Lecture 2 NDH

LECTURE 2: DRUG AND MEDICATION
DRUG AND MEDICATION
PREVENTION OF ERRORS
The Nurse's Role-
- The monumental task of ensuring medication safety with all of the potential problems that
could confront the patient can best be managed by consistently using the “rights” of medication
administration.
1. Right Drug.
The first right of drug administration is to check and verify if it’s the right name and form. Beware of
look-alike and sound-alike medication names. Misreading medication names that look similar is a
common mistake. These look-alike medication names may also sound alike and can lead to errors
associated with verbal prescriptions. Check out The Joint Commission’s list of look-alike/sound-alike
drugs.
2. Right Patient.
Ask the name of the client and check his/her ID band before giving the medication. Even if you know
that patient’s name, you still need to ask just to verify.
3. Right Dose.
Check the medication sheet and the doctor’s order before medicating. Be aware of the difference
between an adult and a pediatric dose.
4. Right Route.
Check the order if it’s oral, IV, SQ, IM, etc..
5. Right Time and Frequency.
Check the order for when it would be given and when was the last time it was given.
6. Right Documentation.
Make sure to write the time and any remarks on the chart correctly.
7. Right History and Assessment.
Secure a copy of the client’s history to drug interactions and allergies.
8. Drug approach and Right to Refuse.
Give the client enough autonomy to refuse the medication after thoroughly explaining the effects.
9. Right Drug-Drug Interaction and Evaluation.
Review any medications previously given or the diet of the patient that can yield a bad interaction to the
drug to be given. Check also the expiry date of the medication being given.
10. Right Education and Information.

Provide enough knowledge to the patient of what drug he/she would be taking and what are the
expected therapeutic and side effects.
The Patient's Role
- Encourage patients to be their own advocates and to speak up and ask questions.
- Only the patient really knows what is being taken and when, and can report the actual as
opposed to the prescribed drug regimen being followed.
TEACHING POINTS
 When in doubt, do not hesitate to ask questions.
 Never use adult medications to treat a child.
 Measure liquid medications using appropriate measuring devices.
 Call your health care provider immediately if your child seems to get worse or seems to be
having trouble with a drug.
 When in doubt, do not hesitate to ask questions.
 Never use adult medications to treat a child.
 Measure liquid medications using appropriate measuring devices.
 Call your health care provider immediately if your child seems to get worse or seems to be
having trouble with a drug.
PRESCRIPTIONS AND MEDICATION ORDERS
- The primary means in which a physician communicate with other health care team members
regarding the desired treatment regimen for a patient.
- It can be handwritten, typed, preprinted, verbal or entered in a computer system.
- Prescriptions are used in the OPD or ambulatory setting whereas medication orders and used in
inpatient setting.
- A legal order that can be used for medications, devices, laboratory test, special procedures and
the like.
COMPONENTS
The following information must be present:
- Name, address, age, birthdate, date of issue
- Drug, dosage and form
- Frequency, route of administration
- Duration, quantity
- Height and weight (for pediatric client)
- Physician's DEA number (for controlled drugs)

RULES ON WRITING AN ORDER
- Do not use trailing zeros for doses expressed as whole numbers.
- Use a decimal point when the dose is less than a whole unit.
- Use commas for dosing units at or above 1,000 or use words such as 1 thousand to improve
readability.
- Place adequate space between entries.
TYPES OF MEDICATION ORDER
1.) PRN Order
- medications are given on "as needed" or “when necessary” basis for specific signs and
symptoms within a designated number of hours
- It can be prescription medications or over-the-counter medications.
- Cannot have multiple medications with same reason such as both Tylenol and morphine
“PRN for pain”.
Example:
- Tylenol 650 mg PO every four hours PRN for pain or fever.
- Mary complains of headache. You have check the therapeutic or medication sheet and
found that she have not received any Tylenol within the past 4 hours.
- According to the order, the medication is for “pain” and “fever”.
- This means that you can give Mary Tylenol for her headache.
2.) SINGLE/ ONE TIME ORDER
- medications to be given only once and are ordered to be given at a specific time and
then discontinued.
Example:
- Pen-vee K 1000 mg PO 1 hour pre-op dental surgey
- Seconal 100 mg HS before surgery
3.) STAT ORDER
- medications need to be given immediately or NOW.
Example:
- Demerol 100 mg IM now
- Tramadol 50 mg/ml IV now

4.) ROUTINE/ STANDING ORDER
- Detailed order for a medication given on a routine or regularly scheduled basis.
Example:
- Ciprofloxacin 500 mg 1 tab PO BID x 7 days
- Vancomycin 1500 mg IV q 12 hrs for 3 days
IMPORTANT NOTE!
- Do not accept medication orders that state “continue previous medications” or “same
medications” because they are not complete medication orders.
5.) ANCILLARY ORDER
- It refers to information other than medication that allow the nurse to do certain things
to a patient.
Example:
- Catheterize with a 16 French, 5 ml, indwelling catheter. If residual is greater than 75 ml,
leave the catheter in place and notify the physician; if less than 75 ml, remove and notify
the physician.
6.) HIDDEN ORDER
- Drugs that have been administered outside of the facility (Emergency Room visit, Dental
visits, Specialist appointments).
- Drugs that may be administered during a procedure in the facility but not documented
in the patient’s chart (example: Lidocaine w Epi).
- Drugs that may be part of a bundled procedure such as a Prep kit for a colonoscopy.
- Drugs that may be used as part of a protocol but not individually documented on the
chart.

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LECTURE 2: DRUG AND MEDICATION

DRUG AND MEDICATION

The Nurse's Role-

Check the order if it’s oral, IV, SQ, IM, etc..

5. Right Time and Frequency.

7. Right History and Assessment.

Secure a copy of the client’s history to drug interactions and allergies.

8. Drug approach and Right to Refuse.

9. Right Drug-Drug Interaction and Evaluation.

10. Right Education and Information.

The Patient's Role

 When in doubt, do not hesitate to ask questions.

 Never use adult medications to treat a child.

 Measure liquid medications using appropriate measuring devices.

 When in doubt, do not hesitate to ask questions.

 Never use adult medications to treat a child.

 Measure liquid medications using appropriate measuring devices.

PRESCRIPTIONS AND MEDICATION ORDERS

- It can be handwritten, typed, preprinted, verbal or entered in a computer system.

The following information must be present:

- Name, address, age, birthdate, date of issue

- Drug, dosage and form

- Frequency, route of administration

- Height and weight (for pediatric client)

- Physician's DEA number (for controlled drugs)

- Do not use trailing zeros for doses expressed as whole numbers.

- Place adequate space between entries.

TYPES OF MEDICATION ORDER

1.) PRN Order

- It can be prescription medications or over-the-counter medications.

- Tylenol 650 mg PO every four hours PRN for pain or fever.

- According to the order, the medication is for “pain” and “fever”.

2.) SINGLE/ ONE TIME ORDER

- Pen-vee K 1000 mg PO 1 hour pre-op dental surgey

- Seconal 100 mg HS before surgery

3.) STAT ORDER

- medications need to be given immediately or NOW.

- Demerol 100 mg IM now

- Tramadol 50 mg/ml IV now

- Detailed order for a medication given on a routine or regularly scheduled basis.

- Ciprofloxacin 500 mg 1 tab PO BID x 7 days

- Vancomycin 1500 mg IV q 12 hrs for 3 days

5.) ANCILLARY ORDER

6.) HIDDEN ORDER

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