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Medication Administration

"Administering a medication is a continual process and goes beyond the task of simply giving medication to a client" -College of Nurses of Ontario

Roles and Responsibilities of RNs

Roles of Nursing Students in Medication Administration

Double Checking, Double Signing and Documentation of Medications

Essential Tips for Safe Practice

Roles and Responsibilities of RNs

There are three controlled acts that registered nurses are authorized to perform:

  1. Performing a prescribed procedure below the dermis or a mucous membrane
  2. Administering a substance by injection or inhalation
  3. Inserting an instrument, hand or finger
    • beyond the external ear canal
    • beyond the point in the nasal passages where they normally narrow
    • beyond the larynx
    • beyond the opening of the urethra
    • beyond the labia majora
    • beyond the anal verge
    • into an artificial opening in the body

See: College of Nurses reference document: Legislation and Regulation, RHPA: Scope of Practice, Controlled Acts Model

Roles of Nursing Students in Medication Administration

Nursing students must:

  • have the knowledge (indications, contraindications, dose, interactions, adverse effects, route and knowledge of how to administer drug safely) skill, and judgement to assess the appropriateness of the medication for a particular patient
  • know patient drug allergies

Nursing students need to assess:

  • the developmental stage of the infant/child/adolescent patient
  • any alterations in the infant/child/adolescent's condition or functional status which interferes with the physical capacity to take oral medications
  • the child and family's level of understanding, knowledge of each medication and their readiness to assume self or parent medication administration

Competent medication administration includes:

  • preparing the medication correctly
  • ensuring the 8 Rights:
    • right PATIENT
    • right MEDICATION to be given
    • right REASON
    • right DOSE - what is the patient's weight
    • right ROUTE
    • right FREQUENCY
    • right TIME/ DAY of order
    • right SITE
  • monitoring the patient while administering the medication
  • appropriately intervening as necessary
  • evaluating the outcome of the medication on the patients health status
  • documenting the process

When preparing and administering medications:

A copy of the order (care plan) should be used as a reference to check the correct dose three times.

  • First when one identifies the vial/syringe/bottle/bag/powder/capsule/tablet the medication is in
  • Secondly when one is preparing the medication and
  • Thirdly after one has completed the preparation process

The nursing student must ensure that the right medication is administered to the correct patient by:

  • checking the patient's identification number (on the ID band secured to the patient) and name on the order (e.g. KidCare)
  • verifying patient using two unique identifiers (e.g. patient name & SickKids Medical Record Number)

When preparing and administering medications, the nursing student must:

  • administer it within 30 minutes of the scheduled time
  • document the medication administration in KidCare
  • administer a second dose if a child vomits an intact tablet or capsule. If the tablet/capsule is not intact or visible, or if the dose administered was liquid, the primary RN and the physician should be notified

Independent Double Checking, Double Signing and Documentation of Medications

Who can double check?

  • RN, CNS/NP, physician, pharmacist, pharmacy technician, RRT, MR
  • Not students

What needs to be double checked?

High alert medications (listed below) require a double check, double sign and documentation in the permanent record when administered to the patient.

  • Specific drugs (e.g. Digoxin, Heparin, Insulin, Narcotics)
  • Medications for newborn infants
  • Antineoplastic agents
  • Continuous infusions of sympathomimetic, antiarrhythmic, cardiac, hypotensive and vasodialating medications (e.g. Dopamine, Epinephrine, Propranolol, Milrinone, Hydralazine, Nitroglycerine, etc)
  • Continuous and intermittent infusions of electrolytes (Calcium, Magnesium, Phosphate, Potassium [equal to or greater than 60 mmol/L], Sodium chloride 3%)
  • Parenteral nutrition TPN and TNA
  • Epidurals

Independent double check procedure:

EACH RN should complete the checks and calculations independently, without knowledge of (without seeing) the other person's calculations. The results of their checks must concur. 

If you participate in the medication administration process as a student, you will be the third person performing the checks and calculations. 

What Are We Double Checking?

Infusion pump check:

  • right drug for right patient
  • pump set correctly at start of infusion for ordered rate
  • all subsequent rate changes
  • at change of shift/handover

The double check process:

  1. Check order: patient name, medication, dose, route, date and time of order
  2. Check strength of the medication written on the container label
  3. Prepare medication and check the dose that has been drawn up
  4. Hand over: prepared medication, container & order to 2nd person doing independent double check
  5. Ask the second person to do exactly the same check as you: patient name, medication, dose, route, date and time of order, strength of the medication written on the container label & the dose that has been drawn up
  6. First and second person go to patient and verify identity using two standard identifiers: e.g. patient's full name & medical record number against order and patient's ID band
  7. Verify pump settings
  8. Administer medication
  9. Document in the permanent record

Essential Tips for Safe Practice

  • Know the medication
  • Confirm patient information
  • Double check orders and verify with others if uncertain
  • Avoid abbreviations
  • Use a leading zero before a decimal (e.g. 0.5 ml)
  • Minimize distractions when drawing up medications
  • Communicate with patients and families
References : Burke, 2005; Hughes & Edgerton, 2005; College of Nurses of Ontario Medication Practice Standard, 2004; Rich, 2005.