Chapter 6. Non-Parenteral Medication Administration
Nurses play an essential role in medical reconciliation; preparing, administering, monitoring, evaluating, teaching patients; and documenting responses to medications. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety.
This chapter discusses guidelines to follow for mitigating medication errors and adverse drug events (ADEs). Non-parenteral routes of medication administration are discussed, and the steps for following each of these processes safely is outlined.
- Safe and accurate medication administration is a key nursing responsibility.
- Medication administration is a complex process that requires the full attention of the nurse to avoid medication errors and adverse drug events.
- Nurses can reduce errors by following guidelines, knowing the types of medication errors that are most likely to occur and strategies for their prevention, and understanding the implications of the medication being given.
- There are several routes for medication administration. Knowing when it is appropriate to use each route, and knowing the process for medication administration via that route, will help to mitigate medication errors.
- The SEVEN rights and three checks provide a process for safe drug administration and are a collaborative effort of the nurse, the pharmacist, and the physician.
- Accurate and timely documentation of medication administration and the effect of the medication on the patient is an important responsibility of the nurse and promotes patient safety.
- Patient education is an extremely important factor in medication adherence and proper self-administration and is an important nursing responsibility.
Suggested Online Resources
1. Canadian Patient Safety Institute’s (CPSI) Medication Safety. This resource explains how to reduce adverse drug events by following the medication reconciliation process.
2. Centers for Disease Control and Prevention’s Medication Safety Basics. This website outlines medication safety basics and provides several medication safety fact sheets.
3. Institute for Safe Medication Practices Canada (ISMP). This is the website for an independent, national, not-for-profit organization committed to the advancement of medication safety in all healthcare settings.
4. Institute for Safe Medication Practices Canada’s (ISMP) Medication Reconciliation. This website provides a definition of medication reconciliation and resources to complete the medication reconciliation process to ensure safe and effective communication for all healthcare providers regarding use of all medications.
Agency for Healthcare Research and Quality. (2014). Checklists. Retrieved from http://psnet.ahrq.gov/primer.aspx?primerID=14.
Agrawal, A. (2009). Medication errors: Prevention using information technology systems. Br J Clin Pharmacol, 67(6), 681.
Baker, G. R., Norton, P., G., Flintoft, V., Blais, R., Brown, A., Cox, J., . . . Tamblyn, R. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. CMAJ, 170(11), 1678-1686. https://doi.org/10.1503/cmaj.1040498
Bell, C. M., Brener, S. S., Gunraj, N., Huo, C., Bierman, A. S., Scales, D. C., . . . Urbach, D. R. (2011). Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. Journal of American Medical Association, 306(8), 840-847. http://dx.doi.org/10.1001/jama.2011.1206.
Boullata, J. (2009). Drug administration through an enteral feeding tube: The rationale behind the guidelines. American Journal of Nursing, 109(10), 34-42. Retrieved from https://www.nursingcenter.com/wkhlrp/Handlers/articleContent.pdf?key=pdf_00000446-200910000-00027.
British Columbia Institue of Technology )(BCIT). (2015). In, NURS 1020: Clinical techniques. Vancouver, BC: BCIT
Butt, A. R. (2010). Medical error in Canada: Issues related to reporting of medical error and methods to increase reporting. McMaster University Medical Journal, 7(1), 15-18. Retrieved from https://sghrp.ca/reports/open-report.php?id=23.
Canadian Institute for Health Information (CIHI). (2013, March). Adverse drug reaction—Related hospitalizations among seniors,
2006 to 2011. Retrieved from https://secure.cihi.ca/free_products/Hospitalizations%20for%20ADR-ENweb.pdf.
Canadian Patient Safety Institute. (2012). Canadian incident analysis framework. Retrieved from http://www.patientsafetyinstitute.ca/en/toolsResources/IncidentAnalysis/Documents/Canadian%20Incident%20Analysis%20Framework.PDF#search=canadian%20analysis%20incident%20framework.
Centers for Disease Control and Prevention. (2018). Medication safety basics. Retrieved from https://www.cdc.gov/medicationsafety/basics.html.
Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses’ workarounds in acute healthcare settings: A scoping review. BMC Health Services Research, 13(175). https://doi.org/10.1186/1472-6963-13-175.
Institute for Healthcare Improvement. (2015). High-alert medication safety. Retrieved from http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx.
Institute for Safe Medication Practices (ISMP). (2011). Guidelines for timely administration of scheduled medications (acute). Retrieved from https://www.ismp.org/guidelines/timely-administration-scheduled-medications-acute.
Institute for Safe Medication Practices (ISMP). (2017a). List of error prone abbreviations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list.
Institute for Safe Medication Practices (ISMP). (2017b). High-alert medications in long-term care (LTC) settings. Retrieved from https://www.ismp.org/recommendations/high-alert-medications-long-term-care-list.
Institute for Safe Medication Practices (ISMP). (2018). High-alert medications in acute care settings. Retrieved from https://www.ismp.org/recommendations/high-alert-medications-acute-list.
Lilley, L. L., Rainforth Collins, S., Snyder, J. S., & Swart, B. (2016). Pharmacology for Canadian health care practice (3rd ed.). Toronto, ON: Elsevier Canada.
Lung Association of Saskatchewan. (2018). Inhalers. Retrieved from https://sk.lung.ca/lung-diseases/inhalers.
Lynn, P. (2011). Photo atlas of medication administration (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Martindale Pharma. (n.d.) Bisacodyl. Retrieved from https://www.medicines.org.uk/emc/product/3298/smpc.
Munden, J. (Ed.). (2007). Nursing: Perfecting clinical procedures. Philadelphia, PA: Wolters Kluwer: Lippincott, Williams & Wilkins.
National Patient Safety Agency. (2009). Safety in doses. Improving the use of medication in NHS. Retrieved from http://www.nrls.npsa.nhs.uk/resources/?entryid45=61625.
National Priority Partnership. (2010). Preventing medical errors: A $21 billion opportunity. Retrieved from http://psnet.ahrq.gov/resource.aspx?resourceID=20529.
Perry, A., Potter, P., & Ostendorf, W. (2018). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., . . . Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707. https://doi.org/10.1056/NEJMsa0907115.
Prakash, V., Koczmara, C., Savage, P., Trip, K., Stewart, J., McCurdie, T., . . . Trbovich, P. (2014). Mitigating errors caused by interruptions during medication verification and administration: Interventions in a simulated ambulatory chemotherapy setting. BMJ Quality and Safety, 23(11). https://doi.org/10.1136/bmjqs-2013-002484.
Ramadan, W. H., & Sarkis, A. T. (2017). Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: An observational comparative study. Chronic Respiratory Disease, 14(3). https://dx.doi.org/10.1177%2F1479972316687209.
Royal Children’s Hospital Melbourne (RCH). (2017). Enteral feeding and medication administration. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Enteral_feeding_and_medication_administration/.
Saskatoon Health Region. (2017). Enteral tube feeding: Adult [Number 1020]. Retrieved from https://www.saskatoonhealthregion.ca/about/NursingManual/1020.pdf.
The Joint Commission (TJC). (2012). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx.