ADMINISTRATION OF MEDICATIONS

Medication Abbreviations

A.C. P.C. S.L.

T.I.D. Q.I.D PCN
NTG I.D. P.O.
N.P.O. H.S. I.V.
I.M. B.I.D. SUPP
NGT S.L.

Standard Scheduled Times

B.I.D 0900, 2100 OR 0900, 1700

T.I.D. 0900, 1300, 1700
Q.I.D. 0900, 1300, 1700, 2100
Nightly 2100
A.C. 0730, 1130, 1630
P.C. 0900, 1300 1800
Every 2 hours 0800, 1000, 1400, 1600, 2000, 2200, 2400, 0200, 0400, 0600
Every 4 hours 0800, 1200, 1600, 2000, 2400, 0400
Every 6 hours 0600, 1200, 1800, 2400
Every 8 hours 0800, 1600, 2400

Note: Modern pharmacies deliver unit doses in 24-hour intervals. Deviation from standard administration times
will result in shortages unless the pharmacy is notified of the deviations.

Automatic Stop Order (A.S.O.)

Some drugs are subject to automatic stop orders. For example, narcotics are automatically stopped every 72
hours unless reordered by the physician. When checking your MAR, look for the A.S.O. date and notify the
physician. Other drugs subject tot the A.S.O date are:

Sedatives
Antibiotics
Anticoagulants
Antihistamines
Steroids
Tranquilizers

Special Medications Requirements

Insulin: Used to control the symptoms of diabetes mellitus when this disease cannot be satisfactorily controlled
by diet and exercise alone. It is an injectable medication that is administered 30 minutes before meals or as
otherwise ordered.

Oral Hypoglycemic Agents Sulfonylureas: May increase the ability of insulin in the body to bind to various
cells and increase the number of insulin receptors. For the greatest effect, give 30 minutes before meals, usually
before breakfast.

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Types of Medication Orders

PRN = one that is to be given as necessary

STAT = a single order that is to be given immediately
SINGLE = to be given only one at the time indicated (e.g., pre-operative medication)
ROUTINE (schedules) = meant to be administered until a discontinuation order is received.

Concurrent information to know prior to administration of the medication include: diagnosis, allergies, and diet
of the patient. For example: Patients allergic to iodine cannot have a Betadine cleanser as a pre-op preparation
of the skin.

Diagnostically relevant information would be: patients who have sickle cell anemia cannot have morphine for
pain because it causes the cells to sickle, and the pain will be increased.

Diet comes into play when a patient is N.P.O. for an A.M. procedure and has A.M. medications ordered. Also,
when certain foods will interact with the absorption of the medication. Example: Tetracycline should not be
administered along with milk-based feedings, milk, or other diary products.

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MEDICATION ADMINISTRATION

1. Start of shift routine, go to report.

2. After report, make a quick check on all patients to be sure they are breathing and are in no distress.

3. Go to nurses station; obtain your patients MARs. Orders are always checked. Hospital policy will
determine who does it and when it is done.

4. Pull your first patients chart. As you grab the first chart and the first MAR, make sure you have the right
patient.

5. Go to the first orders, when the patient was admitted to your floor. This means look for the day one of each
medication order. Continue through all orders in the chart. Make sure that the medication order has not
been changed or discontinued! All orders are continued until the doctor discontinues the medication.
Automatic stop orders are for narcotics, usually. ICU orders and other floor order are no longer in effect.
Orders prior to surgery are not to be used. New orders should come when your patient returns from recovery.

6. Position M.D. orders and MARs side by side. Use your left and right index fingers. Find the first med
ordered in the chart; put your left finger on it. Find the same drug on the MAR; put your right finger on it.
Move your finger together, and be sure that everything matches (drug name, drug dose, drug times, etc.).
Put a check or some symbols to indicate that you have verified this drug against the M.D. orders. Now, if
you get interrupted and have to leave, when you return you will know where you left off. This time is also
a good time to sign your name to the MAR. You have now verified the right drug, right dose, and right
route. The right time will be determined by hospital routine times to pass meds and M.D. orders (e.g., q 36
hrs). Continue down the M.D. orders looking for all drugs orders.

7. Note any errors and correct MARs with your staff/change nurse or instructor. The M.D. orders guide us.
The MARs are dangerous and useless until we have checked and corrected them.

8. While chart is open, note any lab that is ordered qday or for the current day. Fasting blood sugar, PT/PTT
results could determine if insulin and heparin will be given. Also note any special orders not mentioned in
report.

9. Making notes on your MARs is okay. For example, write AP _______ on MAR so that you remember to
check the apical pulse prior to giving the digoxin. The MARs are used for 24 hours, so write small.

10. Repeat items 1 through 9 with each patient you have. This should be done quickly. Your speed will improve
with practice.

11. Now that you know your MARs are correct, prepare your meds at the correct time. Check drug label against
the MAR three times.

12. Now that you are at the bedside, be sure you have the MAR. Put the stamped portion of the MAR right
next to the I.D. band. Read the patient name and hospital number or birth date (check hospital policy).
Compare I.D. with MAR ask the patient to state his/her name. This must match.

13. Give drugs from simple to complex. For example, give pills, and then the eye ointment that may blur
the patients vision. Or give an eye drop prior to a rectal suppository.

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14. Document on your MARs the time given, initials, signature and title. Refer to your clinical handbook for
narcotics and documentation.

15. Your day on the floor will revolve around your meds. Blood levels of the drug are critical. On your time
management sheet, write only the times drugs are due. This will help you to pace yourself. Stop everything
a few minutes prior to a drug and go prepare and give it. Then continue with your other duties.

16. Be safe! Remember, someone love the person you are caring for.

IN A NUTSHELL

1. Report

2. Quick Rounds

3. Obtain MARs

4. Obtain M.D. orders, chart.

5. Find day one of med order. Be sure it has not been changed or discontinued.

6. Use left and right index fingers to compare order against the MARs.

7. Make corrections

8. Check lab and other special orders.

9. Make notes to yourself on the MARs (check B/P)

10. Repeat 1 through 9 on each patient.

11. Prepare meds. Do the three label checks.

12. Check and compare the I.D. band and the MAR.

13. Give drugs simple to complex.

14. Document on MARs

15. Your day should revolve around your med times.

16. Be safe.

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