1. Chapter 10 Administration Procedures

2. Three Checks and Six Rights
Three Checks When Preparing Medications
Read the label:
1. Check the drug label with the medication administration record (MAR) when removing the container or unit-dose package.
2. Check the drug label again immediately before pouring or opening the medication, or preparing the unit-dose.
3. Check the drug label once more when replacing the container and/or before giving the unit-dose to the patient/client.

3. Three Checks and Six Rights
Six Rights Before Administering Medications
1. Right medication
2. Right patient/client
3. Right dosage
4. Right route
5. Right time
6. Right documentation

4. Medication Orders
A correct medication order or prescription bears the patient/client’s name, room number, date, name of drug (generic or trade), dose of the drug, route of administration, and times to administer the drug
It ends with the signature of the physician or healthcare provider ordering the drug

5. Types of Orders
1. Standing order with termination. Example: Keflex (cephalexin) 500 mg PO every 6 hours × 7 days
2. Standing order without termination. Example: digoxin (Lanoxin) 0.5 mg PO every day 
3. A prn order. Example: morphine 2 to 4 mg IV q 4 h prn pain
4. Single-dose order. Example: atropine 0.3 mg subcutaneous 7:30 a.m. on call to OR
5. Stat order. Example: morphine sulfate 4 mg IV stat
6. Protocols. Example: for K <3.5, K 20 mEq PO q 4 hour × 2 days

6. Mobile Cart System
Place the patient/client’s drawer on the top of the cart. Read each medication order, and choose the unit-dose from the drawer and compare the label with the order.
After comparing the order with the unit measure, compute the dose. Check the drug label, then open or prepare the unit-dose, or pour the amount of a liquid medication.
Label the unit-dose, read the order again, and verify the dose. After preparing all of the patient/client’s medications, read the name on the medicine sheet, check the patient/client’s identification band, and administer the drugs.

7. How medications are administered
Enteral: Through the gastrointestinal system
Usually oral or through nasogastric tube
Oral is most common, cost-effective route
Can also be given dissolved on or under the tongue (sublingual), rectal route if needed
Parenteral: Injected
Intramuscular
Subcutaneous
Intradermal
Intravenous
Other routes: skin, eyedrops, eardrops, inhaled, time-release patch, nose drops, vaginal suppository

8. Oral Medications Check expiration dates. Check for allergies.
Check with the physician if certain drugs are administered when the patient/client is NPO (nothing by mouth).
Do not touch stock medications with hands.
Do not break tablets that are not scored.
Do not crush enteric-coated tablets.

9. Liquid Medications Shake liquid medications thoroughly before pouring.
Pour liquids at eye level.
Wipe the lip of the bottle with a paper towel before recapping.
Disguise liquids if distasteful or irritating.
Juice
Straw
Don’t dilute liquid cough medicines.

10. Parenteral Route Adult maximum one site Angle of insertion 3 mL
2 mL deltoid
Angle of insertion
Intramuscular (IM): 90-degree angle
Subcutaneous: 45-degree angle; use a 90-degree angle if the subcutaneous layer of fat is thick and the needle is short

11. Medication Administration Techniques
Skin and mucous membranes
Ear drops
Adult: Pinna up and back
Child: Pinna down and back
Rest on the unaffected side for 10 to 15 minutes
Eye drops or ointment
Drops: lower conjunctival sac
Ointment: spread inner to outer canthus of eye

12. Nasogastric Route Head of bed elevated 30 degrees Check placement
15 mL of air
Aspirate stomach contents.
Check acidity of stomach contents.
Flush at least 30 mL of warm water to ensure patency.

13. Neonatal and Pediatric Considerations
Offer a popsicle to numb the taste buds.
Mix with a teaspoon of puréed fruit, ice cream, or syrup.
Pinch the nostril closed and drink medication through a straw.
Distract the child with conversation or a toy.
Use a decorative adhesive bandage to cover the injection site.

14. Geriatric Considerations
Offer a popsicle to numb the taste buds.
Mix with a teaspoon of puréed fruit, ice cream, or syrup.
Injections
Predetermine the injection site.
Insert the needle quickly.
Inject the medication slowly.