reactions

To reduce the incidence of severe

reactions and to minimise the effect on your patients, it is essential that, as the nurse responsible for administering medication, you have a knowledge of the adverse effects of drugs, how to recognise them and how to prevent them.

Principles of Safe Medication Administration

Unfortunately errors in administering medication happen all too often.

To minimise the risk of these occurring a number of principles need to be followed when preparing to administer medication to a patient

The 5 Rights

THE RIGHT TIME THE RIGHT ROUTE

THE RIGHT AMOUNT/ DOSETHE RIGHT MEDICATION/DRUGTHE RIGHT PATIENT

ALLERGIES, EXPIRY DATE

Medication Storage

Chemical components Schedule classification Organisation Requirements

NURSES RESPONSIBILITY TO KEEP LOCKED WHEN UNATTENDED

Calculation Formula

Strength required x Volume

Stock Strength

Drugs and Poisons Regulation 1996

Sections relevant to Enrolled Nurses

Section 52Section 58ASection 155Section 162Section 252

Opioid analgesics

Non-clinical use criminalized since 1914

Widely used in medicine as strong analgesics

Analgesia derives from Greek an- “without” and algia “pain”

Narcotic effects can be reversed by the drug naloxone (Narcan)

Advantages

Despite extensive research , no other analgesics have been found that are more effective for severe pain.

No upper limit to dosage and achievable pain relief as long as dose increased gradually to allow tolerance to develop to adverse reactions

Types of Routes and Preparations

Injection – can be given IV, IMI, SC and epidural

Oral – Mixtures and Controlled release tablets

Patches for transdermal absorption Dose required intravenously and by

epidural is significantly less than when given IV, IMI or orally.

Key Opioid Side Effects

Cough suppression Decreased gastrointestinal

motility

Common Side effects Nausea and vomiting Drowsiness, dizziness, headache Orthostatic hypotension Respiratory Depression Itchiness Dry mouth Miosis – pupil constriction Urinary retention Constipation

Serious Side Effects CNS disturbances;

Confusion Hallucinations Delirium Urticaria Hypothermia Bradycardia/Tachycardia Ureteric or Biliary spasm Muscle rigidity Myoclonus- convulsive body movements Flushing- due to histamine release

Opioid Side Effects

Psychologic Dependence – Addiction

A pattern of compulsive drug use

A continuous craving for an opioid

Tolerance Necessity for increasing the dose

over time to achieve the desired clinical effect.

Develops to analgesic effects sedation emetic effects euphoria respiratory depression

Dependence

Withdrawal syndrome – caused when drug discontinued

dosage rapidly reduced when antagonist

administered.

Withdrawal Syndrome Severe dysphoria Anxiety Eye tearing Rhinitis Goose bumps Sweating Nausea and vomiting Cramps and deep pains

S8 Storage Regulations

Kept in a separate locked cabinet with keys kept in possession of an RN.

Cabinet must be minimum of 10mm thick steel with continuous welding to all joints.

Door of cabinet the same with pick proof lock and steel back plate.

S8 Regulations

A Register must be kept with all drugs signed in and out and checked by two nurses: RN/EN (Med)

All medications selected, administered and recorded by the SAME NURSE

S8 Register

Information recorded includesPatient’s namePrescribed drug and doseDate and time of

administrationBalance of medication

Both Nurse administering and the witness must sign the register.

Administration Procedure

Ensure legal medication order Witness RN/EN(Med) unlocking S8

cabinet. Check drug together against order Observe removal of drug and

return balance.

S8 Administration Accompany RN/EN (Med) to the

patient Witness the administration of drug Counter sign medication sheet Assessment, monitoring and

evaluation of patient for analgesic effects as well as adverse reactions.

Documentation of these effects

REMEMBER

THE ADMINISTERING NURSE IS TOTALLY RESPONSIBLE FOR THEIR ACTIONS AND IS ACCOUNTABLE IN A COURT OF LAW