Chapter 2: Legal, Regulatory, and Ethical Aspects of Drug Administration

Key Concepts

• Federal Laws: Control how certain drugs can be administered.
• State Laws: Define who can prescribe, dispense, and administer medications.
• Agency Guidelines: Dictate further specifics on drug administration.

Legal and Ethical Considerations

• Mixing Medications with Food/Drinks: Ethical responsibility to inform the patient and document it.
  • Covert Drug Administration: Secret administration without patient knowledge is unethical.

Foods/Drinks to Avoid with Medications

• Grapefruit Juice: Affects metabolism of many drugs, potentially causing toxicity.

Guidelines on Drug Forms

• Do Not Crush List: Includes enteric-coated, extended, and time-release medications.

Terms to Know

• Drug Diversion: Illegal transfer of drugs (e.g., narcotics).
• Impaired Nurses: Nurses under the influence; must be reported.

Regulations

• Federal Law: FDA oversees new drugs.
• State Law: Dictates who can prescribe and administer drugs.
• Facility Guidelines: Specific procedures on how drugs are given and recorded.
• Controlled Substances: Secure double-lock storage, waste management witnessed by another nurse.
  • Prescription Drugs: Require prescriptions, even in hospitals for over-the-counter meds.

Critical Terms

• Physical Dependence: Physical withdrawal symptoms when the drug is discontinued.
• Psychological Dependence: Mental craving for the drug.

At-risk Populations

• Geriatric Population
• Pediatric Patients
• Critically Ill Patients

Drug Orders

• Components of a Legal Prescription: Name, Date, Drug, Route, Dose, Frequency, Signature.

Types of Drug Orders

• Standing Orders: Regular, ongoing until updated or discontinued.
• Emergency (Stat) Orders: Immediate, often within 30 minutes.
• Single/One-time Orders: Given at a specific time.
• PRN Orders: As needed, with specified intervals (e.g., Q4 hours).

Nursing Responsibilities

• Know your Nurse Practice Act: Varies by state, dictates scope of practice.
• Professional Responsibility: Legal and ethical accountability for actions.
• Follow the Nursing Process: Assessment, evaluation, and implementation phases.

Reducing Errors

• Verification Systems: Bar coding and electronic medical records.
• Preventing Drug Errors: Check the patient first, notify healthcare provider, document, and complete incident reports.
• High Alert Drugs: High risk of harm (e.g., Potassium, Insulin, Narcotics, Chemo, Heparin).
• Black Box Warnings: Indicate severe risks (e.g., NSAIDs, Antidepressants).
• Medication Reconciliation: Comparing patient drug orders to avoid duplications and interactions.

Protecting Healthcare Workers

• Vaccinations: Required for preventable diseases.
• Needle Stick Precautions: Use of Sharps containers and needle-less systems.
• Incident Documentation: Report exposures to risk management.

Controlled Substances

• Schedules 1-5: Range from high abuse potential (Schedule 1) to minimal abuse (Schedule 5).
• Possession and Use: Only with prescription and regulated access.

Final Notes

• Nurse Practice Act: Defines scope, practice standards, and expanded roles.
• American Nurse Association: Defines practice standards and role expectations.