DRUG ADMINISTRATION

GREETINGS and ASKING FOR HELP

Nurse 1 : Good morning, Linda.
Nurse 2 : Good morning, Tom.
Nurse 1 : Can you help me?
Nurse 2 : Sure. What can I do for you?
Nurse 1 : Im going to administer this medication to Mr. William Jamison. I need your help.
Nurse 2 : Okay. Lets begin.

RIGHT PATIENT: Name, bed number, ID band/bracelet, date of birth

Nurse 1 : Lets start with the name. The name is William Jamison in Bed 2. ID bracelet is 005012.
Nurse 2 : Patients name, William Jamison, Bed 2 and ID bracelet 005012. Ok. Confirmed.
Nurse 1 : Good. His date of birth is July 10, 1965.
Nurse 2 : William Jamisons date of birth is July 10, 1965. Correct.
Nurse 1 : Lets look at the medication order. Does it match the patients ID?
Nurse 2 : Let me check. Yes. The medication order matches the patients ID.
Nurse 1 : Good. Lets continue.

RIGHT MEDICATION: Drug name/label

Nurse 1 : The drug name is paracetamol.
Nurse 2 : Yes. Its paracetamol. P-A-R-A-C-E-T-A-M-O-L.
Nurse 1 : Paracetamol. Confirmed. Lets check the medication order. Does it match the drug?
Nurse 2 : Here is the medication order and here is the drug. They match.

RIGHT DOSE: Dose

Nurse 1 : Next, lets check the dose. The dose is 500 mg.
Nurse 2 : The label on the drug says 500 mg.
Nurse 1 : Now, lets check the medication order. It says 500 mg.
Nurse 2 : So, they match.

RIGHT TIME: Drug administration time and frequency

Nurse 1 : The paracetamol should be administered three times a day, after meal. Can you check with
the label?
Nurse 2 : The label says three times a day after meal. Checked.
Nurse 1 : Lets check the medication order. Okay, three times a day after meal. Confirmed.

RIGHT ROUTE
Nurse 1 : Next, we will check the route.
Nurse 2 : According to the medication order, it should be administered per oral.
Nurse 1 : Okay. Checked.

RIGHT DOCUMENTATION
Nurse 1 : We have completed the preparation. I will sign here. Now, its your turn. Can you sign there?
Nurse 2 : Okay. I will sign here. There you go.

CLOSING
Nurse 1 : Thank you, Linda. Appreciate your help.
Nurse 2 : Youre welcome. Its my pleasure.
NURSE-PATIENT PRE-OPERATIVE COMMUNICATION
1. GREETINGS, INTRODUCTION AND PURPOSE OF VISIT

Nurse : Good morning, Mrs. Smith. How are you feeling today?
Patient : Good morning, Nurse. Im okay.
Nurse : Very good. Im going to ask you some questions to make sure youre ready
for the surgery. So, just relax, okay?
Patient : Okay. Im ready.
2. LEGAL CHECK-LIST: CHECKING ID, QUESTIONS, AND INFORMED CONSENT

Nurse : Good. First, let me confirm your ID.

Can you say your name and date of birth, please?
Patient : My name is Linda Smith. My date of birth is March 24, 1970.
Nurse : Thats confirmed.
Has dr. Goblet given you the information about your surgery?
Patient : Yes, he came to see me last night.
Nurse : Okay. Do you still have any questions about your surgery?
Patient : Well how long will the surgery last?
Nurse : It is scheduled to last for one hour.
Patient : One hour? Okay.
Nurse : All right. Did you sign the informed consent?
Patient : Yes, I did. I signed it last night after the doctors information.
Nurse : Good. Is this your signature?
Patient : Yes, its my signature.
3. MEDICAL AND NON-MEDICAL CHECKLIST

Medical Check list: Allergies, food and drink

Nurse : Next, Im going to ask about your allergies. Do you have any drug allergies?
Patient : Yes. Ultram.
Nurse : Ok. Ultram. What about any antibiotic allergies?
Patient : No. I dont think so.
Nurse : Good. Did you eat any breakfast this morning?
Patient : No, I didnt. Ive been fasting since last night.
Nurse : Good. You have to empty your stomach at least 8 hours before surgery.

Non-medical checklist: Dentures, contact lenses, hearing aids, make up, nail polish, jewelry

Nurse : Do you have any dentures in?

Patient : No, I dont have any.
Nurse : Are you wearing contact lenses?
Patient : No. I have taken them off.
Nurse : Good. And, what about hearing aids?
Patient : No. I dont wear any hearing aids.
Nurse : All right. I can see you dont have any make up on. What about nail polish?
Patient : No. Nurse Linda, helped me to remove it this morning.
Nurse : Okay. Do you wear any jewelry like rings, earrings, or necklace?
Patient : No, everything is out.
Nurse : Does your family keep the jewelry?
Patient : Yes. I gave them all to my family to keep.
Nurse : Good.

4. CLOSING

Nurse : Do you still have any questions about your surgery?

Patient : Hmm. When can I eat and drink again after surgery?
Nurse : After the surgery, your intestines are still sleeping. You can eat after the
intestines are active again, that is, after you pass gasses or after you can
hear rumbling noise from your stomach.
Patient : Okay. Thank you, Nurse.
Nurse : Youre welcome. It seems that you are ready for surgery.
Patient : Thank you, nurse.
Nurse : All right. The operating team will take care of you now.
Dont worry. Youll be in good hands.
MODEL DIALOG (POST)
GREETINGS AND PURPOSE OF VISIT
Nurse : Good afternoon, Daniel.
Daniel : Good afternoon, Nurse.
Nurse : Im Mary. Ill be your nurse this afternoon.
Daniel : Hi Mary.
Nurse : How are you feeling today?
Daniel : I have a little bit of pain down in the area where the operation was.

PAIN ASSESSMENT
Nurse : Hows the pain? Throbbing pain, sharp pain?
Daniel : Its very sharp pain.
Nurse : Sharp pain? Okay. Let me check the wound.
Daniel : How is it? Is there anything wrong with the wound?
Nurse : The wound area looks red, but that is usually normal after a surgery.
When do you feel the pain?
Daniel : When I move, I feel a sharp pain.
Nurse : I see. Here is a pain chart. 0 is no pain; 1-3 is mild pain; 4-6 is
moderate pain; 7-10 severe pain. Whats your pain level?
Daniel : Around 6 or 7. Can I get something to reduce the pain?
Nurse : Ill check your chart to see if the doctor has prescribed medication
for your pain. Yes. He has prescribed a pain killer for you.
Daniel : Okay. Is there anything wrong with the wound?
Nurse : We dont have to worry about it right now. We will have to talk to
the doctor and see what he has to say about your pain.
Daniel : Alright. So, when can I get the pain killer?
Nurse : Ill get it for you.

GIVING MEDICATION
Nurse : Hi Daniel. Here is the pain killer. Let me help you take the medicine.
Daniel : Okay. Thanks.
Nurse : This medicine will help reduce your pain.
Daniel : Good.
CLOSING
Nurse : Okay, Daniel. Do you need anything else?
Daniel : No. Thank you. Im okay.
Nurse : Im going to visit other patients. Ill be back to check on you in an
hour. But if you need any help before then, just press this bell.
Daniel : Okay, Nurse.
Nurse : See you in an hour.
Handling angry patients

Nurse : Good afternoon, maam. Did you press the bell?

Patient : Yes. (angry)

Ive been pressing the bell many times.

But there seems to be no response at all.

Why is the service very slow in this hospital? Slow response.

Nurse : Im sorry about that, maam.

I have just returned to the nurse station after an emergency call to help a patient in another
room.

Patient : Shouldnt there be a stand-by nurse at the nurse station?

Nurse : Some nurses are taking their patients for lab tests. Some are administering medication to
patients. Im the stand by nurse, maam.

Again, sorry for the inconvenience. What can I do for you, maam?

Patient : I need to go to the bathroom.

I need help getting down from the bed.

Ive been pressing the bell for a long time.

Nurse : Okay, maam. Let me help you.

Patient : Thank you. Next time, please respond quickly.

Nurse : We will maam.

BREAKING BAD NEWS
Situation: A patient comes to the out-patient clinic to get the biopsy result that was done the day
before.

SETTING UP THE INTERVIEW: Greetings, Introduction, seating arrangement and ID confirmation

Nurse Good morning. Are you Mary Smith?
Client Yes, Im Mary Smith.
Nurse Hi. My name is Betty. Im the nurse working in the clinic today.
Client Hi, Betty.
Nurse Come in. Please have a seat. Lets just move a little closer together.
Client Ok. Thank you.
Nurse May I know your full name, maam?
Client Sure. My names Mary Samantha Smith.
Nurse And, whats your birth date?
Client June 10th, 1955.
Nurse Okay. Thanks. The reason Im asking is to make sure you are the correct patient.
Client Okay. I understand.

PERCEPTION OF PATIENT: Identifying the Perception or expectation of patient about the news
Nurse So, Mary. Can you tell me why you are here today?
Client I had breast biopsy a week ago. So, you knew that, right?
Nurse Yes, I did. I just want to see your expectation for being here today.
Did you speak to your family doctor before coming here today?
Client No, I didnt. She is on vacation, so I havent had the chance to do it.
Do you have some information?
Nurse I do. Yes, I do. I just want to see if your doctor has given you any information at all
before I talk to you. Let me get the information here.
Client Okay.

INVITATION: Invite patient so share his/her opinion on how to receive the news: details or conclusion
Nurse I have this paper with me right here. Do want someone to be with you before I share
the result?
Client I came alone. Is this the pathology report?
Nurse Yes, this is the pathology report from the biopsy that you had.
Client There is a lot of information in the report.
Nurse Thats right. We have a lot of details here. Do you want me to explain each detail or just
go down to the conclusion of diagnosis?
Client Just give me the diagnosis for now.
KNOWLEDGE: Give the diagnosis and help patient to understand it.
Nurse Now. Lets go down to the very bottom part here to the diagnosis.
Client Okay. What does the MRI result say?
Nurse Maam, I wish I had better news to share with you, but Im sorry to tell you that
according to the result, you have a breast cancer, a breast carcinoma cancer.

EMOTION: Manage the patients emotion, and empathize with them

Client What? Cancer? Why me.? (Crying)
Nurse I understand this is not easy for you, maam.
Do you want me to call someone to talk to you now?
Client No, thats okay my husband is out of town. Just give me some time to calm myself
down.
Nurse Okay, maam. Just tell me if you need anything. Ill bring you a glass of water. Here it is.
Client Thank you, nurse.

STRATEGIES: Recommend follow up strategies to take

Nurse Okay. The plan today is first of all to inform you. Then, to help you see some options
that you can take.
Client Okay. There are still possible options for me to take?
Nurse Yes, maam. The doctor would like to see you, and examine you and explain some of
the options like surgery.
Client I see. What kind of surgery?
Nurse You also have to see a surgeon who will examine you and explain some surgical options
to you. There are choices that you can make. Whatever choice you make is good with
us. Are you doing okay for now?
Client Im okay.
Nurse Im going to help you to change your clothes for the examination. This way, please.
Client Okay. Thanks.
 COMMUNICATION AT PATIENTS DISCHARGE
No Health education point Language Expressions
1 Follow up appointment (Doctor) You need to see dr. (name)
dates and time (Purpose) To change your wound and to get information
of follow up treatment.
(Day, date, Time) You need to see your doctor (name)
on (day, and date) at (time).

For example:
You need to see dr. (name) to (purpose). Your next doctor
appointment is on (day, and date) at (time).

2 Medication teaching You have three types of medicine that you need to take
and schedule at home.

(name of drug) The first one is the antibiotic.

(purpose) It is for preventing infection.
(dose) Take one capsule
(frequency) Take it three times a day
(condition) Take it after meal.

3 Self-care (e.g. diet,
wound care, activity)
(Diet) Please limit consumption of liquid and glucose-
contained food.
(Wound care) You need to change your wound dressing
at least once a day.
(Activity) Please limit your physical activities. Dont
carry heavy burden. Watch your steps to avoid falling.

4 Symptom management (pain) If you feel pain in the area where the surgery was,
at home (e.g. pain, please consult the doctor. While waiting for the doctors
nausea, short of appointment, you can try the deep breathing technique.
breath)
(nausea) When you feel like you want to vomit, relax,
take a deep breath, and drink warm water.

(short of breath) Raise the position of the head with

pillow or other support. Then, practice the deep
breathing technique.