Medications Managing and Administering Medication The Medication Administration Checklist Administering medications is an important and vital responsibility. It is important to make sure that no errors occur when administering medication as such errors can result in serious complications or even the death of a resident. To ensure safe and effective medication administration, there are seven basic areas to review. 1. Make sure you have the right resident Remember that many people have the same name, including first and last names Remember that many people closely resemble other people in both looks and mannerisms Ask a resident for his or her full name and confirm the name with the apartment or room number; if the resident is not in his or her room such as in a medication room determine his or her room number Try to set up your MAR with recent pictures of each resident, and review the pictures prior to looking for a resident 2. Make sure you have the right drug Review the drug information written on the left-hand side of the MAR, including the drug name and dosage Look in the appropriate medication storage area for the correct drug marked with the correct resident s name Review the drug name and dosage, then match it against the information in the MAR for the resident whose name is on the medication container
3. Make sure you have the right dose Check the dosage on the medication container to make sure it matches the MAR If a dosage does not make sense or seems unusual, seek clarification prior to administering the drug 4. Make sure you know the proper route of administration Review the MAR to determine the proper route of administration for that medication for the relevant resident Keep in mind that there are many routes of administration: by mouth, sublingually, inhaled, topical, drops, etc. 5. Make sure you have the right time and day Check the MAR for any specifics on the appropriate time and day for administration Timely administration must be within 30 minutes before or 30 minutes after the prescribed administration time Know your abbreviations for time and frequency; if you are not sure about an abbreviation, ask for clarification 6. Make sure you know the proper technique for administration Know how to operate any necessary medical equipment, such as inhalers, nebulizers, syringes, etc. Make sure all necessary equipment is on hand and in good working order prior to beginning a medication administration procedure Do not attempt to perform a new procedure by yourself; have an experienced staff member assist you until you are very comfortable with the process and proper techniques If you are not sure about how a procedure should be done, refer to a manual and/or ask your supervisor for assistance
7. Make sure you chart the medication administration appropriately Remember to chart medication administration every time, as soon as the medication has been administered Follow your facility s charting procedures for various types of medication and forms and times of administration Remembering to review these seven areas will help insure that you administer medication in the safest, most effective way possible. As the responsible party, only you can prevent medication errors. You must remember to concentrate and not allow yourself to be distracted during medication administration. You must also read the MAR and prescription labels or manufacturer s instructions, then check and re-check the orders at least twice before leaving to medication room to administer drugs. If you follow these steps, you should be able to take pride in a job well done and your residents will enjoy an optimum level of care. Methods for Various Routes of Administration Part of providing optimum care includes administering medicines in an appropriate and effective way. Because there are so many different routes of administration, it is important that you familiarize yourself with the basics of the major types of administration routes. Oral Medications Oral medications are meant to be taken by mouth. The medication should be placed into the resident s mouth and then chewed or swallowed as directed. Water or juice may be necessary for this process. Sublingual Medications Sublingual medications are also taken by mouth, but they are not swallowed or chewed. Instead, the medication is placed under a resident s tongue and allowed to dissolve. Eye Medication (General Instructions) Determine which eye to treat Wash hands thoroughly and put on gloves Hold the medication bottle up to the light to examine it for discoloration or sediment
If the medication is in good condition, hold it between your hands for two minutes to bring it to room temperature Moisten a cotton ball or tissue and clean around the eyes, starting from the side nearest the nose and working outward Have the resident tip his/her head back and toward the eye receiving medication so any excess medication flows away from the tear duct Instruct the resident to look up and away before administering eye medication and then proceed with process for eye drops or ointments/creams/gels Eye Drops Gently pull down the lower lid of the eye to form a pocket and administer the prescribed number of the drops into the pocket without touching the dropper to the eye Have the resident look up at the ceiling Instruct the resident to close his/her eyes gently without squeezing the lids shut after each drop Wait at least one minute between drops of the same medication and five minutes between different eye medications Eye Ointments/Creams/Gels Pull down the lower lid of the eye and gently tilt the resident s head back slightly Squeeze a small amount of medication onto the edge of the conjuctival sac (lower eye lid) Administer the medication smoothly, moving from the inner eye to the outer eye and following the physician s orders regarding the length of the ribbon of medication to be given Cut off the ribbon of medication by turning the tube or having the resident close his/her eye Instruct the resident to roll his/her eyes behind closed lids after the ointment application to help distribute the medication over the surface of the eyeball
Wait at least ten minutes before administering any other eye medications Ear Medications Have the resident lie on the opposite side from the one for which the medication is prescribed Wash your hands thoroughly Check the medication for discoloration and then hold the bottle between your hands to bring it to room temperature Shake the bottle (if appropriate) and fill the dropper Pull the resident s earlobe back and up to expose the ear canal Without allowing the dropper to touch the ear, squeeze one drop from the dropper to check your position and then squeeze the dropper again until empty, letting the drops run into the ear canal Continue holding the ear until all ear drops have moved down into the ear canal and then massage the area in front of the ear Have the resident remain lying on his/her side for ten minutes after administration and place a cotton ball in his/her ear so the medication cannot run out Rectal Medication (Suppository) Allow the suppository to warm up slightly by placing it still wrapped into your pocket; this makes the suppository melt slightly and makes it unnecessary to use a lubricant Have the resident lie on his/her left side with the right knee raised toward the chest Wash hands thoroughly and put gloves on Insert the suppository into the rectum and along the bowel wall until it goes past the ring of muscles of the rectal sphincter, preventing it from being naturally pushed back out If the resident has an urge to have a bowel movement, have him/her lie still and breathe deeply several times
Remember to keep your fingernails short and never push a suppository against resistance, as long nails and/or unnecessary pressure can cause injury to or perforation of the bowels, resulting in severe illness or death After the suppository is fully inserted, wash your hands and instruct the resident to remain in a reclining position on his/her left side for at least 20 minutes Place the call light in a very accessible place for the resident, as he/she may experience a sudden and urgent need to have a bowel movement Rectal Medication (Enema) Give a Fleets-type enema only, unless your nurse has given you special training to do otherwise Protect the bedding with a waterproof pad Have the resident lie on his/her left side with the right knee raised toward the chest Wash your hands thoroughly and put gloves on Gently insert the enema tip about four (4) inches into the rectum and have the resident take slow, deep breaths Slowly roll up the bottle until all of the fluid has been expelled into the bowels Remove the enema tip from the rectum and throw away the bottle Dispose of your gloves and wash your hands thoroughly Have the resident hold the fluid in as long as possible, taking slow deep breaths to try to retain the fluid for the prescribed period Place the call light in a very accessible place for the resident, as he/she may experience a sudden and urgent need to have a bowel movement Vaginal Medication (Creams) These medications should be applied when the resident is in bed for the night so the medication will stay in the vagina as long as possible Wash your hands and put on gloves
If the applicator is not pre-filled, attach the applicator to the tube of medication and squeeze until the applicator is full Lubricate the tip of the applicator to make insertion easier Have the resident lie on her back with her legs slightly apart Insert the applicator approximately two inches into the vagina Push the plunger until all of the cream has been expelled into the vagina If the applicator is reusable, keep your gloves on and wash the applicator in soap and warm water, as instructed on the medication box; if the applicator is disposable, remove your gloves around the applicator and throw them away If necessary, put on new gloves and apply any additional topical ointments that have been prescribed Have the resident remain in a reclining position for at least 30 to 45 minutes Vaginal Medication (Douches) Douches are most easily administered in the shower Wash your hands thoroughly and put on gloves Gently insert the douche into the vagina Slowly roll up the bottle until all of the fluid has been expelled into the vagina Remove the bottle and allow the fluid to be released When the process is complete, wash or dispose of materials as appropriate Remove and dispose of your gloves and wash your hands Transdermal Patches These should be typically applied to the chest or upper back, but review the MAR to determine where the last patch was applied, as sites should be rotated to minimize skin irritation
Wash your hands thoroughly and put on gloves; gloves must be worn, as the drugs in unwrapped patches can be rapidly absorbed into unprotected skin Unwrap the patch and apply it to skin that is not reddened or irritated from previous patches Destroy used patches by placing sticky sides together and flushing in the toilet; do not throw patches in the trash Nasal Medication (Inhalers) Wash your hands thoroughly Shake the inhaler and remove the cap from the mouthpiece Instruct the resident to take a deep breath and then exhale, pushing all of his/her air out Hold the inhaler upright and place it in the resident s mouth with his/her lips closed firmly around the mouthpiece Have the resident tilt his/her head back slightly and take a slow and deep breath Depress the top of the canister or squeeze the inhaler as the resident breathes in deeply When his/her lungs feel full, have the resident remove the mouthpiece Have the resident hold his/her breath for a few seconds and then purse his/her lips and exhale very slowly Allow at least a few minutes between puffs of medication When all medication has been administered, have the resident rinse his/her mouth, gargle, and drink some liquid Clean out the inhaler at least once a day by removing the canister and rinsing the plastic case and cap under warm running water or wiping it with alcohol and allowing it to dry
Nasal Medication (Nebulizers) Wash your hands thoroughly Fill the nebulizer cup with a combination of medication and/or saline, as ordered Attach the cup to the tubing and mouthpiece Turn the machine on and instruct the resident to inhale and exhale normally through the mouthpiece until the medication is gone and no more mist is created Rinse and cleanse the nebulizer according to the manufacturer s instructions; this may be scheduled on the MAR Nasal Medication (Sprays) Wash your hands thoroughly Have the resident blow his/her nose gently and tilt his/her head back Shake the bottle and administer the prescribed number of sprays without touching the dropper to the resident s nose Rinse the tip of the dropper in hot water and dry