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Chapter 1
DRUG ADMINISTRATION: GENERAL PRINCIPLES
LEARNING OUTCOMES
By the end of this chapter you will have an understanding of the general principles of drug administration.
PROFESSIONALISM
You may well worry about making mistakes. Everyone is human after all and prone to error. The key is to minimise where the faults can occur. As health carers we always put the patient first and apply our professionalism. As with any clinical skill we need to highlight the importance of vigilance, knowledge and professionalism when administering drugs, as many drug errors occur when staff fail to follow correct procedures or do not recognise the limitations of their own knowledge and skill.
So, why do drug errors occur? Well, research tells us that mistakes happen due to:
1 drugs that look or sound alike,
2 high staff workload,
3 low staffing levels,
4 inexperienced staff.
Professionalism in nursing Nurses are expected to display competent and skilful behaviour.
TIME-AND-MOTION STUDIES
Question 1.1 How much time do you think nurses spend during a shift dispensing and administering drugs? The UK Department of Health informed us in 2007ā2008 that āEach hospital in England and Wales administers about 7,000 medicine doses each day, and this activity can take up a substantial amount of nursesā time.ā (Safety in Doses: Improving the Use of Medicines in the NHS, 2007ā2008, Department of Health)
The Department of Health report A Spoonful of Sugar (2001) estimated that 40% of nursing time is spent administering medicines.
However, there are more up-to-date studies and research suggesting that the nurseās time is broken down into these categories:
- documentation, 35.3%;
- medication administration, 17.2%;
- care co-ordination (handovers, etc.), 20.6%;
- patient care activities, 19.3%;
- patient assessment (observations), 7.2%.
Whichever time-and-motion study you wish to go by, it is obvious that a large proportion of the nurseās time is spent on drug administration.
LATIN ABBREVIATIONS
We have all seen the medic on the TV hospital soap opera shouting āadrenaline stat!ā in the emergency room but what does āstatā actually mean? Well, it means we need to be conversant with Latin abbreviations, thatās what it means.
Have a go at seeing how many of the Latin abbreviations you know in Activity 1.1.
Here is a list of Latin abbreviations used when prescribing. What do they mean?
| STAT | OM | QDS |
| AC | ON | QQH |
| BD | PC | TDS |
| OD | PRN | TID |
We tend to use specific accepted abbreviations in health care to do with medicines, such as mg, PRN, IV, etc., but not mcg as we write micrograms in full so as not to get confused with mg. Healthcare workers are told not to use abbreviations in their written care plans, medical records, etc., as mistakes can happen. Terms may have two meanings: for instance, DOA can be taken to mean dead on arrival or date of admission. DRUG WASTAGE
Another area of investigation by the Audit Office concerns wastage of drugs: the Audit Office found that Primary Care Trusts could save almost Ā£7 million each year if general practitioners (GPs) prescribed more efficiently. Wastage costs the National Health Service (NHS) approximately Ā£200 million. Iām sure we have all met the elderly neighbour with bottles of pills dating back 10 years or more collecting dust in their bathroom cabinets. As health carers we all need to deliver better patient education, explaining why that course of antibiotics that the GP prescribed needs to be completed, even if the patient is feeling better.
Hereās a question: what do you think about schemes to recycle drugs back to the pharmacist to be redistributed to other patients? What if the bottles have been opened and the drugs spilled over a dirty floor and put back in the bottle (perhaps even licked by the dog!). Would you like to take them? Only use sealed bottles and unopened blister packs, I hear you say, but what if these had been stored on top of a heater for the last 6 months and become unstable?
PROFESSIONAL JUDGEMENT
When administering medication, we need to be aware of the following.
- It is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner.
- It requires thought and the exercise of professional judgement (Dougherty and Lister, 2011).
What does this actually mean? Letās look at an example.
Question 1.2 If a patient has senna and lactulose prescribed and informs you that they have opened their bowels four times that day, do you administer their prescribed laxatives? Also remember, it is very easy to get distracted, and lose concentration in the clinical area, so always concentrate on the job in hand.
MEDICATION PROCESS
The medication process is made up of four parts.
- Prescribing: it is often the nurse who notices that a doctor has prescribed something to which the patient is allergic, perhaps because the nurse knows the patient better.
- Dispensing and preparation: a nurse should not use trade names for drugs as confusion may occur, for example Voltarol instead of diclofenac sodium. Perhaps the pharmacist has reconstituted the medication with the wrong transport medium, for example sodium chloride instead of water for injection.
- Administration: you need to be very clear which route a medication should be given through and that the dose has been calculated correctly.
- Monitoring: you need to check the administrat...
