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Nursing Resource Guide


Administering Drugs with Caution

By Hedy Cohen, RN, BSN

Administering medication. It's one of your most important nursing activities and one of the riskiest.

Legally, a licensed nurse is held to certain expectations for administering medications:

•knowing a drug's indications, safe dosages, toxicity, possible adverse effects, and contraindications
•refusing to accept an unclear drug order unless the prescriber clarifies it
•knowing how often to monitor the patients responses.
As an advocate for safe medication practices, I want to review ways to reduce the chance of problems and alert you to sources of error that can affect each drug dose you administer.

History-taking tips
The first step to safeguard against trouble is to obtain a thorough medication history. Find out all of the drugs your patient takes: their names, doses, intended effects, and administration times. Ask about prescription and over-the-counter (OTC) preparations, herbal supplements, and vitamins. The more she takes, the greater her risk.

Finding out about drug allergies is important too because they can trigger reactions ranging from mild to life-threatening. Check your patient's chart for a history of allergies before you administer any drug, and carefully monitor her after giving it. If she develops an allergy after receiving a drug, prominently note the drug name in her chart and describe the details of her reaction.

Five rights: Not foolproof
Although the "five rights" of drug administration help prevent problems, don't assume they're foolproof. Here's why.

The right drug. A prescriber's sloppy handwriting, a pharmacy error, or a nursing mistake can lead to administering the wrong drub. For your part, check the medication administration record for ordered drugs, be on guard for sound-like or look-alike drug names, and ask the pharmacist, your instructor, or the prescriber if you have any questions.
The right patient. Before giving a medication, check your patient's I. IF she's alert, ask her to state her name. Overlooking the ID, misreading the name and "hearing" the name you expect are all potential sources of error.
The right dose. Miscalculation by the prescriber, the pharmacist, or the nurse is a major concern: For unfamiliar doses, check a reference. Question the prescriber about any dose that's higher or lower than the recommended amount. And always have another dose to check your figures.
The right route. Given by the wrong route, some medications are fatal. If you're unsure of the route, don't administer the medication.
The right time. Some drugs must be given at precise intervals to maintain therapeutic levels. Always check with the prescriber or the pharmacist if the schedule changes.

Involving the patient
Another source of medication errors is the patient. That's why you need to teach her:

•why she's taking a specific medication
•how to take it properly, including not stopping until the practitioner gives the okay
•possible adverse responses
what steps to take if she isn't getting the expected response
•how to protect herself if she's allergic to a medication: Tell her never to take it and to inform every healthcare provider she sees about her allergy. Also suggest that she wear an allergy bracelet.
Back up your teaching with written instructions, and remember to tell your patient about potential problems with OTC drugs.
Defensive documentation
If a medication error occurs in spite of your best efforts, don't hesitate to report it. Notify the prescribing physician right away, then document exactly what happened, including the patient's response and actions taken. Fill out an incident report according to your facility's policy. Although being involved in a medication error can be upsetting, detailed documentation is likely to help if you ever need to discuss an error in court.



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