-Incomplete patient information
-Unavailable drug information
-Miscommunication of drug orders
-Lack of appropriate drug labeling
-Environmental distractions
Five Most Common Medication Errors
-Right patient
-Right medication
-Right dose
-Right route of administration
-Right time of delivery
Five Rights of Drug Administration
-Checking the drug with the MAR
-Checking the drug when preparing it, pouring it, and taking it out of the unit-dose container, or connecting the IV tubing to the bag
-Checking the drug before administering it to the patient
Three Checks of Drug Administration
Allergic reaction
An acquired hyperresponse of body defenses to a foreign substance (allergen)
Anaphylaxis
A severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life-threatening shock
Adverse events (AEs)
Usually due to undesirable reactions of drug therapy; do not necessarily have to be causally linked with a specific therapy
Serious Adverse Event (AE)
Used to define threat of death or immediate risk of death
Side effect
Expected drug reaction
Expected drug effect
Implies a known effect with an intended therapeutic outcome
Compliance
Taking a medication in the manner prescribed by the health care provider
-Cost of drug
-Forgetting doses
-Annoying side effects
-Self-adjustment of doses
-Fear of dependency
Factors that cause a patient to deviate from compliance
STAT order
Refers to any medication that is needed immediately and is to be given only once; the time between writing the order and administrating the drug should be 5 minutes or less
ASAP order
Should be available for administration to the patient within 30 minutes of the written order
Single order
A drug that is to be given only once, and at a specific time
prn order
Drug is administered as required by the patient's condition
Routine orders
Are usually carried out within 2 hours of the time the order is written by the health care provider; orders not written as STAT, ASAP, NOW or PRN
Standing order
Written in advance of a situation that is to be carried out under specific circumstances
Central nervous system drugs and hypertensives
Often best administered at bedtime
-Metric
-Apothecary
-Household
Three systems of measurement
Metric
Most common system of drug measurement
Apothecary measurements
The Joint Commission placed this on the "Do Not Use" list
4-5 mL
1 teaspoon or 60 drops
15-16 mL
1 tablespoon or 3-4 teaspoons
1 kg
2.2 pounds
-Enteral
-Topical
-Parenteral
Routes of Drug Administration
Enteral route
Drugs given orally and those administered through nasogastric or gastrostomy tubes
Orally disintegrating tablets (ODTs)
A newer type of drug formation that allows for quick dissolving and absorption of medications
Enteric coated tablets
Designed to dissolve in the alkaline environment of the small intestine; Do not crush this because the medication will be exposed to the stomach
Sustained-release (SR) tablets or capsules
Designed to dissolve very slowly ; releases the medication over an extended time and results in a longer duration of action for the medication
Extended-release (XR) or Long Acting (LA) medications
Allows for the convenience of once or twice a day dosing; must not be crushed or opened
Sublingual route
The medication is placed under the tongue and allowed to dissolve slowly; Rich blood supply causes rapid onset; no food or drink until completely dissolved
Buccal route
The tablet or capsule is placed in the oral cavity between the gum and the cheek; Preferred for sustained delivery; Bypasses first-pass metabolism
Nasogastric (NG) tube
A soft, flexible tube inserted by way of the nasopharynx with the tip lying in the stomach; used for short term treatment
Gastrostomy (G) tube
Surgically placed directly into the patient's stomach; used for longer-term treatment
Topical drugs
Applied to the skin, or the membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina, and rectum
-Dermatologic preparations
-Instillations and irrigations
-Inhalations
Types of topical applications
Dermatologic preparations
Drugs applied to the skin; most commonly used topical route; ex.) creams, gels, lotions
Instillations and irrigations
Drugs applied into the body cavities or orifices. Routes may include eyes, ears, nose, urinary bladder, rectum and vagina
Inhalations
Drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses.
Bronchoconstriction
Most common indication for inhaled drugs due to bronchitis or asthma
Ophthalmic route
Used to treat local conditions of the eye and surrounding structures
Otic route
Used to treat local conditions of the ear, including infections and soft blockages of the auditory canal
Nasal route
Used for both local and systemic drug administration; the nasal mucosa is the absorptive surface for the medication
Transdermal delivery system
Medication is applied to the skin; usually contained in a patch or disk; avoids first-pass effect of liver and enzymes; ex.) nitroglycerin for angina pectoris
Astringent effect
Shrink swollen mucous membranes or loosen secretions and facilitate drainage
Vaginal route
Used to deliver medications for treating local infections and to relieve vaginal pain and itching
Rectal route
A safe and effective means of delivering drugs to patients who are comatose or who are experiencing nausea and vomiting; normally in suppository form
Parenteral route
Delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins
-intradermal
-subcutaneous
-intramuscular
-intravenous
Types of Parenteral drug administration
Intradermal injection
Administered into the dermis layer of the skin; drugs are more easily absorbed because the dermis contains more blood vessels
Subcutaneous injection
Delivered to the deepest layer of the skin; used for rapid absorption
-outer aspect of the upper arms, in the area above the triceps muscle
-middle two thirds of the anterior thigh area
-subscapular areas of the upper back
-upper dorsogluteal and ventrogluteal areas
-abdominal areas, above the iliac crest and below the diap
Ideal body sites for subcutaneous injections
Intramuscular injection
Delivers medication into specific muscles; more rapid onset because muscles have a rich blood supply
-Ventrogluteal
-Deltoid
-Dorsogluteal
-Vastus lateralis
Four common sites for IM injections
Ventrogluteal
The preferred site for IM injections; provided the greatest thickness of gluteal muscles, contains no large blood vessels or nerves, is sealed off by bone, and contains less fat than buttock area; it is a suitable site for children and infants over 7 mont
Deltoid
This site is used in well-developed teens and adults for volumes of medication not to exceed 1 mL
Dorsogluteal
This site is used for adults and for children who have been walking for at least six months; rarely used due to potential for damage to the sciatic nerve
Vastus lateralis
Usually thick and well developed in both adults and children; the middle third of the muscle is the site for IM injections
Intravenous
Medications and fluids are administered directly into the bloodstream and are immediately available for use by the body; fastest drug onset but also most dangerous method due to potential for contamination or swift adverse reactions
-Large volume infusion
-Intermittent infusion
-IV bolus (push) administration
Three basic types of IV administration
Large volume administration
This type of IV administration is for fluid maintenance, replacement, or supplementation
Intermittent infusion
A small amount of IV solution that is arranged in tandem with or piggybacked to the primary large-volume infusion; used to instill adjunct medications
IV bolus (push) administration
A concentrated dose delivery directly to the circulation via syringe to administer single-dose medications
-bypasses first-pass effect and enzymes
-available to patients unable to take medication orally
Advantages of Parenteral route
-only small doses can be used
-pain and swelling at injection site
Disadvantages of Parenteral route
ventrogluteal
deltoid
dorsogluteal
vastus lateralis
-Incomplete patient information
-Unavailable drug information
-Miscommunication of drug orders
-Lack of appropriate drug labeling
-Environmental distractions
Five Most Common Medication Errors
-Right patient
-Right medication
-Right dose
-Right route of administration
-Right time of delivery
Five Rights of Drug Administration
-Checking the drug with the MAR
-Checking the drug when preparing it, pouring it, and taking it out of the unit-dose container, or connecting the IV tubing to the bag
-Checking the drug before administering it to the patient
Three Checks of Drug Administration
Allergic reaction
An acquired hyperresponse of body defenses to a foreign substance (allergen)
Anaphylaxis
A severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life-threatening shock
Adverse events (AEs)
Usually due to undesirable reactions of drug therapy; do not necessarily have to be causally linked with a specific therapy
Serious Adverse Event (AE)
Used to define threat of death or immediate risk of death
Side effect
Expected drug reaction
Expected drug effect
Implies a known effect with an intended therapeutic outcome
Compliance
Taking a medication in the manner prescribed by the health care provider
-Cost of drug
-Forgetting doses
-Annoying side effects
-Self-adjustment of doses
-Fear of dependency
Factors that cause a patient to deviate from compliance
STAT order
Refers to any medication that is needed immediately and is to be given only once; the time between writing the order and administrating the drug should be 5 minutes or less
ASAP order
Should be available for administration to the patient within 30 minutes of the written order
Single order
A drug that is to be given only once, and at a specific time
prn order
Drug is administered as required by the patient's condition
Routine orders
Are usually carried out within 2 hours of the time the order is written by the health care provider; orders not written as STAT, ASAP, NOW or PRN
Standing order
Written in advance of a situation that is to be carried out under specific circumstances
Central nervous system drugs and hypertensives
Often best administered at bedtime
-Metric
-Apothecary
-Household
Three systems of measurement
Metric
Most common system of drug measurement
Apothecary measurements
The Joint Commission placed this on the "Do Not Use" list
4-5 mL
1 teaspoon or 60 drops
15-16 mL
1 tablespoon or 3-4 teaspoons
1 kg
2.2 pounds
-Enteral
-Topical
-Parenteral
Routes of Drug Administration
Enteral route
Drugs given orally and those administered through nasogastric or gastrostomy tubes
Orally disintegrating tablets (ODTs)
A newer type of drug formation that allows for quick dissolving and absorption of medications
Enteric coated tablets
Designed to dissolve in the alkaline environment of the small intestine; Do not crush this because the medication will be exposed to the stomach
Sustained-release (SR) tablets or capsules
Designed to dissolve very slowly ; releases the medication over an extended time and results in a longer duration of action for the medication
Extended-release (XR) or Long Acting (LA) medications
Allows for the convenience of once or twice a day dosing; must not be crushed or opened
Sublingual route
The medication is placed under the tongue and allowed to dissolve slowly; Rich blood supply causes rapid onset; no food or drink until completely dissolved
Buccal route
The tablet or capsule is placed in the oral cavity between the gum and the cheek; Preferred for sustained delivery; Bypasses first-pass metabolism
Nasogastric (NG) tube
A soft, flexible tube inserted by way of the nasopharynx with the tip lying in the stomach; used for short term treatment
Gastrostomy (G) tube
Surgically placed directly into the patient's stomach; used for longer-term treatment
Topical drugs
Applied to the skin, or the membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina, and rectum
-Dermatologic preparations
-Instillations and irrigations
-Inhalations
Types of topical applications
Dermatologic preparations
Drugs applied to the skin; most commonly used topical route; ex.) creams, gels, lotions
Instillations and irrigations
Drugs applied into the body cavities or orifices. Routes may include eyes, ears, nose, urinary bladder, rectum and vagina
Inhalations
Drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses.
Bronchoconstriction
Most common indication for inhaled drugs due to bronchitis or asthma
Ophthalmic route
Used to treat local conditions of the eye and surrounding structures
Otic route
Used to treat local conditions of the ear, including infections and soft blockages of the auditory canal
Nasal route
Used for both local and systemic drug administration; the nasal mucosa is the absorptive surface for the medication
Transdermal delivery system
Medication is applied to the skin; usually contained in a patch or disk; avoids first-pass effect of liver and enzymes; ex.) nitroglycerin for angina pectoris
Astringent effect
Shrink swollen mucous membranes or loosen secretions and facilitate drainage
Vaginal route
Used to deliver medications for treating local infections and to relieve vaginal pain and itching
Rectal route
A safe and effective means of delivering drugs to patients who are comatose or who are experiencing nausea and vomiting; normally in suppository form
Parenteral route
Delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins
-intradermal
-subcutaneous
-intramuscular
-intravenous
Types of Parenteral drug administration
Intradermal injection
Administered into the dermis layer of the skin; drugs are more easily absorbed because the dermis contains more blood vessels
Subcutaneous injection
Delivered to the deepest layer of the skin; used for rapid absorption
-outer aspect of the upper arms, in the area above the triceps muscle
-middle two thirds of the anterior thigh area
-subscapular areas of the upper back
-upper dorsogluteal and ventrogluteal areas
-abdominal areas, above the iliac crest and below the diap
Ideal body sites for subcutaneous injections
Intramuscular injection
Delivers medication into specific muscles; more rapid onset because muscles have a rich blood supply
-Ventrogluteal
-Deltoid
-Dorsogluteal
-Vastus lateralis
Four common sites for IM injections
Ventrogluteal
The preferred site for IM injections; provided the greatest thickness of gluteal muscles, contains no large blood vessels or nerves, is sealed off by bone, and contains less fat than buttock area; it is a suitable site for children and infants over 7 mont
Deltoid
This site is used in well-developed teens and adults for volumes of medication not to exceed 1 mL
Dorsogluteal
This site is used for adults and for children who have been walking for at least six months; rarely used due to potential for damage to the sciatic nerve
Vastus lateralis
Usually thick and well developed in both adults and children; the middle third of the muscle is the site for IM injections
Intravenous
Medications and fluids are administered directly into the bloodstream and are immediately available for use by the body; fastest drug onset but also most dangerous method due to potential for contamination or swift adverse reactions
-Large volume infusion
-Intermittent infusion
-IV bolus (push) administration
Three basic types of IV administration
Large volume administration
This type of IV administration is for fluid maintenance, replacement, or supplementation
Intermittent infusion
A small amount of IV solution that is arranged in tandem with or piggybacked to the primary large-volume infusion; used to instill adjunct medications
IV bolus (push) administration
A concentrated dose delivery directly to the circulation via syringe to administer single-dose medications
-bypasses first-pass effect and enzymes
-available to patients unable to take medication orally
Advantages of Parenteral route
-only small doses can be used
-pain and swelling at injection site
Disadvantages of Parenteral route
ventrogluteal
deltoid
dorsogluteal
vastus lateralis