Desired Over Have

Desired Over Have
Module 1: Safe Dosage

Rights of Medicine Administration:
1. Client
a. 2 Identifiers
i. Name
ii. ID number
iii. Telephone number
iv. Photo identification
2. Medicine
a. 3 Checks
i. When removing from dispensing system
ii. Compare medicine label with the MAR; note the
expiration date
iii. Review the medication at the clients bedside
3. Route
a. Compare/clarify
b. Vocabulary (Liquid Medications):
i. Enteral Oral/enteral tubes
ii. Parenteral Injection/infusion
4. Time
a. STAT Immediately
b. PC 30 minutes after a meal
c. PRN Nurses judgment
5. Dose
a. Match prescription
b. Perform conversion; verify
c. Calculate the dosage
6. Documentation
a. Document immediately
Types of Prescriptions:
1. Routine carried out until changed or at the identified end date
a. I.E. Opioids or antibiotics
2. Single Implemented once
a. Used in diagnostic procedures, surgery, etc.
3. STAT One time; immediate
a. I.E. Emergency situations
4. PRN Nursing judgment based on clients needs
a. I.E. Pain or temperature
5. Standing Protocol-based
6. Now Once; less urgent than STAT; within 90 minutes
Prescription Components:
Date
Time
Client name
Medicine name
Dosage
Route
Time
Frequency
Provider signature
-ONLY ADMINISTER MEDICATIONS YOU HAVE PREPARED

YOURSELFSteps to Administering Medication:
1. Plan
2. Implement
3. Evaluate
a. Note any errors
Risk
Reduction:
Medicine dispensing system
Electronic medical records
Bar code scanning
-WWW.ISMP.ORGError Prone Abbreviations:

QD = Once daily
QID = 4 times daily
HS = Hours of sleep or strength
DC = Discharge or discontinue
High
Alert Medications:
Anticoagulants
Chemotherapeutic agents
Opioids
Hypoglycemic
-LOOK FOR TALLMAN LETTERS TO REDUCE MEDICATION

ERRORS-ALWAYS USE LEADING ZEROS DO NOT USE TRAILING
ZEROS-
Abbreviations with Medications:

ER, XL, SR
o Some form of delayed action or release
o Sustained release
Do Not Crush Medications:
1. Delayed-Release
2. Long-Acting
3. Enteric-Coated
Atraumatic Care:
Therapy that eliminates or minimizes the physical or
psychological distress children and families experience in health
care settings
Subcutaneous Administration:
Location
o Infants and toddlers anterolateral thigh
o Toddlers and older children posterior area of the upper
arm
IV insertion sites
o Forearm
o Wrist
o Ankle
o Foot
o Scalp
Endotracheal Administration:
Inconsistent distribution of medication
4 medications distributed in this manner
o L = Lidocaine
o E = Epinephrine
o A = Atropine
o N = Naloxone (Narcan)
Module 2: Medication Administration

Working with Military Time:
Standard time
o Conventional time
o 12-hr clock
Military time
o International standard notation of time
o Astronomical time
o 24-hr clock
0001 to 2400
Converting time
o Standard a.m. to military add a leading zero
5:30 a.m. = 0530
o Military to standard a.m. remove leading zero
0530 = 5:30 a.m.
o Standard p.m. to military convert by adding 12
5:30 p.m. = 1730
o Military to standard p.m. convert by subtracting 1200
1730 = 5:30 p.m.
Systems of Measurement:
1. Metric
a. GRAMS
i. mcg, mg, g, kg
1. Body weight g & kg
2. Medication calculation mcg, mg, & g
b. LITERS
i. mL, L
1. Volume mL & L
c. METERS
i. mm, cm, m
1. Length mm, cm, & m
d. Measuring Fluid
i. 1 mL = 1 g
1
1
1
1
1
1
1
L
L
L
L
L
L
L
x
x
x
x
x
x
x
1 LITER
1,000 = kiloliters (kL)
100 = hectoliters (hL)
10 = dekaliters (daL)
0.1 = deciliters (dL)
0.01 = centiliters (cL)
0.001 = milliliters (mL)
0.000001 = microliters (mcL)
1
1
1
1
1
1
1
g
g
g
g
g
g
g
x
x
x
x
x
x
x
1 GRAM
1,000 = kilograms (kg)
100 = hectograms (hg)
10 = dekagrams (dag)
0.1 = decigrams (dg)
0.01 = centigrams (cg)
0.001 = milligrams (mg)
0.000001 = micrograms
(mcg)
e. Weight and Volume
WEIGHT
VOLUME
1
1
1
1
1
kg = 1,000 g
g = 1,000 mg
g = 1,000,000 mcg
mg = 1,000 mcg
L = 1,000 mL
1
1
1
1
1
g = 0.001 kg
mg = 0.001 g
mcg = 0.000001 g
mcg = 0.001 mg
mL = 0.001 L
f. Converting Units of Measurement

i. STEP 1
1. Identify unit of measurement you need to
calculate
ii. STEP 2
1. Identify unit of measurement that is available
iii. STEP 3
1. Set up an equation. Solve for X
iv. STEP 4
1. Reassess
2. Apothecary
a. Historical measuring system
b. Minimal use today due to the error rate
c. Units of measurement:
i. Grain
ii. Scruples
iii. Drachm
iv. Ounces
v. Pounds
3. Household
a. 1 oz. = 30 mL
b. Units of measurement:
i. Ounces (oz.)
ii. Teaspoons (tsp.)
iii. Tablespoons (tbsp.)
c. Instruments for measurement:
i. Calibrated syringe
ii. Dropper
HOUSEHOLD
1
1
1
1
tsp.
tbsp.
oz.
cup (8 oz.)
METRIC
5 mL
15 mL
30 mL
240 mL
2.2 lbs.
1 kg
Other Systems:
Medications
o Insulin
o Heparin
o Penicillin
o Vitamin
Label may indicate USP, which stands for United States
Pharmacopeia (International Units)
-SPELL OUT UNITS; DO NOT USE ABBREVIATIONSCommon Abbreviations:

ABBREVIATIONS
AC
PC
PCN
Daily
STAT
PO
SL
ID
IM
IV
top
p
c
s
liq
susp
NPO
MEANING
Before meals
After meals
As needed
Everyday
Immediately
By mouth
Sublingually
Intradermal
Intramuscular
Intravenous
Topical
After
With
Without
Liquid
Suspension
Nothing by mouth
Rounding:
<1
o Round to nearest hundredth
>1
o Round to nearest tenth
Module 3: Oral Medications

Medication Dispensing Chain:
1. Provider
2. Pharmacist
3. Nurse
Storage Areas for Medications:
Medicine carts
o Loaded with 24-hour supply by a pharmacist
Medicine cabinets
o Loaded with 24-hour supply by a pharmacist
Medicine rooms
Automated dispensing systems
o Includes controlled substances
Medicine Dispensing Systems:
1. Pharmacy bulk system
a. Used for multiple doses
2. Unit-dose system
a. Uses for individual doses
b. Hospital utilizes this method to minimize error
c. Forms:
i. Solid oral
ii. Liquid oral
iii. Topical
iv. Injectable
v. Intravenous
MAR:
Medical administration record
Transcribed
o Name of medication
o Dose
o Route
o Frequency
o Date of prescription
o Expiration of prescription
Ensure that all documentation is completed within MAR upon
receiving
Special instructions may be included within a clients MAR
documentation
o Always follow ALL special instructions
Using an Automated Medicine Dispensing System:
1.
2.
3.
4.
5.
6.
Log into computer dispensing system

Select the clients name
Select the medication
Enter the amount of medication desired
Push dispense; retrieve medication
Examine and check medication
a. 3 Checks
i. When removing from dispensing system
ii. Compare medicine label with the MAR; note the
expiration date
iii. Review the medication at the clients bedside
Forms of Medications:
Tablet
o Scored or Unscored
Capsule
o Medication encased in gelatin
Time-release capsule
o Small beads with a 12-24 hour release
Time-release tablet
o 12-24 hour release; can be taken daily or twice a day
Enteric-coated tablet
o Will not dissolve until passed through the stomach,
preventing irritation of the stomach lining
Caplet
o Cross between a capsule and a tablet
Routes for Administration of Solid Oral Medications:
1. Sublingual
a. Medication is placed under the tongue; faster acting
2. Buccal
a. Medication is placed between the cheek and the gums
Liquid Oral Medications:
Elixir
o Contains:
Medicine
Sweetener
Alcohol
Water
Syrup
o Contains:
Medicine
Concentrated sugar
Water
Suspension
o Contains:
Medicine
Water
Solution
o Contains:
Medicine
Saline or water
Steps for Liquid Oral Medication Administration:

1. Calculate the correct dose
2. Choose the appropriate measuring tool
a. Medicine cup
i. Used for amounts up to 30 mL
b. Medicine spoon
i. Used for amounts less than 5 mL
Module 4: Injectable Medications

Routes for Medicine Administration Parentally:
1. Intradermal
a. I.E. TB and allergy testing
2. Subcutaneous
a. Slower absorption rate
b. I.E. Heparin and enoxaparin
3. Intramuscular
a. Used for larger volumes of medications
Subcutaneous Injection Sites:
Anterior upper arm
Abdomen
Upper back
Upper hip
Interior thigh
-AVOID SKIN LESIONS AND BONY PROMINENCESIntramuscular Injection Sites:

Ventrogluteal
o Preferred
o Used for both adults and children
Anterior vastus lateralis
o Used for infants
Deltoid
o Recommended for immunizations in both adults and
children
Intravenous Therapy:
Used for the administration of medicines, or to provide fluids and
electrolytes
Types:
o Peripheral short IV catheter
Rests within the vein
o Peripherally inserted central catheter
Tip is inserted into the superior vena cava
o Central catheter: subclavian insertion
o Central catheter: internal jugular vein
Calibrated Syringes:
Oral tinted syringe

Clear oral syringe
Syringe for injection
o Calibrated in mL
1-20 mL
10 and 20 mL syringes are used to add medication to
IV solutions
60 mL syringes are used to irrigate wounds
Preventing Needle Stick Injuries:

Risks:
o Hepatitis B
o Hepatitis C
o HIV
Preventative measures
o Safety syringes
o Sharps disposal
Reading and Interpreting Labels:
Check dosages
Check unit of measurement
Ensure correct formulation for route
Check expiration date
Use single-dose preparation only once
Store in appropriate place
Working with Insulin:
Insulin promotes removal of glucose from the blood as well as
storage of glycogen in the liver
Injection variations
o Subcutaneous
Injection or pump
o Intravenously
Must dilute; administers at slow, continuous rate
Insulin aspart (Novolog)
Insulin lispro (Humalog)
Insulin glulisine (Apidra)
Units of measurement
o Standard measurement is the unit
o Insulin concentrations
U-100 (100 units/mL)
U-500 (500 units/mL)
Administered subcutaneously
Client education
o Insulin sources
Manufactured human insulin
Analogs
Source of insulin can affect the onset, peak, as well
as the duration of time
o Insulin types
o Onset time
o Peak time
o Duration
Types of insulin
o Rapid acting (clear)
Administered subcutaneously or intravenously
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
o Regular or short acting (clear)
Administered subcutaneously or intravenously
Regular insulin (Humulin R, Novolin R)
o Intermediate acting
Administered subcutaneously
NPH insulin (Humulin N) (cloudy)
Insulin determir (Levemir) (clear)
o Long acting
Insulin glargine (Lantus)
o Pre-mixed
Vocabulary
o Onset - When action of insulin starts
o Peak - Time it takes insulin to reach max therapeutic level
in the body
o Duration - How long the insulin works
Mixing Insulin
o Step 1 Determine if you can mix the insulin
o Step 2 Prepare the mixture in a single syringe
-CAN ONLY MIX SHORT OR RAPID ACTING INSULIN WITH OTHER

INSULIN-MAKE SURE REGULAR INSULIN IS INSERTED INTO THE
SYRINGE FIRSTINSULIN TYPE
TRADE
NAME
ONSET
PEAK
DURATION
Rapid Acting
Insulin lispo
Short Acting
Regular
insulin
NPH insulin
Intermediate
Acting
Long Acting
Insulin
glargine
< 15
minutes
0.5 to 1
hour
1 to 2 hours
1 hour
0.5 to 1
hour
2 to 3 hours
3 to 4 hours
4 to 12
hours
N/A
18 to 24
hours
24 hours
5 to 7 hours

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Module 1: Safe Dosage

-ONLY ADMINISTER MEDICATIONS YOU HAVE PREPARED

-WWW.ISMP.ORGError Prone Abbreviations:

-LOOK FOR TALLMAN LETTERS TO REDUCE MEDICATION

Abbreviations with Medications:

Module 2: Medication Administration

f. Converting Units of Measurement

-SPELL OUT UNITS; DO NOT USE ABBREVIATIONSCommon Abbreviations:

Module 3: Oral Medications

Log into computer dispensing system

Steps for Liquid Oral Medication Administration:

Module 4: Injectable Medications

-AVOID SKIN LESIONS AND BONY PROMINENCESIntramuscular Injection Sites:

Oral tinted syringe

Preventing Needle Stick Injuries:

-CAN ONLY MIX SHORT OR RAPID ACTING INSULIN WITH OTHER

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