TMCC

Maxine S. Jacobs Nursing Program

Nursing Program Medication Administration Policy

The information on this page is for students who have been accepted to the TMCC Nursing Program and are current students.

Medication Administration Policy (Revised: Dec. 14, 2012; Adopted: Dec. 14, 2012; Effective: January 2013)

Overview

The TMCC Nursing faculty are committed to safe medication administration and reduction of medication errors among its nursing students and graduates of the program. A strong medication administration policy along with appropriate faculty supervision is needed to oversee student medication administration. Failure to follow will result in withdrawal from the program.

After reading the Safe Medication Administration Policy, students must download and sign the Medication Administration Policy Acknowledgment form.


Medication Administration Proficiency Exam (MAPE)

Prior to administering medications in the clinical setting for any clinical course, each student must achieve 100% on a Medication Administration Proficiency Exam (MAPE). A MAPE is given for each clinical course at the beginning of each semester during semesters when the student is administering medications. Students may participate in clinical prior to achieving 100% on the MAPE, but may not administer medications. Students will have three opportunities to take and pass the MAPE at 100%.

There are two sections of the MAPE exam:

  1. Medication Administration Principles (the "7 Rights and 3 Checks"), and
  2. Dosage calculations.

The medication administration principles and the calculations will be a paper and pencil test.

  • MAPE #1: 14 questions: 2 questions med admin principles; 12 questions drug calculations.
  • MAPE #2: 12 questions: 2 questions med admin principles; 10 questions drug calculations
  • MAPE #3: 10 questions: 2 questions med admin principles; 8 questions drug calculations

The guidelines for rounding principles to be used in math calculations are included in this policy (see below).

Each of the three MAPEs exams are given one week apart to provide students ample time to prepare and remediate. A MAPE may include tablets, capsules, liquids, injectables, and intravenous calculations. Hand calculators and #2 pencils will be provided. The MAPE may be scheduled prior to the beginning of classes. Students will be notified of the dates of exams. Students who do not attend the scheduled test date will forfeit that testing opportunity and will not be able to makeup or retest.

Students who do not achieve 100% on the third test will be withdrawn from the nursing program.

Students who are not successful with the first MAPE should make individual appointments with faculty for remediation. Students are strongly advised to practice drug dose calculations, or seek assistance from the Tutoring and Learning Center.


Medication Administration Principles

All medications are expected to be administered safely through use of the SEVEN RIGHTS. Medications are to be administered in a timely manner and documented accurately

Confirm the following seven (7) "Rights" each time a medication is administered. Compare the medication label with the Medication Administration Record (MAR).

  1. Right Patient: Verify a patient's identity by checking the ID bracelet while asking them to state their name and birth date; this would prevent the Right Drug from being administered to the Wrong Patient. Two patient identifiers must be used and compared to the MAR.
  2. Right Medication: Read the medication and check for spelling or "sound alike" medications.
  3. Right Dose: Re-check any dosage calculations, and verify with the physician if the order is illegible or incomplete. Administering the wrong dose can have fatal consequences. Verify with the physician if the dose seems out of the ordinary. A nurse can be held liable even if the physician's order was wrong.
  4. Right Route: For example, administering Insulin intravenously instead of subcutaneously could send a diabetic patient into shock or a coma due to excessively fast absorption. Also, if the patient isn't supposed to have anything to eat or drink but the drug route states PO (by mouth), the nurse should consult the physician.
  5. Right Time: Some medications have blood serum levels that must be maintained in a therapeutic range. Delayed administration could compromise the effectiveness of some medications.
  6. Right Documentation: Accurate documentation of the medication administration time, patient response to the drug, and any refusal is essential for continuity of care between providers and for maintaining legal records. Co-signature by a staff RN or clinical faculty is required with the documentation of each medication given by a student.
  7. Right of Patient to Refuse: A patient may refuse any medication. The accurate documentation and physician notification impacts the plan of care.

Students must prepare medications for only one patient at a time for safety. Students must perform "three checks" of the "rights" to ensure the correct medication is being administered to the right patient.

  • First Check: When obtaining the medication. Compare the package label (utilizing the 7 "rights" with each check) with the MAR when removing the medication from the stock supply or unit-dose shelf or drawer. Look at both the trade and generic name, and check expiration dates on all medication labels.
  • Second Check: Before preparing, pouring, or scanning the medication. Compare the MAR with the prepared medication and container. If partial amounts of a drug are to be administered (1/2 pill, 1mL from a 2mL vial, etc.) verify that the amount prepared is consistent with your calculations.
  • Third Check: Triple check the prepared medication against the MAR. Check the package label again and compare with the MAR.

Note: The three (3) checks should be performed prior to entering the patient's room.

One final and fourth check may be made at the patient's bedside prior to administration. The student will use a minimum of two patient identifiers when administering medications. This can include the patient's verbalized name and birth date. Compare the patient's name and ID band with the MAR, computer printout, or computer screen information.

High-alert medications may require additional verification by two licensed professionals. High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. The consequences of an error with these drugs are more devastating to patients. Employing redundancy, such as requiring independent double-checks is a strategy to reduce the risk of error. Some high-alert drug classifications include anticoagulants (Heparin), all insulins, IV antiarrhythmics, and many more. Students should be familiar with hospital policy regarding which drugs are considered high-alert.


Guidelines for Rounding of Medication Calculations

  1. If the number is > 5 then round up (example: 1.57= 1.6; 1.45 = 1.5; 0.686 = 0.69).
    If the number is < 5 then round down (example: 0.543 = 0.54).
    Round at the end of the problem.
  2. Converting pounds and kilograms: carry out to the nearest 100th (example: 120 pounds = 54.54 KG).
  3. Drops (gtt) and Units: Drops and units are too small to divide into parts. Always round to the nearest whole number (example: 89.5 = 90; 89.4 = 89).
  4. Milliliters (Ml):
    If the answer is < 1 ml then round to the nearest 100th (example: 0.376 = 0.38 ml)
    If the answer is > 1ml then round to the nearest 10th (example: 1.57 = 1.6 ml
  5. Tablets:
    Scored tablets, as a rule, can only be given whole or broken in half. Round to the nearest half (0.5) tablet (example: 1.45 tablets = 1.5 tablets; 1.2 tablets = 1 tablet).
  6. IV Calculations:
    Intravenous infusions can be calculated in drops per minute (gtt/min), or milliliters per hour (ml/hr).

For TMCC-specific testing purposes: When calculating intravenous infusion rates, round the answers to whole numbers (example: 62.5 ml/hr = 63 ml/hr; 33.3 ml/hr = 33 ml/hr; 83.6 ml/hr – 84).

Note: the newer IV infusion pumps can deliver tenths of a milliliter per hour (62.5 ml/hr). In the clinical area, when the new IV pumps are used then the infusion rate may be rounded to the tenths. Check with your instructor or reference nurse.


Medication Administration

After scoring 100% on the MAPE, students may administer medications as outlined below. Students may give medications to the patients they are caring for provided clinical faculty or a staff RN supervises all dosage calculations, pouring/drawing up, administration, and documentation of medications.

  1. LPNs may not administer medications with students.
  2. Each semester students will be evaluated by clinical faculty for medication administration safety. Once the student has been taught medication administration for the individual course, passed the MAPE exam, and been supervised during medication administration the first time by the faculty (for each route), the nursing clinical instructor will determine if supervision can be provided by a staff RN. The student will be notified when this is accomplished.
  3. Medications are not administered in the clinical setting during the first semester. During the second semester, students may give secondary intravenous (IV) medications (IV piggy back, [IVPB]) under the supervision of the TMCC clinical faculty or staff RN. No IV "push" or direct IV administration of medications will be allowed in the second semester. Students may use a saline flush to ensure patency of an IV site upon initiation of an IV and prior to connecting an IVPB medication or IV fluids at faculty discretion. Students may give all routes of medications in semesters 3 and 4 under the supervision of clinical faculty or the designated staff nurse for that patient.
  4. Nursing students will not administer medications of any kind in Labor and Delivery or NICU. If vitamins or other medications have been added to formula by an RN, students may not feed newborns the formula or breast milk.
  5. No student will give medications without knowledge of generic/trade name, classification, mechanism of action, reason for patient receiving medication, patient dose and route, safe dosage range, relevant nursing implications and incompatibilities of drugs concurrently given. The student must have the required pharmacology references available during the clinical experience, as outlined in each clinical syllabus.
  6. When administering IV medications, the student is required to utilize IV medication textbook required by the nursing program. Students must have the required textbook with them in the clinical setting.
  7. Under no circumstances will students give meds without supervision by either faculty or a staff RN.
  8. Failure to follow this policy will result in withdrawal from the program.

Clinical Requirements

  1. At the beginning of each shift, the student will check the medication record to determine which medications are to be administered that shift and their respective times of administration.
  2. Medications will be prepared for administration ideally within 30 minutes of the actual written time of administration, except for extenuating circumstances (i.e., SNF, patient off floor, patient NPO, missing meds, etc.).
  3. Oral medication will be placed in a medicine or soufflé cup in their unit dose package (do not open packages to half a tablet until checked by the instructor but be sure to state that tablet is to be halved). The medications should be secured until the time of administering them. Equipment needed for medications delivered by other routes (syringes, IV tubing, etc.) should be available.
  4. Asepsis (medical and/or surgical) must be maintained during the entire medication procedure.
  5. PATIENT ID BAND MUST BE CHECKED PRIOR TO MEDICATION ADMINISTRATION.
  6. PRIOR to check by the instructor or staff RN,the student will be knowledgeable about:
    1. drug action/type (i.e., antihypertensive-type ace inhibitor)
    2. major side effects and incompatibilities
    3. correct IV drip rate (ml/hr) or IV pump rate for IV meds
    4. the correct medication dosage: i.e., a tablet must be halved, a fraction of the medication is to be used, and/or if more than one tablet, vial etc. needs to be used
    5. proper needle/syringe size, appropriate site selection, and appropriate amount of medication to be injected at each site
    6. all proper abbreviations related to medication administration
    7. saline flush procedures
    8. safe dose ranges
  7. PRIOR to check by the instructor or staff RN,the student will have the following drug information documented:
    1. BP and apical pulse taken by the STUDENT within one hour of medication administration of vasoactive drugs and/or drugs that will affect heart rate or rhythm
    2. Appropriate laboratory values needed for specific medications. For example:
      1. PT, PTT levels, and INR levels
      2. Potassium and sodium levels
      3. Dilantin, phenobarbital, digoxin
      4. Aminophylline and theophylline levels
      5. Blood glucose levels, whether laboratory results or point of care equipment for glucose monitoring
  8. The student will be knowledgeable of normal ranges and/or therapeutic ranges and of inappropriate vital signs and/or levels (based on the normal and/or therapeutic ranges) that will cause a medication to be held and will state these to the instructor at the time of the medication check. Failure to have vital signs and lab or drug values will be considered as failure to meet the provision of this policy and will require remediation.
  9. The students will demonstrate skill proficiency in all medication administration.
  10. All students must have the following with them at all clinical sites:
    1. a working watch with a second hand;
    2. a stethoscope; and.
    3. access to program-required current drug resources and hospital computer drug references.
  11. All medications must be documented immediately following administration, or no more than 10 minutes later, unless a special circumstance has prevented it.

See Also: TMCC Nursing Program Student Handbook | Nursing Program Acknowledgment Release form.