Oral medications are placed between the teeth and the inner appearance of the client`s cheek. Sublingual drugs are administered under the back of the tongue: in case of medication error, the first reaction of the nurse should be to immediately monitor the patient`s condition and pay attention to the side effects of the drugs. Second, the nurse must inform the nurse manager and the prescribing service provider of the error. The supplier may place additional orders to counteract the effects of the drug or to monitor for possible side effects. In some situations, family members of the patient who are legal guardians or powers of attorney must also be notified. Finally, a written report documenting the incident must be submitted and often referred to as an incident report. Crash reports are designed to detect if error patterns occur due to system-wide processes that can be modified to avoid future errors. Customers in the home environment should also be informed of the proper and safe disposal of unused and expired medicines in order to prevent their use by others and protect the environment. The U.S. Drug Enforcement Administration (DEA) regularly organizes National Prescription Drug Take-Back Days for the disposal of prescription drugs, some local law enforcement agencies may have a local take-back program, and some local health authorities and pharmacies may also take back unwanted drugs. If these resources are not available in the community, the home care client should be asked to hire their local waste department to determine how these drugs should be disposed of.

Another type of rectal medication is an enema. An enema is the administration of a substance in liquid form into the rectum. Many enemas are formulated in disposable plastic containers. Heating the solution to body temperature before administration may be beneficial, as the cold solution can cause spasms. It is also helpful to encourage the patient to empty their bladder before administration to reduce the feeling of discomfort. Place an incontinence pillow under the patient and position it on the left side in the Sims position. Lubricate the container nozzle and expel the air. Slowly insert the lubricated nozzle into the rectum and gently push the contents into the rectum. Ask the patient to keep the enema according to the manufacturer`s recommendations. Be sure to consider the economic needs of an older person with respect to their medications. Medications can be expensive and many seniors live on a strict budget. Nurses often advocate for less expensive alternatives for patients, such as using a generic brand instead of a brand brand or a class of drugs that is less expensive.

Be aware that a senior with financial concerns may try to save money by not taking medication as often as prescribed. Even the older person may “feel good” with their medications and think they don`t need to monitor or take medication because they are “cured.” Affirm that “feeling good” usually means that the medication works as prescribed and should continue to be taken. Finally, empower patients to take control of their health management by providing ongoing education and support. During this stage, the nurse ensures that the route of administration is suitable for the specific drug and also for the patient. [16] Many drugs can potentially be administered through multiple routes, while other drugs can only be safely administered through one route. Nurses must administer medication through the route specified in the prescription. If a nurse discovers an error in the prescription or believes that the path is dangerous for a particular patient, the route should be clarified with the prescription provider prior to administration. For example, a patient may have a PEG tube in place, but the nurse notices that the drug prescription indicates the route of administration as an PO. If the nurse believes that this medication should be administered through the PEG tube and that the route indicated in the prescription is an error, the service provider must be notified and the prescription must be reviewed before administering the drug through a PEG probe. As always, follow the agency`s guidelines for this drug administration procedure.

Position the patient at least 30 degrees and, if possible, in a high Fowler position. If there is gastric aspiration, turn off the suction. See Figure 15.12[34] for an image of a nurse positioning the patient using a PEG tube before administering a drug. Follow the probe to the point of entry into the patient to make sure you are accessing the correct tube. [35],[36] Controlled substances and narcotics are immediately recorded in the narcotics file when they are removed from their secure, double-locked cabinets. This documentation is NOT made after administration of the drug. The results and controlled substances are then documented in the patient`s medication record as soon as they are administered. During the shift change, two nurses conduct a complete count of all narcotics and controlled substances. If a discrepancy occurs, it is immediately reported for further investigation. Liquid medications are available in multi-dose vials or single-dose containers. It may be necessary to shake liquid medications if they are suspensions before watering.

Make sure the label is clearly written and easy to read. When pouring a liquid medicine, it is ideal to put the label in the palm of your hand so that when a liquid medicine flows outside the bottle, it does not blur the writing and makes the label unidentifiable. If you pour liquid medications, read the dose at eye level and measure against the meniscus of the poured liquid. When administering oral medications, always follow the agency`s specific policies and procedures. During these three checks, the nurse must ensure that it is the right medication, the right patient, the right dosage, the right way and the right time. See Figure 15.9[23] for a photo of the nurse identifying the patient prior to administering the drug. The sixth correct and correct documentation should be made immediately after the administration of the drug to the patient in order to avoid an error by another nurse who accidentally administers the dose a second time. These six rights, which were completed three times, significantly reduced medication errors.

Nurses are legally and ethically responsible for the accurate and complete administration, monitoring and documentation of medications. Drugs are distributed to patients in a variety of methods. During hospital care, single-dose packaging is a common method of dispensing medications. See Figure 15.4[18] for an image of the unit dose. A complete order for medications must include the customer`s full name, the date and time of the order, the name of the drug, the dosage ordered and the form of the drug, the route of administration, the time or frequency of administration, and the signature of the prescribing physician or the signature of the authorized independent practitioner. Z-route injections are a special type of intramuscular injection used for the administration of iron, for example, to avoid skin coloration as a result of medications. This pathway is also beneficial for ensuring that the injected drug is fully injected into the muscle and not into the subcutaneous tissue. Drug orders are often transcribed manually into a drug delivery file (MAR) or Medex if the establishment does not use computerized order entry.

When barcode scanning is used in an agency, this scanning is not intended to replace the confirmation of two patient IDs, but to add another layer of security to the drug delivery process. The national patient safety targets set by the Joint Committee stipulate that at least two patient identifiers must be used when administering medicinal products for patients. [11] Decreased awareness: Patients who are not awake, awake and focused on time, place and person are also at high risk. Sometimes a family member or friend who visits that patient/resident/client can help you with both unique identification processes and also serve as a person to ask you questionable medications and ask you questions. Recent literature shows that up to ten rights should be completed as part of a safe drug administration process. These additional rights include the right history and assessment, the right drug interactions, the right to refuse, and the right education and information. Information on each of these rights is described in more detail below. [6], [7] Many older adults suffer from “polypharmacy,” which means that many medications must be followed, and these medications must be taken several times a day.