Preparing and Administering Medications

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Chapter 26

• Preparing and Administering Medications

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Medication Administration Basics

• As a clinical medical assistant
• Be familiar with medications ordered by physician
  and procedures necessary to administer them
• Look up any drugs you are not familiar with
• Be familiar with
• Terminology
• Abbreviations
• Symbols and sign

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Safety Guidelines

• To ensure safety, follow these guidelines
• Know the policies of your office
• Give only medications ordered in writing
• Check with the physician if you have doubts

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Safety Guidelines (continued)

• Avoid distractions while preparing and
  administering medications
• Work in a quiet, well-lit area
• Check the label when taking medication from
  shelf, when preparing it, and when replacing it
  on shelf

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Safety Guidelines (continued)

• Place the order and the medication side by side
  to compare for accuracy
• Check the strength of medication and routes for
  administration
• Read labels carefully
• Check patients medical record for allergies
• Check medications expiration date

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Safety Guidelines (continued)

• Be alert for indications that medications
  properties have changed
• Measure exactly
• Have sharps containers as close as possible

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Safety Guidelines (continued)

• Put on gloves for all procedures that might
  result in contact with blood or body fluids
• Stay with the patient while oral medication is
  being taken
• Never return a medication to the container after
  it is poured or removed
• Never recap, bend, or break a used needle

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Safety Guidelines (continued

• Never give a medication poured or drawn up by
  someone else
• Never leave the medication cabinet unlocked when
  not in use
• Never give keys for the medication cabinet to an
  unauthorized person

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Checkpoint Question 1

• When are the three checks for safe medication
  administration performed?

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Answer

• The three checks are performed when the
  medication is taken from the shelf, when it is
  poured, and when it is put back on the shelf.

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Seven Rights for CorrectMedication Administration

• Right patient
• Right time
• Right dose
• Right route
• Right drug
• Right technique
• Right documentation

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Systems of Measurement

• Most common system used is metric system
• Apothecary system still used by some physicians
• Household system is sometimes used by patients

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Metric System

• Based on multiples of ten
• Decimals used not fractions
• Base unit of length is the meter (m)
• Base unit of weight is the gram (g or gm)
• Base unit of volume is the liter (L or l)

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Prefixes

• Micro (0.000001)
• Milli (0.001)
• Centi (0.01)
• Deci (0.1)
• Kilo (1000.0)

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Apothecary System

• Liquid measurements include
• Drop (gt)
• Drops (gtt)
• Minim (min, m)
• Fluid dram (fl dr)
• Fluid ounce (fl oz)
• Pint (pt)
• Quart (qt)
• Gallon (gal)

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Apothecary System (continued)

• Solid measurements include
• Grain (gr)
• Dram (dr)
• Ounce (oz)
• Pound (lb)

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Household System

• Teaspoon (tsp)
• Tablespoon (Tbsp)
• Ounce (oz)
• Cup (c)
• Pint (pt)
• Quart (qt)
• Pound (lb)

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Checkpoint Question 2

• What are three systems of measurement and which
  one should be avoided? Why?

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Answer

• The three systems used to measure medications are
  the metric, apothecary, and household systems.
  Household measurements, which are often used by
  patients, should be avoided because they are
  inaccurate.

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Converting Between Systemsof Measurement

• While working in clinical setting, medical
  assistants may find it necessary to convert from
  one system to another

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Apothecary or Householdto Metric

• To change
• Grains to grams, divide number of grains ordered
  by 15
• Grains to milligrams, multiply grains by 60
• Ounces to cubic centimeters or millimeters,
  multiply ounces by 30

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Apothecary or Householdto Metric (continued)

• To change
• Cubic centimeters (or mL) to fluid ounces, divide
  the cc (or mL) by 30
• Kilograms to pounds, multiply kilograms by 2.2
• Pounds to kilograms, divide the pounds by 2.2

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Metric to Metric

• To change
• Grams to milligrams, multiply grams by 1000 or
  move the decimal point three places to the right
• Milligrams to grams, divide the milligrams by
  1000 or move the decimal point three places to
  the left
• Milligrams to micrograms, multiply the milligrams
  by 1000 or move the decimal three places to the
  right

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Metric to Metric(continued)

• To change
• Micrograms to milligrams, divide the micrograms
  by 1000 or move the decimal three places to the
  left
• Liters to milliliters, multiple the liters by
  1000 or move the decimal three places to the
  right
• Milliliters to liters, divide the milliliters by
  1000 or move the decimal three places to the left

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Calculating Adult Dosages

• Administration of medication is an exact science
• Errors in calculations could prove fatal
• Dosages are most frequently calculated for adults
  by
• Ratio method
• Formula method
• Measurements must be in the same system and same
  unit of measurement before calculation can be made

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Ratio and Proportion

• Ratio method to calculate dosages
• Use amount of medication ordered and information
  on medication label to create a ratio
• Once ratio has been determined, the proportion
  can be calculated
• Dose on handKnown quantity Dose
  desiredUnknown quantity

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Formula Method

• Formula method is written as
• (Desired On hand) x Quantity

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Checkpoint Question 3

• Before calculating dosages, what must be done
  with the measurements?

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Answer

• To accurately calculate dosages, you must ensure
  that the measurements are in the same system and
  in the same unit of measurement.

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Calculating Pediatric Dosages

• Calculating dosage by body surface area (BSA)
  using chart
• Youngs rule
• Clarks rule
• Frieds rule

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Checkpoint Question 4

• What is the most accurate method used to
  calculate a pediatric dosage?

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Answer

• The most accurate method used to calculate a
  pediatric dosage is by the Body Surface Area
  (BSA) using the nomogram.

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Routes of Medication Administration

• Physician chooses after considering many factors
• Cost
• Safety
• Speed by which drug will be absorbed by body
• Route of administration

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Oral, Sublingual, andBuccal Routes

• Oral
• Tablets, capsules, pills, liquids taken by mouth
• Usually absorbed through walls of the
  gastrointestinal tract
• Sublingual
• Placed under the tongue must not be swallowed
• Absorbed directly into bloodstream

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Oral, Sublingual, and Buccal Routes (continued)

• Buccal
• Placed in the pouch between cheek and gum
• Absorption through vascular oral mucosa

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Checkpoint Question 5

• What are the disadvantages of the oral route for
  medication administration?

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Answer

• Oral medication typically takes effect slowly.
  Also, the oral route cannot be used for patients
  who are unconscious, for those with nausea or
  vomiting, and for those who are NPO.

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Parenteral Administration

• Administration by injection used
• If patient cannot take medications orally
• If drug cannot be absorbed through
  gastrointestinal system
• For more rapid absorption of drug
• Medication cannot be retrieved once injected
• Possible for infections to develop

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Equipment for Injections

• Ampules, vials, cartridges
• Needles and syringes

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Ampules

• Small glass containers
• Break at the neck
• Aspirate solution into syringe
• Once open, all medication must be used or
  discarded

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Vials

• Glass or plastic container sealed with rubber
  stopper
• Single dose or multiple dose
• May hold solution or powder
• Powders must be reconstituted

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Cartridges

• Prefilled syringes contain premeasured medication
  in disposable cartridge with needle attached
• Placed in a holder for administration
• After use, discard cartridge into sharps
  biohazard container

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Needles and Syringe

• Variety used for injections
• Type of injection
• Size of patient

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Syringes

• 3 mL hypodermic syringe is most common
• 5 or 10 mL usually used for irrigation only
• All consist of plunger, body or barrel, flange,
  and tip

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Needles

• Lengths vary from 3/8 inch to 1 ½ inch
• Gauge varies from18 to 30
• Choose needle appropriate for route of injection
• Insulin syringe used strictly for administering
  subcutaneously to diabetic patients

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Checkpoint Question 6

• What are ampules and vials and how do they differ?

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Answer

• Ampules and vials are medication containers. An
  ampule is a glass container with a narrow neck
  that must be broken to obtain the medication. A
  vial is a glass or plastic container sealed with
  a rubber stopper. Vials may contain medication in
  either solution or liquid form, or in dry form.

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Types of Injections

• Intradermal
• Subcutaneous
• Intramuscular
• Z-track method

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Checkpoint Question 7

• Name the types of injections and the possible
  sites for each type.

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Answer

• Types of injections include intradermal,
  subcutaneous, and intramuscular. Sites for
  intradermal injections include the anterior
  forearm and the back. Sites for subcutaneous
  injections include the upper arm, thigh, back,
  and abdomen. Sites for intramuscular injections
  include the deltoid, ventrogluteal, and vastus
  lateralis.

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Other Medication Routes

• Rectal administration
• Vaginal administration
• Transdermal administration
• Inhalation
• Intravenous