Oral medication administration

Authors: Rednenko V.V., Rednenko L.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• patient or simulator
• manipulation table (bedside table)
• medication drawer or cabinet
• PPE: medical gown, hat, mask, non-sterile gloves
• medication administration record (MAR)
• waste containers (tray)

Clinical situation:

• You are a nurse at a hospital. Give medications to patient as physician’s directives

Order of the skill performance:

Preparatory stage:

• Check the equipment at the workplace, complete the workplace if necessary
• Put on your protective equipment
  • Perform hygienic handrub
  • Put on your gloves

Maine stage:

• Prepare medications

• • Unlock medication cart or drawer.
  • Proceed from top to bottom of MAR or computer record when preparing medications.
  • Select correct medication from drawer or shelf.
  • Compare label to medication order on MAR or computer record.

• • Complete any necessary calculations:
    • Pour pill from a multidose bottle into the container lid and transfer the correct amount to a medication cup.

• • • Leave unit dose medications in wrapper and place in medication cup.
    • Measure liquid medication by holding the medicine cup at eye level and reading the level at the bottom of the meniscus. Pour from the bottle with the label uppermost and wipe neck with a paper towel if necessary. Sometimes calibrated droppers are provided.

• • Recheck each medication with written record. This is the second medication check to ensure preparation of the correct dose.
  • When all medications have been prepared, compare each one again to the medication order. (All medications should be checked three times to prevent errors.)
  • Crush pills if patient is unable to swallow them:
    • Place pill in paper souffle cup in mortar or pill crusher. Cover pill with another paper souffle cup placed inside the first one. Crush pill until it is in powder form.
    • Do not crush time-release capsules or enteric-coated tablets.
    • Dissolve in water or juice or mix with apple sauce to mask the taste.
    • Cut tablets at score mark only.
• Take medication to patient once it is prepared. Medication should be given as close to the ordered time as possible. Agency policy usually considers 30 minutes before or after the ordered time as an acceptable variation.
  • Identify the patient
    • Say hello to the patient, introduce yourself;
    • Specify the last name, first name and patronymic of the patient, check the prescription sheet
  • Get informed consent
    • Inform the patient about the upcoming manipulation,
    • Obtain verbal consent to conduct it
  • Complete necessary assessments before giving medications. Nurse’s responsibility includes checking that the patient is not allergic to the drug. Additional checks include assessment of blood pressure, apical pulse rate, or respiratory rate depending on the action of the medication.
  • Assist the patient to a comfortable position. Sitting as upright as possible makes it easier to swallow medication and less likely to cause aspiration offluids.
  • Administer the medication:
    • Offer water or fluids to take with medication. Be aware of any fluid restrictions if they exist.
    • Ask patient how he or she prefers to take the medication (one at a time, all at once, from the cup or their hand)
    • Open unit dose medication packages and give medication to patient.

• • • Discard any medication that falls on the floor.
    • Mix powder medications with fluids at the bedside.
  • Remain with the patient until all medication has been taken. Check the patient’s mouth, if needed. (The nurse’s signature on the medical record indicates that the patient has taken the medication. It is unsafe to leave medication at the bedside.)

Final stage:

• remove gloves and place in waste container (tray)
• perform hygienic handrub
• record medication administration on the appropriate form:
  • Sign after drugs have been given.

• • If a medication was refused, record this according to agency policy on the medication record.
  • Document vital signs or particular nursing assessments according to agency format (apical pulse, blood pressure reading).
  • Sign in narcotic book for controlled substances when they are removed from locked area.
• Check on the patient within 30 minutes after giving medication. This is particularly important following pain medication or any PRN (as needed) med.