Dosage Forms & Medication Administration: Nursing Considerations

1. What Do We Know About The Nature and Prevalence of Oral and Transdermal Dosage Form Alteration?

This chapter will review what is published in medical literature about inappropriate oral and transdermal dose alteration. The literature is scarce about this topic, and this chapter will discuss the known prevalence and challenges in defining acceptable versus unacceptable dosage form alteration. Nursing professionals have been charged with administering doses, measuring their effects and outcomes, and managing adverse effects. Nursing and ARNP professionals are in a unique position to influence this aspect of clinical therapeutics because they know more about drug administration than any member of the health care team. The discussion about the hidden nature of the problem of altered dosage form is specifically included to heighten awareness in this unique stakeholder among health care professionals.

2. Understanding Drug Dosage Form Design and FDA Dosing and Administration Recommendations

This chapter helps the learner understand what constitutes administration of drugs outside of FDA dosage and administration recommendations. Examples of common drug dose alteration practices will be discussed, with an in-depth comparison of FDA and compendium (e.g., Mosby’s®, Lexicomp®) drug dosing recommendations.

3. Dynamics Surrounding Real-Life Drug Action and Performance Under Altered Dosage Conditions

After completing Chapter Two, the learner is ready to look at some case studies in altered dosage form drug administration. We will look at three cases involving inappropriate dosage and administrations and alterations, including crushed tablets, altered capsules, and considerations for transdermal dosage forms.

4. Capturing The Effect of Altered Dosage Forms in Your Practice

This chapter will discuss the status of clinical practice in addressing altered drug dosage forms and administrations. The challenges associated with overlooked appreciation and assessment of altered dosage forms and administration are many. Often, the alteration of dose or aberrant administration is not even recognized as out of the ordinary or as a clinical risk. Whether the alteration in dosage is recorded or even recognized varies from institution to institution, and in the outpatient setting, the practice is typically not part of the clinical assessment unless the patient is injured or hospitalized as a result of some treatment failure or adverse event involving the medication that was inappropriately altered.