Policy Update: Med Administration

The highlights only...please refer to the policy on Meditech for the full text. You'll notice a few changes to the policy, so please be aware of this!

• Know the pt's identifying information. Know allergies, weight/height, lab values, current medications, diagnoses/co-morbidities, ability to swallow.
• Know what the drug does, normal doses, side effects/adverse reactions, interactions, effects on lab values.
• You may refuse to administer any drug that: you deem inappropriate for the pt's condition, is outside the scope of nursing practice, or the setting is inappropriate.

Procedure for giving meds:

• Rights: patient, medication, does, time, route, documentation (date, time, signature), allergies, refusal, education given.
• Medications for only one patient are removed from the Pyxis, prepared, and administered at a time.
• Verified medications are transferred to the pt's room in the original package, or if prepared, the med name is labeled on the container (e.g. meds in a syringe or cup must be labeled). Transport of meds to pt's room must be secure, not carried in pockets.
  
• Bring MAR to bedside, verify pt's armband with indentifying information on MAR. Use 2 identifiers for verification.
• Observe the pt swallowing oral medications. If giving med by IVP, stay with pt while med is infusing (don't put it on the IV pump and leave).
• Monitor pt's response. If unexpected response, refer to new policy: Medication Administration Unanticipated Evens #13.003.
• Document medication administration on MAR.
  
• Education must be given to pt and/or family before initiating new medications. Include: name of med, expected action, possible side effects/interactions, danger signs to report, schedule of administration, and to question anything that isn't familiar or hasn't been explained completely.

Medication Initiation Times:

• Now and Stat orders - within 30 minutes
• ASAP - within 1 hr
• Initial doses of IV meds take priority over other treatments and medications, and are given ASAP after any ordered cultures are done.
• For severe sepsis, septic shock, or pneumonia, antibiotics are given within 1 hr of MD's order, following blood cultures.

Other information to know:

• All IVPB are mixed in the pharmacy. In the event of an emergency, RN may mix medication. The RN who mixes the medication must administer it. Label drug with pt name, med, concentration, date/time, name of person preparing. All non-pharmacy mixed drugs must be discarded within 12 hrs.
• For IV meds: if adjustments to infusion rate are based on sliding scale or lab test, consider verifying adjustment with another RN.
• Please refer to policy for specifics on transdermal, IVP, IVPB, and extravasation.

Reference: Medication: Administration, Standard 13.001