PRINCIPLES OF MEDICATION ADMINISTRATION

Administration of medications is a basic activity in nursing practice

 Nurses must be knowledgeable about the
specific drugs and their
administration, client
response, drug interactions,
client allergies
 Nurses are accountable for
the safe administration of
medications
 Nurses must know all the
components of a drug order
and questions those orders that
are not complete, unclear,
outside the recommended range
 Nurses are legally liable if they
give a prescribed drug and the
dosage is incorrect or the drug
is contraindicated for the client

Components of a Drug Order:

 Date and time
 Drug name
 Drug dosage
 Route of administration
 Frequency and duration of administration
 Any special instructions
 Physician or other health care
provider’s signature
The “Five-Plus-Five Rights” of Drug Administration
• The rights of medication administration are the foundation for medication safety
• To provide safe drug administration, the nurse should practice the “Rights” of drug
administration
TRADITIONAL FIVE (5) RIGHTS
• Right Client
• Right Drug
• Right Dose
• Right Time
• Right Route
Experience indicates that FIVE (5) Rights are essential to professional nursing practice
• Right Assessment
• Right Documentation
• Client’s Right to Education
• Right Evaluation
• Client’s Right to Refuse
RIGHT CLIENT
 The nurse is responsible of
accurately identifying the patient
when administering a medication
 Verify client by checking the
identification band
 Distinguish between two clients with
the same last name
RIGHT DRUG
 means that the client receives the
drug that was prescribed
 A telephone order or verbal
order for medication must be
cosigned by the prescribing health
care provider within 24 hours
Components of a Drug Order:
 Date and time
 Drug name
 Drug dosage
 Route of administration
 Frequency and duration of administration
 Any special instructions
 Physician or other health care provider’s signature
Four (4) Main Categories of Drug Orders:
 Standing Order – an ongoing
order or may be given for a specific
number of doses or days
◦ e.g. Digoxin 0.25 mg PO daily
 One-time or Single Order –
given once and usually at a specific
time
◦ e.g. Diazepam 5mg IV before surgery
 PRN Orders – given at the client’s
request and nurse’s judgment
◦ e.g. Tylenol 650mg q3 to 4h PRN for
headache
 STAT Orders – given once,
immediately
◦ e.g. Morphine sulfate 2mg IV STAT
RIGHT DOSE
 is the dose prescribed for a particular client
 Nurses must calculate each drug dose accurately
  Before calculating a drug dose, the nurse should have a general idea of the answer based
on knowledge of the basic formula or ratios or proportions
RIGHT TIME
 is the time at which the prescribed dose should be administered
 Administer drugs at the specified times.
 Drugs may be given 30 minutes before or after the time prescribed if the administration
interval is >2hours
 Administer drugs that are affected by foods before meals
 Administer drugs that can irritate the stomach (gastric mucosa) with food
 Daily drug dosages are given at specified times during a day: bid, tid, qid or q2h, q4h.
Q6h. q12h
RIGHT ROUTE
 is necessary for adequate or appropriate absorption
 The more common routes are oral, sublingual (under tongue for venous absorption),
buccal (between gum and cheek), inhalation (aerosol sprays), suppository (rectal,
vaginal) & parenteral (ID, SC, IM, IV)
 Assess the client’s ability to swallow before the administration of oral medications
 Do not crush or mix medication in other substances before consultation with a pharmacist
 Use aseptic technique when administering drugs. Sterile technique is required with the
parenteral routes
 Stay with the client until oral drugs have been swallowed
RIGHT ASSESSMENT
 requires that appropriate data be collected before administration of the drug
 e.g. taking apical HR before administration of digitalis preparations or serum blood sugar
levels before the administration of insulin
RIGHT DOCUMENTATION
 requires that the nurses immediately record the appropriate information about the drug
administered
This includes:
◦ Name of the drug,
◦ Dose,
◦ Route,
◦ Time and date,
◦ Nurse’s initials or signature
RIGHT TO EDUCATION
 requires that clients receive accurate and thorough information about the medication and
how it relates to their particular situation including therapeutic purpose, possible side
effects, dietary restrictions
RIGHT EVALUATION
 requires that the effectiveness of the medication be determined by the client’s response to
the medication
RIGHT TO REFUSE
 client can and do refuse to take a medication,
 it is the nurse’s responsibility to determine when possible the reason for the refusal and
to take reasonable measures to facilitate the client’s taking the medication and reinforce
the reason for the medication
Nurses’ rights when administering medications
 These rights ensures the nurse of what is needed to provide safe medication
administration
The nurses’ six rights are
1. The right to a complete and clear order
2. The right to have the correct drug, route and
dose dispensed
3. The right to have access to information
4. The right to have policies to guide safe medication administration
5. The right to administer the medication safely
6. The right to stop, think and be vigilant when administering medication
The right to a complete and clear order
 The drug, dose, route and frequency be ordered by the health care provider
 The nurse must question the health care provider if the order is not complete or is unclear
The right to have the correct drug, route and dose dispensed
 Dispensing medications correctly is the role of the pharmacist
The right to have access to information
 Includes the right to expect current and readily accessible information e.g. nursing drug
reference
  Nurses are only to administer drugs with which they are knowledgeable
The right to have policies to guide safe medication administration
 Health care administration’s role is to provide the structure on which nurses administer
drugs safely
 Policies guide nursing practice
The right to administer the medication safely
 Nurses’ right and responsibility to speak up when they are first aware of situations that
impinge negatively on safe administration of medications
 Nurses should be advocate for safety in the health care settings
The right to stop, think and be vigilant when administering medication
 Nurses have the right and responsibility to stop and think, consult with other health
profesionals
FORMS & ROUTES FOR DRUG ADMINSTRATION
Forms and routes are used for the administration of medication including:
◦ Sublingual
◦ Buccal
◦ Oral (tablet, capsules, liquids, suspension, elixirs)
◦ Transdermal
◦ Topical
◦ Instillation (drops and sprays)
◦ Inhalation
◦ Nasogatric and gastrotomoy tubes
◦ Suppossitories
◦ parenteral
Tablets & Capsules
• Tablets and capsules are the most common drug forms
• Oral medications are not given to clients who are vomiting, lack of a gag reflex or who are
comatose
• Do not mix medication with a large amount of food or beverage or with contraindicated food
Enteric-coated capsules must be swallowed whole to maintain a therapeutic drug level; “Do not
cut or crush!”
• Administer irritating drugs with food to decrease GI discomfort
• Administer drugs on empty stomach if food interferes with medication absorption
• Drugs given sublingually or Buccally remain in place until fully absorbed
Liquids
• Forms of liquid medication include elixirs, emulsions and suspensions
• Elixirs are sweetened hydroalcoholic liquids
• Emulsions are a mixture of 2 liquids that are not fully soluble
• Suspensions are liquids in which particles are mixed but not dissolved; The meniscus is the
slightly concave curved line of a dose of liquid.
• The bottom of the meniscus should be used to measure the desired dose of medication
Transdermal
• Transdermal medication is stored in a patch laced on the skin and absorbed through skin,
thereby having systemic effect
• Transdermal patches should be rotated to different sites and not reapplied over the next exact
same area when changed
• The area should be thoroughly cleaned prior to administration of a new transdermal patch
• Wash hands and wear gloves to administer medicated patches to prevent transfer of medication
Topical
• Applied most frequently to the skin
• can be applied to the skin with glove, tongue blade or cotton-tipped applicator
• Use appropriate technique to remove the medication from the container and apply it to the
clean, dry skin
Instillations
•liquid medications usually administered as drops, ointment or sprays in the
following forms:
• Eyedrops
• Eye ointment
• Eardrops
• Nose drops and sprays
Administration of Eye Drops
• Remove any discharge by gently wiping out from inner canthus.
• Use separate cloth for each eye
• Gently draw the skin down below the affected eye to expose the conjunctival sac
• Administer the prescribed number of drops into the center of the sac (not directly on the
cornea)
• Gently press on the lacrimal duct with sterile cotton ball or tissue for 1-2 min. after instillation
to prevent systemic absorption
• Client should keep eyes closed for 1-2 min. to promote absorption
Administration of Eardrops
• Wash hands
• Medication should be at room temperature
• Client should sit up with head tilted slightly toward the unaffected sid
To Straighten the ear canal:
• CHILD: pull down and back on auricle
• AFTER 3 YEARS OF AGE/ADULT: pull up and back on auricle
• Instill prescribed number of drops
• Have client maintain position for 2-3 min
Administration of Nose Drops & Sprays
• Wash hands and wear gloves
• Advise the patient to blow the nose
• Have the client tilt head back for drops to reach frontal sinus and tilt head to affected side to
reach ethmoid sinus
• Administer the prescribed number of drops or sprays
• Have the client keep head tilted backward for 5 minutes after instillation
Correct Use of Metered Dose Inhaler
• Insert the medication canister into the plastic holder
• Shake the inhaler well before using. Remove cap from mouthpiece
• Breath out through the mouth. Open mouth wide and hold the mouthpiece 1 to 2 inches from
the mouth; do not put the mouthpiece in mouth unless using a spacer
• With open mouth, take slow, deep breath through mouth and at the same time push the top of
the medication canister down
•Hold breath for 10 seconds; exhale slowly through pursed lips
•If a second dose is required, wait for 1-2 minutes
•Teach patient to rinse the mouth after to prevent irritation and secondary infection to oral
mucosa especially when using a steroid drug
Nasogastric and Gastrostomy Tubes 
 Check for proper tube placement before administering medications. Replace any
aspirated gastric fluid.
 Pour drug into syringe without plunger or bulb, release clamp, and allow medication to
flow in properly, usually by gravity.
 Flush tubing with 50 mL of water, or the prescribed amount. (Refer to agency policy for
exact amount.)
 Clamp tube and remove syringe.
SUPPOSITORIES
1. Rectal Suppositories
• Can be given rectally for local and systemic absorption
• Suppositories tend to soften at room temperature and therefore need to be refrigerated
• Use a glove for insertion
• Instruct the client to lie on left side and breath through the mouth to relax the anal
sphincter
2. Vaginal Suppositories
• Generally inserted into the vagina with an applicator
• Wear gloves
• The client should be in the lithotomy position
• Remain lying for a period of time to allow for absorption
• After the insertion of the medication, provide the client with a sanitary pad
Parenteral
Safety is a special concern with parenteral medication
Administered via injection to bypass the first pass effect of the liver
Types of parenteral routes include:
◦ Intradermal
◦ Subcutaneous
◦ Intramuscular
◦ intravenous Intradermal
• Local effect
• Syringe: 1 ml calibrated in 0.01 ml increments (usually 0.01 to 0.1 ml injected)
• Sites: location to observe inflammatory reaction such as ventral mid-forearm
 • Used for observation of an inflammatory (allergic) reaction to foreign proteins e.g.
tuberculin testing, testing for drug sensitivities
• Insert the needle bevel up, at a 10- 15 degree angle
• Inject medication slowly to form a wheal (bleb)
• Do not massage the area
• Assess for allergic reaction in 24 to 72 hours (measure the diameter of local reaction)
after tuberculin testing
Subcutaneous
• Systemic effect
• Usually slower in onset than with IM route
• Syringe: 1-3 ml (Usually 0.5 to 1.5 ml injected)
• Sites: abdomen, upper hips, upper back, lateral upper arms and lateral thighs
• Sites should be rotated with subcutaneous injections i.e. Insulin & Heparin
• Insert the needle at an angle appropriate to body size: 45 to 90 degrees
• Aspirate except heparin & Insulin
• Gently massage the area unless contraindicated, as with heparin & Insulin
• Inject medication slowly
• Apply gentle pressure to the injection site to prevent bleeding into the tissue
Intramuscular
• Systemic effect
• Syringe: 1-3 ml (usually 0.5 to 1.5 ml injected)
• Usually more rapid effect of drug than with SQ
• Sites: Ventrogluteal, Dorsogluteal, Deltoid and Vastus Lateralis (pediatrics)
• Volume of drug administration:
• Ventrolgluteal 1-3 ml
• Dorsogluteal 1-3 ml
• Deltoid muscle 0.5 to 1.0 ml
• Vastus lateralis <0.5 ml in infants (max = 1 ml), adult 2.0 ml
• Flatten the skin area using the thumb and index finger and inject between them
 • Insert the needle at 90 degree angle
Z-Track Injection technique
• Prevents the medication from leaking back into the subcutaneous tissue
• Used for medications that cause visible permanent skin discolorations (e.g. iron
dextran)
• Gluteal site is preferred
• STEPS:
1. pull the skin to one side and hold
2. insert needle
3. Hold skin to side
4. inject medication
Intravenous
• Systemic effect • More rapid than the IM or subcutaneous routes
• Site: cephalic vein of the arm, dorsal vein of hand for direct IV
• Equipment – needle
• Adults: 20-21 gauge
• Infants: 24 gauge
• Children: 22 gauge
Direct IV
• Procedure:
1. Wash hands and wear gloves
2. Apply tourniquet
3. Cleanse area using aseptic technique
4. Insert the needle into the vein until blood
returns
5. Remove the tourniquet
6. Stabilize the needle
7. Inject medication slowly
8. Dress site