MEDICATION MEDICATION ADMINISTRATION Topic ADMINISTRATION Topic 11

Topic 1 Client ID Documentation Drug SchedulesTopic 1 Client ID Documentation Drug Schedules

As the student nurse gains experience in medication administration, psychomotor skills ( the how to ) become more refined. Psychomotor skills, however represent only a small part of medication administration. Knowledge, physical and mental status as well as client attitudes and responses can make medication administration a complex experience

List reasons for the importance of being competent in the administration of medications

All drugs prescribed or over the counter are potentially dangerous

Prescription or medication order is a legal document

It is a legal requirement

To ensure maximum safety for person who might benefit from drugs

To protect the enrolled nurse and health care facility from serious consequences of medication incidents.

INDICATIONS FOR INDICATIONS FOR MEDICATION USEMEDICATION USE Maintain normal body function. Eg. Maintain normal body function. Eg.

Insulin.Insulin. Diagnostic Eg Barium.Diagnostic Eg Barium. Symptomatic relief, Eg Analgesia.Symptomatic relief, Eg Analgesia. Prophylaxis, Eg Vaccines.Prophylaxis, Eg Vaccines. Alter psychological functions, Eg Alter psychological functions, Eg

Contraception.Contraception. Reverse control disease process, Eg Reverse control disease process, Eg

Antibiotics.Antibiotics.

Describe the drug controls in New South Wales

COMMONWEALTH COMMONWEALTH REGULATIONS REGULATIONS

The role of the Australian The role of the Australian Government in regulation of the Government in regulation of the pharmaceutical industry is to pharmaceutical industry is to protect the health of the people protect the health of the people by ensuring that medications are by ensuring that medications are safe and effective. safe and effective.

AGED CARE ACT 1997AGED CARE ACT 1997

To ensure that the facilities employ To ensure that the facilities employ appropriately skilled staff who can provide appropriately skilled staff who can provide for the needs of the residents in their care. for the needs of the residents in their care.

They must maintain accreditation standards.They must maintain accreditation standards.

The enrolled nurse must work within the The enrolled nurse must work within the policy and protocols of their employing policy and protocols of their employing facility.facility.

CONTROL IS AT 3 CONTROL IS AT 3 LEVELSLEVELS

1.1. The Therapeutic Goods Act The Therapeutic Goods Act ( 1989 ). Medication ( 1989 ). Medication manufacturer, sales, testing, manufacturer, sales, testing, labeling and distribution. labeling and distribution.

2.2. The Customs Act ( 1901 ) The Customs Act ( 1901 ) Advertising of therapeutic goods Advertising of therapeutic goods to health professionals and publicto health professionals and public

CONTROL IS AT 3 CONTROL IS AT 3 LEVELSLEVELS

3. The National Health Act ( 1953 ) 3. The National Health Act ( 1953 ) Applies to Pharmaceutical Benefits Applies to Pharmaceutical Benefits Scheme that provides subsidized Scheme that provides subsidized drugs to public. Also limits the drugs to public. Also limits the amount of drugs supplied, number amount of drugs supplied, number of times and frequency that the of times and frequency that the supply can be repeated. Not all supply can be repeated. Not all drugs are subsidized. drugs are subsidized.

The Australian Therapeutic Goods Administration ( TGA ) a section of the Commonwealth Department of Health, provides a framework for the regulation of therapeutic goods to ensure their safety, efficiency, quality and timely availability. Before a drug can be marketed in Australia, it must be evaluated by TGA. The product will be assessed for quality, safety, efficacy and cost effectiveness.

NSW LEGISTRATION NSW LEGISTRATION

NSW Poisons and Therapeutic NSW Poisons and Therapeutic Goods Act ( 1966 ) Poisons and Goods Act ( 1966 ) Poisons and Therapeutic Goods Regulation Therapeutic Goods Regulation ( 2002 ) ( 2002 )

Nursing Home Act 1993.Nursing Home Act 1993.

POISONS AND POISONS AND THERAPEUTIC GOODS THERAPEUTIC GOODS ACT 1966ACT 1966 Covers the control Covers the control

of poisons and of poisons and outlining any outlining any criminality criminality related to related to poisonspoisons

The poisons and therapeutic goods regulation 1994 has a direct impact on nurses during their day to day routines and covers the practical aspects of the possession, storage, supply, administration and recording of the poisons and the poisons list which classifies substances into their various substances.

NSW DEPARTMENT OF NSW DEPARTMENT OF HEALTHHEALTH Guidelines for the Handling of Guidelines for the Handling of

Medication in NSW Public Hospitals Medication in NSW Public Hospitals Guidelines fro the Handling of Guidelines fro the Handling of

Medication in Community Based Medication in Community Based Health Services and Residential Health Services and Residential Facilities in NSWFacilities in NSW

Private Hospitals and Day Procedure Private Hospitals and Day Procedure Centre and Nursing Homes Centre and Nursing Homes Regulations Regulations

NSW DEPARTMENT OF NSW DEPARTMENT OF HEALTHHEALTH These are the standards that regulate These are the standards that regulate

enrolled nurse practice enrolled nurse practice Public hospitals must ensure that Public hospitals must ensure that

employees who are administrating employees who are administrating medication have appropriate medication have appropriate qualifications and training. qualifications and training.

Health care institutions establish Health care institutions establish individual policies that must meet individual policies that must meet Commonwealth, State and local Commonwealth, State and local government regulations government regulations

AUSTRALIAN NURSE AUSTRALIAN NURSE COMPETENCIESCOMPETENCIES

This organization outlines and limits the This organization outlines and limits the role and boundaries of the enrolled role and boundaries of the enrolled nursing practice nursing practice

The inclusion of medication The inclusion of medication administration in the scope of practice administration in the scope of practice for the EN will ensure public safety for the EN will ensure public safety through quality management and risk through quality management and risk assessment intervention. assessment intervention.

Enrolled Nurses who have been competent in the medication module will be permitted to administer medication by what ever route including S4 drugs but not S8 drugs of addiction.

CLIENT CLIENT IDENTIFICATIONIDENTIFICATION

How do you Identify How do you Identify a client?a client?

DOCUMENTATIONDOCUMENTATION Medication charts should have patients:Medication charts should have patients:

• Full name.Full name.•MRN.MRN.•Date of birth.Date of birth.•Allergy.Allergy.•Legible order.Legible order.•Drug ordered by Generic name.Drug ordered by Generic name.•Signature of Doctor and their Signature of Doctor and their

printed name.printed name.

DOCUMENTATIONDOCUMENTATION

•Date medication ordered. Date medication ordered. •Times for medication.Times for medication.•Reasons for use of medication.Reasons for use of medication.•Age and weight of paediatric Age and weight of paediatric patient.patient.

•Cessation date. Forms of Cessation date. Forms of medication, eg rectally, orally, medication, eg rectally, orally, transdermal.transdermal.

MEDICATION MEDICATION ADMINISTRATIONADMINISTRATION

TERMINOLOGYTERMINOLOGY

DRUG SCHEDULESDRUG SCHEDULES

Schedule 1. Dangerous poisons eg Schedule 1. Dangerous poisons eg Arsenic.Arsenic.

Schedule 2. Medicinal Poisons, eg Schedule 2. Medicinal Poisons, eg Paracetamol.Paracetamol.

Schedule 3. Potent substances, eg Insulin.Schedule 3. Potent substances, eg Insulin. Schedule 4. Restricted substances, eg Schedule 4. Restricted substances, eg

Oral hypoglycaemics.Oral hypoglycaemics. Schedule 4D. Prescribed Restricted Schedule 4D. Prescribed Restricted

Substances, eg Diazepam.Substances, eg Diazepam.

DRUG SCHEDULESDRUG SCHEDULES

Schedule 5. Domestic Poisons, eg Schedule 5. Domestic Poisons, eg Bleach.Bleach.

Schedule 6. Industrial and Schedule 6. Industrial and Agriculture, eg Phenol.Agriculture, eg Phenol.

Schedule 7. Special Poisons, eg Schedule 7. Special Poisons, eg Insecticides.Insecticides.

Schedule 8. Drugs of Addiction, Schedule 8. Drugs of Addiction, eg Morphine.eg Morphine.

PROHIBITED DRUGSPROHIBITED DRUGS

Substances which are controlled Substances which are controlled under the Drug Misuse and under the Drug Misuse and Trafficking Act 1985 and are not Trafficking Act 1985 and are not specified in Schedule 8 of the specified in Schedule 8 of the Poisons and Therapeutic Goods Poisons and Therapeutic Goods Act, eg Heroin.Act, eg Heroin.

INDICATIONS INDICATIONS

An illness or An illness or disorder for disorder for which a drug has which a drug has a documented a documented specific specific usefulness. usefulness.

CONTRAINDICATIONSCONTRAINDICATIONS

A factor that makes dangerous or A factor that makes dangerous or undesirable the administration of undesirable the administration of a drug or the performance of an a drug or the performance of an act or procedure in the care of a act or procedure in the care of a specific patient.specific patient.

SIDE EFFECTSIDE EFFECT

A side effect occurs when a medication A side effect occurs when a medication causes unintended, secondary causes unintended, secondary effects ( that may be predictable ) effects ( that may be predictable ) Side effects may be harmless or Side effects may be harmless or injurious. If the side effects are injurious. If the side effects are serious enough to negate the serious enough to negate the beneficial effects of medication’s beneficial effects of medication’s therapeutic action, the prescriber therapeutic action, the prescriber may discontinue the medication.may discontinue the medication.

ADVERSE ADVERSE REACTIONS/AFFECTSREACTIONS/AFFECTS

These are generally unexpected These are generally unexpected effects of the medication. They effects of the medication. They may be related to the may be related to the pharmacological effect or they pharmacological effect or they may be related to the individual may be related to the individual taking the medication.taking the medication.

NEAR MISSNEAR MISS

Error recognised prior to Error recognised prior to administration of medication administration of medication given to patientgiven to patient

SENTINEL EVENTSENTINEL EVENT

An error in drug administration An error in drug administration that may cause permanent that may cause permanent disability or death.disability or death.

The trade name, brand name or proprietary name is the name under which a manufacturer markets a medication

Is the name by which the chemist knows it, it provides an exact description of the drug’s chemical composition.

Is the name given by the manufacturer who first developed the drug. To prevent confusion and to reduce medication errors, medication orders should be written using the generic name

Lets look at an exampleLets look at an example

D – (- ) –a amino – r – benzyl D – (- ) –a amino – r – benzyl penicillin trihydratepenicillin trihydrate

Amoxycillin trihydrateAmoxycillin trihydrate

Alphamox, Cilamox, and Amoxyn.Alphamox, Cilamox, and Amoxyn.

THERAPEUTIC EFFECTTHERAPEUTIC EFFECT

The therapeutic effect of the drug The therapeutic effect of the drug is the intended use of the drug, is the intended use of the drug, that is , its desired effect.that is , its desired effect.

E.g. Panadol for a headache, the E.g. Panadol for a headache, the therapeutic effect is pain relief. therapeutic effect is pain relief.

All health facilities should have as part of their quality improvement programs a system in place or reporting medication errors. Please check where these are kept.

Ac = before meals

Bid/bd = twice a day

h= hour

pc= after meals

prn= whenever there is a need/necessary

m = mane

n = nocte

IV = intravenous

SC = subcutaneous

IM = intramuscular

mist = mixture

asap = as soon as possible

qqh = every 4 hours

po = by mouth ( orally )

qid= four times a day

tds= three times a day

q2h= every 2 hours

q4h=every 4 hours

stat=give immediately