chapter 3 legal aspects of medication administration
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CHAPTER 3
LEGAL ASPECTS OF MEDICATION ADMINISTRATION
LEVELS OF LAWFDA WATCHES OVER TESTING, APPROVAL
AND MARKETING OF NEW DRUGS1. FEDERAL LAWS
CONTROLLED SUBSTANCESPRESCRIPTION DRUGSOTC MEDICATIONS
2. STATE LAWS AND REGULATIONS3. INDIVIDUAL HOSPITALS OR AGENCY
RULES
Federal Legislation
Harrison Narcotic Act of 1914 – limited indiscriminate use of addictive drugs
Federal Food, Drug, and Cosmetic Act of 1938 – gave authority to government to determine the safety of a drug prior to marketing, labeling, specification, and advertising
Durham-Humphrey Amendment of 1952 – restricted number of prescription refills
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CONTROLLED SUBSTANCESCONTROLLED SUBSTANCES ACT OF 19705 DRUG SCHEDULES
1. HIGH LEVEL OF DEPENDENCY2. HIGH LEVEL OF DEPENDENCY3. HIGH LEVEL BUT LESS THAN 1&24. LOW LEVEL COMPARED TO 35. LOW LEVEL COMPARED TO 4
Controlled SubstancesNurses may possess these only if:
They are administering the drugs to the patient for whom they were prescribed
They themselves are the patient for whom the physician has prescribed the drug
They have been delegated the responsibility for the unit supply
It is a crime for the nurse to have a controlled substance UNLESS 1 OF THE 3 ABOVE CONDICTIONS ARE MET.
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CONTROL OF NARCOTICSMUST COUNT THE NARCOTICS BETWEEN
AN ON-COMING AND OFF-GOING STAFF MEMBERS EVERY 8 HOURS
CHART IN MAR AND NARCOTIC BOOKALL NARCOTICS FOR A DISCHARGED/
DECEASED PATIENT ARE RETURNED TO PHARMACY FOR A COUNT AND DISPOSAL
WASTED/ USED MEDICATION MUST BE WITNESSED ON DISPOSAL
NO DRUG SHARING
DEPENDENCEPHYSICAL DEPENDENCE – PHYSIOLOGICAL
NEED TO RELIEVE PHYSICAL SYMPTOMS
PHYSCHOLOGICAL DEPENDENCE – ANXIETY, STRESS, OR TENSION THAT IS FELT IF THE PERSON DOES NOT HAVE THE MEDICATION
CAN HAVE ONE, BOTH OR NEITHER
OTC MEDICATIONSDO NOT NEED PRESCRIPTIONPURCHASED AT DRUG STORESLOW DOSAGELOW RISK FOR SIDE EFFECTSWARNING LABELS AND SPECIAL
INFORMATION AVAILABLE TO PURCHASERSHERBAL MEDICATIONS
STATE LAW & HEALTH CARE AGENCIESCHECK THE NURSE PRACTICE ACT IN THE
STATE IN WHICH YOU WORKPROFESSIONAL REPSONSIBILITY:
ADMINSTER DRUGS APPROPRIATELY, ETHICALLY AND TO BEST OF ABILITY
LEGAL RESPONSIBILITY:GOOD JUDGMENTPROPER ACTIONS IN CARRYING OUT
PROFESSIONAL DUTY
State Nurse Practice Act
Determines the level of authority and responsibility of the nurse
Different levels of nursing will have different levels of authority and accountability
Nurses must adhere to the Nurse Practice Act of the state in which they are practicing
Responsibilities may vary in state Nurse Practice Acts
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Nursing Responsibilities
All nurses have legal responsibility for their actions.
The Nurse Practice Act determines the level of responsibility and authority of the nurse.
Nurses must have the authority to delegate to a person with the authority to carry out the task.
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NURSE LICENSURE COMPACTHOLD A LICENSE IN ONE STATE BUT ABLE
TO WORK IN A STATE WITHIN THE COMPACT
WWW.NCSBN.ORGNEW JERSEY IS NOT YET IN THE COMPACT
AGENCY/ INSTITUTIONAL POLICIESMAY BE MORE RESTRICTIVE OR SPECIFIC
THAN STATE NURSE PRACTICE ACTWRITTEN POLICIES –
EDUCATIONAL PREPARATIONPOLICIES
ORIENTATIONPARTICULAR POLICIES, PROCEDURES, AND
RECORD KEEPING RULES*EXPECTED TO USE NURSING PROCESS IN
MEDICATION ADMINISTRATION
Question 1
Of the following, who is not permitted by law to prescribe medication?
1. Physician assistant2. LPN3. Dentist4. Nurse practitioner
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DELEGATIONTHE RESPONSIBILITY FOR PERFORMING A T
ASK IS PASSED FROM ONE PERSON TO ANOTHER BUT THE ACCOUNTABILITY FOR WHAT HAPPENS (OUTCOME) REMAINS WITH THE ORIGINAL PERSON
MUST HAVE THE AUTHORITY TO DELEGATETHE RECEPTOR OF DELEGATION MUST BE
ABLE/ HAVE AUTHORITY TO PERFORM THE DELEGATED TASK
ADMINISTRATIONCHECK MAR AGAINST THE ORIGINAL
ORDERBAR CODING FOR MEDICATION DELIVERYUSE THREE CHECKS FOR SAFETY
BEFORE TAKING FROM DRUG CARTBEFORE PREPARING, MEASURING DOSEBEFORE OPENING THE MEDICATION AT THE
BEDSIDE, OR PUTTING THE BOTTLE BACK
DRUG DISTRIBUTION CENTERSFLOOR STOCK (FROWNED UPON)INDIVIDUAL PRESCRIPTION ORDER SYSTEMUNIT DOSECOMPUTERIZED OR AUTOMATED
DISPENSING SYSTEM (PIXIS)
NARCOTIC DISPENSING:Locked cabinet within locked med roomSigned out in narcotics book and MARCounted each shift
REQUIREMENTS FOR ORDERSPATIENT’S FULL NAMEDATE WRITTENNAME OF DRUGROUTE, DOSE AND FREQUENCYDURATIONSIGNATURE OF PRESCRIBERADDITIONAL NEEDED DETAILS
Avoid grapefruit Empty stomachTake with food, etc
TYPES OF ORDERSSTANDING ORDER
EX: TYLENOL 400mg PO DAILYSTAT ORDER
BENADRYL 50 mg PO NOWSINGLE ORDER
DEMEROL 50 mg IM X1 ON CALL TO ORAS NEEDED (PRN) ORDER
IBUPROFEN 200mg PO PRN EVERY 6 HOURS FOR TEMP 101 OR GREATER
MEDICATION ERRORSOOPSIES DO HAPPENCHECK THE PATIENT STATUS FIRSTNOTIFY THE PHYSICIANMONITOR THE PATIENTNOTIFY NURSING SUPERVISORCHART EXACT CIRCUMSTANCESINCIDENT REPORTS GO TO RISK
MANAGEMENT; DO NOT CHART IN PATIENT RECORD THAT AN INCIDENT REPORT HAS BEEN FILED
INCIDENT REPORTSBE EXACTBE FACTUALSEQUENTIAL HAPPENINGS AS BEST YOU
CAN RECALLKEEP A PERSONAL COPY. USED TO ASSESS FOR PATTERNS OF
ERRORSCOULD BE A SYSTEM ERROR OR A
PERSONAL DEFICIENCY
MEDICATION SAFETYCHECK, CHECK AND CHECK AGAINIF NOT SURE, LOOK IT UPDOUBLE CHECK CRITICAL MEDSALWAYS USE 2 CHECKS FOR PATIENT IDNEVER LEAVE MEDS FOR THE PATIENT TO
TAKE LATERNEVER EVER RECAP A USED NEEDLEDISPOSE OF ITEMS PROPERLY
Question 2
Morphine is in the category of:
1. Supplements.2. Unscheduled drugs.3. Scheduled drugs, or controlled
substances.4. Over-the-counter medications.
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Question 3
Which of the following statements is true regarding herbal products?
1. Very few people try herbal products.2. Herbal products are regulated by the
federal government.3. Herbal products are considered
supplements.4. There is a great amount of information
known about side effects.
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Chapter 4
Foundations and Principles of Pharmacology
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1991 by Mosby, an imprint of Elsevier Inc. 25
Learning Objectives
Define the key words used in pharmacology and medication administration
Explain differences between the chemical, generic, official, and brand names of medicines
List the basic types of drug actions Describe the four basic physiologic
processes that affect medications in the body
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Drug Names
Generic nameTrade name; ® symbolChemical nameOfficial name
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Drug Receptor Sites
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Drug Attachment
AgonistAntagonistPartial Agonist
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Four Processes of Drug Utilization
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Absorption
How a drug enters the body and passes intobody fluids and tissuesAbsorption processes:
Diffusion—high concentration to lower concentration
Filtration—a filter prevents passage of certain molecules
Osmosis—diffusion through a semipermeable membrane from a less dense solution to a more dense solution
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Distribution
Blood systemLymph systemBarriers:
Blood-brainPlacental
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Metabolism
BiotransformationFirst-pass effectAffected by genetic and developmental factors
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Excretion
GI tractKidneysLungsSkin
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Question 1
A nephrotoxic drug is harmful to the:
1. Skin.2. Kidneys.3. Lungs.4. Liver.
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Basics of Drug Action
Desired actionAdverse reactionsIdiosyncratic reactions
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Bioequivalence
Define Brand name versus generic Generic equivalent
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Drug Interactions
Drug action may depend on ability to dissolve quickly or slowly
Controlled by medication formOil-based drugs
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Food, Alcohol, and Drug Interactions
Food interactionsAlcohol interactionsDrugs and laboratory testsChronotherapy
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Question 2
An idiosyncratic response is a drug reaction that is:
1. Expected.2. Predicted.3. Unique.4. Anticipated.
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Question 3
Which medicine is more likely to cause an allergic reaction?
1. Acetaminophen2. Aspirin3. Cough suppressant4. Antidepressant
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QUESTIONS?
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