PAASS - What to Know Before Giving Medication
Just because a medication is ordered by a physician/NP and prepared by a pharmacist doesn't mean it's correct. Patient safety ultimately lies with the last line of defense before administration - the nurse. Being knowledgeable of drug class, action, dose range & other important information can prevent potential medication errors and adverse events.
P - Purpose
What does this medication do? What ailment or disorder is it meant for? Knowing the purpose of the drug you're about to give is the most basic yet vital piece of information. It holds the key to how you will proceed with administration and assessment going forward. It can also provide your first red flag. Your patient is here for an asthma flare but this is a potent diuretic. Wait, huh? Hold on…
Many drugs can sound and look alike, despite efforts like capitalizing part of the drug name. To give you an idea of just how many medications are reported as being confused with one another, see the complete list by The Institute for Safe Medication Practices here.
Was it a DTap or TDap immunization you were supposed to give? Did he say alprazolam or lorazepam? Take a moment to stop, clarify & reassess. You will never regret it.
How does this drug work? If you can identify the mechanism of action you can predict many of the potential side effects and reactions that could occur. For example: If you’re treating hypertension with a loop diuretic it’s helpful to know where & how these drugs work in the body - leading you to further monitor the patient for dehydration, hyponatremia, hypokalemia & hypomagnesemia.
Drugs only work as intended when given correctly. The action of the medication relies on proper route of administration. So make sure that painful IM injection you’re about to give was ordered correctly and shouldn’t be subcutaneous instead!
A - Adverse Effects
Knowing the possible side effects can ensure you are prepared to treat them. Does administration of this particular drug have a potential for anaphylaxis? If so, you can be prepared by having a corticosteroid, antihistamine, H2 blocker and epinephrine available at bedside before you start. Adverse effects can vary ranging anywhere from nausea and headache to edema and changes in cardiac rhythms.
S - Safe Dosage Range
Is the dose ordered within the appropriate range? Dosages can come in many forms: milliliters, drops, grams, milligrams, micrograms, etc. Some are based on weight: mg/kg, ml/kg, or even based on body surface area. Being comfortable with unit conversions and drug calculations are crucial. Don’t just assume the math is correct because the pharmacy label says so. Check it yourself. Utilize available resources such as the drug pamphlet insert (provided with the medication, ask your pharmacist), an in-print/online medication handbook or your hospital's online medication database (if available).
S - Special Nursing Considerations
Does this drug require frequent monitoring of vital signs? For example, some drugs may cause a sudden drop in blood pressure so taking a set of vitals at the fifteen minute mark is necessary. This is also a great time to think about what patient/family education you’ll provide. For example, your patient was prescribed Pyridium for a UTI - let them know their urine might turn reddish orange! Or maybe the medication you’re giving can cause delayed excessive hiccups, bruising or even hives. Do they need to increase fluids or avoid alcohol, avoid direct sunlight? The list goes on and obviously differs with each drug, but whatever the follow up - be sure your patient is educated and leaves prepared to monitor themselves accordingly.
Truth be told, I once came quite close to making a potentially fatal medication error. Our hospital did not have a policy on double checking insulin, however being an outpatient adult oncology unit, administration of insulin was rare. So we all double checked with each other, just in case. Our open box of TB syringes were located directly next to our insulin syringes. I had a few years of experience under my belt.
I grabbed what I thought was an insulin syringe out of the correctly marked box, drew up the ordered amount and asked a seasoned nurse to double check me. I told her the ordered dose. She quickly eyeballed the vial & syringe and gave her blessing. I walked less than twenty feet, over to the patient's chair. Something in my gut didn’t feel right. I opened the alcohol swab, prepped the site for administration. Still a pang resonated in my gut. I stopped, excused myself. Exited the room and tried to find another nurse to double check. It was a first year nurse that caught my mistake. “That looks like a lot. Is that an insulin syringe?”. It wasn’t. Always double check, even triple check... especially when something doesn’t feel quite right.
About Ashley Hay, BSN, RN
Over 10 years of nursing experience in several areas of pediatric & adult oncology including clinical research, chemotherapy, transplant, hematology, proton therapy, GI surgery, wound care, post anesthesia recovery, etc.
Ashley Hay, BSN, RN has '10' year(s) of experience and specializes in 'Oncology'. Joined Aug '16; Posts: 48; Likes: 143.Apr 28In SNFs, the average patient takes 25 medications every morning. The average nurse to patient ratio is at least 15:1. Do the math. If the nurses did the PAASS with every medication, the pass would take more than a day. Certainly it's important to know what drugs we are administering and why but reality is reality.Apr 28Quote from CapeCodMermaidCouldn't agree more with you...as a seasoned nurse. Most of us have given a variety of meds many, many times over the years, so we become familiar - and when you don't know, you look them up. But, let's not forget how overwhelming it was as a new nurse, expected to know and administer all of these drugs and having little to no experience with them. For me personally, it took hands on experience and circumstance to put it all together and have it stick. I frequently found outlines/mnemonics like this helpful when starting out and hope others will as well.In SNFs, the average patient takes 25 medications every morning. The average nurse to patient ratio is at least 15:1. Do the math. If the nurses did the PAASS with every medication, the pass would take more than a day. Certainly it's important to know what drugs we are administering and why but reality is reality.Last edit by Ashley Hay, BSN, RN on Apr 29Apr 29What I´m talking about on my job all day.
The 6-R´s are not the end of our responsibilty.
(Right patient, Right med, Right time, Right dose, Right application, Right dokumentation and that´s it)
Having the an idea, what you have in your hands and you do to your patients ...
I agree with PAASS all day long. But the key ist the money.
- If I like to have currant informations about med´s --- My personal problem.
- Enough qualified personal --- ROFLLast edit by Elfriede on Apr 29
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