The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [543]
10 Administer the drug as prescribed. To meet legal requirements and hospital policy (DH 2003b, C; NMC 2008a, C; NMC 2008b, C; NMC 2009, C).
11 Offer a glass of water, if allowed, assisting the patient where necessary. To facilitate swallowing of the medication (Chernecky et al. 2002, E; Jordan et al. 2003, E).
12 Stay with the patient until they have swallowed all the medication. To ensure that medication has been taken on time (Chernecky et al. 2002, E).
Postprocedure
13 Record the dose given in the prescription chart and in any other place made necessary by legal requirement or hospital policy. To meet legal requirements and hospital policy (DH 2003b, C; NMC 2008a, C; NMC 2008b, C; NMC 2009, C).
Problem-solving table 13.1 Prevention and resolution (Procedure guideline 13.3)
Table 13.9 Considerations for specific types of administration
Consideration Rationale
Administer irritant drugs with meals or snacks To minimize their effect on the gastric mucosa (Jordan et al. 2003, Shepherd 2002a)
Administer drugs that interact with food, or that are destroyed in significant proportions by digestive enzymes, between meals or on an empty stomach To prevent interference with the absorption of the drug (Jordan et al. 2003, Shepherd 2002a)
Do not break a tablet unless it is scored and appropriate to do so. Break scored tablets with a file or a tablet cutter. Wash after use Breaking may cause incorrect dosage, gastrointestinal irritation or destruction of a drug in an incompatible pH. To reduce risk of contamination between tablets (DH 2007, Jordan et al. 2003, NMC 2008a, Shepherd 2002a)
Do not interfere with time-release capsules and enteric-coated tablets. Ask patients to swallow these whole and not to chew them The absorption rate of the drug will be altered (Jordan et al. 2003, Perry 2007)
Sublingual tablets must be placed under the tongue and buccal tablets between gum and cheek To allow for correct absorption (Perry 2007)
When administering liquids to babies and young children, or when an accurately measured dose in multiples of 1 mL is needed for an adult, an oral syringe should be used in preference to a medicine spoon or measure An oral syringe is much more accurate than a measure or a 5 mL spoon
Use of a syringe makes administration of the correct dose much easier in an unco-operative child
Oral syringes are available and are designed to be washable and reused for the same patient. However, in the immunocompromised patient single use only is recommended. Oral syringes must be clearly labelled for oral or enteral use only (DH 2007, NPSA 2007d)
In babies and children especially, correct use of the syringe is very important. The tip should be gently pushed into and towards the side of the mouth. The contents are then slowly discharged towards the inside of the cheek, pausing if necessary to allow the liquid to be swallowed. If children are unco-operative it may help to place the end of the barrel between the teeth To prevent injury to the mouth and eliminate the danger of choking the patient (Watt 2003)
To get the dose in and to prevent the patient spitting it out (Watt 2003)
When administering gargling medication, throat irrigations should not be warmer than body temperature Liquid warmer than body temperature may cause discomfort or damage tissue.
Topical administration
Definition
Medication applied onto the skin and mucous membranes primarily for its local effects, for example creams and ointments (Chernecky et al. 2002, Snyder 2007).
Related theory
Creams
Creams are emulsions of oil and water and are generally well absorbed into the skin. They are usually more cosmetically acceptable than ointments because they are less greasy and easier to apply (BNF 2011). They may be used as a ‘base’ in which a variety of drugs may be applied for local therapy (BNF 2011).
Ointments
Ointments are greasy preparations, which