Drug Administration: Nurse ResponsibilitiesFitness Equipment
The importance of accuracy at every step during ordering, transcribing, administering, and monitoring drug therapy cannot be overemphasized.
With the non-automated order and distribution systems, once a prescription order has been written for a hospitalized patient, the nurse interprets it and makes professional judgment on its acceptability. Judgments must be made regarding the type of drug, therapeutic intent, usual dose, and mathematical and physical preparation of the dose. The nurse must also evaluate the method of administration in relation to the patient’s physical condition, as well as any allergies and the patient’s ability to tolerate the dose form. If any part of an order is vague, the prescriber who wrote the order should be consulted for clarification. Patient safety is of primary importance, and the nurse assumes responsibility for verification and safety of the medication order. If, after gathering all possible information, it is concluded that it is inappropriate to administer the medication as ordered, the prescriber should be notified immediately. An explanation should be given as to why the order should not be executed. If the prescriber cannot be contacted or does not change the order, the nurse should notify the director of nurses, the nursing supervisor on duty, or both. The reasons for refusal to administer the drug should be recorded in accordance with the policies of the employing institute.
Transcription of the prescriber’s order is necessary to put it into action. After verification of an order, a nurse or another designated person transcribes the order from the physician’s order sheet onto the Kardex or onto an MAR. These data may also be entered into a computerized patient database that produces a Kardex or MAR. When this process is delegated to a ward clerk or unit secretary, the nurse is still responsible for verifying all aspects of the medication order. The nurse must sign the original medication order indicating that he/she received, interpreted, and verified the order. The nurse then sends a carbon copy of the original order to the pharmacy, often by fax. A small supply is issued either in unit dose or in a container containing a daily supply. The container is labeled with the date, patient’s name, room number, and drug name and strength/dose. When the supply arrives from the pharmacy it is stored in the medication room or in the patient’s medication drawer of a medication cart.
In the long-term care setting, carbon copies of new medication orders are sent to the local pharmacy to be filled. If a stat dose is needed or the medication must be started very soon, the pharmacy is notified via telephone or fax, and written verification of the medicine(s) ordered is also supplied to the pharmacy. Because the local pharmacy generates the medication administration record only on a monthly basis, new orders must be added to the current medication record by the nurse transcribing via the fax or drug reorders such as PRN orders.
The nurse, using standard drug administration methodology, prepares and administers drug by following the order on the medication administration record or drug profile according to the six rights of drug administration. With the new CPOE that is supported by CDSSs, both the verification and transcription of the medication orders are built into the system. It should be emphasized that bar coding and handheld devices do not eliminate the need for the nurse to use standard administration procedures for medications such as checking all aspects of the drug order, right patient, right drug, right time, right dose, and right route, and for documentation of drug response.