ADMINISTRATION OF MEDICATION

Good day! I am Yeesha P. Balmes, a first year student of BSN 11J at Davao Doctors College and today I
will be doing a return demonstration on the administration of oral, intradermal, and intramuscular
medication. Medicines are chemicals or compounds used to cure, halt, or prevent disease; ease
symptoms, or help in the diagnosis of illnesses. As a nurse, it is our duty to ensure that the right
medication is properly drawn up in the correct dose, and administer at the right time through the right
route to the right patient. By doing so, it can help limit or reduce the risks of administration errors.

Prior to the procedure…

STEPS RATIONALE
Check Doctor’s order To prevent patient care delay
Knows the reason why client is receiving the To prevent prescription errors and consequent
medication risks to patients
Check the MAR To ensure safe medication preparation and
administration.
Check for the drug name, dose, frequency, route
of administration, expiration date for DRUG NAME: check if you have the current
administering the medication medication and if it is appropriate for the patient
in the current context

DOSE: check the dose that makes sense for the

age, size, and condition of the patient.

ROUTE: check if the route is appropriate for the

patient’s current condition

TIME: stick to the prescribed schedule

EXPIRATION DATE: Expired medicines are at risk

of bacterial growth and it may be less effective.
Verify the client’s ability to take medication orally.

Determine whether the client can swallow, is NPO

or nothing by mouth, is nauseated or vomiting
has gastric suction, or has diminished or absent
bowel sounds.
Perform hand hygiene To deter the spread of microorganisms
Arrange and organize medication trays and cups To promote effective time management
in the preparation area including medication
tickets, if not using MAR
Prepares medication for one patient at a time. One of the safety considerations in administering
Obtain the correct drug, compare the name of medication. To avoid the switching of medicines
medication on label with MAR or medication of different patients.
ticket and exit ADS after removing drug
Check or calculate drug dose as necessary, To reduce medication errors
double-check calculation, check the expiration
date on all medications, and return outdated
medication to the pharmacy, if there are any.
Check the record for medication count and
compare the current count with the supply
available especially if preparing controlled
substances.

PERFORMANCE

Place packaged unit-dose or capsules or tablets
directly into the medicine cup. Do not remove
medication from the package until at the bed side
If using a stock container, pour the required
number into the bottle cap, and then transfer the
medication to the cup without touching the
tables
Break only the scored tablets if necessary in order
to obtain the correct dosage. Use a cutting or
splitting device if needed.
If the client has difficulty swallowing, check if the
medication can be crushed.
It can affect the medicines sterility. The medicine
packaging also protects the medication from hear,
air, light and/or moisture. Exposure to these
elements may affect the effectiveness of the
medication.
Failure to obtain the correct dosage may cause
underdosing which may lead to ineffective
treatment or overdosing which may lead to drug
toxicity.

-If acceptable, crush the medication

-If unacceptable, ask the pharmacist if you can
have other versions of the medicine on hand.
Place the prepared medication and MAR together
on the medication cart.
Recheck the label on the container before
returning the bottle, box, or envelope to its
storage place
Avoid leaving prepared medication unattended
Lock the medication cart before entering the
client’s room
Check the room number against the MAR if
agency policy does not allow MAR to be removed
from the medication cart
Introduce self and verify client’s identity using the Introducing oneself to patient can form basis of
agency protocol therapeutic nurse-patient relationship.

We need to verify client’s identity to avoid errors

and misidentification.
Provide for client privacy To promote dignity
Educate the client and family member of the Educating them can help the patient determine
medication to be taken, its purpose, route of whether a medication if working appropriately (If
administration, intended effect, and possible side medication is repeatedly given, it means that the
effects medication is working. However, if it changes, it
might indicate that the medication isn’t working.
Therefore, it is really important to discuss and
address everything to your patient.)
Assist the client to a sitting position o, if not In positioning your patient, use the proper body
possible, to a side-lying position mechanics to avoid the straining of back muscles
If not previously assessed, take the required
assessment measures such as PR, RR, BP
Compare names of medication on tables with
medication tickets at the client’s bedside. If using
the MAR, scan the client’s barcode to verify the
administration of medication. Pick up the due
medication and compare the labels with barcode
on the drug and eMAR
Administer the medication at the correct time. To make the drug more effect
Take the medication to the client within the
guideline of the agency.
Give the client sufficient water or preferred juice
to swallow the medication
 If the patient is unable to hold the pill To avoid choking
cup, use the pill cup to introduce the
medication into the patient’s mouth.
(ONE TABLET AT A TIME)
 If an older child or adult has difficulty
swallowing, ask the client to place the
medication at the back of the tongue
before taking the water.
 If the medication has an objectionable
taste, ask the client to suck a few ice
chips before hand, or give the medication
with juice, applesauce, or pudding if
there are no contradictions.
 If the client says that the medication you
are about to give is different from what
the client has been receiving, do not give
the medication without first checking the
original order.
Stay with the client until all medication has been To know if the patient really swallowed/drank the
swallowed medicine.
Document each medication given Documentation is important to provide an
accurate reflection of nursing assessment, and
changes in clinical state, and in order for other
nurses to know the medication that was already
 administered to avoid medication errors.
Record the medication given, dosage, time, any
complaints or assessment of the client, and your
signature
If the medication was refused or omitted, record
this fact on the appropriate record: Document
the reason, when possible, and the nursing
actions according to agency policy.
Dispose of all the supplies appropriately To eliminate risks that might affect one’s health.
Also to help in keeping the hospital environment
clean and tidy.
Replenish stock and return the cart to the
appropriate place and discard used disposable
supplies.

PARENTERAL ADMINISTRATION

PREPARATION

STEP
Check doctor’s order
Check the MAR
Check the label on the medication carefully
against the MAR to make that the correct
medication is being prepared
Follows the 3 checks for administering
medication:

Read label on the medication

1.) When it is taken from the medication cart
2.) Before withdrawing the medication
3.) After withdrawing the medication
Organizes the equipment to be used

PREPARING MEDICATION FROM VIALS

Perform hand hygiene and observe other

appropriate infection prevention procedures

Prepares the medication vial for dug withdrawal:

  Mixes the solution, if necessary, by
rotating the vial between the palms of
the hands, not by shaking.
 Removes the protective cap, or clean the
rubber cap of a previously opened vial
with an antiseptic wipe by rubbing in a
circular motion.
Some vials contain aqueous suspensions, which
settle when they stand. In some instances,
shaking is contraindicated because it may cause
the mixture to foam.
The antiseptic cleans the cap and reduces the
number of microorganisms.

Withdraws the medication:

 Attaches an aspirating needle as agency Using the filter needle prevents any solid particles
practice dictates, to draw up premixed from being drawn up through the needle.
liquid medications from multidose vials.

 Ensures that the needle is firmly attached

to the syringe

 Removes the cap from the needle, then

draw up into the syringe the amount of
air equal to the volume of the medication
to be withdrawn.
 Carefully insert the needle into the
upright vial through the center of the
rubber cap, maintaining the sterility of
the needle.
 Inject the air into the vial, keeping the The air will allow the medication to be drawn out
bevel of the needle above the surface of easily because negative pressure will not be
the medication created inside the vial. The bevel is kept above
the medication to avoid creating bubbles in the
medication.
Withdraws the prescribed amount of medication
using either of the following methods:

a. Holds the vial down, move the needle tip
so that it is below the fluid level, and
withdraw the medication
b. Inverts the vial, ensure the needle tip is
below fluid level, and gradually withdraw
the
Proponents of this method say that keeping the
vial in the upright position allows particulate
matter to precipitate out of the solution. Leaving
the last few drops reduce the chance of
withdrawing foreign particles.
Keeping the tip of the needle below the fluid leel
prevents air from being drawn into the syringe.

PREPARING MEDICATIONS FROM AMPULES

Perform hand hygiene and observe other

appropriate infection prevention procedures
Prepares the medication ampule for drug
withdrawal:

 Flicks the upper stem of the ampule This will bring all medication down to the main
several times with a fingernail. portion of the ampule.
 Uses an ampule opener or place a piece The sterile gauze protects the fingers from the
of sterile gauze or alcohol wipe between broken glass, and any glass fragments will stay
your thumb and the ampule neck or away from the nurse.
around the ampule neck, and break off
the top by bending it toward you to
ensure the ampule is broken away from
yourself and away from others.
 Places the antiseptic wipe packet over This method ensures that all glass fragments fall
the top of the ampule before breaking off into the packet and reduces the risk of cuts
the top
 Disposes the top of the ampule in the
sharps container
Withdraws the medication

 Place the ampule on a flat surface

 Attach the filter needle/straw to the This filter needle/straw prevents glass particles
syringe. from being withdrawn with the medication.
 Remove the cap from the filter needle Thiis will keep the needle sterile.
and insert the needle into the center of
the ampule. Do not touch the rim of the
ampule with the needle tip or shaft
 With a single-dose ampule, holds the
ampule slightly on its side, aspirate the
medication
 If giving an injection, replace the
aspirating needle with a regular needle
 Tighten the cap at the hub of the needle
and place over the medication tray

INTRADERMAL ADMINISTRATION

Organizes the equipment

Performs hand hygiene and observe other To deter the spread of microorganisms
appropriate infection prevention procedures.
Introduces self and verifies the client’s identity To ensure that the right client receives the
using agency protocol medication

“Good day Ma’am/sir. I am Yeesha P. Balmes

and I will be your student nurse from (oras). Can
you state your name and date of birth, please?
(tubag). Thank you.”
Explain to the client that the medication will Providing information can facilitate acceptance of
produce a small wheal, sometimes called a bleb.
A wheal is a small raised area, like a blister. The
client will feel a slight prick as the needle enters
the skin.
Prepares the client/Provide client privacy
Selects and cleanse the site:
and compliance with the therapy.
“For today, I will be doing a skin test to you. You
will feel a small prick, and this will produce a
small wheal. This test will help us indicate if you
have allergy/ies regarding the medication that
we are planning to administer.”

 Select a site (e.g. the forearm about a

hand’s width above the wrist and three or
four finger widths below the antecubital
fossa)
 Avoid using sites that are tender,
inflamed, or swollen, and those that have
lesions.
 Applies gloves as indicated by agency
policy. Cleanse the skin at the site using a
circular motion starting at the center and
widening the circle outward. Allow the
area to dry thoroughly.
Prepares the syringe for the injection:

 Removes the needle cap while waiting for

antiseptic to dry
 Expels any air bubbles from the syringe
 Grasps the syringe in your dominant
hand, close to the hub, holding it
between thumb and forefinger. Hold the
needle almost parallel to the skin surface,
with the bevel of the needle up
Injects the fluid:
A small amount of air will not harm the tissues.
The possibility f medication entering the
subcutaneous tissue increases when using an
angle greater than 15 degree. (INTRADERMAL
ANGLE SHOULD ONLY BE 5 – 15 DEGREE)

 With the nondominant hand, pull the skin Taut skin allows for easier entry of the needle and
at the site until it is taut. For example, if less discomfort for the client.
using the ventral forearm, grasp the
patient’s dorsal forearm and gently pull it
to tighten the ventral skin
 Insert the tip of the needle far enough to
place the bevel through the epidermis
into the dermis.
 Stabilizes the syringe and needle. Inject This verifies that the medication entered the
the medication carefully and slowly so dermis.
that it produces a small wheal on the
skin.
 Withdraws the needle quickly at the
 same angle at which it was inserted.
Activate the needle safety device. Applies
a bandage if indicated.
Do not massage the area It may spread the solution to the underlying
subcutaneous tissue.
Removes and discards gloves
Perform hand hygiene
Circle the injection site with ink to observe for the
redness or duration (hardening), per agency
policy.
Documents all the relevant information. Record
the testing material given, the time, dosage,
route of administration, site, and nursing
assessments.
Evaluate the condition of the site 30 minutes,
depending on the test. Measure the area of
redness and induration in millimeters at the
largest diameter and document findings.
Document if the client has a positive or negative
skin test result. Follow agency protocol on
labeling of allergies.

INTRAMUSCULAR INJECTION

Introduce self and verify client’s identity using the This ensures that we will be giving the right
agency protocol. medication to the right client.
Assist the client to a supine, lateral, prone, or Appropriate positioning promotes relaxation of
sitting position, depending on the chosen site. If the target muscle.
the target muscle is the gluteus medius
(ventrogluteal site), have the client in the supine
position flex the knee(s); in the lateral position,
flex the upper leg; and in the prone position, toe
in.
Obtain assistance in holding an uncooperative This prevents injury due to the sudden movement
client. after needle insertion
Explains the purpose of the medication and how Information can facilitate acceptance and
it will help, using language that the client can compliance with the therapy.
understand. Include relevant information about
effects of the medication.
Selects, locates, and cleanse the site.
Select a site free of skin lesions, tenderness,
swelling, hardness, or localized inflammation, and
one that has not been used frequently.
If injections are to be frequent, alternate sites. This is to reduce the discomfort of intramuscular
Avoid using the same site twice in a row injections. If necessary, discuss with the
prescribing primary care provider an alternative
method of providing the medication
Locate the exact site for the injection.
Apply clean gloves
Clean the site with an antiseptic swab. Using a This will help reduce the discomfort of the
circular motion, start at the center and move injection
outward about 5 cm or 2 inches

Transfers and holds the swab between the third

and fourth fingers of your nondominant hand in
readiness for needle withdrawal, or position the
swab on the client’s skin above the intended site.
Prepares the syringe for injection

 Remove the needle cover and discard

without contaminating the needle
 If using a prefilled unit-dose medication, Medication left on the needle can cause pain
take caution to avoid dripping medication when it is tracked through the subcutaneous
on the needle prior to injection. If this tissue.
does occur, wipe the medication off the
needle with a sterile gauze.
Inject the medication using the Z-track technique

a. Uses the ulnar side of the nondominant Pulling the skin and subcutaneous tissue or
hand to pull the skin approximately 2.5 pinching the muscle makes it firmer and
cm (1 in) to the side. Under some facilitates needle insertion.
circumstances, such as for an emaciated
client or an infant, the muscle may be
pinched.
b. Holding the syringe between the thumb Using a quick motion lessens the client’s
and forefinger (as if holding a pen), pierce discomfort
the skin quickly and smoothly at a 90
degree angle
c. Holds the barrel of the syringe steady If the needle is in the small blood vessel, it takes
with your nondominant hand and time for the blood to appear.
aspirate by pulling back on the plunger
with your dominant hand. Aspirate for 5
to 10 seconds.
d. If blood appears in the syringe, withdraw
the needle, discard the syringe, and
prepare a new injection.
e. If blood does not appear, inject the
medication steadily and slowly
(Approximately 10 sec/ml)
Withdraws the needle:

 Withdraw the needle smoothly at the This minimizes tissue injury

same angle of insertion.
 Apply gentle pressure at the site with a Use of an alcohol swab may cause pain or a
 dry sponge. burning sensation
 It is not necessary to massage the area at Massaging the area may cause the leakage of
the site of injection medication from the site and result in irrigation.
 If bleeding occurs, apply pressure with a
dry sterile gauze until it stops
Activate the needle safety device or discard
uncapped needle and attach syringe into the
proper receptacle.
Removes the discard gloves and perform hand
hygiene.
Document all relevant information. The time of
administration, drug name, dose, route, and the
client’s reactions.
Assess the effectiveness of the medication at the
time it is expected to act.