Nurses are required to administer medications by different routes. This lecture deals with oral medications which are in solid / tablet /caplet/capsule form. It is assumed that your patient can swallow and has a gag reflex which is intact. In some instances there will be specific instructions for you to use thickened fluid so that the patient does not have swallowing difficulties.
A medication is said to be given orally if it is to be given by mouth and the patient is to swallow it. Other routes of administration into the stomach include the n/g tube and PEG route. These routes will be discussed in our next lecture.
Key words to remember are: 5 rights, oral, medication error, professional responsibility, registered nurse, mistake, legal responsibility, nebuliser, medication administration record, advocate.
Figure 1. For optimal effect the right medication must be given at the right time, via the right route, to the right patient, and in the right amount. (The 5 – Rs)
As a Nurse you are required to check the “five R” as they are referred to in the Nursing and Hospital environments. Checking the “five Rs” will result in the safe administration of medication and it is a standard of practice in most countries.
1st . R = Right Patient . Make sure you are giving the medication to the right patients. If you had all the other “Rs” but this one is wrong. If your patient is alert, conscious and orientated to time, person, place and time you can confirm his identity with him/her. If your patient is disorientated then you will need to check on his identity bracelet for his name and date of birth. Be very careful, there are times when there are two patients with the same name. Checking everything is all the more important, in this type of situation. If you as the nurse are doing agency work, and are not sure who is who, you are likely to make a mistake. Studies show that more medication mistakes are made by nurses when they are not in their familiar surroundings.
If you gave a medication to the wrong patient, you will have made a medication error. If you make a medication error, you have a professional responsibility to inform the treatment team and physician as soon as you discover the error so that the patient can be treated for the mistake, if treatment is warranted. This action will safe you and the hospital against liability. Even, if you are found libelous, it may be interpreted as a honest mistake. The consequences for lying, delaying and hiding an error are much more severe and could result in losing your license to practice. However, if you disclose that you made an error, it is not likely that any harm will come your way.
Once an error has been committed it is also appropriate to notify the patient, and if the patient is a minor or involuntary, notify the parents/guardian of the patient. Other people who need to be in the loop are the nurse in charge, and your nursing supervisor. Finally, complete the medication error report or the incident report according to the policy of your institution.
If a medication error is made and you follow the policies and procedures of the institution the consequences will be minimal. However, if a medication error is made, you lie about it and it is found out, you will most likely be in court, be paying with “numerous sleepless nights”, thousands of dollars in legal fees, thousands of dollars in compensation and will become unemployable. So act right even when you have made a mistake.
2nd. R = Right Medication
. If the prescription says Ampicillin 250 mg capsule. Make sure you give ampicillin capsule and not elixir. In nursing a medication error will said to have been committed if you knowingly gave the wrong form of the drug. The word committed has been chosen very deliberately because it implies that you knew that you were giving the wrong from of the medication. Only a qualified treating physician can alter a prescription. Nurses are not physicians. In practice, if you are feel that a prescription is wrong or is not appropriate for a particular patient you must contact the physician and ask him/her to alter and sign the alteration or rewrite the prescription according to the practice in your area.
It is not sufficient to give the medication. If a patient has been prescribed morphine and you know that the patient does not need it then you are required to notify the physician the prescription is not appropriate. You will not get any “kudos” but you will have saved a medication prescription error.
In some institutions you are allowed to substitute a “brand name” of a medication for a generic drug. Do not do this if the policy is not clear. If in doubt, check with the prescribing physician, the nurse in charge or the Nursing Supervisor. By checking you are effectively transferring responsibility and accountability. Nothing is without a price, when you check a medication, you are also communicating that you are “not sure”. Always think of “risk to benefit ratio”, the benefit of an action must always be greater than the risk.
