MABINI COLLEGES, INC.

Daet, Camarines Norte

College of Nursing and Midwifery
Email: mabinicollege@hotmail.com

DRUG ADMINISTRATION

PRACTICE GUIDELINES

 Nurses who administer medications are responsible for their own actions. Question any order that is
illegible or that you consider incorrect. Call the provider who prescribed the medication for clarification.
 Be knowledgeable about the medications you administer. You need to know why the client is receiving
the medication. Look up the necessary information if you are not familiar with the medication.
 Controlled substances must be stored in a secured, locked area, with proper documentation and
access restricted to authorized healthcare personnel.
 Use only medications that are in a clearly labeled container.
 Do not use liquid medications that are cloudy or have changed color. Oral suspension is an exception.
 Calculate drug doses accurately. If you are uncertain, ask another nurse to double-check your
calculations.
 Administer only medications personally prepared.
 Before administering a medication, identify the client correctly using the appropriate means of
identification, such as checking the identification bracelet.
 Do not leave medications at the bedside, with certain exceptions (e.g., nitroglycerin, cough syrup).
Check agency policy.
 If a client vomits after taking an oral medication, report this to the nurse in charge, or the primary care
provider, or both.
 Take special precautions when administering certain medications; for example, have another nurse
check the dosages of anticoagulants, insulin, and certain IV preparations.
 Most hospital policies require new orders from the primary care provider for a client’s post-surgery care.
 When a medication is omitted for any reason, record the fact together with the reason.
 When a medication error is made, report it immediately to the nurse in charge, the primary care
provider, or both.
 Always check a medication’s expiration date.
 Perform hand hygiene between clients. Antiseptic gels are appropriate to use if hands are not visibly
soiled. Hand washing with soap and water is required for visibly soiled hands.

TEN “RIGHTS” OF MEDICATION ADMINISTRATION

1. RIGHT MEDICATION
 The medication given was the medication ordered.

2. RIGHT DOSE
 The dose ordered is appropriate for the client.
 Give special attention if the calculation indicates multiple pills or tablets or a large quantity of a liquid
medication. This can be an indication that the math calculation may be incorrect.
 Double-check calculations that appear questionable.
 Know the usual dosage range of the medication.
 Question a dose outside of the usual dosage range.

3. RIGHT TIME
 Give the medication at the right frequency and at the time ordered according to agency policy.
 Medications should be given within the agency guidelines.

4. RIGHT ROUTE
 Give the medication by the ordered route.
 Make certain that the route is safe and appropriate for the client.

5. RIGHT CLIENT
 Medication is given to the intended client.
 Check the client’s identification band with each administration of a medication.
 Know the agency’s name alert procedure when clients with the same or similar last names are on the
nursing unit.

6. RIGHT CLIENT EDUCATION

  Explain information about the medication to the client (e.g., why receiving, what to expect, any
precautions).

7. RIGHT DOCUMENTATION
 Document medication administration after giving it, not before.
 If time of administration differs from prescribed time, note the time on the MAR and explain the reason
and follow-through activities (e.g., pharmacy states medication will be available in 2 hours) in nursing
notes.
 If a medication is not given, follow the agency’s policy for documenting the reason why.

8. RIGHT TO REFUSE
 Adult clients have the right to refuse any medication.
 The nurse’s role is to ensure that the client is fully informed of the potential consequences of refusal
and to communicate the client’s refusal to the healthcare provider.

9. RIGHT ASSESSMENT
 Some medications require specific assessments prior to administration (e.g., apical pulse, blood
pressure, laboratory results).
 Medication orders may include specific parameters for administration (e.g., do not give if pulse less
than 60 or systolic blood pressure less than 100).

10. RIGHT EVALUATION

 Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the client experience
any side effects or adverse reactions?).

CHECK THREE TIMES FOR SAFE

MEDICATION ADMINISTRATION

FIRST CHECK
 Read the MAR and remove the medication(s) from the client’s drawer. Verify that the client’s name and
room number match the MAR.
 Compare the label of the medication against the MAR
 If the dosage does not match the MAR, determine if you need to do a math calculation.
 Check the expiration date of the medication.

SECOND CHECK
 While preparing the medication (e.g., pouring, drawing up, or placing unopened package in a
medication cup), look at the medication label and check against the MAR. Oral Medications
 The oral route is the most common route by which medications are given. As long as a client can
swallow and retain the drug in the stomach, this is the route of choice (see Skill 35.1).
 Oral medications are contraindicated when a client is vomiting, has gastric or intestinal suction, or is
unconscious and unable to swallow. Such clients in a hospital are usually on orders for “nothing by
mouth” (the Latin is nil per os: NPO).

THIRD CHECK
 Recheck the label on the container (e.g., vial, bottle, or unused unit- dose medications) against the
MAR before returning to its storage place or before giving the medication to the client.

ROUTES OF MEDICATION ADMINISTRATION

1. Oral Route (PO - Per Os)

 The most common and convenient method.

 Includes tablets, capsules, liquids, and suspensions.
 Sublingual (SL): Placed under the tongue for rapid absorption.
 Buccal: Placed between the cheek and gums for absorption.

2. Parenteral Route (Injection)

 Intravenous (IV): Directly into the bloodstream for immediate effect.

 Intramuscular (IM): Injected into muscle tissue (e.g., deltoid, vastus lateralis).
 Subcutaneous (SC or SubQ): Injected into the fatty tissue (e.g., insulin, heparin).
 Intradermal (ID): Injected just below the skin (e.g., TB test, allergy testing).

3. Topical Route
  Applied directly to the skin or mucous membranes.
 Includes creams, ointments, patches, and transdermal medications.

4. Inhalation Route

 Medication is inhaled into the lungs via a nebulizer, inhaler, or ventilator.

 Used for respiratory conditions (e.g., asthma, COPD).

5. Rectal Route (PR - Per Rectum)

 Medication is inserted into the rectum in the form of suppositories or enemas.

 Useful for patients unable to take oral medications (e.g., unconscious, vomiting).

6. Vaginal Route

 Medications in suppository, cream, or tablet form are inserted into the vagina.
 Used for infections, hormonal therapy, or contraception.

7. Ophthalmic Route

 Medications administered as eye drops or ointments.

8. Otic Route

 Medications administered as ear drops.

9. Nasal Route

 Medications administered as sprays or drops into the nostrils.

 MABINI COLLEGES, INC.
Daet, Camarines Norte
College of Nursing and Midwifery
Email: mabinicollege@hotmail.com

PERFORMANCE EVALUATION CHECKLIST

ADMINISTERING ORAL MEDICATIONS

Name: _______________________________________ Date of Clinical Rotation: ____________________

Year/Clinical Grouping: _________________________ Rating: ________________
Instruction: Rate the following criteria after you have practiced the skills. Check appropriate scale.
Legend: 0 – Unable to Perform 1 – Able to Perform with Assistance 2 – Able to Perform
ORAL MEDICATIONS
 The oral route is the most common route by which medications are given. As long as a
client can swallow and retain the drug in the stomach, this is the route of choice.
 Oral medications are contraindicated when a client is vomiting, has gastric or intestinal
suction, or is unconscious and unable to swallow. Such clients in a hospital are usually on
orders for “nothing by mouth” (the Latin is nil per os: NPO).
PURPOSE
 To provide a medication that has systemic effects or local effects on the GI tract or both (see specific
drug action)

EQUIPMENT
 Client’s MAR or computer printout
 Dispensing system
 Disposable medication cups: small paper or plastic cups for tablets and capsules, waxed or plastic
calibrated medication cups for liquids
 Pill crusher or cutter
 Straws to administer medications that may discolor the teeth or to facilitate the ingestion of liquid
medication for certain clients
 Drinking glass and water or juice
 Soft foods such as applesauce or pudding to use for crushed medications for clients who may choke on
liquids

STEPS 0 1 2 Remarks
ASSESSMENT
Assess:
1. Type of administration: oral, sublingual, or buccal
2. Allergies to medication(s)
3. Client’s ability to swallow the medication
4. Presence of vomiting or diarrhea that would interfere with the ability to absorb the
medication
5. Specific drug action, side effects, interactions, and adverse reactions
6. Client’s knowledge of and learning needs about the medication
7. Perform appropriate assessments (e.g., vital signs, laboratory results) specific to
the medication.
8. Determine if the assessment data influence administration of the medication (i.e.,
is it appropriate to administer the medication or does the medication need to be
held and the prescriber notified?).
PREPARATION
9. Know the reason why the client is receiving the medication, the drug classification,
contraindications, usual dosage range, side effects, and nursing considerations for
administering and evaluating the intended outcomes for the medication.
10. Check the MAR.
11. Check for the drug name, dosage, frequency, route of administration, and
expiration date for administering the medication, if appropriate. Rationale: Orders
for certain medications (e.g., controlled substances, antibiotics) expire after
 a specified time frame and they need to be reordered by the primary care
provider.
12. If the MAR is unclear or pertinent information is missing, compare the MAR with
the prescriber’s most recent written order.
13. Report any discrepancies to the charge nurse or the primary care provider, as
agency policy dictates.
14. Verify the client’s ability to take medication orally.
15. Determine whether the client can swallow, is NPO, is nauseated or vomiting, has
gastric suction, or has diminished or absent bowel sounds.
16. Organize the supplies.
17. Gather the MAR(s) for each client together so that medications can be prepared
for one client at a time. Rationale: Organization of supplies saves time and
reduces the chance of error.
PROCEDURE
18. Perform hand hygiene and observe other appropriate infection prevention
procedures (e.g., clean gloves).
19. Unlock the dispensing system.
20. Obtain the appropriate medication.
21. Read the MAR and take the appropriate medication from the shelf, drawer, or
refrigerator. The medication may be dispensed in a bottle, box, or unit-dose
package.
22. Compare the label of the medication container or unit- dose package against the
order on the MAR or computer printout. Rationale: This is a safety check to
ensure that the right medication is given. If these are not identical, recheck
the prescriber’s written order in the client’s chart. If there is still a
discrepancy, check with the pharmacist.
23. Check the expiration date of the medication. Return expired medications to the
pharmacy. Rationale: Outdated medications are not safe to administer.
11. Use only medications that have clear, legible labels. Rationale: This ensures
accuracy.
12. Prepare the medication.
13. Calculate the medication dosage accurately.
14. Prepare the correct amount of medication for the required dose, without
contaminating the medication. Rationale: Aseptic technique maintains drug
cleanliness.
15. While preparing the medication, recheck each prepared drug and container with
the MAR again. Rationale: This second safety check reduces the chance of
error. Compare the medication label to the MAR.
TABLETS OR CAPSULES
16. Place packaged unit-dose capsules or tablets directly into the medicine cup. Do
not remove the medication from the package until at the bedside. Rationale: The
wrapper keeps the medication clean. Not removing the medication facilitates
identification of the medication in the event the client refuses the drug or
assessment data indicate to hold the medication. Unopened unit-dose
packages can usually be returned to the medication cart.
17. If using a stock container, pour the required number into the bottle cap, and then
transfer the medication to the disposable cup without touching the tablets.
18. Keep medications that require specific assessments, such as pulse
measurements, respiratory rate or depth, or blood pressure, separate from the
others. Rationale: This reminds the nurse to complete the needed
assessment(s) in order to decide whether to give the medication or to
withhold the medication if indicated.
19. Break only scored tablets if necessary to obtain the correct dosage. Use a cutting
or splitting device if needed. Check the agency policy as to how unused portions of
a medication are to be discarded.
20. If the client has difficulty swallowing, check if the medication can be crushed.
Some medications that should not be crushed include time-released and enteric-
coated medications. An example is oxycodone (OxyContin), a long-acting opioid
that normally lasts 12 hours after administration. If the tablet is crushed, the client
gets a surge of action in the first 2 hours, and may then start having severe pain
again in 4 to 6 hours, because the opioid effect wears off too soon. The crushing
of these tablets causes an uneven effect, and the long or sustained action of the
medication is lost.
21. If it is acceptable, crush the tablets to a fine powder with a pill crusher or between
two medication cups. Then, mix the powder with a small amount of soft food (e.g.,
custard, applesauce).
LIQUID MEDICATION
22. Thoroughly mix the medication before pouring. Discard any medication that has
changed color or turned cloudy, the exception being oral suspensions.
23. Remove the cap and place it upside down on the countertop. Rationale: This
avoids contaminating the inside of the cap.
24. Hold the bottle so the label is next to your palm and pour the medication away
 from the label. Rationale: This prevents the label from becoming soiled and
illegible as a result of spilled liquids.
POURING THE MEDICATION FROM THE BOTTLE
25. Place the medication cup on the flat surface at eye level and fill it to the desired
level, use the bottom of the meniscus (crescent-shaped upper surface of a column
liquid) to align with the container scale. Rationale: This method ensures
accuracy of measurement.
26. Before capping wipe the lip of the lid with a paper towel. Rationale: This prevents
the cap from sticking.
ALL MEDICATIONS
27. Place the prepared medication and MAR together on the medication cart.
28. Recheck the label on the container before returning the bottle, box, or envelope to
its storage place. Rationale: This third check further reduces the risk of error.
29. Avoid leaving prepared medications unattended. Rationale: This precaution
prevents potential mishandling errors.
30. Lock the medication cart before entering the client’s room. Rationale: This is a
safety measure because medication carts are not to be left open when
unattended.
31. Check the room number against the MAR if agency policy does not allow the MAR
to be removed from the medication cart. Rationale: This is another safety
measure to ensure that the nurse is entering the correct client room.
32. Provide for client privacy.
33. Prepare the client.
34. Introduce self and verify the client’s identity using agency protocol. Rationale:
This ensures that the right client receives the medication.
35. Assist the client to a sitting position or, if not possible, to a side-lying position.
Rationale: These positions facilitate swallowing and prevent aspiration.
36. If not previously assessed, take the required assessment measures, such as pulse
and respiratory rates or blood pressure. Take the apical pulse rate before
administering digitalis preparations. Take blood pressure before giving
antihypertensive drugs. Take the respiratory rate prior to administering opioids.
Rationale: Opioids depress the respiratory center. If any of the findings are
above or below the predetermined parameters, consult the primary care
provider before administering the medication.
37. Explain the purpose of the medication and how it will help, using language that the
client can understand. Include relevant information about effects; for example, tell
the client receiving a diuretic to expect an increase in urine output. Rationale:
Information can facilitate acceptance of and compliance with the therapy.
38. Administer the medication at the correct time.
39. Take the medication to the client within the guidelines of the agency.
40. Give the client sufficient water or preferred juice to swallow the medication. Before
using juice, check for any food and medication incompatibilities. Rationale: Fluids
ease swallowing and facilitate absorption from the GI tract. Grapefruit juice
may not be safe for clients who take certain medications. Liquid medications
other than antacids or cough preparations may be diluted with 15 mL (1/2 oz)
of water to facilitate absorption.
41. If the client is unable to hold the pill cup, use the pill cup to introduce the
medication into the client’s mouth, and give only one tablet or capsule at a time.
Rationale: Putting the cup to the client’s mouth maintains the cleanliness of
the nurse’s hands. Giving one medication at a time eases swallowing.
42. If an older child or adult has difficulty swallowing, ask the client to place the
medication on the back of the tongue before taking the water. Rationale:
Stimulation of the back of the tongue produces the swallowing reflex.
43. If the medication has an objectionable taste, give the medication with juice,
applesauce, or pudding if there are no contraindications. Rationale: Juices,
applesauce, or pudding may mask the taste of the medication.
44. 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. Rationale: Most clients are familiar with the appearance of
medications taken previously. Unfamiliar medications may signal a possible
error.
45. Stay with the client until all medications have been swallowed. Rationale: The
nurse must see the client swallow the medication before the drug
administration can be recorded. The nurse may need to check the client’s
mouth to ensure that the medication was swallowed and not hidden inside
the cheek. A primary care provider’s order or agency policy is required for
medications left at the bedside.
46. Document each medication given.
47. Record the medication given, dosage, time, any complaints or assessments of the
client, and your signature.
48. If medication was refused or omitted, record this fact on the appropriate record;
document the reason, when possible, and the nurse’s actions according to agency
 policy.
49. Dispose of all supplies appropriately.
50. Discard used disposable supplies.
51. Replenish stock (e.g., medication cups) and return the cart to the appropriate
place.
EVALUATION
52. Return to the client when the medication is expected to take effect (usually 30
minutes) to evaluate the effects of the medication on the client.
Observe for desired effect (e.g., relief of pain or decrease in body temperature).
53. Note any adverse effects or side effects (e.g., nausea, vomiting, skin rash, or
change in vital signs).
Compare to previous findings, if available.
Report significant deviations from normal to the primary care provider.
Total Score and Rating

Excellent – 90-100 Very Satisfactory – 85-89 Satisfactory

– 80-84 Unsatisfactory – 75-79

Comments / Suggestions:
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Clinical Instructor
Student’s Signature