Medication Administration

Student Responsibilities

  • 6 'Rights' every time
  • Know the medication's administration requirements
  • Know the medication's side effects
  • Know what to watch for, and what to do if it happens
  • Know drug interaction risks with foods, botanicals and herbals
  • Use appropriate safety devices
  • Administer no more than 60 minutes before or after time scheduled to be given
  • Document medication administration, or reason not administered, and the patient's response to the medication

Pyxis™ MedStation

Pyxis™ is an electronic storage and dispensing system for medications on all campuses. Pyxis™ access is controlled by use of a logon (user ID) and password.

In order to use the Pyxis™ MedStation, students must complete education in RISE.

Your instructor will provide you with a Student Access form which will need to be signed by you, then submitted to the Pharmacy by your instructor before you will be granted access to the Pyxis™ MedStation. You will use your network ID and password to access the MedStation. When you are signed in, your password is your electronic signature and you are responsible for all activity that occurs under your password.

Students may not use the override function, witness for controlled substances, document resolution of a controlled substance discrepancy, perform the inventory (counting narcotics) or add patients into the system.


  • Micromedex: Can be found in Epic, directly on the Medication Administration Record (MAR) (preferred) or on the Swedish intranet under the "Resources" tab at the top of the page
    • Includes information on dosing, administration, interactions, adverse reactions, indications, and even what the drug should look like
    • A tutorial (Training Center) is available on the bottom of the first page of Micromedex
  • Medication Standards
    • Standards can be searched for on the Swedish intranet under the "Standards" tab at the top of the page
    • Hazardous medication and anticoagulant information can be found here as well
  • Pharmacists
    • PCAP (Patient Care Area Pharmacist) are assigned to specific units and specific shifts. When on, they are available by pager
    • IV Room Pharmacists: supervise and verify all IV medications

Therapeutic Duplication

How do you decide which medication to give for nausea when there are two medications ordered without further instructions?

  • Don't decide. Choosing between two PRN medications for the same indication such as pain or nausea is called therapeutic duplication and is out of RN scope of practice
  • Licensed Independent Practitioners (LIPs) are to write orders that clearly indicate the circumstances when PRN medications are to be given, and in what order, if there is more than one (e.g. a first choice and subsequent choices for failure/breakthrough)
  • A link to a therapeutic duplication document will appear on the MAR entries in this situation. The linked document lists the order in which to give PRN medications if not specified elsewhere Always consult with the RN to whom you are assigned in this circumstance

Pill Cutters/Crushers

  • Single patient use
  • Must have a label that identifies the correct patient associated with its use
  • Cleaning: to prevent drug interactions, allergic reactions, and for infection prevention
    • Procedure: Clean after each use; rinse with water or clean with an alcohol wipe; dry check to be sure all caked medication residue is removed before next use
  • At Discharge: Pill crushers go into regular garbage; pill cutters go into sharps container. Make sure patient label is removed first and discard the label into confidential waste container

Glass Ampoules

  • Use a filter straw/needle to withdraw medication from a glass ampoule

Therapeutic Interchange

  • Therapeutic interchange is a physician committee approved process that promotes reduced health care costs
  • The Pharmacy will automatically swap formulary medications for non-formulary medications. The interchange will be documented on the MAR

Discharge Medications

Patients often require medication after discharge.

Verify the patient's pharmacy of choice in Epic to ensure prescriptions are sent to the correct pharmacy upon discharge.

Medication Errors

  • Real: events reach the patient
  • Potential: events did not reach the patient, but might have under different circumstances

Patient safety is achieved with strong systems and strong individuals. Individuals make mistakes (generally not purposefully). Systems reduce the opportunity for the mistakes to reach the patient. Reporting of both 'real' and 'potential' errors are the foundation needed to create strong systems. Medication variances are reported electronically with an eQVR (electronic quality variance report).

In the event of a real or identified potential error, complete an eQVR with the assigned RN or your instructor.

*It is important to notify your instructor of any medication errors; your school reports all errors to the Nursing Commission.

Adverse Drug Reactions (ADRs)

  • Unexpected or unanticipated adverse outcome from a medication (includes hypersensitivity reactions)
  • Reporting is everyone's responsibility: nurses, physicians, and pharmacists
  • In the event of an adverse drug event, refer to the Adverse Drug Reaction Reporting and Monitoring procedure which can be found under the "Standards" tab on the Swedish intranet at the top of the page