It’s been said that hospitals are one of the most dangerous places for patients. Although we provide great care, we can also do great harm – especially when administering medications. We all know the 5 rights, but even if we comply, mistakes are made. Potassium is given to a patient with a level of 5.5mEq or Dilantin is given to a patient with an existing level of 30mcg/ml (normal is 10-20). By not doing our due diligence prior to administration, we put our patients at risk.
Making sure you give the right drug to the right patient isn’t enough. We have to truly understand how every drug we give will affect the individual patient. Mastering that is quintessential way we can provide “great care” to patients.
When giving a drug, answer these questions to administer them safely:
1. Why is this patient on this medication?
It’s not enough to know the classification of the drug. You need to understand why YOUR patient is getting it. For example, Neurontin is an anti-convulsive drug. However, we also give this drug to patients with diabetes who suffer from neuropathic pain. Understanding why your patient is on the drug helps you to assess for effectiveness – are you assessing for seizure activity or are you assessing for pain level? Same drug – different expected result.
2. Is there anything I need to check prior to giving?
We cause many iatrogenic disorders by not assessing patients prior to administering medications. I once cared for a young man with a brain injury that was loaded with Dilantin. He had received Dilantin 3 days in a row when I took care of him. Prior to giving, I checked his Dilantin level and found it to be 30mcg/ml! This was a toxic amount. We held his dose but he had to stay on our unit for 5 extra days to monitor his cardiac rhythm. We caused it by not checking his levels. When in doubt, check!
3. What do I expect as a result?
We should always be thinking about the expected results from the administration of medications. Do we expect an increase in urine output, a drop in the heart rate, pain level or blood pressure? How will we know if this medication is working? What assessments do we need to perform to evaluate.
Following these tips can help you to continue providing great care and doing no harm.
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