Medication Administration: Pre-procedure (Nursing)

00:04 So, now let's talk about actually administering those medications.

00:07 So, the first thing when I go to give meds is first what I have to do, verify the order.

00:12 So, sometimes this can be on the computer, or sometimes it could even be written.

00:18 So, I need to make sure as a nurse that I can even understand that order, does it even make sense to me, before I go do my medications.

00:25 Then the first thing I'm gonna do is gather those, and most of the time, for me, this is gonna be in the medication administration room.

00:32 So, this is what we call our first check, when you hear your instructor do, three checks before you give meds, so you're gonna hear this time and time again in your school.

00:43 So, first of all, when I say, "Hey, students, make sure you perform your first check." As a nurse, when I'm in the clinical setting, my first check is getting those medications out of the med dispensing system.

00:55 So, there's different variations of this med dispense system but the thing looks really cool, to be honest with you.

01:02 Typically, on the unit which you're gonna have is a large machine, and you're gonna be able to sign as the nurse, or even the student, depending on your policy and your school's policy.

01:12 You're gonna be able to sign in, refer to the patient's actual medications order, just for that patient, and then, pull the meds prescribed.

01:21 So, the nice thing on these systems, there's a screen on there, so you can visually see those orders when you pull from that system.

01:28 Kina think of about it like you push a button and the drawer pops out and gives you your meds, kinda like a little surprise.

01:35 Alright, so the med dispense system, be familiar with this.

01:38 Again, this is gonna vary from each clinical site that you go to or each clinical facility.

01:44 So, now that we've gathered our medications from the dispensing system, so that's our first check. Every time I pull out from the system, I'm gonna pull out, is that actual pill that I pulled the same that's on the screen under that order? So, that's check number one.

02:00 Then, once I've gathered those medications for my patient, I'm gonna prepare those medications and make sure those are the appropriate dose, I'm giving it in the right route.

02:10 So, making sure that I'm giving it exactly in the right route and the right indication.

02:16 I'm gonna start thinking through these rights as I'm gathering and preparing my supplies.

02:21 So, that is gonna be our second check when we prepare the medicine.

02:25 Here's a great example, if I have a patient that has PO meds, that I get from the medication system, the dispensing system, maybe I have to give them insulin, too.

02:36 So, when I pull up my injection, I've gotta make sure that the amount of insulin I pull up is the appropriate dose and medication for the patient when I go to their room.

02:48 So, let's recap that again.

02:50 So, you're going to check your medication order, two.

02:54 The med dispense system, one, and then, number two is when you prepare your meds.

02:58 There will be a third one later, too.

03:00 Alright. So, now that we've done all that, we're gonna take everything and go to our patient's room.

03:06 So, of course, when you enter that patient's room, don't forget your hand hygiene.

03:10 Then, we're gonna provide privacy, so depending on the place, it could be shutting the door or maybe pulling the curtain.

03:17 So next, after we've provided that privacy, when I walk into my patient's room, I always want to greet them with a, "Hello. How are you doing? This is your Nurse Samantha." So, here's a really funny thought, every time we come in, unless we introduce ourself, a lot of the times the patients are like, "Who is this?" There's so many people that come in and out of your room.

03:39 Please make sure when you explain a procedure to a patient, you are introducing yourself and why you are there, so really important.

03:47 We tend to overlook this and take advantage of this sometimes, but really important for your patient to go, "Oh, okay, this is my nurse or nursing student coming to give my meds for me." Then once we've explained that procedure to the patient, typically, depending on your clinical facility or even the lab, maybe, you're practicing in, you typically have a bedside computer, for example, or it could even be a paper chart.

04:13 Some of you may say, "Okay, what is a paper chart?" Well, believe it or not, some of those may still be around.

04:19 So, just be familiar with your agency's policy or their equipment that they have.

04:24 So, once I've gathered those meds from the room, I've came in, I've said hello to my patient, let them know what I'm doing, we typically need to make sure, or excuse me, not typically, always need to make sure it's the right person.

04:38 So, in the healthcare system, there could be lots of John Smiths, there could be lots of John Doe's, for example.

04:46 So, we always are going to use, what we call, two patient identifiers.

04:51 You're gonna hear this a lot from your nursing faculty.

04:55 Okay, I know that was a lot of information, but right now, just let's recap, we're in the patient's room, I've said, hello, introduced myself, I'm coming to give your meds.

05:06 Now, don't forget, two patient identifiers, so make sure you ask your patient, "Sir, can you give me your name, state your name and date of birth for me." Great.

05:17 So, date of birth is a kicker, let's talk about that for a minute.

05:21 So, when we ask a patient's name, again, like I talked about previously, there could be lots of John Smiths.

05:28 I wanna make sure that I'm in the right John Smith's room, for example.

05:32 So, that's why we always do name and date of birth as our two patient identifiers.

05:38 Okay, so now, that we've actually figured out indeed this is the right patient as one of those medication rights.

05:45 Then, we're gonna sign in our computer or refer to our electronic health record, or excuse me, our paper record, depends on your facility.

05:55 We're going to compare the meds that we have to that medication administration record.

06:01 We call that an M-A-R or a MAR, you may hear that from the nurses.

06:05 So, any time at the bed side, we're gonna take our medication, this is our third check, guys, we're gonna take the medication and then look at the either screen in the room for the bedside computer or the paper sheet that has the medication information on it.

06:21 So, it's important here to compare this and make sure it's the right pill and it's the right route, and it's the right drug here.

06:28 So, now, let's talk about allergies. Really important to check the allergies.

06:32 Let me give you a specific example of that.

06:35 So as a working nurse, I got to serve on a committee that reviewed cases like this.

06:41 So, here's an example of a case where allergies are really important.

06:45 Patient comes in the hospital, they did a simple back surgery.

06:48 So, any time you have a back surgery, it's really common that you're gonna get a pain medication for that because it's pretty painful, to be honest with you.

06:57 So, the patient came in, the doctor saw the patient of course, ordered pain medication which happened to be Lortab.

07:04 Well, the patient was allergic to Lortab. So, the doctor orders the Lortab.

07:10 Pharmacy, typically, their job is to look at the physician's orders, typically, cross-check them against the allergies, make sure there's no drugs that the patient has to interact and then they load that particular medication onto the system, that we can see as nurses.

07:28 So, there, a second check after the physician.

07:31 Well, the nurse or the -- excuse me, the patient courses on the floor and needs pain medication.

07:37 The nurse goes to the med dispense system. Sure enough, the Lortab is there.

07:42 She pulls the Lortab and then goes and administers it to the patient.

07:47 So, you're thinking, "Man, this is listed, right?" So, it seems like such a simple ordeal that the patient has Lortab listed as the allergy, but this was missed by the physician, the physician ordered it, the pharmacy checked it and the nurse gave it.

08:06 So, this is why I paused a minute on this, because guys, as nurses, we are the final check.

08:12 We're the ones that give and administer those medications to the patient so we have to be really diligent in all of these safety checks.

08:20 So, now, once we've done all those steps, once I go give the medication to the patient, I need to check that making sure that the meds not damaged or something doesn't look off about it, and making sure that the patient's med is in date.

08:36 Because if it's expired, it's probably not gonna be as effective, right? Then, before we give our medication, we wanna assist our patient to a comfortable position.

08:45 So, if a patient is swallowing a medication, for example, they surely don't wanna be lying out flat, so make sure we put them and assist them to a 90-degree or their head of bed up at least 30-degrees, whatever they can tolerate.

08:59 But the higher the better? Of course, when it comes to swallowing, right? When you eat, you wanna be head up.

09:05 Then, we're gonna perform our hand hygiene again and put on gloves when we go to give those medications.