Drug Administration: Legal and Ethical Considerations
Before medications are administered, the nurse must understand the professional responsibilities associated with medication administration, drug orders, medication delivery systems, and the nursing process as it relates to drug therapy. Ignorance of the nurse’s overall responsibilities in the system may result in delays in receiving and administering medications, and serious administration errors. In either case, care is compromised and the patient may suffer unnecessarily.
The practice of nursing under a professional license is a privilege; the nurse must understand that this responsibility includes accountability for one’s actions and judgments during the execution of professional duties. An understanding of the nurse practice act and the rules and regulations established by the state boards of nursing for the various levels of entry (practical nurse, registered nurse, and nurse practitioner) is a solid foundation for beginning practice. Many state boards have developed specific guidelines for registered nurse to use when delegating medication duties to assistive personnel.
Standards of care are guidelines developed for the practice of nursing. These guidelines are defined by the nurse practice act of each state, by state and federal laws regulating health care facilities, by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and by professional organizations such as the American Nurses Association (ANA), and other specialty nursing organizations such as the Intravenous Nurses Society, Inc. Nurses must also be familiar with the established policies developed by the health care agency must adhere to the minimum standards of state regulatory authorities; however, agency policies may be more stringent than those recognized by the state. Employment within the agency implies the willingness of the nurse to adhere to established standards and to work within established guidelines to make necessary changes in the standards. Examples of policy statements relating to medication administration include the following:
- Educational Requirements of professionals authorized to administer medications. Many health care facilities require passage of a written test to confirm the knowledge and skills needed for medication calculation, preparation, and administration before granting approval to administer any medications.
- Approved lists of intravenous solutions and medications that the nurse can start or add to an existing infusion.
- Lists of restricted medications (e.g., antineoplastic agents, magnesium sulfate, allergy extracts, lidocaine, RhoGAM, and heparin) that may be administered only by certain staff members.
- Lists of abbreviations that are not to be used in documentation to avoid medication errors.
Before administering any medication, the nurse must have a current license to practice, a clear policy statement that authorizes the act, and a medication order signed by a practitioner licensed with prescriptive privileges. The nurse must understand the individual patient’s diagnosis and symptoms that correlate with the rationale for drug use. The nurse should also know why a medication a ordered, the expected actions, usual dosing, proper dilution, route and rate of administration, minor side effects to expect, adverse effects to report, and contraindications for the use of a particular drug. If drugs are to be administered using the same syringe or at the same intravenous (IV) site, drug compatibility should be confirmed before administrations. If unsure of any of these key medication points, the nurse must consult an authoritative resource or the hospital pharmacist before administering a medication. The nurse must be accurate in calculating, preparing, and administering medications. The nurse must asses the patient to be certain that therapeutic and adverse effects associated with the medication regimen are reported. Nurses must be able to collect patient data at regularly scheduled intervals and record observations in the patient’s chart for evaluating a treatment’s effectiveness. Claiming unfamiliarity with any of these nursing responsibilities, when an avoidable complication arises, is unacceptable; in fact, it is considered negligence of nursing responsibility.
Nurses must take an active role in educating the patient, family and significant others in preparation for discharge from the health care environment. (A person’s health will improve only to the extent that the patient understands how to care for himself or herself). Specific teaching goals should be developed and implemented. Nursing observations and progress toward mastery of skills should be charted to document the learner’s degree of understanding.