Handwashing for drug administration & NVA

Posted
by cazrella (New) New

I have an upcoming practical exam where I need to administer an oral medication using the 6 rights of medication administration and do a neurovascular assessment using the 5 Ps. I'm aware of the 5 moments of hand hygiene but I'm still unsure when to perform it for these two situations...

Drug administration:

Before touching patients identification band (to check it's the right patient)

After touching patient identification band

Before touching medication bottle

After touching medication bottle

Before documentation

After documentation

Am i missing more? (What if I touch the medication chart?) Or do you just wash hands before and after giving the drug (I won't be touching the drug, so I won't be using gloves)

Neurovascular assessment?

Before touching patient's hand

After touching patient's hand

Should I wash my hands before and after I document each of the 5Ps?

I'd really appreciate some feedback. I don't want to fail! Thanks :)

mrsboots87

Specializes in Neuro, Telemetry. Has 7 years experience. 1,761 Posts

You do not need to wash your hands nearly that much. Wash when entering the room. Check arm band. Put on gloves. Do any required assessments with gloves on. Remove gloves. Use pen to not on chart or whatever you need. Wash hands when leaving room. In med room, you do not need to wash unless you soiled your hands on the way, or will need to have direct contact with a drug which is unlikely. So since you washed before leaving the patient room, you are fine. If its and IV or INJ med set up, you would wash and then put on gloves. But since its just a PO, you pull the med from the med card. If its in an individual package, take the whole thing to the room. If its in a card or bottle, then pop the pill into the med cup and take the med cup with you. Then when entering the patient room, wash hands, do your third check. Give med to patient following the med admin procedure you will be graded on. Then wash hands as you leave. Basically, you just wash before and after patient contact or donning/doffing gloves or when entering exiting a room. The only other reason to wash in the middle of care or when pulling a med is if you have somehow contaminated your hands and would risk contaminating the med without washing. Dont overthink it.

mrsboots87

Specializes in Neuro, Telemetry. Has 7 years experience. 1,761 Posts

Also, for testing in school, you will be wearing gloves during an assessment. And you can keep those gloves on the whole time, unless your touch yourself or something dirty. At which point, you just change your gloves. You dont actually wash again. In the real world, unless you will be assessing a dirty area of the body, or an infectious person, you may not wear gloves. In these situations it would quite rude to wash your hands after every patient touch. Also, why do you need to document each of the 5Ps individually. You would not do this in real life. You would go in and do your entire assessment. Then come out and note or chart afterword. Dont waste your time, doing part of the assessment, then noting, then more assessment, then noting. Because yes, you will need to wash your hands or cahnge gloves every time you pick up your men to note. Thats a huge waste of time and by the time you get out your hands will be raw from all that sanitizer.

cazrella

6 Posts

@MrsBoots87, thanks for replying with helpful comments :)

However, with the oral drug administration we aren't required to wear gloves as we won't be 'touching' the medication-rather transferring it from the medication cap to the medication cup to give the patient. The medication bottle is kept in the patient's drawer for the assessment. The chart is by the bed and we sign off in the room. I understand it might be different than compared with the clinical setting but with this set-up I wash my hands (hand gel) when entering the room and after I exit the room? But I don't need to wash it after I touch the patient's arm band to check it's the right patient or before/after touching medication bottle?

With the NVA, all the student's have recorded each P on the observation chart as they go along. I understand in the clinical setting you do your procedure then document everything at the end? For the purposes of my assessment, we are required to ask the patient for consent and then go grab the observation chart and then do the NVA (the chart will be next to us). Student's have been writing down the results one at a time, doing hand hygiene(hand gel) before and after touching patient...Rather, I should ask for consent (patient will be in 'room'), exit room and grab NVA chart, enter room, do hand hygiene, assess patient's hand for NVA, wash hands, document all 5 Ps, then also wash hands on exiting room? (we document in room)

Is this more on par now?

NurseGirl525, ASN, RN

Specializes in ICU. 3,663 Posts

I've always had to wear gloves when doing med passes. I've gotten quite good at opening those stupid packs with my gloves. I've also never seen documentation done in the room. At both of my facilities computers were either in wall in the hallways or we used what is called a cow (computer on wheels) but it was not allowed in the rooms due to possible contamination. Lots of people have mrsa these days.

It's going to be hard for people to help you here because it sounds like you do it way different than I do. I walk in the room, wash hands, scan, put gloves on, administer meds, take off gloves, and wash when I leave, then I document in the hallway outside the patients room. I also get my assessments done before I even pull the meds so that's a whole other thing. If an assessment needs done afterwards, depending on the route of the drug I may reassess 15-30 min after I have administered the med.