Oral Medication

MEDICATION ADMINISTRATION
ORAL MEDICATION
Introduction
Medications now come in multiple forms for administration via multiple
routes, the prescribed route will depend on availability, cost, speed and
the child’s ability/tolerance of the chosen route.
The oral route is the most common route of administration in children.
This is for several reasons:
 It is associated with less pain and anxiety than other routes such
as intramuscular injections.
 It is often cheaper than other preparations such as intravenous.
 Less equipment is required and the procedure is often less time
consuming and more convenient.
The majority of oral medication for infants are available in liquid form.
These drugs often include a sweet flavor to make them more palatable
to youngsters.
The three main areas of medicine management in children; health
education, administering the prescribed medicine safely.
Devices for giving oral medication

 In case of infants: a syringe, dropper or calibrated spoon
 In case of elder children: cylindrical dosing spoon(which
resembles a long test tube with a small spoon at the top) or
cup, silverware spoon.
Basic principles
Child development consideration are important in the administration of
medicines, some basic principles include:
 Be confident and firm
 Approach the child family with a positive attitude
 Be honest and understanding
 Allow the child to have control where appropriate
 Use the appropriate language that the child understands
 Discuss with the child what they might taste/smell/see/hear/feel
 Listen to all involved
 Explain the benefits of compliance with the medicine taking
Drug calculations
Pediatric dose circulation is usually based on either body surface area
(mg/m2 ) or body weight (mg/kg) of the child. Body weight is used more
frequently for case of calculations.
To calculate drug doses use the following formula:
What you want / what you have × what it is in (dilution) ml
For example: a child is prescribed 90mg of paracetamol and the
medication supplied is 120mg of paracetamol in 5mls:
90 / 120 × 5 = 3.75mls
Medication error arising from poor mathematical skills of nurses are an
ongoing problems.
To enhance safety:
 Take time working out calculations
 Recheck answers
 Do not be rushed by colleagues/patients/parents/careers
 Answers that look wrong are probably wrong and in initial mental
estimate of dose may be useful.
Special considerations
 If the volume of suspension is large, consider using an alternative
preparation (e.g. soluble tablets)
 Crushing tablets or opening capsules generally makes the
medication unlicensed for use. Any harm caused by this practice is
a shared responsibility between the nurse administering drug and
the prescriber who has a legal requirement to authorize this
practice.
 Some tablets are not suitable for crushing. For example slow
release capsules should not be crushed as the coating prevents
The release And absorption of the drug until it has reached the
small intestine.
 Soluble tablets/capsules Should not be crushed but dissolved in
water.
 Some capsules Should not be broken What opened as the
preparation inside the shell is coated in a matrix(e.g. vancomycin
tablets).
 It is good practice to avoid crushing tablets or dissolving the
contents of capsules. However, if this is unavoidable, care should
be taken to ensure the dose drawn up is as accurate as possible.
Liaising with pharmacy and an appropriate tablet cutter should be
used.
 Personal protective equipment(PPE) should be considered
whenever there is a risk of inhalation of history of allergies for the
person administering the medicine or at the recommendation of
the manufactures guidelines.
Contraindication
 Unconscious child
 Absent gag reflex
 In ability to swallow
 Vomiting
Cautions to prevent worsening of the child's condition
 Digestive tract trauma/illness
 Post gastro-intestinal surgery
 Nil-by-mouth
 Nausea
 Diarrhea
Preparation of equipment
 Prescription chart
 Medication formulary (e.g. British National formulary (bnf),
medicines for children, guys formulary or refer to the gos Intranet
pharmacy home page). Ensure appropriate formulary is checked.
 Manufacturers drug information(If required)
 Disposable medication tray
 Medication
 Medicine spoon/pot(with measured volumes) or
 Purple oral syringe
 Cup/beaker/Ieat (if required)
 Tablet splitter/tablet cutter
 Sterile water(for dissolving medication)
 Non sterile gloves(if required)
Must do ‘s’ areas that are in bold should be read aloud
 Systematic check of chart
 Allergies
 Weight gain
 Weight/age/Surface area
 Right patient
 Right medicine
 Right time
 Right dose
 Signed by a prescriber
 Drug commence date completed
 Expiry
 Double checking - this must occur from start to finish
Preliminary assessment
 Check the prescription is And correctly written and is signed and
dated by the prescribing practitioner.
 Check the medication is required and has not already been given.
Ensure any preliminary checks and observations have been
carried out if necessary prior to administration(e.g. Blood
pressure monitoring prior to administration of anti-
hypertensives).
 Check the child does not have any known allergy or
contraindication to the prescribed medication. Inform the
prescribing practitioner immediately if the child does and do not
give the medicine.
 Check that record weight has been recorded and dated on the
prescription chart
 On admission
 Weekly as an inpatient
 Check in an approved drug formulary that the dose, route and
frequency of prescribed medication are accurate.
 Check the medication supplied in suitable for oral administration
 If more than one medicine is prescribed, check for compatibilities
and drug interactions, if they are not inform the prescribing
practitioner.
 Check if it is necessary for the medication to be given before or
after food/fluid because the administration of some medication
on an empty stomach can cause gastric irritation and the effect of
other medication maybe inhibited by the presence of food.
Inform child and family
 Negotiate with the parent/caregiver and child regarding mixing
the medication with food two disguise the taste. NB: the nurse
and parent/guardian should consider the potential benefits and
risks of convert administration of medications in food/fluid
carefully.
 Identify if the child has any previous experience of taking
medications and if so what this experience was like for them.
 Using age and or developmentally appropriate language, explain
to the child what medication is due and why. Explain this to the
parent caregiver as well. Negotiate roles for the administration of
the medication with the child/caregiver/parent.
 Where possible, allow the child as much control and choice as
possible in the procedure.
 Be firm but fair with the child.
 If a choice is available, identify the child's preference for the form
of oral medication(e.g. tablet or suspension) and the type of
vessel to be used.
PROCEDURE
Steps Of Procedure Rationale
1. Ensure treatment room door is closed. 1. To minimize disruptions and reduce the
risk of a mistake
2. Wash hands according to the 2. To reduce the risk of cross infection.
trust guidelines.
3. Remove the medication from the 3. To prevent a medication error occurring
box and check the name, dose and if the medication bottle or tablet strip has
expiry date of the medication's been put in the incorrect box.
original container (e.g. bottle label,
tables strip, vial)
4. Dispense medication into the 4. To reduce the risk of cross infection.
appropriate vessel without directly
touching the medication with your
hands.
5. Check the child is available to tike 5. To prevent tampering of medication.
the medication.
6. Take the medication directly to 6. To prevent accidental ingestion of
the child for administration. medication by others.
7. Do not leave the medication in a 7. To ensure trust policy is adhered to and
room for the parent/career to that the medication given via the wrong
administer later. route.
8. Do not take medication that requires 8. To minimize the risk of administering

administration via different routes into medications via the wrong route.
the room at the same time (i.e. oral and
intravenous medication)
9. Follow administering medication must 9. To reduce risk of drug error occurring.
do's) areas in bold should be read aloud
10. identify patient:- the electronic 10. To adhere to trust policy.
prescription must be taken to the
patient for this check outpatients to
follow their policy for patient
identification.
 Witness. have you seen the patient
take the drugs ?
 sign the chart
 remember: check the name, date
of birth and hospital number on
the medication chart corresponds
with the details on the child's name
band.
11. All children should have a name 11. To ensure safe administration to
band in situ or a photograph to confirm correct patient.
the child's identify. both people checking
the drug should check this students must
double- check the name band with the
staff nurse who checked the drug.
12. Do not attempt to administer the 12. To promote development of a trusting
medicine while the child is a sleep / relationship between child and nurse and
crying. to reduce the risk of aspiration.
13. Assist the child if necessary in 13. To promote ingestion of medication.
repositioning for administration of
medicines.
14. Unless contraindicated by condition 14. To reduce risk of spillage and to reduce
or treatment the child should be in an the risk of aspiration.
upright position, a baby can be
positioned in a semi- reclined position
with the head elevated on your the
parent/career’s lap.
15. Allow time for the child to take the 15. To decrease feelings of anxiety at
medicine. being rushed and aid compliance.
16. Do not force the vessel/medicine 16. To reduce exposure to syringes and
into the child's mouth). unnecessary medication of the procedure.
17. Oral syringe/spoon can be inserted 17. To ensure the child has the ability to
into the side of the mouth between the maintain the airway in the pressures of
check and the gum or can be placed on fluid.
the tip of the tongue.
18. Encourage older children to use a 18. To ensure child receives an accurate
medicine pot or spoon to take dose.
medication.
19. Ensure the medication is given 19. To ensure child receives an accurate
slowly and use a medicine spoon to dose.
retrieve any medicine that has been spilt
or spat out.
20. Stroke a baby's check or under the 20. To encourage the sucking reflez.
chin.
21. Encourage older children to use a 21. To make the procedure seem a less
spoon or medicine pot rather than a "medical" one.
syringe.
22. Unless contraindicated offer the 22. To eliminate the taste of medicines.
child a flavored drink/ice cube between
and after medicines.
23. Provide positive reinforcement as 23. To encourage the child to take this
appropriate during and after the further medicines.
procedure.
24. Assist the child in re-positioning if 24. To promote the child's comfort.
required after the procedure.
25. If the child refuses or is unable to 25. To enable the responsible practitioner
take the prescribed medicine inform the to make a decision regarding the child’s
responsible prescriber. treatment.
26. Document the incident in the 26. To maintain accurate records.
appropriate section of the drug chart
and in the child's Health care notes.
27. Discard any unused medicine 27. To prevent the misuse of medicine by
according to trust policy (refer to gosh others.
medication policy.)
28. Dispose of equipment according to 28. To reduce the risk of cross infection.
trust waste policy, wash hands.
29. Sign for the administration of the 29. To reduce the risk of drug error where
medication on the child's prescription medication is given twice.
chart once administration is complete.
30. If the process required double- 30. To adhere to NMC guidelines. (NMC
checking ensure both signatures" are on 2004, Griffith 2003, NMC 2002)
the medication chart.
31. Monitor the effects of the medicine 31. To adhere to NMC guidelines. (NMC
administered and document in the 2004 Griffith 2003, NMC 2002)
nursing records.
32. Observe for and report immediately 32. To facilitate early detection and action
to the nurse in charge and responsible of any adverse effects of the
prescriber for any adverse effects of the medication( 2003)
medication.
33. Stabilize child's condition. complete 33. To facilitate a risk assessment as trust
incident form. policy.

Oral Medication

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MEDICATION ADMINISTRATION

Devices for giving oral medication

8. Do not take medication that requires 8. To minimize the risk of administering

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