By: Norazura binti Selamat

Jururawat U32 (KUP)

1.Right Medication
Pastikan ubatan yang betul: semak BHT dan carta
pengubatan pesakit.

2.Right Patient
Pastikan pesakit yang betul: semak BHT
Semak tag bayi.

3.Right Route
Pastikan tempat yang betul: semak BHT dan carta
pengubatan pesakit.

4.Right Dose
Pastikan dos yang betul: semak BHT dan carta
pengubatan pesakit.
5.Right Time
Pastikan masa yang betul: semak BHT dan carta
pengubatan pesakit.

6.Ensure Responsibility
Pastikan tanggungjawab: tarikh luput ubatan.
Tiada kemerahan, tiada kebengkakan, tiada
‘leaking’ di tempat intervena.

7.Ensure Record
Pastikan rekod: semak BHT dan tandatangan di
ruangan yang betul di dalam carta pengubatan
pesakit.
 Vit K prevent neonatal hemorrhage during first few
days of life before infant is able to produce Vit K
administration
 For term baby: 1mg - IM
 For preterm baby: 0.5mg – IM

Site: Anterolateral thigh / vastus lateralis muscle

Never give an IM injection in buttocks. Using the vastus
lateralis muscle avoid the risk of sciatic nerve damage
from gluteal injection. Also, the vastus lateralis muscle
has a larger muscle mass than the gluteal region and
therefore has reduced risk of severe local reaction. The
deltoid in infant is not insufficiently bulky to absorb IM
medication adequately. The vastus lateralis muscle
avoid the picker layer of subcutaneous fat on the
anterior thigh.
 Vaccine Hep B dose 1

 Hep B immunoglobulin
- dose 100unit IM = 0.5ml
- to give as soon as possible within 24 hours
- give at the different site of Vaccine Hep B
dose 1
Brand Name Penicillin G

Drug Type Antibacterial

Indication Many gram positive organisms especially B haemolytic

streptococcus, clostridium welchii and tetani. First line drug in
congenital syphilis. Penicillin or ampicillin and an
aminoglycoside [gentamycin] are recommended for the
treatment of suspected early onset sepsis.
Presentation 1 megaunit

Method IV stat

Dose 100 000 iu /kg

BD dose at 1st week of life.
After 7th days of life TDS Dose. For meningitis + GBS +ve QID
Dose.
Dilution 2mls  1 megaunit
Administration Slow injection at proximal cannula site. Give one hour prior to
the administration of gentamycin unless a gram negative
infection is suspected – then administer concurrently with
gentamycin. Flush line well.
Brand Name Garamycin
Drug Type Antibacterial
Indication Treatment for gram negative bacillary infections.
Gentamycin is used in combination with penicillin for
early onset sepsis or with flucloxacillin or vancomycin
for late onset sepsis before antibiotic sensitivities are
known.
Presentation 80mg / 2ml
Dose Weight

5mg /Kg 48 hourly < 1.2 kg

5 mg /Kg 36 hourly 1.2kg to 2.5 kg

5 mg /Kg 24 hourly >2.5 kg

Dilution Add 0.5ml (20mg) of gentamycin to 9.5mls normal

saline or 5% dextrose to give a 2mg/ml solution.
Administration IV infusion over 30 minutes

Drug Type Antibacterial

Side Effect Ototoxic and nephrotoxic particularly when used in

conjuction with frusemide. Serum level should be
measured if drug given longer than 48 hours or earlier
when renal fuction is compromised. The dose interval
may be increased if there is renal impairment.

Other Gentamycin is given at varying intervals depending on

Consideration birth weight and renal function of infant – please read
medication order carefully. Monitor urine output and
report concerns to medical staf.
Brand Name Vasopressor

Indication Oliguric prerenal failure.

Persistent pulmonary hypertension of newborn.
Cardiocirculatory failure.

Presentation 200mg / 5ml ampoule

Method IV infusion

Dilution Solution with normal saline or 5% dextrose

Administration Syringe pump infusion.

Side Effects Tachycardia

Other Infant must have continuous ECG and BP monitoring.

Considerations Monitor oxygen requirements. Monitor urine output.
Monitor IV stat carefully – tissue ischaemia can occur
with infiltration – preferable to have central access.
Do not flush line or suddenly stop infusion
Brand Name Dobutrex

Drug Type Vasopressor

Indication Circulatory failure

Action Positive inotropic agent and peripheral vasodilator

Presentation 250mg vial
Method IV infusion

Administration Syringe pump infusion. Must be administered as a

continuous infusion due to its short half life.
Solution is stable for 24 hours.

Other Infant must have continuous ECG and BP monitoring.

Considerations Monitor oxygen requirements. Monitor renal output.
Preferebly given through a central line. Do not flush
line or suddenly stop infusion.
Brand Name Adrenalin - Inotrope

Drug Type Vasopressor

Indication Acute circulatory collapse. Hypotension and circulatory failure

resistant to other drug management.
Action Stimulate alpha and beta receptors causing increased heart rate;
increased myocardial contractility, i.e. it has positive inotropic
effect with low dosage. High dosage will increase systemic vascular
resistance and systemic vasoconstriction.
Presentation 1mg / ml
Method IV infusion
Dilution 5% dextrose or normal saline
Administration infusion via syringe pump

Side Effects Cadiac arrthymia, renal vascular ischaemia, severe hypertension

with possible intracranial haemorrhage, increases myocardial
oxygen consumption. Therapeutic doses may cause hypokalaemia.
IV infiltration will cause tissue ischaemia and necrosis.
Other Considerations Infant must have continuous cardiac and blood pressure monitoring.
Effectiveness of drug is increased if acidosis is corrected prior to
administration.
Drug Type Vasopressor

Indication Heart rate less than 80/minute despite ventilation with 100% oxygen
and external chest compression.
Action Stimulate alpha and beta receptors causing increased heart rate;
increased myocardial contractility that has positive inotropic effect
with low dosage. High dosage will increase systemic vascular
resistance and systemic vasoconstriction.
Presentation 1mg / ml
Method IV or ETT
Dose 0.1 – 0.3ml/kg
Dilution Intravenous administration – dilute 1:10 with normal saline.
Administration Rapid injection via proximal cannula site / tracheal administration
rapid insertion followed by effective ventilation to disperse the drug.
Can be repeated several few minutes.

Side Effects Cadiac arrthymia, renal vascular ischaemia, severe hypertension with
possible intracranial haemorrhage, increases myocardial oxygen
consumption. Therapeutic doses may cause hypokalaemia. IV
infiltration will cause tissue ischaemia and necrosis.

Other Considerations Monitor heart rate. Maintain patency and position of endotracheal
tube. Document sequence, amount and type of medication given.
Drug Type Sedative

Indication Sedation during mechanical ventilation in conjunction with

a narcotic if analgesia is indicated. Midazolam maybe given
alone for its sedation properties. May also be used as
anticonvulsant.

Presentation 15mg / 3ml ampoule.

5mg / ml

Method IV infusion

Administration Continuous intravenous infusion.

Other May cause respiratory depression – Infant must have cardio

Considerations respiratory monitoring. May cause hypotension.
Drug Type Analgesic

Indication Used as an intravenous infusion for analgesia and sedation in

ventilated babies

Action Narcotic analgesia – stimulates brain opioid receptors. GIT

secretions and motility decreased. Increases smooth muscle tone.
Elimination half life is approximately 9 hours in preterm infants.

Presentation 10mg/ ml ampoule.

Method IV infusion
Dilution With 5% dextrose or normal saline.
Administration Syringe pump continuous infusion.

Side Effects Respiratory depression – decrease response to CO2 tension. Apnoea.

Urinary retention. Hypertension. Seizures. Reduced gut mobility.
Prolonged use >5 -7 days maybe associated with dependence.

Other Considerations Observe for signs of respiratory and cardiac depression – continuous
cardio-respiratory monitoring mandatory. Observe for urinary
retention. Observe for abdominal distension or delay in passage of
stool. May be reversed with Naloxone.
Brand Name Actrapid HM

Drug Type Hormone

Presentation 100units/ml injection.

Method IV infusion

Dilution Make a 4 unit/ml stock solution by diluting 0.4ml of

100 unit/ml to 10ml with WFI. Then dilute as
ordered by doctor.

Administration Administration by infusion using a syringe pump.

Do not flush infusion – infant will receive a bolus
dose.
Change infusion 24th hourly.
Follow sliding scale for the baby.
Multivitamin
- Start at day 14 of life.
- Dose 1mls.
- Daily.

Folate
- Start together with MVT.
- Dose 0.1mg.
- Daily.

FAC (Ferric Ammonium Citrate) 400mg/5ml,

elemental iron : 86mg/5ml
- Start at day 28th of life.
1. Sediakan troli ubat – bersihkan,kemas
2. Pastikan peralatan lengkap
3. Pastikan ubat mendapat arahan daripada HO,MO (nama,tanda
tangan,tarikh mula ubat) dicatat dalam medication chart sama
dalam BHT pesakit.
4. “Verbal Order” hanya boleh disediakan hanya ketika
emergency.
5. Pastikan ubat-ubat pesakit yang telah dipesan dibekalkan oleh
farmasi.
6. Inform HO/MO jika ubat yang diperlukan tidak disediakan oleh
farmasi.
7. Pastikan tanda-tanda vital diambil terlebih dahulu.
8. Elakkan sebarang conversation semasa menyediakan ubat.
9. Kira dos ubat dengan tepat dan jika ada keraguan, rujuk pada
doctor/ staffnurse senior.
10. Cuci tangan sebelum menyediakan ubat -ubatan
Gunakan prinsip 7R dalam pemberian ubat:
 Right patient
 Right medication
 Right dose
 Right route
 Right time
 Ensure Responsibility
 Ensure Record
Jumlah dos ubatan = dos diperlukan x isipadu ubat
kekuatan ubat

Contoh :
IV C. pen 250 000 iu BD

250 000 x2
1 000 000

= 0.5 mls
1.Catat dalam carta ubat untuk elak
pemberian berulang.
2.Perhatikan kesan sampingan ubat jika ada.
3.Perhatikan samaada infiltrasi atau flebitis di
tempat suntikan.
 Prepare medication for one patient at a
time.
 Do not label the medicine by patient room
number or bed number.
 Narcotics are to be checked by every shift
and the narcotic cabinet must be locked.
1. Mengaplikasikan amalan 7R pada setiap
masa pemberian ubat.
2. Sentiasa memberi penerangan kepada
pesakit.
3. Rujuk arahan bila memberi ubatan yang
baru atau tidak pasti.
4. Selalu merujuk kepada staff senior atau
Pegawai Perubatan/Pegawai Farmasi jika
ada keraguan.
5. Mematuhi Ordinan Dadah Berbahaya dan
Peraturan-peraturan (Akta Dadah
Berbahaya Akta 340)
1. Pemberian ubat adalah satu tugas utama
jururawat.
2. Tanggung jawab jururawat untuk mematuhi
pemberian ubat-ubatan dalam keadaan
selamat.
3. Gunakan proses dan amalan prinsip 7R
untuk mengelakkan berlakunya kesilapan
pemberian ubat.