This presentation outlines the responsibility and role of nurses in administrating medication and calculation of medication in Australia. This presentation was compiled by Gulzar Malik, an experienced and qualified Nursing Educator at IHNA. For more information about IHNA's return to nursing programs, please call 1800 22 52 83.

1. Medication Administration and
Drug Calculations

2. Contents
• Review of key terms
• Routes of drug administration
• Legal & ethical aspects
• Role & responsibility of nurses
• Medication errors
• Medication administration documentation
• Review

3. Pharmacology
• Pharmacology is the study of drugs, their properties, actions
and effects on the living system.
• Pharmacokinetics - The way drugs move through the body
systems.
ABSORPTION BODY
METABOLISM
EXCRETION
DISTRIBUTION
Chemical &
Physiological
factors affect
Factors affect
Effectiveness
in functions
of excretion
sites affect
Sites of metabolism
& factors affect

4. Pharmacology
 Pharmacodynamics - impact of drugs on body:
◦ Dose-response relationship
◦ Drug receptor interaction
◦ Drug receptor relationship - selectivity, affinity of chemical,
agonists, antagonists
◦ Drug interactions

5. Key terms
 What is a Drug?
◦ A drug is any natural or synthetic substance
that alters the physiological function or state of
a living organism.
◦ Two main groups
 Medicinal (chemical)
 Non-medicinal (vitamins, herbal)
 What is medication?
◦ A drug administered for therapeutic effects.

6. Key terms
• Why do drugs have different names?
o Chemical name describes the constituents that
make up its molecular structure
o Generic name given by manufacturer when fist
developed, simpler then chemical name
o Trade name brand name under which manufacturer
markets drug
• How do they work?
o Chemical interaction between drug and body’s cells
interact with cell membrane, cell enzymes, or certain
components of cell

7. Routes of drug
administration
• Enteral - Oral, Sublingual,
Buccal, Nasogastric tube,
Orogastric tube,
Gastrostomy tube,
Jejunostomy tube, Rectal.
• Topical- skin preparations,
transdermal patches,
mucous membranes (eye
drops, throat swabs, rectal
& vaginal, bladder
irrigation, nasal & throat
sprays).
• Inhalations – aerosol
therapy, metered dose
inhalers.
• Parenteral – Intradermal,
Subcutaneous,
Intramuscular, Intravenous.
• Other routes - Intrathecal,
Epidural, Intraperitoneal,
Intrapleural, Intraosseous.

8. Legal & Ethical aspects
Laws
• Poisons Act 1964
• Drugs and Poisons and Controlled Substances
Regulations Act 1981.
• Therapeutic Goods Act 1989 sets out the legal
requirements for the import, export,
manufacture and supply of therapeutic goods
in Australia (advertising, labelling, product
appearance and appeal guidelines).
• Therapeutic Goods Administration (TGA)-
regulatory agency.
• Scheduling of substances and the safe storage
of therapeutic goods, are covered by the
relevant State or Territory legislation.

9. Legal & Ethical
Aspects
Three key legal principles:
1. Accountability
2. Duty of care
3. Negligence

10. Legal & Ethical
Aspects
Ethical issues
• Rules and principles for right conduct
• Standards of ethical practice and conduct
set by the profession

11. Role &
Responsibilities
 Prescriber: medical doctor responsible
for diagnosing, charting and initiation of therapy
 Pharmacist: supply, distribution,
preparation, and resource of drug information
 Registered Nurse:
administers medications

12. Over-the-Counter
Medicines (OTC)
• Can buy them for self-treatment from
pharmacies, supermarkets, health food
stores and other retailers.
• Examples include cough and cold
remedies, anti-fungal treatments,
sunscreens, non-prescription
analgesics such as aspirin and
paracetamol.

13. Schedules of medicines
& poisons
National classification system:
• Schedule 1 Not currently in use
• Schedule 2 Pharmacy Medicine
• Schedule 3 Pharmacist Only Medicine
• Schedule 4 Prescription Only Medicine OR Prescription
Animal Remedy
• Schedule 5 Caution
• Schedule 6 Poison
• Schedule 7 Dangerous Poison
• Schedule 8 Controlled Drug**
• Schedule 9 Prohibited Substance

14. Prescription Medicines
• You require a doctor's prescription to
buy prescription medicines from a
pharmacist.
• Only authorised health care
professionals can supply them, such
as in a hospital setting.
• Examples include contraceptive pills,
antibiotics and strong painkillers.

15. Role & responsibility of nurses
 Check medication orders
◦ Medication chart details
◦ Standing orders confirmed
◦ Emergency or telephone order APP
documented
◦ Nurse initiated medications documented
◦ Record of medication administration
 Ensuring safe practice
◦ Check orders
◦ Check drug labels
◦ Check patient ID
◦ Store as packed

16. Role & responsibility
of nurses
 Storage of medications
◦ Bedside drug locker
◦ Pharmacy cupboard
◦ Imprest or medications cupboard
◦ DD cupboard
◦ Medication trolley
◦ Drug fridge

17. Rights of medication
administration
1. Right patient
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Right documentation
+ Right to refuse

18. Medication
administration
• Procedure for safe drug administration
o Patient ID
o Preparation- pharmacy/drug room/ bed side
o Information
o Administration
o Safety
o Completion
o Documentation (drug chart, IV, FBC, Pt’s
progress notes)

19. ID Band
X a
The Australian Commission for Safety and Quality in
Health Care has developed a national standard for
patient identification bands. This standard will
become a part of accreditation standards.

20. Medication Errors
• Accountability, Reporting & Acting on drug
errors
o Report to physician
o Monitor client for adverse effects
o Document in chart, client history
o Report to shift in-charge
o Adverse incident form
o Education to avoid future errors

21. Negative Effects
• Assess patient before and after medication
administration and report all adverse effects:
o Side effect
o Adverse reaction
o Allergic reaction
o Anaphylactic shock
o Medication error

22. Medication Errors
• Defined as “deviations from a physician’s order”
(Mayo & Duncan, 2004)
• Common sources of medication errors
o Illegibly written orders
o Dispensing errors
o Administration errors
• Withholding medications
o Document clearly with rationale
o Incident report if wrongly withheld

23. Medication Errors
• Common causes for drug errors by
nurses
o Orders are not clear
o Order is misread
o Nurses are distracted or interrupted
o Nurses are tired or exhausted
o Lack of adequate knowledge

24. Drug calculations
• Tablets
Number of tablets
= Required / Prescribed dose
Stock dose
• Liquids
Volume
= Required / Prescribed strength x Stock Volume
Stock strength

25. Drug calculations
• Intravenous orders
Rate/hour = Prescribed / Required Volume
Hours
Drops per Minute = Prescribed / Required Volume x Drip factor of giving set
Time (in Minutes)
The drip factor of standard giving set is 20

26. Documentation
• Drug chart
• IV orders
• Narcotic/PCA orders
• Patient history
• Fluid balance chart
• Additional Hospital requirements
• Specific drug administration protocol
charts

27. Drug Levels
Gentamicin Levels
• Specimens should be collected as one of the following
combinations:
o Level 1 (GENT1) - immediately post dose, and Level
2 (GENT2) - 6 to 8 hours post dose, or
o A spot test (GENT), or
o Pre (GENTPR) - immediately before the dose, and
post dose (GENTPO) - 30mins post dose for IV, or 1 to
1.5 hours post dose for IM.
Record dose, exact times of collection and start/finish
times of infusion.

28. Review
• It is the role and responsibility of nurses to
administer medications safely and competently.
• Drug administration is guided by codes of
practice under legal and ethical frameworks in
Australia.
• The fundamental rule of medication
administration is
o Do it right the first time, no second chances
o Follow medication administration polices and
guidelines
o Take time to check and check again

29. References &
Resources
• Australian Nursing and Midwifery Council 2008. Code of Professional Conduct.
Australian Nurses Council Inc. Canberra. ACT.
• Byrant, B., Knights, K., Salerno, E. 2007, 2nd Ed., Pharmacology for Professionals,
Australia : Mosby.
• The Pharmacy Guild of Australia, March 2009,Australia’s unique medication scheduling
system. Retrieved January 8, 2011 from www.guild.org.au
• Nurses & Midwives Board of Western Australia June 2010. Medication Management
Guidelines for Nurses and Midwives. Retrieved June 24, 2010 from Nurses & Midwives
Board of Western Australia.
• Nurses & Midwives Board of Western Australia June 2010. Medication Management
Guidelines for Nurses and Midwives. Retrieved January 4, 2012 from Nurses & Midwives
Board of Western Australia.
• Cohen, H., Robinson, E.S., Mandrack, M. 2003,Getting to the Root of Medication,
Volume 33, Number 9 (36-45), Nursing, Commonwealth Standard, Drugs, Poisons and
Controlled Substances Regulations 2006.
• Drugs and Poisons regulation Group (DPRG) January 2008, Department of Human
Services (DHS), Key Requirements for Nurses Providing Acute Care (Other than Nurse
Practitioners), www.health.vic.gov.au/dpu
• Mayo, A.M. 7 Duncan, D. 2004, Nurse Perceptions of medication Errors: What We Need
to Know for Patient safety, Journal of Nursing Care Quality, July/September, Volume 19,
number 3 (209-217), Lippincott Williams & Wilkins, Inc.

30. IHNA offers qualifications in
aged care, disability and
nursing. Go to
http://www.ihna.edu.au to kick
start your health career.
Thank you for
viewing this
presentation!