GNO Medication Review

General Nursing Orientation (GNO)
Medication administration reading material

2016
King Faisal Specialist Hospital and Research Center Gen Org
General Nursing Orientation
Medication Administration Review
Welcome to KFSH&RC Gen Org,
During the General Nursing Orientation (GNO), you will be tested for your basic
knowledge about medication administration/calculation and the International Patient
Safety Goals (IPSG) in relation to safe administration of medications.
On the 3rd day GNO, you will sit for a medication administration 1st attempt that
assesses your knowledge and clinical judgment on IPSG and medication calculations. In
addition to general questions, there will be questions about the most common
medications for some of the disorders. There are case studies in the challenge that are
selected based on your area of specialty, being pediatric or adult. Please note that the
passing mark for the exam is a minimum score of 80 % is a requirement before starting
the process of medication administration competency-based check-off in the clinical
area.
If you didn’t make in in the 1st attempt; you will be offered a session where
different concepts of medication calculations and IPSG are reviewed by a Clinical
Instructor to help/prepare you for the 2nd attempt of the medication exam which is
usually scheduled on the last day of the GNO.
You will be provided with detailed information about the medication exam by your GNO
coordinator.
We hope that the content of this package is helpful for you.
Updated 2016 Page 2

International Patient Safety Goals
Goal (1) Identifying Patients Correctly
 Patients are identified by full

name and medical number (MRN)
 Know your patients
 Know what is the reason for the patient
being admitted, know their family,
history, diagnosis, and allergies
 However, when you communicate information with staff about your patients,
identify them by full name and MRN
 Prior to administering medications, blood and blood products or providing and
procedure, verify patient’s name and number on the arm band against the
medication administration record and ask the patient to say his/her full name
Goal (2) Improve Effective Communication

When receiving phone orders from a physician, identify
patients correctly with the physician by verbalizing patient
full name and MRN
 Enter the phone order in Power chart or in the physician
order sheet during ICIS
 Read back the order to the physician
 If you need another nurse to double check the order with you, the second nurse
must follow the same process of listening and reading back the order
 When you read back a medication dose, e.g., 50mg, then read it back as (fifty =
five – zero)
Goal (3) High-Alert Medications
 Two nurses will double check the full six rights of

medications independently
 Refer to the following policies
– High Alert Medication (MCO-CS-PHA-07-001) or
– Nursing Medication Administration (MCO-NA-
NAA-06-016)
– Medication System: Nursing Responsibilities (NA-J-CL-08-05 ) - Jeddah
Updated 2016 Page 3

Updated 2016 Page 4

Updated 2016 Page 5

Goal (4) Prevent Wrong Site, Wrong

Procedure, on Wrong Patients
 Make sure site marking is done on patients prior

to invasive procedures
 Follow the policy and check out the forms to be
filled out prior to sending patients to procedures
 Time-Out: Stop and check all the necessary
documents just before the procedure
Goal (5) Prevent the Risk of Hospital-Acquired Infections

Practice hand hygiene either by washing hands
with an antimicrobial agent and water for at
least 40-60 seconds or by using alcohol based
hand rub for 20-30 seconds
 Hands may need to be washed after 5-10
applications of alcohol based hand rub
 Alcohol based hand gel should not be used
when the hands are visibly soiled or if the
patient has clostridium difficile infection
 Beware….Clean Hands Care
 Refer to the following policy - Hand Hygiene
Procedures (MCO-MCINF-04-027)
- Hand Hygiene
(CEO-J-INC-01-12) -
Jeddah
 World Health Organization (WHO) ‘Five

Moments for Hand Hygiene’ shall be adhered to
by all staff (Appendix A):
Moment 1. Before touching a patient

Moment 2. Before a clean/aseptic procedure
Moment 3. After body fluid exposure risk
Moment 4. After touching a patient
Moment 5. After touching patient surroundings
Updated 2016 Page 6

Goal (6) Prevent Harm Resulting From Patient Falls
 All patients are assessed for the risk of falls using the Fall Risk
Assessment/Reassessment Tool on admission, Daily and more frequently when
patient condition changes for example
 Post falls
 Post-procedures
 Transfers to General Units (4hrs), Critical Care Units (2hrs)
 Change in medication regime that can affect level of consciousness (narcotics,
antihypertensive’ s, hypoglycemic, chemotherapy, diuretics, and laxatives)
 Document the risk assessment
 Take fall precautions as per protocol
 Refer to the policy on Falls Prevention (MCO-MC-ADM-01-016)
- Patient Fall Risk Management (NA-J-CL-05-44) - Jeddah
Common Medications
All nurses are required to know the action, the side effects, and the safety measures when
administering medications below. This package will not deal with drugs individually in
terms of their pharmacokinetics, pharmacodynamics, and mechanisms of action.
However, it is essential that you will show knowledge and clinical judgment when you
are asked questions in relation to the safe administration of the common medications.
These are the common medications you should be familiar with:
1. Insulin and oral hypoglycemic agents (OHA)

2. Anticoagulants (Heparin) ….what is its action??
3. Digitalis
4. Diuretics and Antihypertensives (Lasix and Captopril)…….what to observe for???
5. Opioids and other analgesics…..Morphine
6. Antibiotics …..Gentamycin and Vancomycin (check levels)
7. Emergency medications
8. Anti-dots (Vit K and protamine Sulfate)
Updated 2016 Page 7

Commonly Used Abbreviations
The table below includes a sample of the commonly used abbreviations. However, the list
does not include all the approved abbreviations used in the Hospital.
It will be your responsibility to use the “approved only” abbreviations in your practice.
And also, it will be part of orientation to your clinical area to access the online list of
approved abbreviations.
IM Intramuscular Ac Before meals tsp Teaspoon

IV Intravenous ad lib As desired, freely mg Milligram
SC Subcutaneous am Morning L Liter
ID Intradermal pm Afternoon Pt Patient
OGT Oral gastric tube bid Twice per day qs Sufficient Quantity
PO Oral, by mouth cap Capsule Rx Take (prescription or treatment)
SL Sublingual Tab Tablet Rt Right
cc Cubic centimeter kg Kilogram T.O Telephone order
g Gram prn When needed V.O Verbal order
gtt Drops p.c After meals stat Immediately
ml Millimeter q4h Every 4 hours qid Four times a day
tid Three times a day tbsp Tablespoon NG Nasogastric
min Minute sec Second NGT Nasogastric Tube
q Each, Every amp Ampoule MRN Medical Record Number
Amt Amount BS Blood Sugar BMI Body Mass Index
hr Hour HR Heart Rate BP Blood Pressure
Liq Liquid w/o Without wt Weight
Neb Nebulizer Syr Syrup TFI Total Fluid Intake
KVO Keep Vein Open Lt Left
NOTE: ml – milliliter is approved for documentation only and is not to be

used in medication orders
For more information on the approved abbreviations, please visit

http://www.kfshrc.edu.sa/wps/portal
 BEWARE OF ABBREVIATIONS, USE ONLY THE APPROVED ONES
 Using unapproved abbreviation puts the patient at high risk for

medication errors!
Updated 2016 Page 8

Updated 2016 Page 9

Medication Administration Process

A Critical Pathway for Safe Medication Administration
1.
MEDICATION ADMINISTRATION TIME
NURSE CHECKS MEDICATION FOR

ITS NAME, PATIENT’S FULL NAME,
DOSE, TIME AND ROUTE OF
ADMINISTRATION, AND
DOCUMENTATION (SIX RIGHTS)
ALL ARE OK?
NO YES
 VERIFY INDICATION FOR

REFERS TO PHARMACY
USING THE MEDICATION
AND PHYSICIAN ORDER
 VERIFY THE PROPER DOSE

NEVER GIVE A MEDICATION RANGE AS PER THE PATIENT’S
WHEN IN DOUBT ABOUT ANY WEIGHT, RENAL FUNCTION,
OF THE SIX RIGHTS ETC
 VERIFY WHETHER YOU NEED

TO CHECK PARAMETERS (E.G.
VITAL SIGNS)
ALL OK?
CLARIFY WITH PHYSICIAN

NO
AND PHARMACY YES
PROCEED WITH
MEDICATION
ADMINISTRATION
Updated 2016 Page 10

Medication Administration Process

A Critical Pathway for Safe Medication Administration (continued)
MEDICATION ADMINISTRATION TIME AT BEDSIDE
IDENTIFY PATIENT CORRECTLY BY

FULL NAME AND MEDICAL RECORD
NUMBER (MRN) BY CHECKING ARM
BAND AND STAMP ON MEDICATION IT IS MANDATORY TO TAKE
ADMINISTRATION RECORD (MAR) MAR WITH YOU TO THE
BEDSIDE
COMPARE MEDICATION’S NAME ON

YOUR LABEL AND THE SAME NAME
ON THE MAR
PERFORM THE CHECKS ON THE

DOSE, THE ROUTE AND THE TIME OF
ADMINISTRATION ALERT
YOU NEED TO CHECK THE SIX

RIGHTS WITH ANOTHER NURSE
PRIOR TO ADMINISTRATION?
ADMINISTER MEDICATIONS AS
ORDERED. MAKE SURE YOU DO THE
RIGHT MONITORING SPECIFIC TO
THE MEDICATION (VITAL SIGNS,
BLOOD SUGAR, BLEEDING TIME,
ETC)
SIGN YOUR INITIALS ON THE MAR,

IDENTIFY YOUR INITIALS BY NAME AND ID
NUMBER ON THE KEY SECTION OF THE
MAR.
REMEMBER: IF IT IS NOT
DOCUMENTED … IT WASN’T GIVEN

Tips to Prevent a Medication Error
1. Look-a-Like Medications
Read medication label carefully, some medication are packaged in similar

containers.
2. Sound-a-Like Medications
Some medications have similar sounding names. Legible documentation on ICIS

is necessary when writing orders (physician), when taking phone orders and
transcribing orders (nurse)
Lasix (Furosemide) Losec (Omeprazole)
Lanoxin (Digoxin) Lemoxin (Cefuroxime)

Limoxin (Amoxicillin)
Desoxyn
(Metamphetamine)
3. Decimal Point
Some medications might be ordered with different doses, e.g., Fentanyl patch of
12.5 mcg and Fentanyl patch of 125 mcg. Always clarify with physician before you
transcribe the order. Clarify with pharmacist when you send the order.
ADD THE FIGURE (0) BEFORE THE DECIMAL
0.125 mg DIGOXIN AND NOT .125 mg

1. Unfamiliar With the Medication
Check it out using the hospital formulary, encourage the usage of generic names
with the multidisciplinary team, patients, and families.
2. Patients With Similar Names
Always remember to identify patients correctly by name and medical record

number.
PREPARE AND DISPENSE ONE PATIENT’S

MEDICATIONS AT ONE TIME
Remember the 6 Rights of Medication
 Right Patient
 Right Medication
 Right Dose
 Right Route
 Right Time
 Right Documentation

Use your critical thinking!!!!
My patient is on 50 mg of Warfarin. Is that OK?
When in doubt if this is an inappropriate dose, consult your

physician, the pharmacist, and the hospital formulary!!!!!!
My patient is on 30 mg of Nifedipine Sustained

Release, but he cannot swallow it!
Can I crush the tablet?
Crushing a sustained release medication will allow the absorption of the whole
dose at once. Never, never, never, crush or dissolve these tablets.
Assess your patient’s ability to swallow tablets, talk to physician when patients
have enteral tubes or cannot swallow.
Instruct patients not to chew on tablets that are sustained release
My patient is on Digoxin, Gentamycin,

Captopril, and Warfarin.
Is there anything I need to check prior to give

these medications?
Most probably you should!
Check out these medications in the hospital formulary.

There are some parameters you need to assess before
and after administering these medications!!!!

My patient is on IV fluids of 125 ml per

hour. He hasn’t had any urine output for
12 hours. His bladder doesn’t feel
distended; and he is short of breath.
WHAT SHALL I DO?
Did you complete your assessment? Most probably you should check vital signs,
peripheral edema, lung sounds, and oxygen saturation; THEN YOU CLARIFY
WITH THE PHYSICIAN!
Wait a minute!!!!
Is this a high-alert medication

you are about to administer?
What does that mean? How

can I find out?
High-alert medications are those medications that required two nurses

to independently double check for the six rights. Refer to your policy
to find out more about these medications
Six Rights of a Medication! Is that enough

to follow?
It is necessary and essential to follow the six rights to decrease the

risk of a medication error.
Do not forget to identify the reason for giving a medication to a

patient (indication), the normal dose range, and the
appropriate monitoring based on medication-specific side
effects and toxicity

SELF-STUDY TEST
The following questions will help to assist the nurse to prepare him/herself for the
pharmacology exam during the General Nursing Orientation program.
1. The patient with congestive heart failure is receiving Digoxin and Furosemide.
When caring for this patient you would be most concerned about monitoring for
which of the following electrolytes?
a) Sodium
b) Chloride
c) Potassium
d) Magnesium
2. The patient is receiving heparin via IV pump. Which of the following laboratory
results is the most important for you to monitor?
a) PTT
b) CBC
c) Na, K+
d) BUN and Creatinine
3. The preferable site for an IM injection in a child under two years of age is:
a) Ventrogluteal
b) Vastus lateralis
c) Dorsogluteal
d) Deltoid
4. The patient presents with a pale, swollen, cold arm above the IV site and the IV has
become sluggish. The most reasonable explanation for these symptoms is:
a) The infusion pump needs to be reset.
b) The vein has become phlebitic.
c) The IV solution is too viscous.
d) The IV is infiltrated.
5. When administering packed cells to the patient, the IV solution that should precede
and follow the administration of the packed cells is:
a) Ringer’s Lactate
b) Dextrose 5% in 0.45% Sodium Chloride
c) Dextrose 5% in water
d) Normal Saline (0.9% Sodium Chloride)

DRUG CALCULATION PRACTICE QUESTIONS
1. A patient is to receive 800 ml in 6 hrs. How many ml per hr will he get?
2. A patient is to receive Heparin IV at a rate of 1000 units per hr. If the pharmacy
delivered 250 ml of Dextrose 5% in water with 25,000 units of Heparin, how many
ml per hr should the patient receive?
3. A patient is to receive an insulin drip continuously for 24 hrs at 5 units per hour.
How many units of insulin should be added to a 250 ml to infuse over 24 hrs? How
many ml per hr will deliver 5 units per hour?
4. The order is for Morphine 75 mg in 50 ml Dextrose 5% in water to infuse at 2 mg

per hr. How many mg of morphine are in each ml of fluids? How many ml per hr
should you set the IV to infuse at?
5. A patient has a continuous IV infusion of morphine at 15 mg per hr. The bag from
pharmacy contains 360 mg in 96 ml. How many ml per hr should be
administered? Using tubing that administers 15 drops per ml, how many drops per
min should the IV infuse at?
Answers
C, A, B, D, D
Answers
1. 133 ml per hour

2. 10 ml per hour
3. 120 units, 10.4 ml per hour
4. 1.5 mg per ml, 1.3 ml per hour
5. 4 ml per hour, 1 drop per minute
References
1. Lippincott Nursing Center , 2012
2. Kozier.B, Berman.A, Erb.G, Fundamentals of Nursing: Concepts, Process, and Practice, (2008)
Mosby Publishers
3. Batastini.P and Davidson.J. Pharmacological Calculations for Nurses, A Worksheet, 3rd Edition
(1999) Delmar Publishers
4. Joint Commission International, http://www.jointcommission.org, retrieved December , 2015
5. The Institute for Safe Medication Practice (ISMP), http://www.ismp.org, retrieved November 2015

CALCULATION FORMULAS
Conversions
Kilogram (kg) × 1000  Grams

Gram (g) × 1000  Milligrams
Milligram (mg) × 1000  Micrograms
Liter (L) × 1000  Milliliters
~OR~
Micrograms (mcg) ÷ 1000  Milligram
Milligrams (mg) ÷ 1000  Gram
Grams (g) ÷ 1000  Kilogram
Milliliters (ml) ÷ 1000  Liter
Drop Factor  Number of Drops per Milliliter (ml)
Drug Calculations
Number of Tablets per dose  Required Dose ~OR~ (dose ordered ÷ stock strength)
Available Dose
Patient’s dose in mls  Required Dose × Volume available (ml)

Available Dose
~OR~
Required Dose
Drug concentration
Drug Concentration (mg/mcg/units/mmol etc., per ml)  Amount of drug

Total volume of fluid (ml)
Drug Dose per hour = Rate (mls per hour) × Concentration
Fluid Calculations
Fluid Rate in mls per hour  Total fluid Volume (ml)

Time (hour)

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General Nursing Orientation (GNO)

Medication administration reading material

Welcome to KFSH&RC Gen Org,

We hope that the content of this package is helpful for you.

Updated 2016 Page 2

International Patient Safety Goals

Goal (1) Identifying Patients Correctly

 Patients are identified by full

Goal (2) Improve Effective Communication

Goal (3) High-Alert Medications

 Two nurses will double check the full six rights of

Updated 2016 Page 3

Updated 2016 Page 4

Updated 2016 Page 5

Goal (4) Prevent Wrong Site, Wrong

 Make sure site marking is done on patients prior

Goal (5) Prevent the Risk of Hospital-Acquired Infections

 World Health Organization (WHO) ‘Five

Moment 1. Before touching a patient

Updated 2016 Page 6

Goal (6) Prevent Harm Resulting From Patient Falls

These are the common medications you should be familiar with:

1. Insulin and oral hypoglycemic agents (OHA)

Updated 2016 Page 7

Commonly Used Abbreviations

IM Intramuscular Ac Before meals tsp Teaspoon

NOTE: ml – milliliter is approved for documentation only and is not to be

For more information on the approved abbreviations, please visit

 BEWARE OF ABBREVIATIONS, USE ONLY THE APPROVED ONES

 Using unapproved abbreviation puts the patient at high risk for

Updated 2016 Page 8

Updated 2016 Page 9

Medication Administration Process

NURSE CHECKS MEDICATION FOR

ALL ARE OK?

 VERIFY INDICATION FOR

 VERIFY THE PROPER DOSE

 VERIFY WHETHER YOU NEED

CLARIFY WITH PHYSICIAN

Updated 2016 Page 10

Medication Administration Process

MEDICATION ADMINISTRATION TIME AT BEDSIDE

IDENTIFY PATIENT CORRECTLY BY

COMPARE MEDICATION’S NAME ON

PERFORM THE CHECKS ON THE

YOU NEED TO CHECK THE SIX

SIGN YOUR INITIALS ON THE MAR,

Updated 2016 Page 11

Tips to Prevent a Medication Error

Read medication label carefully, some medication are packaged in similar

Some medications have similar sounding names. Legible documentation on ICIS

Lasix (Furosemide) Losec (Omeprazole)

Lanoxin (Digoxin) Lemoxin (Cefuroxime)

ADD THE FIGURE (0) BEFORE THE DECIMAL

0.125 mg DIGOXIN AND NOT .125 mg

Updated 2016 Page 12

1. Unfamiliar With the Medication

2. Patients With Similar Names

Always remember to identify patients correctly by name and medical record

PREPARE AND DISPENSE ONE PATIENT’S

Remember the 6 Rights of Medication

Updated 2016 Page 13

Use your critical thinking!!!!

My patient is on 50 mg of Warfarin. Is that OK?