To ensure that the process of medication administration is hazard free, the best practices protocol, such as discussed below, may be implemented:
1. Correct prescription by the doctor:
i. The doctor’s orders should be complete in writing, legible and without unauthorized abbreviations.
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ii. Verbal orders should not be acceptable unless it is an emergency. The telephonic orders should be checked/verified from the doctor by another nurse/resident and should be immediately noted down in the case file as well as the nurse’s record, for authentication by the doctor at the earliest on arrival
iii. The orders must include ant precautions to be taken such as slow IV injection/infusion over a period of 5 minutes after dilution or to be administered IV at a fast rate.
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2. Correct Interpretation by the Nurse:
i. The nurse, after reading the orders, should clarify from the doctor, if there are any doubts.
ii. Orders for high risk medications will always be verified from the doctor by the nurse before actual administration of the medication.
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iii. Double check of all the medication orders written in the nurse’s record and the nurse’s work book by the nurse in-charge ward.
3. Correct Drug Identification:
At the correct time:
i. Nurse reading the order carefully one by one item
ii. Nurse taking out the correct drug
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iii. Nurse checking/tallying the name of the drug, strength, the dosage, the route of administration, precautions if any.
4. Correct Patient Identification:
i. Patient Identification is one of the critical points in the process and will be done by a standard procedure
ii. Patient will be identified by at least two identifiers other than the bed/room number
iii. The identifiers may be Patient’s name, CR No. and the ID band worn by the patient. In case, there are two patients with the same/similar names, the nurse should check further identifiers like the patient’s residential address, the disease symptoms, etc.
5. Correct Medication Procedure:
While actually administering the medication, nurse must ensure the following:
i. Briefing the patient about the medication and its effects/adverse effects
ii. Keeping the emergency cart ready for any adverse effects
iii. Correct preparation of the medication
iv. Taking aseptic precautions including disinfection of the site for injection
v. Checking from the patient any past history of allergy to the drug. In case of any doubt giving a subcutaneous test dose for the allergic response, if any
vi. Administering the medication only after reasonable assurance that patient is not allergic to the drug
vii. Ensuring that all the precautions to be taken are being taken.
6. Observation for Adverse Effects:
Nurse observes the patient, checks the pulse rate (and BP if required) and asks the patient if he/she has any adverse symptoms.
7. Management of Adverse Effects:
In IV medication, the symptoms are much quicker, may be during medication itself. If that happens the nurse must:
i. Discontinue medication immediately
ii. Call the doctor
iii. Start the treatment measures to reverse the adverse effects depending upon the seriousness of the adverse effects.
iv. Sometimes, the patients collapse very fast in seconds. Therefore, the Emergency Response Team must be called immediately, for further management.
8. Record of the Patient’s Drug Allergy:
i. Once the patient is stabilized, the adverse effects and the actions taken to resuscitate should all be recorded in the case record
ii. The fact of patient’s allergy to the drug must be made known to the patient/attendants
iii. Drug allergy must be recorded on top of the case file as well as on every page of the case record, in bold red ink.