Chapter 6. Non-Parenteral Medication Administration
Nurses play an essential role in medical reconciliation; preparing, administering, monitoring, evaluating, teaching patients; and documenting responses to medications. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety.
This chapter discusses guidelines to follow for mitigating medication errors and adverse drug events (ADEs). Non-parenteral routes of medication administration are discussed, and the steps for following each of these processes safely is outlined.
- Safe and accurate medication administration is a key nursing responsibility.
- Medication administration is a complex process that requires the full attention of the nurse to avoid medication errors and adverse drug events.
- Nurses can reduce errors by following guidelines, knowing the types of medication errors that are most likely to occur and strategies for their prevention, and understanding the implications of the medication being given.
- There are several routes for medication administration. Knowing when it is appropriate to use each route, and knowing the process for medication administration via that route, will help to mitigate medication errors.
- The seven rights and three checks provide a process for safe drug administration and are a collaborative effort of the nurse, the pharmacist, and the physician.
- Accurate and timely documentation of medication administration and the effect of the medication on the patient is an important responsibility of the nurse and promotes patient safety.
- Patient education is an extremely important factor in medication adherence and proper self-administration and is an important nursing responsibility.
Suggested Online Resources
1. Canadian Patient Safety Institute (CPSI): Medication safety. This resource explains how to reduce adverse drug events by following the medication reconciliation process.
2. Centers for Disease Control and Prevention: Medication safety basics. This website outlines medication safety basics and provides several medication safety fact sheets.
3. Institute for Safe Medication Practices Canada (ISMP). This is the website for an independent national not-for-profit organization committed to the advancement of medication safety in all health care settings.
4. Institute for Safe Medication Practices Canada (ISMP): Medication reconciliation. This website provides a definition of medication reconciliation and resources to complete the medication reconciliation process to ensure safe and effective communication for all health care providers regarding use of all medications.
Agency for Healthcare Research and Quality. (2014). Checklists. Retrieved on June 11, 2015, from http://psnet.ahrq.gov/primer.aspx?primerID=14
Agrawal, A. (2009). Medication errors: Prevention using information technology systems. Br J Clin Pharmacol, 67(6), 681.
British Columbia Institute of Technology (BCIT). (2015). NURS 1020: Clinical techniques. Vancouver: British Columbia Institute of Technology (BCIT).
Butt, A.R. (2010). Medical error in Canada. Issues related to reporting medical error and methods to increase reporting. McMasters Univserity Medical Journal, Clinical Review, 7(1). 15 – 8. Retrieved on June 3, 2015 from http://www.mumj.org/Issues/v7_2010/articles/16.pdf
Canadian Patient Safety Institute. (2012). Canadian incident analysis framework. Retrieved on Nov 14, 2015, from http://www.patientsafetyinstitute.ca/en/toolsResources/IncidentAnalysis/Documents/Canadian%20Incident%20Analysis%20Framework.PDF#search=canadian%20analysis%20incident%20framework
Centers for Disease Control. (2013). Infection control. Retrieved on June 11, 2015, from http://www.cdc.gov/oralhealth/infectioncontrol/faq/protective_equipment.htm
Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses’ workarounds in acute healthcare settings: A scoping review. BMC Health Services Research, 13, 175. doi:10.1186/1472-6963-13-175
Institute for Healthcare Improvement. (2015). High alert medication safety. Retrieved on June 11, 2015, from http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (eds). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
Lilley, L. L., Harrington, S., Snyder, J. S., & Swart, B. (2011). Pharmacology for Canadian health care practice (2nd ed.). Toronto, ON: Elsevier Canada.
Lowry, M. (2016). Rectal drug administration in adults: How, when, why. Nursing Times, 112(8), 12-14. Retrieved from https://www.nursingtimes.net/clinical-archive/neurology/rectal-drug-administration-in-adults-how-when-why/7002595.article
Lynn, P. (2011). Photo atlas of medication administration (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
National Patient Safety Agency. (2009). Safety in doses. Improving the use of medication in NHS. Retrieved on June 11, 2015, from http://www.nrls.npsa.nhs.uk/resources/?entryid45=61625
National Priority Partnership. (2010). Preventing medical errors: A $21 billion opportunity. Retrieved on June 3, 2015, from http://psnet.ahrq.gov/resource.aspx?resourceID=20529
Perry, A., Potter, P., & Ostendorf, W. (2014). Clinical skills and nursing techniques (8th ed.). St Louis, MO: Elsevier-Mosby.
Poon, E. G. et al. (2010). Effect of bar-code technology on the safety of medication administration. N Engl J Med., 362, 1698.
Prakash, V., Koczmara, C., Saveage, P., Trip, K., Stewart, J., Mccurdie, T., Cafazzo, J., & Trbovich, P. (2014). Mitigating errors caused by interruptions during medication verification and administration: Interventions in a simulated ambulatory chemotherapy setting. BMJ Quality and Safety, 0 (1 – 10). doi:10.1136/bmjqs-2013-002484
The Joint Commission (TJC). (2012). National patient safety goals. Oakbrook Terrace, IL: The Commission. Retrieved on June 3, 2015, from http://www.jointcommission.org/standards_information/npsgs.aspx
Vancouver Coastal Health. (2014). Course catalogue registration system. Retrieved from Medication Reconciliation: Top Ten Tips, https://bcpsqc.ca//documents/2012/09/Top-10-Tips-for-Interviewing-Patients.pdf