Ensure that you have made the check of the five rights before you administer any drug to your patient!
The five rights are as follows:
When determining the right drug to administer there are several precautions to follow. Read the entire label on the drug. Check the name carefully. Ensure that you have read the label when drawing up or pouring a medication. To ensure that the right drug is administered, always check the label on the container three times: once when the container is removed from the shelf, again when the drug is removed from the container, and a third time when the container is replaced. Remember that the names of different drugs sometimes sound similar. If you are asked to prepare a drug for another health professional to administer, always show the container to the person who will administer the drug.
The right amount or dose of the drug must be used. To ensure that the right amount of the drug is used, it must be measured carefully and accurately. If drug remains, do not put back into original container; dispose of according to institutional policy. Check the department protocol to ensure that the correct amount is used for the respective examination.
The right patient must receive the drug. Use the institution’s protocol for patient identifiers before administering the drug. Ask the patient to repeat his or her name; read the patient’s identification number, medical record number, and/or check the patient’s birth date as it is printed on the patient’s armband. If the patient is too young to speak or is unable to speak, ask a parent or someone else present to identify the patient. If the patient’s name or any other identifiers do not match, stop, and get the appropriate corrections made before continuing with the procedure. Once the patient is correctly identified, explain the use of the drug with the patient and how it will be administered for the examination.
The drug must be administered at the right time. The physician or practitioner responsible for ordering the drug usually determines the right time for the administration of the drug. As a general rule, the radiologic technologist does not determine the time but should administer the drug at the time specified. Once the drug is administered, do not leave the patient unattended. A patient may have an allergic reaction, and the radiographer must be familiar with the signs of a mild, moderate, and severe allergic reactions.
The right route must be used. Make certain that the drug is administered by the correct route. The physician usually specifies the route by which the drug should be administered. The radiologic technologist must be familiar with the terminology associated with the most common routes.
Finally, document the drug you used, the amount, route of administration, date, and time; if the patient refused to take the medication; and all other pertinent information that would be useful when the examination is reviewed. Document any patient drug allergies before drug administration. Any time a drug is administered to a patient, relevant information must be recorded on the patient’s chart to document the event. If the drug is administered parenterally, the site of injection should be included.
Increasingly, radiologic technologists are expected to chart a drug that they administered or helped to administer. The technologist must follow the proper precautions and make certain that all information is documented on the patient’s chart. If an error occurs in the administration of a drug, or if the patient experiences any adverse effects from the drug, make certain to document the details of the incident thoroughly. Both students and radiologic technologists must follow these simple rules. Errors associated with drug administration are among the most common legal problems in which radiologic technologists are involved. If an error is made, immediately report the incident to a supervisor or physician. Follow the protocol of the facility for reporting drug charting or drug administration errors.
Health care professionals who order, dispense, or administer drugs often use abbreviations. Becoming thoroughly familiar with the common abbreviations that are used is important to ensure the safe and accurate administration of drugs. The list of abbreviations found in Table 22-1 includes those that are frequently encountered when administering drugs. Table 22-2 lists examples of common abbreviations, the intended meanings, misinterpretations, and corrections. The Joint Commission has published a DO NOT USE list of abbreviations. A current list can be found on their website at www.jointcommission.org. For example, the abbreviation U meaning unit has been mistaken for a V (zero), the number 4 (four), and cc; and IU, which stands for international unit, has been mistaken for IV, which means intravenous, and the number 10 (ten). Another common abbreviation, cc for cubic centimeter, has been mistaken for u or units, and, as a result, recommendations are that mL or milliliter be used in its place. In addition to the Joint Commission, the Institute for Safe Medication Practices (ISMP) has also published a list of error-prone abbreviations, symbols, and dose designations, which can be found on their website at www.ismp.org. Organizations are expected to standardize the abbreviations, acronyms, and symbols that will be used and have a list of abbreviations, acronyms, and symbols that should not be used. Most abbreviations can be mistaken for another abbreviation. It is best to write out the word rather than use abbreviations to avoid potential drug administration errors.
|bid||Twice a day|
|od||In the right eye|
|os||In the left eye|
|q2h||Every 2 hours|
|q3h||Every 3 hours|
|qid||Four times a day|
|tid||Three times a day|
Units of Measurement
The radiologic technologist should understand the units used in administering a drug. Too much of a drug can be deadly, and a small amount of the same drug can be therapeutic. Clinical facilities have established units of measurement for the various types of medications that the technologist may administer. Multiple measurement systems are used in the medical field. It is important to understand the units of measurement. A technologist needs to know the different measurements and be able to convert from one unit or system to another. The metric system is commonly used in the United States. The metric system is based on units of 10. The most common units that the technologist encounters are the liter, meter, and gram. The most common unit of measurement for liquid medications is the milliliter, the equivalent of of a liter (Table 22-3).
|Microgram (mcg)||milliliter (mL)||One milliliter (1 mL) is the same as 1 cubic centimeter (1 cc)|
|Milligram (mg)||Cubic centimeter (cc)||1000 milliliters = 1 liter = 1000 cubic centimeters|
|Gram (g or gm)|
|Liter (L)||1000 micrograms = 1 milligram|
1000 milligrams = 1 gram
1000 grams = 1 kilogram
100 milligrams = 0.1 gram
10 milligrams = 0.01 gram
1 kilogram = 2.2 pounds
Drug Administration Routes
Drugs are administered in a variety of ways, including enterally, topically, and parenterally.
Enteral routes include oral, sublingual, buccal, and rectal.
The oral route is the most common method of drug administration. This method of administration is medically termed PO. The drug is taken by mouth and swallowed; it is absorbed from the gastrointestinal (GI) tract. When receiving drugs by the oral route, the patient must be conscious and the head should be elevated to aid in swallowing. Absorption time is longer, which is the reason for oral administration, because the absorption takes place along the entire length of the GI tract.
Oral administration is a safe and convenient method of drug administration if a few simple rules are followed (Box 22-2). When the patient takes a tablet or capsule, ensure that water is available to the patient for ease of swallowing the medication. Remember to always wash your hands thoroughly before preparing or administering an oral medication. Avoid touching tablets or capsules with your hands. Transfer tablets, capsules, or liquid from the container directly into a medication cup or clean paper towel. When pouring liquids, pour away from the label, and wipe the neck of the bottle with a clean, damp cloth before replacing the cap.
Administration by the sublingual route means that the drug is placed under the tongue and allowed to dissolve. Drugs intended to be administered sublingually should not be swallowed. One drug commonly given by the sublingual route is nitroglycerin. This allows for rapid absorption for immediate onset of action.
Administration by the buccal route means that the drug is placed against the mucous membranes of the cheek of the upper or lower jaw. The buccal drug will dissolve. A lozenge is commonly given by the buccal route. This allows for a local effect.
Administration by the rectal route is an option when the patient is not capable of taking a drug orally. The radiologic technologist will have little to no reason to administer a drug rectally. Effectiveness of rectal dosages may be difficult to measure because of varied absorption rates.
The topical route of drug administration involves the application of a drug directly onto the skin. The drug is diffused through the skin and absorbed into the bloodstream. Topical drugs can be applied as lotions or ointments. Drugs for topical application have become available in a unit-dose device called a transdermal patch. The patch is applied to the skin and provides a precise dose of drug released over a specified time. Drugs applied topically include tinctures, ointments, lotions, and sprays. To administer a topical drug to the skin properly, follow the steps outlined in Box 22-3. Drugs administered by this route should not be applied with the bare hand. After topical administration, the skin area must be monitored for any signs of local irritation.
The term parenteral means that the drug is administered by a route other than the GI tract, typically by injection using a syringe and needle. Parenteral administration is used when drug administration by other means would be ineffective or impractical. The parenteral method is a valuable method for administering drugs in an emergency. Parenteral drugs can be administered in four different routes: intradermal (ID), intramuscular (IM), with rapid onset of action; subcutaneous (subcut), with slow and constant absorption, and intravenous (IV), with immediate onset of action. Strict aseptic technique and Standard Precautions should always be used when drugs are administered with a needle. Infection control is of paramount importance in parenteral therapy because of breaking the skin’s protective covering, which increases the risk for infection. The Occupational Safety and Health Administration (OSHA) issued standards on bloodborne pathogens, mandating the use of universal precautions and the Needlestick Safety Prevention program. If a drug is injected incorrectly, it may cause nerve damage or introduce microorganisms into the patient’s system.
Drugs that are injected have a rapid onset of action because they are absorbed directly into the bloodstream. All forms of parenteral administration require the use of a needle, syringe, and container. Because this method of administration involves penetrating the protective layer of the skin, strict aseptic technique and standard precautions should be followed when preparing and administering the drug. Selecting the proper equipment and supplies for parenteral administration depends on the specific injection route, as well as the kind and amount of drug to be administered. The patient must be properly identified and the procedure explained to the patient before the injection. Each parenteral route of injection is discussed separately.
Supplies for Parenteral Drug Administration
Several types of needles are used to administer parenteral drugs. The different types of syringes include (1) standard hypodermic syringe (Fig. 22-1); (2) insulin syringe (Fig. 22-2); (3) tuberculin syringe (Fig. 22-3); and (4) prefilled syringe (Fig. 22-4). The hypodermic needle may be used for a variety of medications. The insulin syringe is used for the administration of insulin. The tuberculin syringe is best used for intradermal injection. The tuberculin and insulin syringes are designed for situations that require the precise measurement of a small volume of drug. Drugs are injected into the body with a plastic syringe. Syringes may be packaged separately from the needle or packaged together with the needle. Syringes can be prefilled or empty. Plastic syringes are disposed of after being used only once.