{"id":2871,"date":"2015-05-22T21:42:27","date_gmt":"2015-05-22T21:42:27","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=2871"},"modified":"2021-06-09T15:25:31","modified_gmt":"2021-06-09T15:25:31","slug":"6-5-installing-eye-ear-and-nose-medications","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/6-5-installing-eye-ear-and-nose-medications\/","title":{"raw":"6.5 Instilling Eye, Ear, and Nose Medications","rendered":"6.5 Instilling Eye, Ear, and Nose Medications"},"content":{"raw":"

Instilling Eye Medications<\/h2>\r\nThe eye is the most sensitive organ to which medication may be applied (Perry et al., 2014). The cornea is especially sensitive, making the conjunctival sac the\u00a0appropriate site for instilling eye (ophthalmic) medications.\r\n\r\nChecklist 48 outlines the steps for instilling eye medications.\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 48: Instilling Eye (Ophthalmic) Medications<\/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

\r\n

2. Perform the SEVEN RIGHTS \u00d7 3 (must be done with each individual medication):<\/p>\r\n\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\n

    Medication calculation: D\/H \u00d7 S = A<\/p>\r\n

    (D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available \u00d7 S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/p>\r\n<\/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. Before instilling eye medication, offer a tissue to the patient.<\/td>\r\nDrops may spill from the eye with administration.<\/td>\r\n<\/tr>\r\n
5. Wear clean non-sterile gloves.<\/td>\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
6. Cleanse the eyelashes and eyelids of any drainage or crusting with a warm washcloth or gauze. Use each area of cleaning surface only once and move from inner to outer eye area.<\/td>\r\nCleansing removes debris from eye area.<\/td>\r\n<\/tr>\r\n
7. Tilt patient's head back slightly if patient is sitting up, or place patient's head over a pillow (under the neck) if they are lying down.<\/td>\r\nTilting the head back makes it easier to reach the conjunctival sac for instilling drops.\r\n\r\nDo not tilt head back if patient has a cervical spine injury.<\/td>\r\n<\/tr>\r\n
8. Invert the eye-drop container and have patient look up and focus on something on the ceiling.<\/td>\r\nKeeping the eye focused will help keep it still.<\/td>\r\n<\/tr>\r\n
9. Gently pull patient's lower lid down, using thumb or two fingers to expose conjunctival sac.<\/td>\r\nPlace eye drop in conjunctival sac, not directly on eyeball (cornea).<\/td>\r\n<\/tr>\r\n
10. Eye drops: Hold eye-drop container above eye, taking care not to touch the eye, eyelids, or eyelashes. Instill one drop or more, if prescribed, into conjunctival sac.\r\n\r\nEye ointment: Apply about 1.5 cm of ointment along conjunctival sac, moving from inner to outer canthus. Twist tube to break off ribbon of ointment.<\/td>\r\nTouching the tip of the container to anything can contaminate the medication.\r\n\r\n[caption id=\"attachment_5062\" align=\"aligncenter\" width=\"150\"]\"DSC_0825\"<\/a> Instill eye drops in left eye[\/caption]<\/td>\r\n<\/tr>\r\n
11. Release lower lid after instillation and ask patient to close eyes gently. Ask patient to move the eyeball while eyes are closed.<\/td>\r\nThis step allows the medication to be distributed across the eye.\r\n\r\n[caption id=\"attachment_5063\" align=\"aligncenter\" width=\"150\"]\"DSC_0826\"<\/a> Have patient close eyes after drop is instilled[\/caption]<\/td>\r\n<\/tr>\r\n
12. Eye drops only: apply gentle pressure over inner canthus for 30 to 60 seconds to prevent medication from entering the lacrimal duct.<\/td>\r\nThis minimizes the systemic effects of the medication.<\/td>\r\n<\/tr>\r\n
13. Instruct patient not to rub eye.<\/td>\r\nThis is to prevent irritation and injury to the eye.<\/td>\r\n<\/tr>\r\n
14. Remove gloves and assist patient to a comfortable and safe position.<\/td>\r\nThis ensures patient safety and comfort.\r\n\r\n[caption id=\"attachment_5570\" align=\"aligncenter\" width=\"150\"]\"Dispose<\/a> Dispose of gloves[\/caption]<\/td>\r\n<\/tr>\r\n
15. Perform hand hygiene<\/a>.<\/td>\r\nHand hygiene prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
16. Document as per agency policy. Include date, time, dose, route; which eye the medication was instilled into; and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/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

Instilling Ear Medications<\/h2>\r\nInternal ear structures are particularly sensitive to temperature extremes. Therefore, ear (otic) medications should always be administered at room temperature. Always use sterile ear drops in case the ear drum is ruptured.\r\n\r\nChecklist 49 outlines the steps for instilling ear\u00a0medications.\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 49: Instilling Ear (Octic) Medications<\/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\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. Before instilling ear drops, don clean non-sterile gloves.<\/td>\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
5. Cleanse external ear of any drainage using a warm wet washcloth.<\/td>\r\nDrainage or debris may prevent some medication\u00a0from entering ear canal.<\/td>\r\n<\/tr>\r\n
6. Position patient with affected ear uppermost, on unaffected side if lying down, or tilt head to side if sitting up.<\/td>\r\nProper positioning helps to stop medication from escaping.\r\n\r\nDo not tilt head if patient has a cervical spine injury.<\/td>\r\n<\/tr>\r\n
7. Draw up medication into ear dropper, ensuring correct dosage.\r\n\r\nDo not return excess medication to stock bottle.<\/td>\r\nRisk for contamination is increased if medication is returned to bottle.<\/td>\r\n<\/tr>\r\n
8. Gently pull ear pinna back and up for an adult.<\/td>\r\nPulling the pinna straightens ear canal.\r\n\r\n[caption id=\"attachment_6411\" align=\"aligncenter\" width=\"150\"]\"Pulling<\/a> Pull the pinna to straighten ear canal[\/caption]<\/td>\r\n<\/tr>\r\n
9. Hold dropper tip just above ear canal. Do not touch dropper tip to ear.<\/td>\r\nTouching the ear with the dropper tip will contaminate the dropper and the medication.<\/td>\r\n<\/tr>\r\n
10. Allow drops to fall on the side of the ear canal.<\/td>\r\nDropping the drops directly into the canal and onto the tympanic membrane will cause the patient discomfort.<\/td>\r\n<\/tr>\r\n
11. Release ear pinna and have patient remain in the position for at least 5 minutes.<\/td>\r\nThis position prevents medication from escaping from ear.<\/td>\r\n<\/tr>\r\n
12. Apply gentle pressure to tragus several times.<\/td>\r\nPressure helps move medication toward tympanic membrane.<\/td>\r\n<\/tr>\r\n
13. If ordered, a cotton ball may be placed loosely in the ear canal.<\/td>\r\nCotton ball helps prevent medication from escaping from ear.<\/td>\r\n<\/tr>\r\n
14. Remove gloves and assist patient to a comfortable and safe position.<\/td>\r\nThis ensures patient safety and comfort.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n
15. Perform hand hygiene<\/a>.<\/td>\r\nHand hygiene prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
16. Document as per agency policy. Include date, time, dose, route; which ear the medication was instilled into; and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/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

Instilling Nasal Medications<\/h2>\r\nNasal medications are instilled for the treatment of allergies, nasal congestion, and sinus infections. The nose is not a sterile cavity, but medical asepsis must be observed because of its connection to the sinuses.\r\n\r\nChecklist 50 outlines the steps for instilling nasal\u00a0medications.\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 50: Instilling Nasal Medications<\/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\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
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\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\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\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\u00a0check at bedside.<\/td>\r\n<\/tr>\r\n
4. Before instilling nasal medication, don clean non-sterile gloves.<\/td>\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
5. Provide patient with tissues and ask that they blow their nose.<\/td>\r\nThis clears the nose prior to medication instillation.<\/td>\r\n<\/tr>\r\n
6. Position patient sitting back or lying down with head tilted back over a pillow (underneath neck).<\/td>\r\nThis position allows medication to flow back into nasal cavity.\r\n\r\nDo not tilt head back if patient has a cervical spine injury.<\/td>\r\n<\/tr>\r\n
7. Nose drops: draw fluid into medication dropper with enough for both nares. Do not return excess fluid into stock bottle.<\/td>\r\nReturning fluid to stock bottle increases risk for contamination of medication.<\/td>\r\n<\/tr>\r\n
8. Ask patient to breathe through the mouth.\r\n\r\nNose drops: hold dropper about 1 cm above naris and drop medication into one naris and then the other.\r\n\r\nNasal spray: have patient hold one nostril\u00a0closed and breathe gently through the other as the spray is being administered.\r\n\r\nDo not touch the naris with the dropper\/spray bottle.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6412\" align=\"aligncenter\" width=\"150\"]\"Hold<\/a> Hold dropper about 1 cm above naris[\/caption]\r\n\r\nBreathing through the mouth will help prevent aspiration of the medication.\r\n\r\nTouching the naris with the dropper\/spray tip will contaminate the dropper\/spray bottle and the medication.<\/td>\r\n<\/tr>\r\n
9. Position patient with head back for 2 to 3 minutes.<\/td>\r\nThis position prevents escape of the medication.<\/td>\r\n<\/tr>\r\n
10.\u00a0Remove gloves and assist patient to a comfortable and safe position.<\/td>\r\nThis ensures patient safety and comfort.<\/td>\r\n<\/tr>\r\n
11. Perform hand hygiene<\/a>.<\/td>\r\nHand hygiene prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
12.\u00a0Document as per agency policy. Include date, time, dose, route; which naris\u00a0the medication was instilled into (or whether it was both nares); and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/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 due to receive a dose of medication instilled into both ears. You find the ear medication stored in the refrigerator. How should you proceed?<\/li>\r\n \t
  2. Your patient is due to receive medication instilled into her right eye, but you notice that her left eye has crusting and discharge. Discuss how you would proceed in this situation.<\/li>\r\n \t
  3. Your patient is to receive nasal drops for a sinus infection. Describe how you would position this patient to receive the nasal drops.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    Instilling Eye Medications<\/h2>\n

    The eye is the most sensitive organ to which medication may be applied (Perry et al., 2014). The cornea is especially sensitive, making the conjunctival sac the\u00a0appropriate site for instilling eye (ophthalmic) medications.<\/p>\n

    Checklist 48 outlines the steps for instilling eye medications.<\/p>\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 48: Instilling Eye (Ophthalmic) Medications<\/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

    \n

    2. Perform the SEVEN RIGHTS \u00d7 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 \u00d7 S = A<\/p>\n

      (D<\/strong> or d<\/span>esired dosage\/H<\/strong> or h<\/span>ave available \u00d7 S<\/strong> or s<\/span>tock = A<\/strong> or a<\/span>mount prepared)<\/p>\n<\/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. Before instilling eye medication, offer a tissue to the patient.<\/td>\nDrops may spill from the eye with administration.<\/td>\n<\/tr>\n
    5. Wear clean non-sterile gloves.<\/td>\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    6. Cleanse the eyelashes and eyelids of any drainage or crusting with a warm washcloth or gauze. Use each area of cleaning surface only once and move from inner to outer eye area.<\/td>\nCleansing removes debris from eye area.<\/td>\n<\/tr>\n
    7. Tilt patient’s head back slightly if patient is sitting up, or place patient’s head over a pillow (under the neck) if they are lying down.<\/td>\nTilting the head back makes it easier to reach the conjunctival sac for instilling drops.<\/p>\n

    Do not tilt head back if patient has a cervical spine injury.<\/td>\n<\/tr>\n

    8. Invert the eye-drop container and have patient look up and focus on something on the ceiling.<\/td>\nKeeping the eye focused will help keep it still.<\/td>\n<\/tr>\n
    9. Gently pull patient’s lower lid down, using thumb or two fingers to expose conjunctival sac.<\/td>\nPlace eye drop in conjunctival sac, not directly on eyeball (cornea).<\/td>\n<\/tr>\n
    10. Eye drops: Hold eye-drop container above eye, taking care not to touch the eye, eyelids, or eyelashes. Instill one drop or more, if prescribed, into conjunctival sac.<\/p>\n

    Eye ointment: Apply about 1.5 cm of ointment along conjunctival sac, moving from inner to outer canthus. Twist tube to break off ribbon of ointment.<\/td>\n

    		Touching the tip of the container to anything can contaminate the medication.<\/p>\n
    \"DSC_0825\"<\/a>
    Instill eye drops in left eye<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    11. Release lower lid after instillation and ask patient to close eyes gently. Ask patient to move the eyeball while eyes are closed.<\/td>\nThis step allows the medication to be distributed across the eye.<\/p>\n
    \"DSC_0826\"<\/a>
    Have patient close eyes after drop is instilled<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    12. Eye drops only: apply gentle pressure over inner canthus for 30 to 60 seconds to prevent medication from entering the lacrimal duct.<\/td>\nThis minimizes the systemic effects of the medication.<\/td>\n<\/tr>\n
    13. Instruct patient not to rub eye.<\/td>\nThis is to prevent irritation and injury to the eye.<\/td>\n<\/tr>\n
    14. Remove gloves and assist patient to a comfortable and safe position.<\/td>\nThis ensures patient safety and comfort.<\/p>\n
    \"Dispose<\/a>
    Dispose of gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    15. Perform hand hygiene<\/a>.<\/td>\nHand hygiene prevents the spread of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    16. Document as per agency policy. Include date, time, dose, route; which eye the medication was instilled into; and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/td>\n<\/tr>\n
    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Instilling Ear Medications<\/h2>\n

    Internal ear structures are particularly sensitive to temperature extremes. Therefore, ear (otic) medications should always be administered at room temperature. Always use sterile ear drops in case the ear drum is ruptured.<\/p>\n

    Checklist 49 outlines the steps for instilling ear\u00a0medications.<\/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
    <\/a>Checklist 49: Instilling Ear (Octic) Medications<\/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>\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. Before instilling ear drops, don clean non-sterile gloves.<\/td>\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Cleanse external ear of any drainage using a warm wet washcloth.<\/td>\nDrainage or debris may prevent some medication\u00a0from entering ear canal.<\/td>\n<\/tr>\n
    6. Position patient with affected ear uppermost, on unaffected side if lying down, or tilt head to side if sitting up.<\/td>\nProper positioning helps to stop medication from escaping.<\/p>\n

    Do not tilt head if patient has a cervical spine injury.<\/td>\n<\/tr>\n

    7. Draw up medication into ear dropper, ensuring correct dosage.<\/p>\n

    Do not return excess medication to stock bottle.<\/td>\n

    		Risk for contamination is increased if medication is returned to bottle.<\/td>\n<\/tr>\n
    8. Gently pull ear pinna back and up for an adult.<\/td>\nPulling the pinna straightens ear canal.<\/p>\n
    \"Pulling<\/a>
    Pull the pinna to straighten ear canal<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Hold dropper tip just above ear canal. Do not touch dropper tip to ear.<\/td>\nTouching the ear with the dropper tip will contaminate the dropper and the medication.<\/td>\n<\/tr>\n
    10. Allow drops to fall on the side of the ear canal.<\/td>\nDropping the drops directly into the canal and onto the tympanic membrane will cause the patient discomfort.<\/td>\n<\/tr>\n
    11. Release ear pinna and have patient remain in the position for at least 5 minutes.<\/td>\nThis position prevents medication from escaping from ear.<\/td>\n<\/tr>\n
    12. Apply gentle pressure to tragus several times.<\/td>\nPressure helps move medication toward tympanic membrane.<\/td>\n<\/tr>\n
    13. If ordered, a cotton ball may be placed loosely in the ear canal.<\/td>\nCotton ball helps prevent medication from escaping from ear.<\/td>\n<\/tr>\n
    14. Remove gloves and assist patient to a comfortable and safe position.<\/td>\nThis ensures patient safety and comfort.<\/td>\n<\/tr>\n<\/tbody>\n
    15. Perform hand hygiene<\/a>.<\/td>\nHand hygiene prevents the spread of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    16. Document as per agency policy. Include date, time, dose, route; which ear the medication was instilled into; and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/td>\n<\/tr>\n
    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Instilling Nasal Medications<\/h2>\n

    Nasal medications are instilled for the treatment of allergies, nasal congestion, and sinus infections. The nose is not a sterile cavity, but medical asepsis must be observed because of its connection to the sinuses.<\/p>\n

    Checklist 50 outlines the steps for instilling nasal\u00a0medications.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 50: Instilling Nasal Medications<\/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>\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

    		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

    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.<\/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. Before instilling nasal medication, don clean non-sterile gloves.<\/td>\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Provide patient with tissues and ask that they blow their nose.<\/td>\nThis clears the nose prior to medication instillation.<\/td>\n<\/tr>\n
    6. Position patient sitting back or lying down with head tilted back over a pillow (underneath neck).<\/td>\nThis position allows medication to flow back into nasal cavity.<\/p>\n

    Do not tilt head back if patient has a cervical spine injury.<\/td>\n<\/tr>\n

    7. Nose drops: draw fluid into medication dropper with enough for both nares. Do not return excess fluid into stock bottle.<\/td>\nReturning fluid to stock bottle increases risk for contamination of medication.<\/td>\n<\/tr>\n
    8. Ask patient to breathe through the mouth.<\/p>\n

    Nose drops: hold dropper about 1 cm above naris and drop medication into one naris and then the other.<\/p>\n

    Nasal spray: have patient hold one nostril\u00a0closed and breathe gently through the other as the spray is being administered.<\/p>\n

    Do not touch the naris with the dropper\/spray bottle.<\/td>\n

    		\n
    \"Hold<\/a>
    Hold dropper about 1 cm above naris<\/figcaption><\/figure>\n

    Breathing through the mouth will help prevent aspiration of the medication.<\/p>\n

    Touching the naris with the dropper\/spray tip will contaminate the dropper\/spray bottle and the medication.<\/td>\n<\/tr>\n

    9. Position patient with head back for 2 to 3 minutes.<\/td>\nThis position prevents escape of the medication.<\/td>\n<\/tr>\n
    10.\u00a0Remove gloves and assist patient to a comfortable and safe position.<\/td>\nThis ensures patient safety and comfort.<\/td>\n<\/tr>\n
    11. Perform hand hygiene<\/a>.<\/td>\nHand hygiene prevents the spread of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    12.\u00a0Document as per agency policy. Include date, time, dose, route; which naris\u00a0the medication was instilled into (or whether it was both nares); and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/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 due to receive a dose of medication instilled into both ears. You find the ear medication stored in the refrigerator. How should you proceed?<\/li>\n
    2. Your patient is due to receive medication instilled into her right eye, but you notice that her left eye has crusting and discharge. Discuss how you would proceed in this situation.<\/li>\n
    3. Your patient is to receive nasal drops for a sinus infection. Describe how you would position this patient to receive the nasal drops.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-2871","chapter","type-chapter","status-publish","hentry"],"part":2860,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2871","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":29,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2871\/revisions"}],"predecessor-version":[{"id":10212,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2871\/revisions\/10212"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/2860"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/2871\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=2871"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=2871"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=2871"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=2871"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}