ST.

LUKE’S COLLEGE OF NURSING

1st Semester
School Year: 2021-2022

GENERAL DISCUSSION SCHEDULE

COURSE CODE : NCM 106

COURSE TITLE : Pharmacology
LESSON NUMBER : 02 – Medication Administration and Safety
TIME ALLOTMENT : 3 Hours
PRESCRIBED FLO : Preferred: e-Learning (E1, E2)
Alternative: Modular (M2)

TOPIC LEARNING OUTCOMES:

After the end of the lesson, the student should be able to:

1. Understand the 10 rights of drug administration and relate it to nursing practice.

2. List requirements of a complete drug order or prescription.
3. Accurately interpret drug orders containing common abbreviations.
4. Differentiate drug dosage forms for various routes and purposes of administration.
5. Identify supplies, techniques, and observations needed for safe and accurate administration by different routes.
6. Discuss the professional responsibility and standards of practice for the professional nurse as related to the medication administration process.

1 Pharmacology 02 – Medication Administration and Safety

 Activities Strategies TA Remarks
1 ATTENTION Open the class with updates on school matters and today’s topic 10 minutes
2 OBJECTIVE Discussion of the learning objectives for the day 5 minutes
3 RECALL Recall safety practices for parenteral medication from concepts in 10 minutes Focusing on rights on medication
fundamentals of nursing. administration, routes and safety measures in
administering medication.
4 STIMULUS Do a 1 hour and 30-minute lecture 90 minutes Focusing on the highlights and the essentials
5 GUIDANCE Conduct exercises as we walk through lectures 30 minutes Question for discussion will be posted in the
chat box
6 PERFORMANCE Conduct a 10-item post-test with discussion afterwards. 10 minutes
7 FEEDBACK Provide feedback to discussion boards in online courses. 10 minutes
8 ASSESSING Conduct a group activity prior to the discussion 10 minutes
9 RETENTION Summarize the main points of the lecture and encourage Q&A before 5 minutes
synthesis

LESSON/TOPIC DISCUSSION

Learning Resources:
1. eBook
o Pharmacology: A Patient-Centered Nursing Process Approach, 9e by Linda E. McCuistion, Saunders (2017), Edition: 9
o Pharmacology and the Nursing Process by Lilley, L., Collins, S. & Snyder, J. (2017). 8th ed. St. Louis, Missouri: Elsevier.
o Mosby's 2020 Nursing Drug Reference, 33rd ed. by Linda Skidmore-Roth, St. Louis, MO : Elsevier (2020), Edition: 33
o Introducing Pharmacology: For Nursing and Healthcare by Roger McFadden, Routledge (2019), Edition: 3
o Pathophysiology and Pharmacology in Nursing (Transforming Nursing Practice Series) by Sarah Ashelford, Learning Matters (2019), Edition:
Second
o Lippincott NCLEX-RN Pharmacology Review by Hill

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 2. Scanned Reference Books
o PHARMACOLOGICAL REVIEWS Vol. 59, No. 4. 2007 by The American Society for Pharmacology and Experimental Therapeutics 70102/3301314
o Pharmacol Rev 59:289 –359, 2007
3. Online Resources
o Philippine Drug Enforcement Agency. Laws and Regulations. https://pdea.gov.ph/laws-and-
regulations#:~:text=WHEREAS%2C%20by%20virtue%20of%20the,chemicals%20as%20provided%20in%20R.A.

LESSON 1 TOPICS:
A. Medication Order
B. Medication Administration
C. Medication Preparation and Storage
D. Medication Safety

ACTIVITY 1: INTRODUCTION

• Open the class with updates on school matters and today’s topic
• Discuss the objectives of today’s lesson

ACTIVITY 2: GROUP ACTIVITY

DIRECTIONS: Divide the class into 6 groups. Each group is given 5 minutes to discuss and answer the following questions:

1. What are safety medication practices and why is it important?

2. What are the ways that you can do to minimize error in administering medications? Give at least 3 examples.

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ACTIVITY 3: MEDICATION ADMINISTRATION AND SAFETY

A. Medication Order

• Medication order – written directions provided by a prescribing practitioner for a specific medication to be administered to a specific individual.
• Elements of a prescription/ medication order:
○ Name of the client
○ Date prescribed
○ Generic or trade name of the drug
○ Dose, route, and frequency of administration
○ Signature of the prescriber.
• Remember! Physician and licensed practitioners are LEGALLY RESPONSIBLE for the prescription.
• Types of medication orders:
o Standing order – order for a medication that will be given at specific times until it is discontinued by a doctor's order.
▪ Ex: Give Coumadin 5mg OD
o STAT orders – administered immediately and only once.
▪ Ex: Heparin 2,000 units TIV STAT.
o Single orders – given only once but not necessarily immediately.
▪ Ex: Cefazolin (Stancef) 1G TIV to be given 1hr prior to surgery.
o PRN order – ordered medication is only given when a specified condition, like pain or nausea, is present.
▪ Ex: Paracetamol (Tylenol) 650mg/tab PO for pain.
• Remember! Check the physician’s orders for the name, dose, and frequency of administration; and determine the time of the most recently administered.
• Higher incidence in medication error happens when doctors uses an abbreviation. In order to minimize these errors, complete writing of the order should
be followed.
• When naming a medication (Nomenclature) These are the things that must be followed:
o The chemical name is a scientific name that precisely describes its atomic and molecular structure. (N-acetyl-para-aminophenol)
o The generic, or nonproprietary, name is an abbreviation of the chemical name. (Paracetamol or acetaminophen)
o The trade name (also known as the brand name or proprietary name) is selected by the drug company selling the product. (Ex. Biogesic, Panadol,
Calpol)

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 • Remember! Trade names are protected by copyright. The symbol ® after the trade name indicates that the name is registered by and restricted to the drug
manufacturer.
• Generic and branded drugs have exactly the same dosage, intended use, effects, side-effects, route of administration, risks, safety, and strength as the
original drug. The only difference they have is patency wherein brand-name products are clinically proven and are frequently tested than generic drugs
which may differ but is acceptable by the FDA
• Generics Act of 1988. AN ACT TO PROMOTE, REQUIRE AND ENSURE THE PRODUCTION OF AN ADEQUATE SUPPLY, DISTRIBUTION, USE AND
ACCEPTANCE OF DRUGS AND MEDICINES IDENTIFIED BY THEIR GENERIC NAMES.
• In order to minimize medication error, writing in complete manner will lessen these events. ALWAYS use leading zeros before a decimal point for amounts
less than one (<1)(e.g., “0.5” mL, NOT “.5” mL) Ex: Isoket .5 mg TIV given as ordered should be written as Isoket 0.5 mg TIV given as ordered.
• Do NOT use trailing zeros after a decimal point, including in the hundredths or thousandths position (e.g., “2.5” mL, not “2.50” mL) Ex: Enoxaparin 40.0mg
SC now should be written as Enoxaparin 40 mg subcutaneously NOW.
• Be aware also with SALAD (Sound Alike Look Alike Drugs)/ (Look Alike Sound Alike) LASA medications because this may contribute to medication error.
• The US Food and Drug Administration (FDA) list of drug names with recommended tall man letters was initiated in 2001 with the agency’s Name
Differentiation Project. TALL MAN LETTERINGS help draw attention to the dissimilarities in look-alike drug names.
• Incomplete and ineligible medication orders are number one factor for medication error. With this kind of questionable order, contact the doctor and verify
the order. If the doctor can’t be reached, document all attempts and the reason for withholding the medication.
• Remember!
o Always consider whether the order makes sense for the patient.
o Clarify any order that seems inappropriate or that duplicates another medication order.
• Verbal/ Telephone orders:
o Verbal orders are strongly discouraged as these orders have higher potential of errors because orders can be misheard or misinterpreted. By
practical application, verbal orders can only be acceptable only in situation where no other option is available (ex. cardiac arrest, surgery).
o Only licensed nurse may accept telephone or verbal orders and should be “Read back” for confirmation before it can be carried out. Telephone or
verbal orders should be date, timed, and authenticated by the physician within 48hours of being given. Orders should be spell-out to avoid SALAD
and express number in the teens, pronounce each digit separately.

B. Medication Administration

• Medication Administration – manner in which a medicine is administered. A drug’s administration route influences the quantity given and the rate at
which the drug is absorbed and distributed. This could be Enteral, Parenteral, Inhalation, Transdermal, Topical.
• Routes of administration include:

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 o Enteral:
▪ Oral – By mouth, is usually the safest, most convenient, and least expensive route; drugs are administered to patients who are conscious and can
swallow.
• Tablets – are sometimes come up with indentions or grooves and may be used to divide dosage.
• Enteric - coated tablets and capsules are coated with a substance that is insoluble in stomach acid.
• Syrups – contains medicinal agents that are dissolved in a solution of sugar (sucrose).
• Suspension – Liquid dosage forms that contains solid, insoluble drug particles dispersed in a liquid base. (MUST BE SHAKEN WELL to assure
thorough mixing of drugs.)
• Effervescent tablets - do not represent a solid dosage form, because they are dissolved in water immediately prior to ingestion.
▪ Remember! Do not crush enteric-coated or sustained release products because this alters their rate of absorption and could be dangerous to the client.
▪ Buccal, sublingual, translingual - certain drugs are given buccally (in the pouch between the cheek and gum), sublingually (under the tongue), or
translingually (on the tongue) to speed their absorption or to prevent their destruction or transformation in the stomach or small intestine.
▪ Gastric –allows direct instillation of medication into the GI system of patients who can’t ingest the drug orally, usually through the use of NGT.
▪ Rectal and vaginal – suppositories, ointments, creams, gels, and tablets may be instilled into the rectum or vagina to treat local irritation or
infection; some drugs applied to the mucosa of the rectum or vagina can be absorbed systemically.
o Parenteral:
▪ Injections require special drug preparations, equipment, and techniques. These drugs must be prepared, packaged, and administered in ways to
maintain sterility. Syringes are equipment to deliver drugs and needles come from variety of sizes or gauges; refers to lumen size, with larger
numbers indicating smaller lumen sizes.
• Ex. a 25-gauge needle is smaller than an 18-gauge needle.
• The lower the gauge number (G18), the stronger the needle.
• The higher the gauge number (G26, Hypodermic needles), the less pain or bruising experienced by patients.
▪ Intradermal – substances are injected into the skin (dermis); this route is used mainly for diagnostic purposes when testing for allergies or
tuberculosis
▪ Subcutaneous (SC) – with the SC route, small amounts of a drug are injected beneath the dermis and into the subcutaneous tissue, usually in the
patient’s upper arm, thigh, or abdomen
▪ Intramuscular – this route allows drugs to be injected directly into various muscle groups at varying tissue depths; it’s used to give aqueous
suspensions and solutions in oil, immunizations, and medications that aren’t available in oral form
▪ Always aspirate before giving medication.
▪ Z track method - A type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue
▪ Intravenous – the I.V. route allows injection of substances (drugs, fluids, blood or blood products, and diagnostic contrast agents) directly into the
bloodstream through a vein; administration can range from a single dose to an ongoing infusion delivered with great precision

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 ▪ Use saline flush before and after giving IV medications.
o Drugs may also be given as specialized infusions injected directly into a specific site in the patient’s body, such as an epidural infusion (into the epidural
space), intrathecal infusion (into the cerebrospinal fluid), intraperitoneal infusion (into the peritoneal cavity), intraosseous infusion (into the rich vascular
network of a long bone), and intraarticular infusion (into a joint).
o Respiratory (inhalation):
▪ Drugs that are available as gases can be administered into the respiratory system; drugs given by inhalation are rapidly absorbed, and
medications given by such devices as the metered-dose inhaler can be self-administered, or drugs can be administered directly into the lungs
through an endotracheal tube in emergency situations.
▪ This route is chosen for drugs intended to affect bronchial smooth muscle or the consistency of bronchial mucus.
o Topical – this route is used to deliver a drug through the skin or a mucous membrane; it’s used for most dermatologic, ophthalmic, otic, and nasal
preparations.
o Ophthalmic drops and ointment: If two or more eye drops are scheduled at the same time, wait 1–5 minutes between instillations.
▪ Blot any excess drug from the inner canthus near the nose to decrease systemic absorption of the drug.
▪ Ointment application starts from inner to outer canthus.
o Otic drops: Solution containing medication which is used for treatment of localized ear infection.
▪ Open the ear canal by pulling the ear up and back for adults, down and back for children, and drop the medication on the side of the canal.

o Nose drops and sprays: Given for temporary relief of nasal congestion and reducing swelling by narrowing blood vessels in the nose.
▪ Have the client hold his or her head back, and drop the medication into the nostrils. Give only as ordered
o Transdermal administration:
▪ A route of administration wherein active ingredients are delivered across the skin for systemic distribution.
▪ Always wear gloves.
▪ If your patient is very young or confused, choose a site on his back so he can't remove the patch.
▪ Rotate sites throughout therapy.

C. Medication Preparation and Storage

• Medication are kept depends on their required temperature to ensure their chemical stability and effectiveness like vaccine should be stored in a
refrigerated environment and usually, medications are kept at 2-8C temperature.
• Reconstitution of drugs is a process of adding a diluent to a dry ingredient to make it a liquid.
• Reconstituted drugs on a vial shall be labeled with the date and time it was mixed and store it properly.
• When reconstituting drugs, use different needles for medication aspiration and administration.

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 • Automated medicine dispensing cabinets
o Nurses must key in security codes, enter requested items, and retrieve medication from specific shelf, thereby assuring accurate dispensing of
required medications Because of its safety features, it improves patient safety and Eliminates turnaround (T.O) time in delivering supplies and
improves operational efficiency.
• 3 checks of medication administration:
1. Before you pour medication from the container
o Check the medication label against the MAR.
2. After you pour medication from the container
o Verify the label against the MAR.
3. At the bedside prior to administration
o Check the medication again.
• Barcoded medication administration (BCMA)
o Allows users to electronically document medications at the bedside or other points-of-care.
o Barcoded system allows the nurse to identify medication before giving it to the patient.
o The system work by patient being admitted and be given ID band with their details and barcoded that is connected to the system.
o When a doctor orders to the patient chart it will be encoded to the system and will be delivered to the pharmacy where they will prepare for it.
o When the medication arrives and ready for administration, the bedside nurse will check it against the MAR with the NUM and prior to
administration, the bedside nurse will scan the barcode on the patient’s ID and verify it against the system.
o Once the system verifies it, the bedside nurse can now give it to the patient and administration message will be sent back to the electronic
medication record (EMR) that the patient already took the medication.
• Remember! BCMA and RFIDMA is NOT a substitute for a nurses’ critical thinking. Protocols should still be strictly observed especially the patient’s rights.
When in bedside, the nurse should not leave the medications not yet taken by the patient to avoid events resulting from patient being overdosed, or missed
doses.
• Unit - Dose System (UDS)
o A system of medication distribution is a pharmacy-coordinated method of dispensing and controlling medications in organized health-care
settings.
o Each patient has a drawer, which is filled daily to meet patient medication needs and medications from these trays are to be given to the patient
withing the day.
• Medication Administration Record (MAR) – Report that serves as a legal record of the drugs administered to a patient at a facility by a health care
professional. It collects all medications that were administered to the patient with the sign of the nurse who administered and the charge nurse who
counter checks the medication.

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D. Medication Safety

• During nurse patient interaction, history taking is crucial for the treatment plan to be effective especially the medications they are currently taking, or
what kind of medications do they take when they have a fever or if they prefer taking herbal medications than the usual prescription of doctors and most
especially which medications they are allergic to.
• When administering medication to a patient, checking it prior with Nurse Unit Manager (NUM) or charge nurse against the doctor’s sheet, Kardex and
medication administration record (MAR) to ensure correctness.
• Medical errors – any errors at any point in patient care that cause or have the potential to cause patient harm.
• Medication errors – may occur during any phase of drug therapy, including prescribing, dispensing, and administration.
• The nurse is legally responsible for safe and accurate administration of medications. This means the nurse may be held liable for not giving a drug or for
giving a wrong drug or a wrong dose.
• Increased length of stay often results from medication errors which in turn increased patient’s hospitalization.
• Medication error(s) results also to compromise nurse’s confidence (self-doubt and embarrassment.) and practice.
• Possible mortality would likely occur if medication error cannot be detected as soon as possible.
• Remember! The nurse is expected to have sufficient drug knowledge to recognize and question erroneous orders. A thinking nurse is the best nurse because
they don’t just do what their doctors said and act as patient’s advocate.
• Adverse Drug Event (ADEs)
o A general term that encompasses all types of clinical problems related to medication use, including medication errors and adverse drug reactions.
o Adverse Drug Reaction (ADRs) –reactions that occurs with the use of the particular drug.
o Two types of ADRs:
▪ Allergic reactions- often predictable
▪ Idiosyncratic reactions - usually unpredictable
• Medication error usually happens to certain types of medication classification such as antibiotics, anticoagulants, antidiabetic drugs (particularly insulin),
antineoplastic (anticancer) drugs, cardiovascular drugs, CNS drugs (opiates, anesthetics etc) and vaccines.
• High alert medications have been identified because of their potentially toxic nature. Hence, requires special care when prescribing, dispensing and/or
administering.
• The Institute for Safe Medication Practices (ISMP) listed high alert medications in which these drugs should be dispense cautiously. This includes
narcotics especially opioids where consciousness and vital signs may become erratic.
• 5 rights of medication administration should be strictly observed to decrease medication error:
o Right patient – Check the name on the order and the patient.
▪ Use at least two (2) patient identifiers.

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 ▪ Ask patient to identify himself/herself.
o Right time – Check the frequency of the ordered medication.
▪ Check that you are giving the ordered dose at the correct time.
▪ Confirm when the last dose was given.
o Right dose – Check the order.
▪ Confirm appropriateness of the dose using a current drug reference.
o Right route – Confirm if the patient can take or receive the medication by the ordered route.
o Right drug – Confirm the rationale for the ordered medication.
• There are things to remember when practicing safe medication administration:
o Follow the “five rights” consistently.
o Interpret the prescriber’s order accurately (ex. drug name, dose, frequency of administration). Question the prescriber if any information is
unclear or if the drug seems inappropriate for the client’s condition.
o Triple check your medications before giving it to the patient.
o Do not leave your medications unattended.
o All medications given shall be charted immediately after administration
o Do not recap syringes after use.
o Dispose syringes to the nearest sharps collector
o Most importantly: HAND WASHING. Before and after each procedure to prevent transmission of microorganisms.

ACTIVITY 4: DISCUSSION / EXERCISE

DIRECTIONS: Divide the class into 6 groups. Each group shall read the case and discuss the following questions after:

Ms. Mabel Zack is transferred to your rehabilitation facility after a cerebral vascular accident (stroke) 2 weeks ago. When you review her chart, it indicates she
has right-sided hemiparesis, memory deficits, and dysphagia (difficulty swallowing).

Questions:
1. Outline appropriate assessments to determine if it is safe to give Ms. Zack oral medications.
2. If a swallowing evaluation indicates that Ms. Zack can take medications orally, what precautions can you take to help ensure her safety?
3. How might you individualize your teaching plan, considering Ms. Zack’s memory deficits?

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ACTIVITY 5: POST TEST

DIRECTIONS: Read each question below and choose the letter that best describe the answer for each. Rationalize the answers after.

1. Pick out the appropriate alimentary route of administration when passage of drugs through liver is minimized:
a. Ora
b. Transdermal
c. Rectal
d. Intraduodenal

2. Which route of drug administration is most likely to lead to the first-pass effect?
a. Sublingual
b. Oral
c. Intravenous
d. Intramuscular

3. In checking the right patient all of these are correct, EXCEPT:

a. Full name
b. Birthdate
c. Medical records number
d. Attending Physician

4. What is characteristic of the oral route?

a. Fast onset of effect
b. Absorption depends on GI tract secretion and motor function
c. A drug reaches the blood passing the liver
d. The sterilization of medicinal forms is obligatory

5. Tick the feature of the sublingual route:

a. Pretty fast absorption
b. A drug is exposed to gastric secretion

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 c. A drug is exposed more prominent liver metabolism
d. A drug can be administrated in a variety of doses

6. Parenteral administration:
a. Cannot be used with unconsciousness patients
b. Generally results in a less accurate dosage than oral administration
c. Usually produces a more rapid response than oral administration
d. Is too slow for emergency use

7. Correct statements listing characteristics of a particular route of drug administration include all of the following, EXCEPT:
a. Intravenous administration provides a rapid response
b. Intramuscular administration requires a sterile technique
c. Inhalation provides slow access to the general circulation
d. Subcutaneous administration may cause local irritation

8. Characteristic unwanted reaction which isn’t related to a dose or to a pharmacodynamic property of a drug is called:
a. Idiosyncrasy
b. Hypersensitivity
c. Tolerance
d. Teratogenic action

9. Idiosyncratic reaction of a drug is:

a. A type of hypersensitivity reaction
b. A type of drug antagonism
c. Unpredictable, inherent, qualitatively abnormal reaction to a drug
d. Quantitatively exaggerated response

10. Three (3) checks of medication administration includes:

a. Checking the medication label against the MAR
b. Verify label against the MAR
c. Checking the medication prior to administration
d. Checking of medication with charge nurse.

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ACTIVITY 6: SYNTHESIS / EXERCISE
• Summarize the lesson, highlighting the salient points.

Prepared by: Reviewed by: Approved by:

Dr. Tristan Jourdan C. Dela Cruz, RN Dr. Mike Daniel Tai, RN Dr. John Michael O. Lorena, RN
Lecturer, Pharmacology Academic Head Dean

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