SESSION 3

CONCEPT OF DRUG
ADMINISTRATION IN
CARING FOR PATIENTS

MR. ERICK SOSTENES

 Objectives
By the end of this session students are expected to be able to:
• Define drug administration
• Explain purposes of drug administration
• Describe principles of drug administration
• Mention routes of drug administration
• Recognize commonly abbreviations used in drug administration
• Describe measurements used in drug administration
• Recognize procedures for safe and storage of drugs
• Identify procedures of ordering drugs from pharmacy
• Describe important information of a prescription of a drug
DEFINITION OF DRUG
ADMINISTRATION

Drug administration: Is the introduction of therapeutic

agents into patients/clients body to modify the
physiological aspects and in the process of assisting
desired outcomes.
PURPOSES OF ADMINISTRATION OF
DRUGS

Drugs may be ordered for several purposes, such as for:

Symptomatic relief
Curative purposes
Diagnostic purposes
Prophylaxis purposes
Research purposes
 PRINCIPLES OF DRUG ADMINISTRATION
To ensure safe administration of drugs, medical care provider has to adhere
to the following principles:
 Read and understand the doctor’s order before preparing the drugs.
 If the medicine order is not clear or not signed consult the nurse in charge
or doctor.
 Wash hands before preparing or giving drugs.
 Ensure that all equipment's used are clean.
 When you have opened the medicine cupboard make sure that you don’t
go away leaving the cupboard open.
PRINCIPLES OF DRUG ADMINISTRATION…
 Lock it before you leave the place.
 Do not administer drugs that have changed from the usual colour, smell
or consistency.
 Never give drugs from unlabeled bottles or containers.
 Send all bottles with soiled labels to the pharmacy for re-labeling.
 To ensure safety, read the label of the drug three times while preparing,
i.e. when taking from the cupboard, before measuring the ordered dose
and before giving it to the patient for verification that you give the right
drug to the patient/client.
 Use all precautions to identify the patient.
 Ask him to tell you his/her name.
 PRINCIPLES OF DRUG ADMINISTRATION…
 If he/she is too ill ask his relative to tell you his/her name.
 Then check his room and bed number and check his case file to verify
that you are giving the drug to the right patient/client.
 Observe the ‘eight Rights’ to ensure that the right medication is given to the
right patient at right time in the right dose and by the right route with right
prescription.
 Be conversant with the indication of the drug, the minimum and maximum
dose, and the possible side effects of the drug.
 Record every drug that has been given.
PRINCIPLES OF DRUG ADMINISTRATION…

 Follow the policy of the hospital for recording drugs.

 If the patient has refused to take the drug, notify the nurse in-charge
and write in the patient’s file about the reason of his refusal.
 The nurse in-charge may convince the patient to take the drug.
 If a patient has vomited the drugs report it at once to the nurse in-
charge who is going to take corrective measure.
 If by bad luck you have given a wrong drug to a patient do not be
afraid to report it at once so that corrective measures may be taken
before it is too late.
EIGHT RIGHTS’ OF PROPER DRUG ADMINISTRATION
The ‘eight Rights’ of proper drug administration should be employed each time you
prepare and administer a medication to a patient.
These rights have been developed as a checklist of activities to ensure the safe delivery
of a medication of a patient.
Right Drug: Know the drugs that you administer: To be sure that the correct drug
has been selected, compare the medication order with the label on the medication.
• A frequent check of the medication label is a good way to avoid a medication error:
one should make a practice of reading the label on each of the following three
occasions.
 When the medication is taken from the storage area.
 Just before removing it from its container
 Upon returning the medication container to storage or prior to discarding the
Right Dose: Know mathematics and dosage calculations.
• It is essential that the patient receive the right dose.
• If the dose ordered and the doses on hand are not the same, carefully
determine the correct dose through mathematical calculation.
• When calculation dosage, it is advisable to have another qualified person
verify the accuracy of your calculations before the medications is
administered.
Right Route: Know the routes used for drug administration.
• Check the medication order to be sure that you have the right route of
administration.
Right Time: Know the time the medicine is to be given.
• Check the medication order to ensure that a drug is administered according
to the time interval prescribed.
• For a drug to be maintained at the proper blood level, care must be taken to
Right patient: Know your patient: Before administering any medication,
always be sure that you have the right patient.
• A good safety practice is to correctly identify the patient on each occasion
when you administer medication.
• In a physician’s office, call the patient by name or ask the patient by name
or ask the patient to state his or her name.
Right Documentation: A patient’s chart is a legal document.
Right resoan: Confirm the rationale for the ordered medication. What is the
patients history?, Why is he / she taking this medication?. Revisit the reason
for long term medication use.
Right response: Make sure that the drug led to the disired effect. If an
antihypertensive was given, has / her blood pressure improved?, Does the
patient verbalize improvement in depression while on atidepresssant?. Be
sure to ducoment your monitoring of the patient and any other
nursingintervetions that are applicable.
IT IS ESSENTIAL THAT HAS THE FOLLOWING DATA ABOUT
DRUG ADMINISTRATION BE ENTERED CORRECTLY.
 The patient’s name.
 The date and time of administration.
 The name of the medication and the amount (dosage) administered.
 The route by which the medication was administered.
 The injection site used.
 Any adverse reactions experienced by the patient.
 Any complication in administering the drug (patient refusing to take the
medication, difficulty in swallowing, and so forth).
 If the medication was not given state why? and
 Disposal of the medication according to agency policy.
ROUTES OF DRUG ADMINISTRATION
There are various routes of drug administration depending on nature of
drug preparation and mode of action, These include:
 Oral route
 Parenteral route
 Topically route
 Inhalation route
 Rectal/Vaginal route
COMMON ABBREVIATIONS USED IN PRESCRIBING DRUGS

• Prescriptions often contain abbreviated words, many of them originated

from Latin.
• For the sake of safety in medicine administration, health care provider
must understand the meaning of these abbreviations;
ABBREVIATIONS USED IN PRESCRIBING DRUGS

• SEE THE TABLE

MEASUREMENTS USED IN DRUG ADMINISTRATION
Drugs are measured by metric measurements.
• The unit of measure for volume is the litre (L).
• One litre contains 1000 millilitres (ml)
• Half litre contains 500 milliliters
• Quarter litre contains 250 milliliters
• Liquid medicines are measured in milliliters.
• The unit measure for weight is the gramme (g)
• 1000 milligrammes (mg ) = 1 gramme
• 1000 grammes = 1 kilogramme.
• 1,000,000 International Unit (I.U) = 1 mega unit
• Mega Units (m.u)
• Drops; like in eye and ear drops and immunization like polio vaccine
PROCEDURES FOR SAFE AND PROPER
STORAGE OF DRUGS
 When storing drugs it is important to ensure that they are protected
from heat, light and moisture which may hasten their deterioration.
 The medicines which are ordered from stores are stored in the
cupboards in the wards.
 These cupboards should preferably be placed in the Nurses/doctor
office room for the safety reasons.
CUPBOARDS
It is recommended that each ward should have:

A cupboard for reagents

 This is used for keeping chemical substances needed for testing
 A cupboard for drugs used internally
 This cupboard is used for storing drugs which are taken internally.
 These drugs are stored in different apartments as follows: Oral drugs in
their own cupboard and separated with tablets and liquids.
 Another cupboard for injectable drugs, which are also divided into vials
and ampoules in different sections from I.V drips.
 A cupboard for drugs for external use: This cupboard is used for
storing drugs which are used externally.
• These may include drugs such as Liniment, calamine lotion, eye
and ear drops for human use.
 A cupboard for antiseptics and detergents for cleansing
purposes: such as Dettol, methylated sprit, Lysol, savlon and others
 A refrigerator: This used for storing drugs which require cool
storage, such as vaccine, insulin.
 A cupboard for drugs which are under Dangerous Drug Act
(DDA)
 Drugs such as pethidine and morphine have to be stored under a
lock and key cupboard and the keys are kept by the in-charge of the
ward or health facility.
Arrangement of drugs in a cupboard
For easy identification drugs can be arranged according to:
o Their classification, e.g. All antibiotics are arranged in
one shelf and next shelf could be for analgesics or
antihistamine.
o Their preparation e.g. Mixtures are arranged together
and suppositories are separated from ampoules.
o Alphabetical order, e.g. All drugs beginning with letter ’
A’ are arranged on one shelf and those beginning with
letter ‘B’ on the next shelf and so on in that logical order.
SAFE STORAGE OF MEDICATIONS
• All medications not being administered should be kept in a safe
storage place.
• This place may vary from office, but there are certain guides and
precautions that should be followed.
• Ideally, there should be one room designated as the Medication
Room. This room should be:
 Well-lighted, away from the flow of patient traffic.
 Contain a sink and a refrigerator
 Have enough cabinet spaces so that internal drugs, external drugs,
and poisonous substances can be kept separate.
 There should be a drawer or metal box for controlled sub-stances.
 This drawer or metal box has to be equipped with a double lock.
There are several ways that drugs may be categorized for safe
storage:
• Drugs for internal use, external use, eye use, and poisonous
substances must be stored separately.
Drugs may be stored according to:
• Preparation: Solid, semisolid, and liquid
• Route: Oral, parenteral, application to skin, sublingual, buccal,
rectal, vaginal, inhalation, and instillation.
• Therapeutic action: Classifications (analgesics, antiemetic)
• Alphabetical order: generic name; trade or brand name
• Principal actions: stimulants, depressants
• Actions of drugs: according to body systems; cardiovascular
• Certain medications must be stored in dark (opaque) containers
• Certain medications must be refrigerated
• Certain medications must be stored in glass containers
• All controlled substances must be stored in a substantially constructed metal
box or compartment that is equipped with a double lock. The narcotic key
must be kept safe from possible misuse.
• All poisonous substances (cleaning materials, etc) should be labeled in red.
• Pharmaceutical drug samples should be properly stored according to the
policy of your office.
 In most offices, these are kept separate from the other medications.
Controlled substances samples must be locked up and dispensed only by
the physician.
• All medications, supplies, and equipment must be checked on a regular basis
to guarantee their freshness.
ESSENTIAL MEDICATION GUIDELINES
Regardless of a medication’s form or the route by which it is
administered, certain basic guidelines must be followed.
These guidelines are:
 Practice medical asepsis.
 Wash your hands before and after administering a medication.
 Work in a well-lighted area that is free from distractions.
 Follow the “8 Rights” of proper drug administration
 Always check for allergies before administering any medication
 Give only drugs that are ordered by a licensed or practitioner
authorized to prescribe medications.
 Never give a medication if there is any question about the order.
 Be completely familiar with the drug that you are administering before
giving it to your patient.
 Always check the expiration date on the medication label.
 Never give a drug if its normal appearance has been altered in any way
(color, structure, consistency, or odor).
 Give only those medications that you have actually prepared for
administration.
 Do not allow someone else to give a medication that you have
prepared.
 Once you have prepared a medication for administration, do not leave it
unattended.
 Be carefully in transporting the medication to the patient.
 When administering oral medications, stay with the patient until you are
certain that the medication has been taken.
 Shake (to mix) all liquid medications that contain a precipitate before
pouring.
 When pouring a liquid medication, hold the measuring device at eye level
with the label toward the pal and read the correct amount at the lowest level
of the meniscus.
 Do not contaminate the cap of a bottle while pouring a medication. Place the
cap with the rim pointed upward to prevent contamination of the portion
that comes into contact with the medication.
 Keep all drugs not being administered in a safe storage place.
 Carefully follow the procedural steps for the type of medication that you are
giving or the type of procedure you are performing.
PROCEDURE OF ORDERING DRUGS FROM PHARMACY
• It is important to know the procedures of ordering drugs from the pharmacy.
• The nurse In-charge of the ward is responsible for ensuring that the ward has got adequate
stock of drugs at all times.
• Each hospital has its own policy for ordering drugs; it is important for health care provider
to make sure he/she know the policy of the hospital.
• Many hospitals prefer ordering routine drugs and other supplies on a particular day of the
week.
• Before writing the requisition, the nurse In-charge should check which drugs need to be
ordered.
• The In-charge has to check the patients’ files for any new drugs which have been prescribed.
• The order should be written as follows:
o The date, name of the drug, the form in which drug is presented e.g. ampoules or tablets,
strength and amount of the drug.
• The order is then sent to the pharmacy, at the arranged time with the authorized personnel
and brought to back to the ward.
• The nurse In-charge checks and verifies the order against the drugs brought and document.
• The drugs are arranged in the cupboard as required.
IMPORTANT INFORMATION IN THE DRUG PRESCRIPTION FORM

• Before administration of any drug to the patient a nurse must have a

doctor’s order which is known as a ‘prescription’.
• However, in emergencies the doctors may give medication order verbally
or by telephone and later confirm the order by signature.
PARTS OF PRESCRIPTION
A prescription has the following parts:
o The name of the patient
o The date and time of writing the order
o The name of the drug
o The dosage and concentration of the drug
o The time and /or frequency of administration
o The route of administration
o Signature of the prescriber
• Many hospitals have specially made prescription forms for out-
patients and the medication orders for in-patients are written in
each patient’s treatment sheet of the patients’ case file.
EVALUATION
• What are Rights of Drug Administration?
• List common abbreviations and their meaning in drug administration.
• How will you arrange drugs in the cupboard in the ward/health
facility/pharmacy/store?
 References
• Alexander, M.F. (2002). Nursing practice, Hospital and Home, (3rd ed.).
London: Architect Inc.
• MOHSW (2008). Basic Nursing Procedure. A manual for Nursing
Practicing in Tanzania. Nursing services Unit (3rd ed.). Dar es Salaam,
Tanzania: Ministry of Health and Social welfare.
• Rice, J. (2006). Principle of Pharmacology for Medical Assisting,
DELMAR CENGAGE Learning.. (4th ed.) . USA, UK and Brazil.