1. Chapter 10 Medication Administration
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2. Objectives
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3. Drug Administration

4. General Guidelines
An EMT can give, or assist a patient in taking, medications only by the order of a licensed physician.
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An EMT can give medications only by the order of a licensed physician. The physician’s order may be a written protocol (standing order) or a verbal order.

5. General Guidelines Assess the patient
Obtain a medication history including:
Prescribed medications (name, strength, daily dosage)
Over-the-counter medications
Allergies to medications
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Before giving any drug, you must assess the patient. The extent of the physical examination you perform will depend on the patient’s illness or present condition. The physical exam provides baseline information by which you will be able to evaluate the effectiveness of the medications given.
Obtain a medication history from the patient including the following:
Prescribed medications (name, strength, daily dosage)
Over-the-counter medications
Allergies to medications

6. General Guidelines
You must be knowledgeable about each drug you give including the following:
Mechanism of action
Indications
Dose
Route of administration
Contraindications
Adverse effects
Special considerations
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You must be knowledgeable about each drug you give, including the following:
Mechanism of action—how the drug exerts its effect on body cells and tissues
Indications—the condition(s) for which the drug has documented usefulness
Dose—the amount of the drug that should be given to the patient
Route of administration—the route and form in which the drug should be given to the patient
Contraindications—the condition(s) for which a drug should not be used because it may cause harm to the patient or offer no improvement of the patient’s condition or illness
Adverse effects—an undesired effect of a drug
Special considerations—factors to consider when giving the drug, such as the impact of age and weight on medication administration (children, older adults, pregnant patients); tips for administration of the drug

7. General Guidelines Information to relay to medical direction:
Patient’s age
Chief complaint
Vital signs
Signs and symptoms
Allergies
Current medications
Pertinent past medical history
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Before giving a medication, consult with medical direction. When speaking with medical direction, be sure to relay relevant information about the patient including the following:
Patient’s age
Chief complaint
Vital signs
Signs and symptoms
Allergies
Current medications
Pertinent past medical history

8. Physician’s Order Order will include: Drug name Drug dose Drug route
Repeat orders back to physician
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The physician’s order will include the name, dose, and route of the drug to be given. Make sure you clearly understand the orders received from medical direction. Repeat the orders back to the physician including the name of the drug, dose, and route of administration. If an order received from medical direction is unclear or seems incorrect, ask the physician to repeat the order.

9. The Six Rights of Drug Administration

10. The Six Rights of Drug Administration
Right patient
Right medication
Right dose
Right route
Right time (frequency)
Right documentation

11. Routes of Drug Administration

12. Routes of Drug Administration
Enteral
Parenteral
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13. Enteral Routes of Drug Administration
Oral route
Requires a responsive, cooperative patient
Advantages
Disadvantages
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Commonly used oral dosage forms include liquids, tablets, and capsules. Aspirin and activated charcoal may be given by this route.

14. Enteral Routes of Drug Administration
Oral route
Technique
Use appropriate personal protective equipment
The inside of the medicine container, its contents, and the inside of the container’s cap are considered clean.
Be careful not to touch these areas.
Giving oral medications usually does not involve exposure to a patient’s blood or other body fluids. However, wearing appropriate personal protective equipment (such as gloves) is a common practice to minimize the chances of communicable disease exposure. The inside of the medicine container, its contents, and the inside of the container’s cap are considered clean. When giving a medication, be careful not to touch these areas.

15. Enteral Routes of Drug Administration
Oral route
Technique
When administering a tablet:
Open the medication container
Pour the correct number of tablets into the inside cap of the container
Pour the tablets into the patient’s hand
Do not contaminate the inside cap of the container
Carefully recap the container
When administering a tablet, open the container and pour the correct number into the inside cap of the container. Transfer the tablets by pouring them into the patient’s hand, making sure not to contaminate the inside cap of the container, and then carefully recap the container.

16. Enteral Routes of Drug Administration
Buccal route
“Pertaining to the cheek”
Advantages
Disadvantages
Technique
Buccal means, “Pertaining to the cheek.” To give a drug by this route, a drug is placed in the mouth against the mucous membranes of the cheek until the drug is dissolved. The drug may act locally on the mucous membranes of the mouth or systemically when swallowed in the saliva. Oral glucose may be given by this route.

17. Enteral Routes of Drug Administration
Sublingual route
Drug given under the tongue
Rapid absorption
Advantages
Disadvantages
Technique
Sublingual drugs are given under the tongue. The drug must remain under the tongue until it is dissolved and absorbed. The drug is absorbed rapidly into the bloodstream due to the rich blood supply under the tongue. The patient should not swallow the drug or take it with water. If swallowed, the drug may be inactivated by gastric juice in the stomach. Nitroglycerin may be given by this route

18. Parenteral Routes of Drug Administration
Inhalation route
Rapid onset of action
Gas (oxygen)
Mist / aerosol (albuterol)
Advantages
Disadvantages
Drugs given by the inhalation route have a rapid onset of action due to the large surface area and blood supply of the lungs. To make sure that normal gas exchange of oxygen and carbon dioxide is continuous in the lungs, drugs given by inhalation must be in the form of a gas (such as oxygen) or fine mist (such as an aerosol). Oxygen is given for its systemic effects. A metered dose inhaler such as albuterol is given for its localized effect on the lungs.

19. Parenteral Routes of Drug Administration
Subcutaneous route
Needle inserted underneath the skin into the subcutaneous tissue
Advantages
Disadvantages
Technique
Drugs given by the subcutaneous (SubQ) route are given by means of a needle inserted underneath the skin into the subcutaneous tissue. The onset of action of SubQ drugs is faster than the oral route but slower than the intramuscular route. Absorption is delayed in circulatory collapse, such as shock. Only a small volume of drug can be given by this route.

20. Parenteral Routes of Drug Administration
Intramuscular route
Medication in a liquid form is injected into a large mass of skeletal muscle
Advantages
Disadvantages
Technique
When a drug is given by the intramuscular route, a medication in a liquid form is injected into a large mass of skeletal muscle. Sites commonly used in prehospital care include the arm (deltoid muscle) and mid-lateral thigh (vastus lateralis muscle). The injection is usually made with a longer needle than that used with a SubQ injection. Larger volumes can be given by the intramuscular route than the subcutaneous route. The onset of action is faster than the SubQ route due to the muscle’s blood supply and large absorbing surface. Epinephrine is an example of a drug that may be given by this route.

21. Reassessment and Documentation
After giving a drug:
Document the reason the drug was given
Document the medication administered and the time you gave it
Reassess the patient
Document the patient’s vital signs and response to the drug.
After giving a drug, document the reason the drug was given, the medication administered, and the time you gave it. Reassess the patient and document the patient’s vital signs and response to the drug. Monitor the patient for possible adverse effects, as well as expected results.

22. Questions?