Lesson 2: MEDICATION 2

I. Administering medication
The use of controlled drugs (CDs) is regulated by legislation. The legislation sets out rules
for the safekeeping of controlled drugs, the records which must be kept, and the manner of
administering controlled drugs.
1.1. In pairs, discuss the following questions.
1 What is your experience of administering controlled drugs?
2 What is your experience of drug prescriptions?
3 What rules relating to the administration of controlled drugs are there in your
country?
4 Why are controlled drugs regulated so strictly?
1.2.  6.1. Natasha, a Ward Nurse, needs to give her patient, Mr song, an injection,
and she is looking for a nurse to help her. Listen to the conversations and answer the
following questions.
1 Why does Natasha need assistance?
2 What medication is Natasha going to give Mr Song?
3 Why can’t Marek help her?
4 Is Anna able to help?
1.3. Natasha asks for the assistance of other nurses. Match the beginnings (1-4) to the
endings (a-d). Sometimes more than one answer is possible.
1 Have you a free at the moment?
2 Are you b checking this morphine with me, please?
3 Are you c got a minute? I just need a drug check.
4 Would you mind d busy at the moment or can you do a drug check with me?
1.4.  6.1. Listen again and check your answers. Then match the questions in
Exercise 1c to the correct responses (a-d).
a. Sorry, Natasha, I’m tied up at the moment.
b. Oh sorry, Natasha, I can’t at the moment. I’m just in the middle of something, and I
can’t leave it.
c. Yes, sure. Let me just wash my hands and I’ll be with you.
d. I will be in a minute.

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 1.5. Complete the following extracts using the words in the box. What do all the
expressions mean?

snowed flat out eyeballs run off

1 No, sorry. I’m up to my _____________ in work.

2 I’d love to help, but I’m _____________ under.
3 I can’t. I’m ______________ at the moment.
4 Actually, I’m ______________ my feet.
1.6. In pairs, practice asking for assistance with a drug check, using Exercises 1c-e as a
guide. Swap roles and practice again.

II. Doing a medication check

2.1.  6.2. Natasha and Anna have gone to the Treatment Room to get some medication
for Mr Song. Listen to the conversation and answer the following questions.
1 Which drug has the doctor prescribed for Mr Song?
2 Why does Natasha ask Anna to get the drug from the drug cupboard?
3 What do they have to do when they take the ampoules from the cupboard?
4 What do they have to do in the drug book?
5 What information does Natasha show Anna on the ampoule?
2.2.  6.2. Listen again and put the following steps in the correct order.
....... Check the number of ampoules left in the cupboard.
....... Draw up the correct amount of the drug in a syringe.
....... Check the expiry date of the drug in the ampoule.
....... Check the time the last injection was given to the patient.
...1... Check the drug order in the Medication Chart.
....... Sign and witness the drug book.
....... Check the amount of drug drawn up in the syringe.
....... Get an ampoule from the locked cupboard.
2.3. In pairs, try to remember the order of the steps in a medication check without
looking at Exercise 2b.
2.4. Match the strategies for correct administration of a medication (1-6) to the
rationales (1-f).

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 1 Anna checks that the drug count is A Out-of-date drugs may not be
correct before checking out an effective.
ampoule of pethidine for Mr Song.
2 Natasha checks the prescription in B This ensures that none of the
the Prescription Chart with Anna. ampoules have been taken and
misused.
3 Natasha and Anna check the ampoule C This is to prove that the syringe
together. contains the controlled drug, not
another colourless liquid.
4 Natasha and Anna check the expiry D This ensures that the correct drug
date on the ampoule. and dose is checked out.
5 Natasha draws up the correct amount E This proves that the patient has
of the drug in the syringe and shows received the controlled drug.
Anna.
6 Anna watches Natasha give Mr Song F Controlled drugs may only be given
the injection of pethidine. with a written order.
2.5. In pairs, practice assisting with a drug check. Student A, you are Natasha; Student
B, you are Anna. Use Exercise 2.2 as a guide. Swap roles and practice again.
III. Communication focus: working as part of a team.
There are many occasions when teamwork is critical in the healthcare environment.
3.1. Match the strategies for working as part of a team (1-6) to the examples (a-f).
1. Ask for assistance politely a. Thanks for helping me, Hans. It was much
easier to do this together.
2. Share the workload b. – Mrs Cho is refusing to drink anything. I don’t
know what to do.
- Have you tried apple juice? I know she’ll
drink that.
3. Acknowledge the contribution c. Would you mind giving me a hand? I need
of the other staff someone to check this medication.
4. Provide alternative suggestions d. I’m really snowed under at the moment. Can

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 anyone else help you?
5. Be an active part of a team e. I’ve finished all my work. Does anyone need a
rather than works as an hand?
individual
6. Recognise when you’re unable f. Do you mind taking beds one and two, and I’ll
to help take three and four?
3.2. Share your knowledge: In a small groups, discuss the following questions and then
feedback your group’s ideas the class.
1. What do you understand by the term team nursing?
2. What are some advantages of team nursing?
3. What are some disadvantages of team nursing?
4. What nursing styles are you familiar with or have worked under (for example, holistic
nursing, primary care nursing, task oriented nursing)?
IV. Checking medication orders for accuracy
Some medications must be checked by two nurses before being given to the patient. It may
also be necessary to check the result of a blood test before the medication can be given. In
the following case, the patient has had a blood test to check the International Normalised
Ratio (INR). The INR measures the time it takes for a blood clot to form in the body.
4.1. In pairs, discuss the following questions.
1 What sort of medications need to be checked by two nurses, and why?
2 Why do some medications require a blood test before being given?
4.2.  6.3. Josh and Susanna, two Ward Nurses, are checking a medication together.
Listen to the conversation and answer the following questions.
1 What does Josh want Susanna to do?
2 Who is the medication for?
3 What kind of medication is it?
4 What result do the nurses check before giving the medication?
5 Who signs the Prescription Chart?
4.3.  6.3 Put the following stages of Josh and Susanna’s medication check in the
correct order. Listen again and check your answers.
...... Check the medication label
...... Crosscheck chart and patient information
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 ...... Check the INR result
...... Sign Medication Chart
...... Crosscheck route
..1... Ask for help
...... Crosscheck dose on Medication Chart
...... Take out medication
...... Countersign Medication Chart
...... Crosscheck time of administration
4.4. Mrs Egerts in bed 6 has been prescribed watfarin 5mg to be taken orally. In pairs,
practice checking medication orders. Student A, you are Josh; Student B, you are
Susanna. Remember to crosscheck all of the information. Swap roles and practice
again.
4.5. Share your knowledge: In small groups, discuss the following questions and then feed
back your group’s ideas to the class.
1. Do you follow the same procedures for checking medication in your country?
2. If not, what procedure do you know?
3. What are the advantages and disadvantages of having a single designated nurse for the
medication round?
V. Medical focus: the metabolism of medication
Patient education in medication safety
Mr Albiston has just been prescribed atorvastatin to lower the levels of cholesterol in his
blood. In order to ensure the safe usage of the medication when Mr Albiston returns home,
Helen, the Ward Nurse, is going to talk to him about his medication.
5.1. In pairs, answer the following questions.
1. Why is patient education about medications an important role for nurses?
2. What are some of the risks of self-medication?
3. What sort of things might a nurse discuss with a patient regarding a new medication?
5.2.  6.4 Listen to the conversation between Helen and Mr Albiston and mark the
following statements True (T) or False (F).
1. Atorvastatin is used for patients with low cholesterol levels.
2. The medication stops atherosclerosis in the arteries.
3. The drug is absorbed in the liver.

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 4. Atorvastatin blocks the enzyme which causes the liver to make cholesterol.
5. It doesn’t matter what time of day atorvastatin is taken.
5.3.  6.4 The diagram below shows the absorption and metabolism of atorvastatin.
Listen again and complete the following patient information leaflet.
After you swallow the

mouth tablet, it
(1)___enters__________ the
gastrointestinal tract, or GIT*.
It (2)_____________
oesophagus
_____________ the
oesophagus, the tube which

stomach (3)___________ __________

liver
the stomach. The tablet
passes into your stomach,
large intestine small intestine where it is absorbed. It
rectum (4)___________ _________
anus
the liquids there so it can
*
a series of organs of the digestive system which runs from pass into your bloodstream. It
the mouth to the anus then (5)____________
____________ the liver (6)____________ the small intestine, the part under the stomach.
The drug is (7)____________, or chemically changed, in the liver. The liver stops the
production of an enzyme which (8)___________ the body to produce a harmful type of
cholesterol. By (9)___________ this enzyme, the amount of ‘bad cholesterol’ which is
(10)______________ ______________ the blood is reduced.
5.4. In pairs, practice explaining the metabolism of medication. Student A, you are a
nurse; Student B, you are a patient. Use the diagram in Exercise 5.3 to help you.
Swap roles and practise again.

VI. Reading: Explaining drug interactions

6.1. Read the information leaflet about atorvastatin interactions and answer the
following questions.
1. What drugs are contraindicated (not advisable) with atorvastatin?

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 2. Why would decreased elimination of atorvastatin be problematic?
3. What other things are contraindicated?

Atorvastatin interactions
Atorvastatin should not be combined with drugs which decrease its elimination from the
body. For example, drugs such as the antibiotic erythromycin and the anti-rejection drug
cyclosporine.

Concurrent use of atorvastatin and ethrythromycin could increase levels of the atorvastatin in
the body and increase the risk of muscle damage.

Statins should not be combined with niacin (nicotinic acid), often sold as an over-the-counter
medication to lower cholesterol and present in multivitamin tablets.

Atorvastatin increases the anticoagulant effect of warfarin, so patients taking atorvastatin and
warfarin together should be monitored carefully.

Statins may cause liver disease, such as jaundice, so it is necessary to monitor liver function.
Alcoholic beverages must be limited or avoided.

Large quantities of grapefruit juice (more than 1.2 litres daily) should not be taken. Grapefruit
juice inhibits an intestinal enzyme whose function it is to break down and absorb medications.
When this enzyme is blocked, the blood level of the drug increases, and toxic side effects
from the medication may be felt.

Fruit related to grapefruit, such as Seville oranges (often used in marmalade), should also be
avoided.

6.2. Complete the following precautions using the phrases in the box.

should/ must not be taken are warned not increases the toxic effects

precaution to take advised not to should be must not take

increasing the risk

1. You are _______________ drink alcohol with the medication, as this can increase the
risk of liver disease.
2. The medication ________________ with drugs such as the antibiotic erythromycin
and cyclosporine, as these reduce the elimination of atorvastatin from the body,
_________________ of muscle damage.

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 3. No statins ________________ combined with niacin (nicotinic acid).
4. You _______________ warfarin and atorvastatin together as this increases the
anticoagulant properties of warfarin.
5. Atorvastatin _____________ with grapefruit juice as this stops a vital enzyme from
working and _______________ of the drug.
6. Not eating citrus fruit related to grapefruit is an important ____________ to avoid
side effects.
6.3. Adverse events relating to medications are a significant and costly problem in hospitals.
Several strategies have been introduced to Best Practice which aim to reduce medication
errors. One such strategy is the use of pharmacists for consultation and review of
medication charts at ward level. Pharmacists usually visit the ward once a week.
 6.5 Listen to a conversation between Helen, a Ward Nurse, and Sonia, the hospital
Pharmacist, and answer the following questions.
1. What is Sonia doing?
2. What is she speaking to Helen about?
3. Why is Sonia concerned?
4. What is nicotinic acid also known as?
5. What action will Helen take?
6.4.  6.5 Listen again and complete the following extracts.
1. I had a talk to him about some things he’ll _____________ _____________ careful of
at home.
2. ...when he started atorvastatin. __________ ___________ __________ ___________
about something he was started on today.
3. He ____________ _____________ taking that with atorvastatin.
4. He ___________ _____________ Vitamin B3 – I mean, nicotinic acid – on its own or
in any other preparation.
5. Does he know ____________ ____________ drink grapefruit juice with the
atorvastatin?
6.5. In pairs, practice explaining the interactions of atorvastatin. Student A, you are a
nurse; Student B, you are a patient who has just been prescribed the drug for the
first time. Swap roles and practice again.
VII. Charting and documentation: Prescription Chart

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7.1. Sonia, the hospital Pharmacist, has just checked Mr Albiston’s Prescription Chart
on her regular ward visit. In pairs, look at a prescription chart and discuss the
following questions.
1. What kind of chart is it?
2. Are you familiar with this style of chart?
3. What sort of information is on the chart?
4. Who is responsible for recording information on the chart?
5. How often is new information added to the chart?
7.2. The following abbreviations are all commonly used on Prescription Charts. Match
the abbreviations (1-10) to their meanings (a-j).
1. tab. a. injection given into the subcutaneous layer of the skin
2. cap. b. at night
3. mg c. injection given into the muscle
4. mcg d. milligram – unit of mass which is 1/1000 of a gram
5. ml e. milliliter – unit of volume which is 1/1000 of a litre
6. po f. gelatine-coated medication
7. sc g. microgram – unit of mass which is 1/1000 of a milligram
8. IM h. solid medication, also called a pill
9. mane i. from the Latin per os: by mouth
10. nocte j. in the morning

7.3. In pairs, take turns to ask for the meaning of an abbreviation.

7.4. In pairs, look at the chart on page 88 again and answer the following questions.
1 When was Mr Albiston ordered atorvastatin?
2 What time does he have to take the medication?
3 Has he already started taking the medication?
4 What new medication was Mr Albiston ordered on 28 April?
5 Has he already been given this medication?
6 Would you give Mr Albiston the medication ordered on 28 April?

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VIII. Checking the ‘five rights’ of medication administration
8.1. In pairs, look at the ‘five rights’ and discuss the following questions.
- Are these the same medication checks which
are performed in your country? The ‘five rights’

- If not, how are they different? 1 The right drug 

- How would you check them? 2 The right patient 
3 The right dose 
4 The right route 
5 The right time 

8.2.  6.6 Beatriz, a Student Nurse, is doing a medication assessment with Jo, a
Registered Nurse. Listen to the conversation and mark the order that Beatriz
checks the five rights in.
8.3. Match the ‘rights’ (1-5) to their meanings (a-e).
1 The right drug a. Check the route of administration on the Prescription
Chart
2 The right patient b. Check how often the medication is to be given and at
what times
3 The right dose c. Crosscheck the name of medication on the Prescription
Chart and the medication label
4 The right route d. Crosscheck the dose of the medication on the
Prescription Chart and on the medication label
5 The right time e. Check the patient’s full name by checking the hospital
label on the Prescription Chart and by checking the
patient’s identity bracelet; also check the patient’s date
of birth if necessary
8.4. In pairs, practice doing nurse-nurse medication checks. Look at Mrs Gupta’s
Prescription Chart on page 87. Ask questions about the medication
administration, following the five rights. Swap roles and practice again.
8.5. Share your knowledge
In a small groups, discuss the following questions and then feed back your group’s ideas
to the class.
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- Do you have Nurse Prescribers in your country?
- What do you think are the advantages and disadvantages of having Nurse Prescriber?

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