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Medication Administration

Everyday ACLS medication errors are being made.  The consequences for the patient receiving the medication can be fatal.  Whether you are a Registered Nurse, LPN, Paramedic, Physician or even a Care Taker at home, it is critical to take that extra minute before administering the medication.

Healthcare facilities have extra safety measures in place to try and prevent the wrong medication as well as the wrong route, dose, patient, and wrong time.  Some health care facilities are starting to implement software for the physician to enter the orders into a computer.  Let’s face it, some physician’s orders are not legible, they work long hours when on-call, and therefore that can increase a potential medication error.  Pharmacies and Pharmaceutical companies are producing one time dose vials, syringes to also help with the safety administration of PALS medication for healthcare facilities.  For the most part the physician writes the orders by hand on an order sheet or prescription pad.  The order is viewed by the nurse and faxed to pharmacy.  The pharmacist fills the order and then it is given to the nurse to administer to the patient.

As a side note, most medical health care professionals will choose to attend and ACLS or PALS Class prior to assuming the duties of drug administration. The order should be viewed closely at first, by the physician, second, by the nurse, third, by the pharmacist, and fourth, by the nurse again prior to administration to the patient. Follow Hospital Protocols for their administration of medications in their facility.  Nurses are may use the following tips to help them with medication administration:

*Verify the medication/medications with the Physician’s orders

-checking the name (if names are different, verify the generic brand with that of the name brand)
-verifying the correct dose (ensure that if the label reads 5mg. and the order reads 2.5mg, you                        will need to give ½ of the medication)
-And note whether the ACLS certification medication is to be given STAT or if it is a timed medication.

*Fax the Order to the Pharmacy Department, and if the hospital protocol requires a phone call to ensure the order was received, or if the medication is to be given immediately–call pharmacy as soon as the order is being faxed.

*Then the order is viewed by the Pharmacist and he/she will fill the prescription
*The medication is then sent to the healthcare professional to be administered to the patient
where the order will be verified again.

There are the 5-Rights that Nurses and other healthcare professional use for medication administration.  They are:
1. RIGHT Patient
2. RIGHT Drug
3 .RIGHT Dose
4  RIGHT Time
5. RIGHT Route

If the patient is able to converse with the medical professional that is administering the medication, then there are a set of questions that can be utilized to ensure the safety administration of the medication.

They are:
-Ask the patient there name, there Date of Birth and check the patients armband to help in proper identification and Verify ANY ALLERGIES!  if the patient is unable to answer any questions, you may ask a family member the patient’s name and date of birth.  If there is no family available, you will need to use the armband and find in the chart any history information that may be available.
Healthcare professionals that administer medications on a daily basis will at some point or another, make a medication administration error.  The high demand for nurses and the extreme high numbers of nurse to patient ratios is the reason for the majority of medication errors.  It is impossible to for a nurse to take 6-10 patients and be expected to provide the excellent care that patients need and deserve.  Also, lack of education can be another source for medication errors.  For example,  if the medication comes to the nurse in grams, but the order is calling for milligrams and the nurse does not know how to convert from grams to milligrams.   Or get a tuberculin syringe for an insulin medication, when they should have gotten an insulin syringe.

I encourage all healthcare professionals, even the ones that have been administering medications for years, to take that extra minute to check and re-check the medications before giving it to the patient.  ALWAYS perform Label Checks:
*When reaching for the medication
*Immediately before opening
*When replacing the medication back to the storage bin
Many times a nurse may be reaching for the Heparin bottle, and ends up with another medication.  If your patient is unable to swallow pills or if they have a feeding tube or NG-tube, verify with pharmacy if the medication can be crushed, because some medications are time released and therefore will cause the patient to receive the dose all at once.

When in doubt about any medication always clarify the order with the physician.  Be an advocate for the patient.  Practice safety medication administration at all times.  This is truly a matter of life or death.

Georgia Medical Academy

2121 Hwy 42 North suite C
Jenkinsburg, Ga. 30234

Kimberly Bratcher

American Heart Association

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