Administration of medications

FIGURE 4-1. The nursing process as it relates to administration of medication. 

Parenteral Dosage Forms and Invasive Devices. Parenteral and invasive devices provide the distinct advantage of the delivery of medication directly into the bloodstream or at the site of action. Additionally, these methods result in assures patient compliance because, in most cases, an individual other than the patient is responsible for the administration of medication by these means. Unfortunately, this attribute is counteracted by numerous problems that are illustrated in Table 11. 

Prescription errors are unintentional mistakes in the prescription, transcription, dispensing, and administration of medications. The patient either receives the medication incorrectly or fails to receive it altogether. Some prescription errors include wrong patient, incorrect medication, inappropriate dose, wrong time, wrong route of administration, and wrong rate of administration. For example, the profile of a patient shows that he is allergic to codeine, and yet he receives Tylenol 3 by an error. 

Weighing and measuring are two of the most important aspects of dispensing, compounding, and administration of medications. The present chapter deals with the fundamental operation of a prescription balance, an understanding of sensitivity requirement, an introduction to various devices used for measuring volumes of liquids, and their pertinent calculations. A knowledge of the systems of measurement, which is covered in Chapter 2, is essential to understand the material presented in this chapter. 

The calculations involved in critical care include determination of solution strengths, flow rates in terms of drops per minute or hour, and flow rates in volume per unit time. Since the administration of medications requires dose adjustments under a clinical monitoring, it is very important to calculate a titration factor which is the amount of medication in units of weight per drop. Most of these calculations are presented in Chapter 10, but the present section will highlight the calculations which involve the titration factor. The titration factor will help the health care professional to rapidly determine the... 

Quinolene antibiotics ciprofloxacin, levofloxacin, ofloxacin Tetracycline antibiotics doxycycline Penicillin antibiotics amoxicillin, penicillin V, Penicillin G Vaccines are available six doses at 0, 2, and 4 weeks, then 6, 12, and 18 months, followed by annual boosters See Tierno 2002 or other medical references for details on administration of medications and/or vaccines... 

Antihistamines (diphenydramine) and neuroleptics. Vitello et al. (1987) assessed the use of as needed medications used to quell fighting and uncooperativeness among patients in a state hospital and found that antihistamines (54%) and neuroleptics (24%) were most commonly used this form of medication was effective in only 32% of patients. Intramuscular (IM) administration of medications tended to occur when aggression was directed toward staff. 

Clozapine is contraindicated in patients who have myeloprohf-erative disorders or who are immunocompromised as a result of diseases such as active tuberculosis or human immunodeficiency virus infection because of their increased risk for agranulocytosis. Concomitant administration of medications that are associated with bone marrow suppression, such as carbamazepine, is also contraindicated. 

The administration of medical records and vaccine scheduling is simplified. 

Emulsions have been used for centuries for the oral administration of medical oils and vitamins and as dermatological vehicles. Recently, their application has been extended as drug carriers in the delivery and targeting of ophthalmic drags. An indomethacin emulsion has been reported to increase ocular bioavailability and efficacy compared to commercially available formulation in rabbits. 0.4% indomethacin emulsion showed 2.2 fold increase in the area under the anterior aqueous drag concentration/time curve compared to a 1% indomethacin suspension. The emulsion formulation also reduced ocular surface irritation caused by indomethacin Similar advantages have been shown for a pilocarpine emulsion which produced a prolonged therapeutic effect in comparison with pilocarpine hydrochloride eyedrops in man. It can be administered only twice a day, rather than four times daily for conventional formulation. 

Sustained delivery of ophthalmic medications is a novel approach in treating chronic intraocular infections in conditions where systemic administration is accompanied by undesirable side-effects and repeated intravitreal injections carry the risk of infection. The administration of medications by implants or depot devices is a very rapidly developing technology in ocular therapeutics. The various types of implant and mechanisms of drug release have been discussed in general in Chapter 4. 

Demonstrate safe administration of medications, particularly vasoactive and analgesic agents, via oral (PO), subcutaneous (SQ), intramuscular (IM), and intravenous (IV) administration routes. 

Common errors of compliance are overuse, underuse, and administration of medications at inappropriate time interrals. Medications can also be administered improperly, taken though expiration dates have passed, or can be taken for the wrong pmpose. The ultimate error in noncompliance, however, is foiling to have the prescription filled. Approximately 7% (280 million) of the 4 billion prescriptions written each year are never purchased. 

Maxinftzing compliance must be an individualized process. Good commimication skills are essential. Warm, empathetic, sincere prescribers generate confidence and trust. Patients cannot be frightened, coerced, or threatened into compliance. Instead, they should be educated, advised, and encouraged to participate in their therapy. Various types of devices have been developed to enhance compliance with administration of medications. 

This issue has been addressed in court cases over the years. In one case seven Boston State Hospital patients filed suit to stop the (nonemergency) administration of medications without their informed consent. Belatedly, the patients claimed the right to refuse medication. The psychiatrists faced a dilemma. On the one hand, they knew by experience that certain drugs were able to significantly relieve emotional distress. On the other hand, some of these drugs had unpleasant side effects euid patients understandably might want to avoid these. The court decided in favor of the patients. It ruled that patients (whether voluntarily or involuntarily admitted to the hospital) should be presumed competent to accept or refuse psychotherapeutic medications. The court added that when a patient was not deemed competent, the decision whether to use medications needed to be made by a court-appointed guardian. 

Brooks D E 1983 Use of an indwelling nasolacrimal cannula for the administration of medication to the eye. Equine Veterinary Journal Supplement 2 135-137 Brooks D E 1999 Equine ophthalmology. In Gelatt K N (ed) Veterinary ophthalmology, 3rd edn. Lippincott Williams Wilkins, Philadelphia, PA, pp. 1053-1116 Brooks D E, Andrew S E, Dillavou C L et al 1998... 

The mainstay of medical treatment of patients with ethanol toxicity is supportive care. In general, a conservative approach is recommended for ethanol intoxication. Supportive therapy for overdose may include treatment for respiratory depression, hypotension, and altered glucose or thiamine levels. If the ingestion occurred within one hour of presentation, placing a nasogastric tube and evacuating the stomach contents can prove helpful. In patients with chronic ethanol abuse, therapy may include administration of thiamine to prevent neurologic injury. The administration of medications to cause emesis is not recommended because of the rapid onset of CNS depression as well as aspiration risks. 

Ask the patient to demonstrate the proper administration of medication. This assures that the patient has the visual acuity, manual dexterity, and mental capacity to administer the medication. 

Patients operating within this scheme are first assessed for suitability (usually by the ward pharmacist). Although this scheme would not be suitable for many patients, there are a significant number of patients who are perfectly capable of self-administration of medication. This not only enables a patient to be in control of their own medication, but also helps to reduce staff workload. 

There are many pediatric medical, nursing, and pharmacy journals that include articles on pediatric drug therapies (Table 2). Pediatrics, the journal of the American Academy of Pediatrics (AAP), and the Journal of Pediatrics are considered by most pediatric practitioners to be the top in the field. Pediatrics is of particular use to clinicians because it includes the policy statements developed by the AAP. These statements are considered to represent standards of practice by pediatricians. Many of these statements are also of interest to clinical pharmacists, such as the yearly schedule for routine childhood immunizations. Other AAP policy statements of note include recommendations on the administration of medications during breastfeeding, the ethical treatment of children enrolled in clinical research trials,and methods to reduce medication errors in the pediatric inpatient setting. The Journal of Pediatrics has also published useful practice recommendations, such as the guidelines for antithrombotic therapy.The pediatric journal for the American Medical Association, Archives of Pediatrics and Adolescent Medicine, often contains large-scale sur-... 

Changes in elderly patients abilities to taste various substances do not necessarily affect the ease or difficulty of administration of medications, but these changes do have an effect on the patients acceptance of a product. For instance, although it may be easier for patients to swallow liquid medications, they may find the taste or smell of the product so objectionable that they will refuse to take any medication prepared in this manner. Indeed, even some solid dosage forms carry with them objectionable tastes or odors that result in limitation of patient acceptance. Although there have been few studies assessing elderly... 

Although it is common practice in today s standard of care to place indwelling catheters in patients for the administration of medications and parenteral nutrition (TPN), catheter-related infections are a common complication. These foreign bodies (especially triple-lumen... 

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