{"id":2863,"date":"2015-05-22T21:39:40","date_gmt":"2015-05-22T21:39:40","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=2863"},"modified":"2021-06-09T15:22:44","modified_gmt":"2021-06-09T15:22:44","slug":"6-2-oral-and-gastric-medication","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/6-2-oral-and-gastric-medication\/","title":{"raw":"6.3 Administering Medications by Mouth and Gastric Tube","rendered":"6.3 Administering Medications by Mouth and Gastric Tube"},"content":{"raw":"

Medication by Mouth<\/h2>\r\nMedication is usually\u00a0given orally, which\u00a0is generally\u00a0the most comfortable and convenient route for the patient. Medication given orally has a slower onset and a more prolonged, but less potent, effect than medication administered by other routes (Lynn, 2011).\r\n\r\nPrior to oral administration of medications, ensure that the patient has no contraindications to receiving oral medication, is able to swallow, and is not on\u00a0gastric suction. If the patient is having difficulty swallowing (dysphagia), some tablets may be crushed using a clean mortar and pestle for easier administration. Verify that a tablet may be crushed by consulting a drug reference or a pharmacist. Medications such as enteric-coated tablets, capsules, and sustained-release or long-acting drugs should never be crushed because doing so\u00a0will affect the intended action of the medication. Tablets should be crushed one at a time and not mixed, so that it is possible to tell drugs apart if there is a spill. You may mix the medication in a small amount of soft food, such as applesauce or pudding.\r\n\r\nPosition the patient in a side-lying or upright position to decrease the risk of aspiration. Offer a glass of water or other oral fluid (that is not contraindicated with the medication) to ease swallowing and improve absorption and dissolution of the medication, taking any fluid restrictions into account.\r\n\r\nRemain with the patient until all medication has been swallowed before\u00a0<\/em>signing that you administered the medication.\r\n\r\nChecklist 44 outlines the steps for administering\u00a0medication by mouth.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 44: Administering Medication by Mouth<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n
Safety considerations:<\/h5>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1.\u00a0Check MAR against doctor\u2019s orders.<\/td>\r\n\r\n

Check that MAR and doctor's orders are consistent.<\/p>\r\n\r\n\r\n[caption id=\"attachment_6140\" align=\"aligncenter\" width=\"150\"]\"Comparing<\/a> Compare physician orders and MAR[\/caption]\r\n\r\nNight staff usually complete and verify this check as well.<\/td>\r\n<\/tr>\r\n

2. Perform the SEVEN RIGHTS\u00a0x 3 (must be done with each individual medication):\r\n
    \r\n \t
  • The right patient<\/li>\r\n \t
  • The right medication (drug)<\/li>\r\n \t
  • The right dose<\/li>\r\n \t
  • The right route<\/li>\r\n \t
  • The right time<\/li>\r\n \t
  • The right reason<\/li>\r\n \t
  • The right documentation<\/li>\r\n<\/ul>\r\nMedication calculation: D\/H x S = A\r\n\r\n(D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available x S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/td>\r\n
\r\n

The right patient: check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\r\n\r\n

\r\n\r\n[caption id=\"attachment_6143\" align=\"aligncenter\" width=\"150\"]\"Compare<\/a> Compare MAR with patient wristband[\/caption]\r\n\r\n<\/div>\r\n

The right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\r\n

The right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\r\n

The right route: check that the route is appropriate for the patient's current condition.<\/p>\r\n

The right time: adhere to the prescribed dose and schedule.<\/p>\r\n

The right reason: check that the patient is receiving the medication for the appropriate reason.<\/p>\r\n

The right documentation: always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\r\n\r\n\r\n[caption id=\"attachment_6278\" align=\"aligncenter\" width=\"150\"]\"Check<\/a> Check the right patient, medication, dose, route, time, reason, documentation[\/caption]\r\n

NEVER document that you have given a medication until you have actually administered it.<\/p>\r\n<\/td>\r\n<\/tr>\r\n

3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:\r\n
    \r\n \t
  1. When the medication is taken out of the drawer<\/li>\r\n \t
  2. When the medication is being poured<\/li>\r\n \t
  3. When the medication is being put away\/or at bedside<\/li>\r\n<\/ol>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_6279\" align=\"aligncenter\" width=\"150\"]\"Perform<\/a> Perform seven checks three times before administering medication[\/caption]\r\n\r\nThese checks are done before administering the medication to your patient.\r\n\r\nIf taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\r\n<\/tr>\r\n
4. Place all medications that patient will receive in one cup, except medications that require pre-assessment (e.g., blood pressure or pulse rate). Place these in a separate cup and keep wrapper intact.<\/td>\r\nKeeping medications that require pre-assessment separately acts as a reminder and makes it easier to withhold medications if necessary.<\/td>\r\n<\/tr>\r\n
5. Do not touch medication with ungloved hands. Use clean gloved hands if it is necessary to touch the medication.<\/td>\r\nUsing gloves\u00a0reduces contamination of the medication.<\/td>\r\n<\/tr>\r\n
6. Circle medication when poured.<\/td>\r\nPour medication. Circle MAR to show that medication has been poured.\r\n\r\n[caption id=\"attachment_6277\" align=\"aligncenter\" width=\"150\"]\"Circle<\/a> Circle medication once it has been poured[\/caption]<\/td>\r\n<\/tr>\r\n
7. Patient education\r\n
    \r\n \t
  • Discuss purpose of each medication, action, and possible adverse effects.<\/li>\r\n \t
  • Ask patient if they have any allergies.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
The patient has the right to be informed and provided with\u00a0reasons for medication, action, and potential adverse effects.\u00a0Giving this information\u00a0will likely improve adherence to medication therapy and patient reporting of adverse effects.\r\n\r\nConfirms patient's allergy history.<\/td>\r\n<\/tr>\r\n
IMPORTANT:<\/span><\/strong> If patient expresses concerns over medications, do not give medication. Verify doctor's order and explore patient concerns before administering medication.<\/td>\r\n<\/tr>\r\n
8. Positioning\r\n
    \r\n \t
  • Help patient to sitting position. If patient is unable to sit, use the side-lying position.<\/li>\r\n \t
  • Have patient stay in this position for 30 minutes after administering medication.<\/li>\r\n \t
  • Offer patient water or desired oral fluid.<\/li>\r\n \t
  • Ensure proper body mechanics for\u00a0health care provider.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_6280\" align=\"aligncenter\" width=\"150\"]\"Position<\/a> Position patient appropriately for medication administration[\/caption]\r\n\r\nCorrect positioning reduces risk of aspiration during swallowing.\r\n\r\nWater or other oral fluids will help with swallowing of medication.\r\n\r\nProper body mechanics reduces risk of injury to health care provider.<\/td>\r\n<\/tr>\r\n
9. Administer medication orally as prescribed.\r\n
    \r\n \t
  • Tablets: place in mouth and swallow using water or other oral fluids.<\/li>\r\n \t
  • Orally disintegrating medications: Remove carefully from packaging. Place medication on top of patient's tongue, and have patient avoid chewing the medication. Water is not needed.<\/li>\r\n \t
  • Sublingually: Place medication under patient's tongue and allow to dissolve completely. Ensure patient\u00a0avoids swallowing the medication.<\/li>\r\n \t
  • Buccal: place medication in mouth and against inner cheek and gums and allow to dissolve completely.<\/li>\r\n \t
  • Powdered medication: mix at bedside with water to avoid thickening of medication that may occur with time.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Follow any specific descriptions for administration of the\u00a0medication.\r\n\r\nWear gloves if placing the medication inside the patient's mouth.\r\n\r\n <\/td>\r\n<\/tr>\r\n
10. Post-medication safety check\r\nDo not sign for any medications if you are not sure the patient has taken them.\r\n\r\nPost assessments determine effects and potential adverse effects of medications.<\/td>\r\n<\/tr>\r\n
11. Return within appropriate time to evaluate patient's response to the medications and to check for possible adverse effects.\r\n\r\nIf patient presents with any adverse effects:\r\n
    \r\n \t
  • Withhold further doses.<\/li>\r\n \t
  • Assess vital signs.<\/li>\r\n \t
  • Notify prescriber.<\/li>\r\n \t
  • Notify pharmacy.<\/li>\r\n \t
  • Document as per agency policy.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Most sublingual medications act in 15 minutes, and most oral medications act in 30 minutes.\r\n\r\n <\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Medication via a Gastric Tube<\/h2>\r\nPatients with a gastric tube (nasogastric, nasointestinal, percutaneous endoscopic gastrostomy [PEG], or jejenostomy [J] tube) will often receive medication through this tube (Lynn, 2011). Liquid medications should always be used when possible because absorption is better and less likely to cause blockage of the tube. Certain solid forms of medication can be crushed and mixed with water prior to administration.\r\n\r\nChecklist 45 outlines the steps for\u00a0administering\u00a0medication via a gastric tube.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 45: Administering Medication via a Gastric Tube<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n
Safety considerations:<\/h5>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1.\u00a0Check MAR against doctor\u2019s orders.<\/td>\r\nCheck that MAR and doctor's orders are consistent.\r\n\r\n[caption id=\"attachment_6140\" align=\"aligncenter\" width=\"150\"]\"Comparing<\/a> Compare physician orders and MAR[\/caption]\r\n\r\nNight staff usually complete and verify this check as well.<\/td>\r\n<\/tr>\r\n
2. Perform the SEVEN RIGHTS\u00a0x 3 (must be done with each individual medication):\r\n
    \r\n \t
  • The right patient<\/li>\r\n \t
  • The right medication (drug)<\/li>\r\n \t
  • The right dose<\/li>\r\n \t
  • The right route<\/li>\r\n \t
  • The right time<\/li>\r\n \t
  • The right reason<\/li>\r\n \t
  • The right documentation<\/li>\r\n<\/ul>\r\nMedication calculation: D\/H x S = A\r\n\r\n(D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available x S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/td>\r\n
The right patient: check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).\r\n\r\n[caption id=\"attachment_6143\" align=\"aligncenter\" width=\"150\"]\"Compare<\/a> Compare MAR with patient wristband[\/caption]\r\n\r\nThe right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context.\r\n\r\nThe right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.\r\n\r\nThe right route: check that the route is appropriate for the patient's current condition.\r\n\r\nThe right time: adhere to the prescribed dose and schedule.\r\n\r\n[caption id=\"attachment_6278\" align=\"aligncenter\" width=\"150\"]\"Check<\/a> Check the right patient, medication, dose, route, time, reason, documentation[\/caption]\r\n\r\nThe right reason: check that the patient is receiving the medication for the appropriate reason.\r\n\r\nThe right documentation: always verify any unclear or inaccurate documentation prior to administering medications.\r\n\r\nNEVER document that you have given a medication until you have actually administered it.<\/td>\r\n<\/tr>\r\n
3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:\r\n
    \r\n \t
  1. When the medication is taken out of the drawer<\/li>\r\n \t
  2. When the medication is being poured<\/li>\r\n \t
  3. When the medication is being put away\/or at bedside<\/li>\r\n<\/ol>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_6279\" align=\"aligncenter\" width=\"150\"]\"Perform<\/a> Perform seven checks three times before administering medication[\/caption]\r\n\r\nThese checks are done before administering the medication to your patient.\r\n\r\nIf taking drug to bedside (e.g., eye drops),\u00a0do third check at bedside.<\/td>\r\n<\/tr>\r\n
4. Place all medications that patient will receive in one cup, except medications that require pre-assessment (e.g., blood pressure or pulse rate). Place these in a separate cup and keep wrapper intact.<\/td>\r\nKeeping medications that require pre-assessment separately acts as a reminder and makes it easier to withhold medications if necessary.<\/td>\r\n<\/tr>\r\n
5.\u00a0Do not touch medication with ungloved hands. Use clean gloved hands if it is necessary to touch the medication.<\/td>\r\nUse gloves to reduce contamination of medication.<\/td>\r\n<\/tr>\r\n
6. Circle medication when poured.<\/td>\r\nPour medication. Circle MAR to show that medication has been poured.\r\n\r\n[caption id=\"attachment_6277\" align=\"aligncenter\" width=\"150\"]\"Circle<\/a> Circle medication once it has been poured[\/caption]<\/td>\r\n<\/tr>\r\n
7. Patient education:\r\n
    \r\n \t
  • Discuss purpose of each medication, action, and possible adverse effects.<\/li>\r\n \t
  • Ask patient if he or she has any allergies.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
The patient has the right to be informed, and providing reasons for medication, actions, and potential adverse effects will likely improve adherence to medication therapy and patient reporting of adverse effects.\r\n\r\nConfirm patient's allergy history.<\/td>\r\n<\/tr>\r\n
IMPORTANT<\/span>:<\/strong> If patient expresses concern about medications, do not give medication. Verify doctor's order and explore patient concerns before administering medication.<\/td>\r\n<\/tr>\r\n
8. Help patient to a high sitting position unless contraindicated.<\/td>\r\nThis position reduces risk of aspiration during swallowing.<\/td>\r\n<\/tr>\r\n
9. Determine if medication should be given with or without food. If the medication is to be given on an empty stomach, the enteral\u00a0feeding may need to be stopped from\u00a030 minutes before until 30 minutes after the medication is given.<\/td>\r\nFollow specific medication guidelines to ensure adequate absorption and distribution of the medication.<\/td>\r\n<\/tr>\r\n
10. Apply clean non-sterile gloves.<\/td>\r\nUsing gloves prevents spread of microorganisms.<\/td>\r\n<\/tr>\r\n
11. Check gastric tube for correct placement as described in Chapter 10<\/a>.<\/td>\r\nEnsure that tube is properly placed prior to administering medication to prevent aspiration.<\/td>\r\n<\/tr>\r\n
12. Dilute medication in 15 to 30 ml of water.<\/td>\r\nDilution keeps the tube from blocking.<\/td>\r\n<\/tr>\r\n
13. Remove plunger from a 60 ml gastric tube syringe and attach syringe to the end of the gastric tube while pinching the gastric tube.<\/td>\r\nMake sure the tip of the syringe fits the end of the gastric tube.<\/td>\r\n<\/tr>\r\n
14.\u00a0Pour medication and water solution into the 60 ml syringe, release pinch, and allow fluid to drain slowly by gravity into the gastric tube.<\/td>\r\nIf fluid does not drain by gravity, gentle pressure may be applied using the plunger of the syringe, but do not force the medication through the tube.\r\n\r\n[caption id=\"attachment_6785\" align=\"aligncenter\" width=\"300\"]\"Administer<\/a> Administer diluted medication via gastric tube[\/caption]<\/td>\r\n<\/tr>\r\n
15. Flush 10 ml of water between medications.<\/td>\r\nThis step prevents interactions between medications.<\/td>\r\n<\/tr>\r\n
16. After the last medication has been given, flush the tube with 30 ml of water.<\/td>\r\nFlushing prevents blocking of the tube.<\/td>\r\n<\/tr>\r\n
17. Keep the patient in a high sitting position to prevent aspiration.<\/td>\r\nThis position prevents aspiration and encourages absorption of medication.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n
18. Post-medication safety check:\r\n \r\n\r\nPost assessments determine effects and potential adverse effects of medications.<\/td>\r\n<\/tr>\r\n
19. Return within appropriate time frame to evaluate patient's response to the medications and to check for possible adverse effects.\r\n\r\nIf patient presents with any adverse effects:\r\n
    \r\n \t
  • Withhold further doses.<\/li>\r\n \t
  • Assess vital signs.<\/li>\r\n \t
  • Notify prescriber.<\/li>\r\n \t
  • Notify pharmacy.<\/li>\r\n \t
  • Document as per agency policy.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Evaluate patient for intended and adverse effects.<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n

Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n

\r\n
    \r\n \t
  1. Your patient is dysphagic. Discuss the steps you should\u00a0take and the considerations you should be cognizant of to administer oral medication safely.<\/li>\r\n \t
  2. Your patient is receiving medication and nutritional sustenance via an enteral gastric tube. The drug reference guide recommends that the medication\u00a0you should administer be given without food. Discuss how you would approach this situation to ensure the safe administration of the medication.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    Medication by Mouth<\/h2>\n

    Medication is usually\u00a0given orally, which\u00a0is generally\u00a0the most comfortable and convenient route for the patient. Medication given orally has a slower onset and a more prolonged, but less potent, effect than medication administered by other routes (Lynn, 2011).<\/p>\n

    Prior to oral administration of medications, ensure that the patient has no contraindications to receiving oral medication, is able to swallow, and is not on\u00a0gastric suction. If the patient is having difficulty swallowing (dysphagia), some tablets may be crushed using a clean mortar and pestle for easier administration. Verify that a tablet may be crushed by consulting a drug reference or a pharmacist. Medications such as enteric-coated tablets, capsules, and sustained-release or long-acting drugs should never be crushed because doing so\u00a0will affect the intended action of the medication. Tablets should be crushed one at a time and not mixed, so that it is possible to tell drugs apart if there is a spill. You may mix the medication in a small amount of soft food, such as applesauce or pudding.<\/p>\n

    Position the patient in a side-lying or upright position to decrease the risk of aspiration. Offer a glass of water or other oral fluid (that is not contraindicated with the medication) to ease swallowing and improve absorption and dissolution of the medication, taking any fluid restrictions into account.<\/p>\n

    Remain with the patient until all medication has been swallowed before\u00a0<\/em>signing that you administered the medication.<\/p>\n

    Checklist 44 outlines the steps for administering\u00a0medication by mouth.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 44: Administering Medication by Mouth<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n
    Safety considerations:<\/h5>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1.\u00a0Check MAR against doctor\u2019s orders.<\/td>\n\n

    Check that MAR and doctor’s orders are consistent.<\/p>\n

    \"Comparing<\/a>
    Compare physician orders and MAR<\/figcaption><\/figure>\n

    Night staff usually complete and verify this check as well.<\/td>\n<\/tr>\n

    2. Perform the SEVEN RIGHTS\u00a0x 3 (must be done with each individual medication):<\/p>\n
      \n
    • The right patient<\/li>\n
    • The right medication (drug)<\/li>\n
    • The right dose<\/li>\n
    • The right route<\/li>\n
    • The right time<\/li>\n
    • The right reason<\/li>\n
    • The right documentation<\/li>\n<\/ul>\n

      Medication calculation: D\/H x S = A<\/p>\n

      (D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available x S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/td>\n

    		\n

    The right patient: check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\n

    \n
    \"Compare<\/a>
    Compare MAR with patient wristband<\/figcaption><\/figure>\n<\/div>\n

    The right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\n

    The right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\n

    The right route: check that the route is appropriate for the patient’s current condition.<\/p>\n

    The right time: adhere to the prescribed dose and schedule.<\/p>\n

    The right reason: check that the patient is receiving the medication for the appropriate reason.<\/p>\n

    The right documentation: always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\n

    \"Check<\/a>
    Check the right patient, medication, dose, route, time, reason, documentation<\/figcaption><\/figure>\n

    NEVER document that you have given a medication until you have actually administered it.<\/p>\n<\/td>\n<\/tr>\n

    3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:<\/p>\n
      \n
    1. When the medication is taken out of the drawer<\/li>\n
    2. When the medication is being poured<\/li>\n
    3. When the medication is being put away\/or at bedside<\/li>\n<\/ol>\n<\/td>\n
    		\n
    \"Perform<\/a>
    Perform seven checks three times before administering medication<\/figcaption><\/figure>\n

    These checks are done before administering the medication to your patient.<\/p>\n

    If taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\n<\/tr>\n

    4. Place all medications that patient will receive in one cup, except medications that require pre-assessment (e.g., blood pressure or pulse rate). Place these in a separate cup and keep wrapper intact.<\/td>\nKeeping medications that require pre-assessment separately acts as a reminder and makes it easier to withhold medications if necessary.<\/td>\n<\/tr>\n
    5. Do not touch medication with ungloved hands. Use clean gloved hands if it is necessary to touch the medication.<\/td>\nUsing gloves\u00a0reduces contamination of the medication.<\/td>\n<\/tr>\n
    6. Circle medication when poured.<\/td>\nPour medication. Circle MAR to show that medication has been poured.<\/p>\n
    \"Circle<\/a>
    Circle medication once it has been poured<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    7. Patient education<\/p>\n
      \n
    • Discuss purpose of each medication, action, and possible adverse effects.<\/li>\n
    • Ask patient if they have any allergies.<\/li>\n<\/ul>\n<\/td>\n
    		The patient has the right to be informed and provided with\u00a0reasons for medication, action, and potential adverse effects.\u00a0Giving this information\u00a0will likely improve adherence to medication therapy and patient reporting of adverse effects.<\/p>\n

    Confirms patient’s allergy history.<\/td>\n<\/tr>\n

    IMPORTANT:<\/span><\/strong> If patient expresses concerns over medications, do not give medication. Verify doctor’s order and explore patient concerns before administering medication.<\/td>\n<\/tr>\n
    8. Positioning<\/p>\n
      \n
    • Help patient to sitting position. If patient is unable to sit, use the side-lying position.<\/li>\n
    • Have patient stay in this position for 30 minutes after administering medication.<\/li>\n
    • Offer patient water or desired oral fluid.<\/li>\n
    • Ensure proper body mechanics for\u00a0health care provider.<\/li>\n<\/ul>\n<\/td>\n
    		\n
    \"Position<\/a>
    Position patient appropriately for medication administration<\/figcaption><\/figure>\n

    Correct positioning reduces risk of aspiration during swallowing.<\/p>\n

    Water or other oral fluids will help with swallowing of medication.<\/p>\n

    Proper body mechanics reduces risk of injury to health care provider.<\/td>\n<\/tr>\n

    9. Administer medication orally as prescribed.<\/p>\n
      \n
    • Tablets: place in mouth and swallow using water or other oral fluids.<\/li>\n
    • Orally disintegrating medications: Remove carefully from packaging. Place medication on top of patient’s tongue, and have patient avoid chewing the medication. Water is not needed.<\/li>\n
    • Sublingually: Place medication under patient’s tongue and allow to dissolve completely. Ensure patient\u00a0avoids swallowing the medication.<\/li>\n
    • Buccal: place medication in mouth and against inner cheek and gums and allow to dissolve completely.<\/li>\n
    • Powdered medication: mix at bedside with water to avoid thickening of medication that may occur with time.<\/li>\n<\/ul>\n<\/td>\n
    		Follow any specific descriptions for administration of the\u00a0medication.<\/p>\n

    Wear gloves if placing the medication inside the patient’s mouth.<\/p>\n

     <\/td>\n<\/tr>\n

    10. Post-medication safety check<\/p>\nDo not sign for any medications if you are not sure the patient has taken them.<\/p>\n

    Post assessments determine effects and potential adverse effects of medications.<\/td>\n<\/tr>\n

    11. Return within appropriate time to evaluate patient’s response to the medications and to check for possible adverse effects.<\/p>\n

    If patient presents with any adverse effects:<\/p>\n

      \n
    • Withhold further doses.<\/li>\n
    • Assess vital signs.<\/li>\n
    • Notify prescriber.<\/li>\n
    • Notify pharmacy.<\/li>\n
    • Document as per agency policy.<\/li>\n<\/ul>\n<\/td>\n
    		Most sublingual medications act in 15 minutes, and most oral medications act in 30 minutes.<\/p>\n

     <\/td>\n<\/tr>\n

    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Medication via a Gastric Tube<\/h2>\n

    Patients with a gastric tube (nasogastric, nasointestinal, percutaneous endoscopic gastrostomy [PEG], or jejenostomy [J] tube) will often receive medication through this tube (Lynn, 2011). Liquid medications should always be used when possible because absorption is better and less likely to cause blockage of the tube. Certain solid forms of medication can be crushed and mixed with water prior to administration.<\/p>\n

    Checklist 45 outlines the steps for\u00a0administering\u00a0medication via a gastric tube.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 45: Administering Medication via a Gastric Tube<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n
    Safety considerations:<\/h5>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1.\u00a0Check MAR against doctor\u2019s orders.<\/td>\nCheck that MAR and doctor’s orders are consistent.<\/p>\n
    \"Comparing<\/a>
    Compare physician orders and MAR<\/figcaption><\/figure>\n

    Night staff usually complete and verify this check as well.<\/td>\n<\/tr>\n

    2. Perform the SEVEN RIGHTS\u00a0x 3 (must be done with each individual medication):<\/p>\n
      \n
    • The right patient<\/li>\n
    • The right medication (drug)<\/li>\n
    • The right dose<\/li>\n
    • The right route<\/li>\n
    • The right time<\/li>\n
    • The right reason<\/li>\n
    • The right documentation<\/li>\n<\/ul>\n

      Medication calculation: D\/H x S = A<\/p>\n

      (D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available x S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/td>\n

    		The right patient: check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\n
    \"Compare<\/a>
    Compare MAR with patient wristband<\/figcaption><\/figure>\n

    The right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\n

    The right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\n

    The right route: check that the route is appropriate for the patient’s current condition.<\/p>\n

    The right time: adhere to the prescribed dose and schedule.<\/p>\n

    \"Check<\/a>
    Check the right patient, medication, dose, route, time, reason, documentation<\/figcaption><\/figure>\n

    The right reason: check that the patient is receiving the medication for the appropriate reason.<\/p>\n

    The right documentation: always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\n

    NEVER document that you have given a medication until you have actually administered it.<\/td>\n<\/tr>\n

    3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:<\/p>\n
      \n
    1. When the medication is taken out of the drawer<\/li>\n
    2. When the medication is being poured<\/li>\n
    3. When the medication is being put away\/or at bedside<\/li>\n<\/ol>\n<\/td>\n
    		\n
    \"Perform<\/a>
    Perform seven checks three times before administering medication<\/figcaption><\/figure>\n

    These checks are done before administering the medication to your patient.<\/p>\n

    If taking drug to bedside (e.g., eye drops),\u00a0do third check at bedside.<\/td>\n<\/tr>\n

    4. Place all medications that patient will receive in one cup, except medications that require pre-assessment (e.g., blood pressure or pulse rate). Place these in a separate cup and keep wrapper intact.<\/td>\nKeeping medications that require pre-assessment separately acts as a reminder and makes it easier to withhold medications if necessary.<\/td>\n<\/tr>\n
    5.\u00a0Do not touch medication with ungloved hands. Use clean gloved hands if it is necessary to touch the medication.<\/td>\nUse gloves to reduce contamination of medication.<\/td>\n<\/tr>\n
    6. Circle medication when poured.<\/td>\nPour medication. Circle MAR to show that medication has been poured.<\/p>\n
    \"Circle<\/a>
    Circle medication once it has been poured<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    7. Patient education:<\/p>\n
      \n
    • Discuss purpose of each medication, action, and possible adverse effects.<\/li>\n
    • Ask patient if he or she has any allergies.<\/li>\n<\/ul>\n<\/td>\n
    		The patient has the right to be informed, and providing reasons for medication, actions, and potential adverse effects will likely improve adherence to medication therapy and patient reporting of adverse effects.<\/p>\n

    Confirm patient’s allergy history.<\/td>\n<\/tr>\n

    IMPORTANT<\/span>:<\/strong> If patient expresses concern about medications, do not give medication. Verify doctor’s order and explore patient concerns before administering medication.<\/td>\n<\/tr>\n
    8. Help patient to a high sitting position unless contraindicated.<\/td>\nThis position reduces risk of aspiration during swallowing.<\/td>\n<\/tr>\n
    9. Determine if medication should be given with or without food. If the medication is to be given on an empty stomach, the enteral\u00a0feeding may need to be stopped from\u00a030 minutes before until 30 minutes after the medication is given.<\/td>\nFollow specific medication guidelines to ensure adequate absorption and distribution of the medication.<\/td>\n<\/tr>\n
    10. Apply clean non-sterile gloves.<\/td>\nUsing gloves prevents spread of microorganisms.<\/td>\n<\/tr>\n
    11. Check gastric tube for correct placement as described in Chapter 10<\/a>.<\/td>\nEnsure that tube is properly placed prior to administering medication to prevent aspiration.<\/td>\n<\/tr>\n
    12. Dilute medication in 15 to 30 ml of water.<\/td>\nDilution keeps the tube from blocking.<\/td>\n<\/tr>\n
    13. Remove plunger from a 60 ml gastric tube syringe and attach syringe to the end of the gastric tube while pinching the gastric tube.<\/td>\nMake sure the tip of the syringe fits the end of the gastric tube.<\/td>\n<\/tr>\n
    14.\u00a0Pour medication and water solution into the 60 ml syringe, release pinch, and allow fluid to drain slowly by gravity into the gastric tube.<\/td>\nIf fluid does not drain by gravity, gentle pressure may be applied using the plunger of the syringe, but do not force the medication through the tube.<\/p>\n
    \"Administer<\/a>
    Administer diluted medication via gastric tube<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    15. Flush 10 ml of water between medications.<\/td>\nThis step prevents interactions between medications.<\/td>\n<\/tr>\n
    16. After the last medication has been given, flush the tube with 30 ml of water.<\/td>\nFlushing prevents blocking of the tube.<\/td>\n<\/tr>\n
    17. Keep the patient in a high sitting position to prevent aspiration.<\/td>\nThis position prevents aspiration and encourages absorption of medication.<\/td>\n<\/tr>\n<\/tbody>\n
    18. Post-medication safety check:<\/p>\n <\/p>\n

    Post assessments determine effects and potential adverse effects of medications.<\/td>\n<\/tr>\n

    19. Return within appropriate time frame to evaluate patient’s response to the medications and to check for possible adverse effects.<\/p>\n

    If patient presents with any adverse effects:<\/p>\n

      \n
    • Withhold further doses.<\/li>\n
    • Assess vital signs.<\/li>\n
    • Notify prescriber.<\/li>\n
    • Notify pharmacy.<\/li>\n
    • Document as per agency policy.<\/li>\n<\/ul>\n<\/td>\n
    		Evaluate patient for intended and adverse effects.<\/td>\n<\/tr>\n
    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    \n

    Critical Thinking Exercises<\/p>\n<\/header>\n

    \n
      \n
    1. Your patient is dysphagic. Discuss the steps you should\u00a0take and the considerations you should be cognizant of to administer oral medication safely.<\/li>\n
    2. Your patient is receiving medication and nutritional sustenance via an enteral gastric tube. The drug reference guide recommends that the medication\u00a0you should administer be given without food. Discuss how you would approach this situation to ensure the safe administration of the medication.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-2863","chapter","type-chapter","status-publish","hentry"],"part":2860,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2863","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":28,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2863\/revisions"}],"predecessor-version":[{"id":10210,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2863\/revisions\/10210"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/2860"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2863\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=2863"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=2863"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=2863"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=2863"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}