Medication Administration

Steps for ANY Medication

  • CHECK MAR (Medication Administration Record)
  • CHECK ORDER
  • CHECK TIME
  • WASH HANDS
  • GET MED: COMPARE MED TO MAR
  • CALCULATE ANY DOSAGES
  • CHECK EXPIRATION DATE
  • TAKE TO PREP ROOM OR PATIENT ROOM
  • PREPARE MEDS – MAKE SURE HAVE THEM ALL
  • DO A SECOND CHECK
  • Take to bedside
  • Identify patient – 2 forms of ID: 22 forms of ID
  • Third and final check (D3PRT)
  • Pre-assess if necessary
  • Tell patient about the med you are giving
  • Give med
  • Stay until patient takes med
  • Document… if not, someone may duplicate!

Other Considerations

  • Do NOT pre-document
  • Chart the effects of the medication
  • If medication is NOT given - chart why
  • Chart route/site given
  • Follow up…
  • Always document follow-up for PRN meds

What if…

  • Patient says “I don’t take that medication?”
  • That looks different than the one I take?
  • Expired?
  • Refuses?
  • Illegible order?
  • Medication not available?

Medication Reconciliation

  • (Page 5) Overview of reconciling meds to ensure accuracy across transitions of care

Oral Medications

  • Oral medications overview and administration

Oral Administration

  • Easiest and most desirable route
  • Food may decrease therapeutic effect – delays stomach emptying
  • Aspiration precautions
  • Non-invasive
  • Convenient
  • May irritate gastric mucosa
  • Can’t use with nausea, vomiting, difficulty swallowing
  • Slower onset of action

Oral Administration: Tablet, Pills, Capsules; Liquids; Buccal; Sublingual

  • Tablets, pills, capsules
  • Liquids
  • Buccal
  • Sublingual

What should you do?

  • Need a smaller dose than the tablet or capsule?
  • Patient is struggling to swallow?
  • Patient is on a pureed diet?
  • Is there a time when you cannot crush a pill?
  • Patient has multiple pills to take at the same time?

Liquid Medications for Oral Administration

  • Do you shake it?
  • Pour label up
  • Hold at eye level to read
  • High Fowler’s if able
  • Cup vs Syringe
  • This Photo by Unknown Author is licensed under CC BY-NC-ND

Pouring into a cup

  • Identify labeling line to pour to
  • Place cup on flat surface
  • Pour to line
  • Measure at eye level
  • Move face to cup, not cup to face
  • Know what line to measure at

Syringes: Quick Intro

  • Syringe: A device used to draw in or eject either air or liquid
  • Made of plastic or glass
  • Designed for one-time use
  • Packaged separately or with needles of appropriate sizes
  • Hypodermic syringe: syringe fitted with a needle
  • Parts to handle carefully: Plunger, Barrel, Tip
  • Avoid touching parts of syringe
  • Copyright notes and image labels

RULES of MEASUREMENT

  • VOLUME
  • ROUND TO
  • Less than 1 mL → 22 decimal places
  • More than 1 mL → 11 decimal place

Activity 15 Draw up

  • Draw up 0.5 mL0.5\,\text{mL}
  • Draw up 2.5 mL2.5\,\text{mL}
  • Draw up 1.2 mL1.2\,\text{mL}
  • Draw up 5 mL5\,\text{mL}
  • Draw up 4.75 mL4.75\,\text{mL}

Additional Oral Routes

  • Buccal: stays local unless dissolved in saliva – then systemic
  • Alternate Cheeks
  • Sublingual: quick delivery into circulation; bypasses stomach and intestines, avoids absorption problems via GI tract
  • Don’t chew/swallow; If you chew or swallow – won’t have desired effect
  • Avoid eating/drinking with med in mouth

Active Learning Template

  • IStering? or Administering Oral Medication (template shown in the module)

Administering Medications

  • (Overview of steps for administration across routes)

Topical Medications

  • Applied directly to the body surface/body cavity
  • Local effects usually… sometimes systemic
  • Examples: Lotions, creams, ointment
  • Transdermal patches (Systemic)
  • Eyes, Ears, Nasal, Vaginal, Rectal applications

Why would you give a topical medication?

  • To achieve local effect at the site of application
  • Systemic effects possible with certain forms (e.g., transdermal patches)

What would be a concern with a topical medication?

  • Local irritation or skin reaction
  • Absorption variability
  • For patches: potential for overdose if multiple patches are used or if applied improperly

Things to consider

  • Skin condition, integrity, and site suitability
  • Allergies to topical ingredients
  • Patient's age, cognitive status, ability to self-administer
  • Temperature sensitivity and storage requirements

Nasal Medications

  • Most common form: nasal instillation = decongestant spray or drops
  • Used to relieve sinus congestion and colds
  • Caution: avoid abuse; overuse leads to rebound congestion
  • Easier if patient can self-administer (control timing when inhaling and spraying)
  • If used frequently – watch for irritation
  • (This Photo by Unknown Author is licensed under CC BY-NC-ND)

Questions?

  • If patient has a nose bleed?
  • If patient reports tasting the medication?
  • Where should the patient be looking?
  • What should the patient do before administering a nasal med?

Ophthalmic

  • Includes eyedrops and ointments
  • Many are OTC (artificial tears, vasoconstrictors)
  • Prescription drops: often for glaucoma, cataracts, antibiotics
  • Age-related problems (poor vision, hand tremors, difficulty grasping) affect older adult’s ability to self-administer
  • The cornea is VERY sensitive to anything applied to it

Otic

  • Internal ear is very sensitive to temperature extremes
  • Instill eardrops at room temperature
  • Helps prevent vertigo, dizziness, or nausea
  • Outer ear anatomy not sterile, but sterile solutions are used if the eardrum is ruptured
  • Prevents infection risk
  • If ear drainage, check that the eardrum has not ruptured
  • Never occlude or block the ear canal with the dropper or irrigating syringe
  • Don’t force medication into an occluded ear canal
  • Pressure can injure the eardrum

Administer TOPICAL, NASAL, OTIC, OPHTHALMIC MEDICATIONS

  • Integrated approach to administering medications across these routes

Activity

  • Practice giving all types of medications
  • (Activity covers topical, nasal, otic, ophthalmic, and oral forms)