Chapter 3: Drug Administration 2 Contact Hours By: Katie Ingersoll, RPh, PharmD Author Disclosure: Katie Ingersoll and Elite do not have any actual or Questions regarding statements of credit and other customer service potential conflicts of interest in relation to this lesson. issues should be directed to 1-888-666-9053. This lesson is $12.00. Universal Activity Number (UAN): 0761-9999-17-079-H01-P Educational Review Systems is accredited by the Activity Type: Knowledge-based Accreditation Council of Pharmacy Education (ACPE) Initial Release Date: April 1, 2017 as a provider of continuing pharmaceutical education. Expiration Date: April 1, 2019 This program is approved for 2 hours (0.2 CEUs) of Target Audience: Pharmacists in a community-based setting. continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 To Obtain Credit: A minimum test score of 70 percent is needed weeks to participants who have successfully completed the post-test. to obtain a credit. Please submit your answers either by mail, fax, or Participants must participate in the entire presentation and complete online at Pharmacy.EliteCME.com. the course evaluation to receive continuing pharmacy education credit. Learning objectives After completion of this course, healthcare professionals will be able Discuss the administration of medications in patients using enteral to: and parenteral nutrition. Describe the eight rights of medication administration. Discuss special considerations for administering medications in Explain the administration of enteral and parenteral medications. pediatric and geriatric patients. Introduction Medication errors that occur at the point of drug administration poised to reduce the frequency of medication administration errors. comprise a significant portion of the errors that can occur in the Understanding medication administration and putting best practice medication use process. As healthcare providers with a wealth of standards in place will help reduce medication administration errors knowledge on the use of medications, pharmacists are perfectly and increase patient safety. Preventing medication errors during drug administration: The eight rights of medication administration The eight rights of medication administration are used to help ensure The right time all the necessary information is verified in order to administer a Before administering a medication, the provider must confirm that the medication appropriately. Historically, healthcare professionals were prescription is written for the correct time of day and frequency, and taught the five rights of medication administration: right drug, right that the scheduled administration time matches up with the prescriber’s patient, right dose, right time, and right route. However, an updated order. listing includes three more: right reason, right response, and right The right route documentation. These eight practices are essential to the safe and The route by which the medication will be given must be documented accurate administration of medications. on the prescription, and verified to ensure it is appropriate for the The right drug patient to whom it will be administered. On receipt of a prescription order, it is imperative that the correct The right reason medication is selected for administration to the patient. If the name The reason for administering a particular medication should be of the drug is unfamiliar, the provider administering the medication confirmed to make sure that the prescribed drug is appropriate for the should consult a reliable reference to ensure the correct medication is patient’s condition. Common conditions the drug is used for should used. If necessary, the provider should consult references to identify be crosschecked against the patient’s conditions to make sure the the purpose of administering the drug, its action, routine routes and medication is given for an appropriate reason. doses, interactions with other drugs, herbs, and foods, side effects, and contraindications. When selecting the medication, the provider should The right response check the medication label to ensure accuracy. The patient’s response to the drug must be monitored. Pharmacy staff should communicate with physicians or nurses to ensure they The right patient are aware of the desired response and the desired response should be The patient’s identity must be confirmed by checking two patient communicated to the patient as part of providing patient counseling. identifiers, including name, date of birth, address, or medical record number. Any inconsistencies should be verified before medication The right documentation administration. Documentation and record keeping are essential. Documentation of what was administered to the patient as well as any patient education The right dose that was provided should be maintained(1)(2). The healthcare provider must confirm that the dose is appropriate for the drug, the condition, and the patient. The dose being administered should be crosschecked with the medication’s label to make sure the correct dose will be administered to the patient. Page 36 Pharmacy.EliteCME.com Routes of administration Routes of administration for drugs can be classified into two concentrations, the desired effect must be taken into consideration categories: enteral or parenteral. Medications that are administered when choosing a medication’s route of administration. For example, through the enteral route are absorbed in the digestive tract. This hormone replacement therapy with estrogen can be administered can apply to any part of the digestive tract, from the mouth to the through several routes of administration, but the desired effect and rectum. The common enteral routes of administration are oral, buccal, potential side effects must be carefully considered before choosing a sublingual, and rectal. dosage form. Some women prefer to use oral treatments due to their Drug administration that bypasses the digestive tract is considered a desired systemic effects. Other women, such as women with estrogen- parenteral route of administration. Parenteral routes are used in many related cancers, must avoid systemic dosage forms, so vaginal circumstances, including when the patient’s gastrointestinal tract is not preparations are used to minimize systemic effects. functioning, rapid effects are desired, or the patient is unconscious. The patient’s condition must also be carefully considered when There are many parenteral routes of administration; the most common choosing a route of administration. Pediatric and elderly patients are are intravenous, intramuscular, and subcutaneous. particularly susceptible to medication administration errors due to their Medications are often formulated in several different dosage forms, vulnerable conditions. The use of multiple medications and enteral or to be administered by various routes. Since the various dosage forms parenteral nutritional support must also be taken into consideration can result in differing durations of action, onset times, and drug when medications are administered.(1) Enteral routes of administration: Oral The oral route is the most commonly used route of medication can be compromised when the patient is nauseous or vomiting. The administration, since oral dosage forms are portable and easy to acidic gastric secretions of the stomach also have the potential to administer. Oral medications are economical, because they do not destroy certain drugs, and irritating medications combined with gastric require sterile preparation and are available in inexpensive forms. acid can cause nausea and vomiting in some patients. Orally administered medications are versatile in that they can be Medications given orally are also subject to the first pass effect. When released slowly in the gastrointestinal tract, or all at once.(3) medications are absorbed through the gastrointestinal tract, they are There are several disadvantages of the oral route of drug transported through the portal vein to the liver where drug metabolism administration. The effects attained through the oral route are often occurs. Some medications are metabolized more than others during too slow for emergency situations, and this route cannot be used the first pass effect, potentially causing a significant decrease in drug when patients are unconscious or unable to swallow. Since orally bioavailability.(4) administered medications are absorbed in the stomach and small Administration alert! Medications that experience significant first pass intestine, this route cannot be used in patients without a functioning effects include morphine, lidocaine, diazepam, and propranolol. gastrointestinal tract or those on NPO orders, and oral administration Dissolution rates and gastric emptying There are many factors that affect absorption of medications that have There can be significant variations in gastric emptying speed from been administered orally. The physical state of the drug can have a patient to patient, since there are many external factors that can have significant impact on the dissolution rate, or the process by which a an impact on this time frame. For example, the stomach naturally has a drug particle is dissolved. Medications given orally in solid dosage more rapid gastric emptying time when empty than immediately after a forms must be dissolved by gastrointestinal fluids before the drug meal. Therefore, medications administered on an empty stomach may particles become available for