{"id":3676,"date":"2015-06-22T20:50:34","date_gmt":"2015-06-22T20:50:34","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=3676"},"modified":"2021-06-09T15:43:22","modified_gmt":"2021-06-09T15:43:22","slug":"administering-topical-medication","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/administering-topical-medication\/","title":{"raw":"6.7 Administering Topical Medications","rendered":"6.7 Administering Topical Medications"},"content":{"raw":"In this section, we address how to administer topical medication using three distinct delivery methods: transdermal patch; creams, lotions, or ointments; and powder.\u00a0Always wear gloves and maintain standard precautions when administering topical medications to the skin, mucous membranes, and tissues. Do not touch any preparations to your own skin, and turn your face away from powdered applications. Always clean the skin or wound before applying a new dose of topical medication.\r\n\r\nChecklist 53 lists the steps for applying a transdermal patch.\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 53: Applying a Transdermal Patch<\/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:<\/span><\/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\nCheck that MAR and doctor's\u00a0orders 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\nMed calculation: D\/H x S = A\r\n\r\n(desired dosage\/have available x stock = amount 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\n[caption id=\"attachment_6295\" align=\"aligncenter\" width=\"150\"]\"Transdermal<\/a> Transdermal patch[\/caption]\r\n\r\nThese checks are done before administering the medication to your patient. If taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\r\n<\/tr>\r\n
4. Before applying a transdermal patch, remove the old patch\u00a0if it is still in place. Clean area thoroughly.\r\n\r\nObserve for signs of skin irritation at old patch and document as per agency policy.<\/td>\r\nNot removing previous patch may result in overdose of the medication. Check between skin folds for old patch.\r\n\r\n[caption id=\"attachment_6298\" align=\"aligncenter\" width=\"150\"]\"Remove<\/a> Remove previous patch[\/caption]<\/td>\r\n<\/tr>\r\n
5. Dispose of old patch as per agency policy (usually in a biohazard trash bag) by folding in half with sticky sides together and wrapping it in a glove, or cutting it before disposal.<\/td>\r\nThis prevents accidental exposure to the medication.<\/td>\r\n<\/tr>\r\n
6. Use a felt tip or soft tip pen\u00a0to write the date, time, and your initials on the outside of the new patch. DO NOT use a ballpoint pen.<\/td>\r\nInitialling patch communicates application date and time to other health care providers.\r\n\r\n[caption id=\"attachment_6296\" align=\"aligncenter\" width=\"150\"]\"Write<\/a> Write the date, time, and your initials on the transdermal patch[\/caption]\r\n\r\nBallpoint pen can damage patch and thus affect medication delivery.<\/td>\r\n<\/tr>\r\n
7. Apply the new patch to a new site that is clear, dry, hairless, and free of skin irritations.<\/td>\r\nIf it is necessary to remove hair, clip the hair instead of shaving to avoid skin irritation.\r\n\r\nA consistent surface ensures even medication distribution.<\/td>\r\n<\/tr>\r\n
NOTE<\/strong>: It is usual to have a \"patch-free period\" of 10 to 12 hours when the patch is removed, because tolerance to the medication may develop if the patch is worn 24 hours\/day. Check doctor's orders to determine if the patch should be removed overnight.<\/td>\r\n<\/tr>\r\n
8. Carefully remove the backing from the patch, taking care to hold it at the edges and not touch the medication with your fingers.<\/td>\r\nThis prevents interference with medication and maintains stickiness of patch.<\/td>\r\n<\/tr>\r\n
9. Apply patch by holding one hand firmly over the patch for 10 seconds, then press around the edges to make sure that the patch is securely attached to the skin.<\/td>\r\nThis prevents loss of patch and ensures effectiveness of medication delivery.\r\n\r\n[caption id=\"attachment_6299\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply new transdermal patch[\/caption]<\/td>\r\n<\/tr>\r\n
10. Perform hand hygiene<\/a>.<\/td>\r\nThis prevents the transfer 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
NOTE:<\/strong>\r\n
    \r\n \t
  • Do not apply new patch to previously used sites for at least one week, so skin irritation is reduced.<\/li>\r\n \t
  • Never cut patch in half; a change in dose requires a new transdermal patch.<\/li>\r\n \t
  • Never apply a heating pad over the patch as it will affect the rate of absorption, with potentially serious adverse effects.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
11. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\r\nAccurate and timely documentation improves patient safety.<\/td>\r\n<\/tr>\r\n<\/tbody>\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\nChecklist 54 lists the steps for applying topical medications as creams, lotions, and ointments.\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 54: Applying Topical Creams, Lotions, and Ointments<\/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:<\/span><\/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
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. If taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\r\n<\/tr>\r\n
4.\u00a0Apply non-sterile\u00a0gloves unless skin is broken; then apply sterile gloves.<\/td>\r\nUsing gloves protects health care provider from contact with medication.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]\r\n\r\nIf skin is broken, sterile gloves will prevent the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
5. Wash, rinse, and dry the affected area with water and a clean cloth.<\/td>\r\nThis removes previous topical medications.<\/td>\r\n<\/tr>\r\n
6. If skin is very dry and flaking, apply topical medication while skin is still damp.<\/td>\r\nApplying while skin is damp helps to retain moisture within skin layers.<\/td>\r\n<\/tr>\r\n
7. Change gloves, performing hand hygiene in between.<\/td>\r\nUse sterile gloves for open skin lesions to prevent spread of microorganisms.\r\n\r\n[caption id=\"attachment_5964\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply sterile gloves if patient has open lesions[\/caption]<\/td>\r\n<\/tr>\r\n
8. Place required amount of medication in palm of hands and soften by rubbing palms together.<\/td>\r\nSoftening makes topical medication easier to spread.\r\n\r\n[caption id=\"attachment_6451\" align=\"aligncenter\" width=\"150\"]\"Rub<\/a> Rub medication in hands to soften and warm[\/caption]<\/td>\r\n<\/tr>\r\n
9. Let patient know that initial application may feel cold. Apply medication using long even strokes that follow the direction of the hair. Do not rub vigorously.<\/td>\r\nThis prevents irritation of hair follicles.<\/td>\r\n<\/tr>\r\n
10. Let patient know that skin may feel greasy after application.<\/td>\r\nSome topical medications contain oils.<\/td>\r\n<\/tr>\r\n
11. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\r\nAccurate and timely documentation improves patient safety.<\/td>\r\n<\/tr>\r\n
12. Perform hand hygiene<\/a>.<\/td>\r\nThis step prevents the transfer 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<\/tbody>\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\nChecklist 55 lists the steps for applying medicinal powder topically.\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

\u00a0 \u00a0\u00a0<\/a>Checklist 55: Applying Topical Powder<\/h3>\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:<\/span><\/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
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. If taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\r\n<\/tr>\r\n
4. Ensure that skin is completely dry and clean before application.<\/td>\r\nThis minimizes potential for powder to cake and crust.<\/td>\r\n<\/tr>\r\n
5. If application is near patient's face, ask patient to turn away from powder or briefly cover face with a clean towel.<\/td>\r\nThis prevents patient from inhaling powder.<\/td>\r\n<\/tr>\r\n
6. Dust skin with a light layer\u00a0of powder.<\/td>\r\nToo thick a layer of powder will congeal and crust.<\/td>\r\n<\/tr>\r\n
7. If ordered, cover the affected site with the prescribed dressing.<\/td>\r\nCovering site prevents soiling of patient's clothes and linens.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n
8. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\r\nAccurate and timely documentation improves patient safety.<\/td>\r\n<\/tr>\r\n
9. Perform hand hygiene<\/a>.<\/td>\r\nPrevents transfer 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
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\u2019s MAR states that their Nitro-Patch should be removed at night. Please explain why this is considered safe practice.<\/li>\r\n \t
  2. Discuss the steps you would take to administer a lotion for a patient with a rash that has several open lesions.<\/li>\r\n \t
  3. Discuss why it is necessary to ensure that your patient\u2019s skin is clean and dry prior to applying a prescribed topical powder.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    In this section, we address how to administer topical medication using three distinct delivery methods: transdermal patch; creams, lotions, or ointments; and powder.\u00a0Always wear gloves and maintain standard precautions when administering topical medications to the skin, mucous membranes, and tissues. Do not touch any preparations to your own skin, and turn your face away from powdered applications. Always clean the skin or wound before applying a new dose of topical medication.<\/p>\n

    Checklist 53 lists the steps for applying a transdermal patch.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 53: Applying a Transdermal Patch<\/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:<\/span><\/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>\nCheck that MAR and doctor’s\u00a0orders 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

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

      (desired dosage\/have available x stock = amount 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
    \"Transdermal<\/a>
    Transdermal patch<\/figcaption><\/figure>\n

    These checks are done before administering the medication to your patient. If taking drug to bedside (e.g., eye drops),\u00a0do third\u00a0check at bedside.<\/td>\n<\/tr>\n

    4. Before applying a transdermal patch, remove the old patch\u00a0if it is still in place. Clean area thoroughly.<\/p>\n

    Observe for signs of skin irritation at old patch and document as per agency policy.<\/td>\n

    		Not removing previous patch may result in overdose of the medication. Check between skin folds for old patch.<\/p>\n
    \"Remove<\/a>
    Remove previous patch<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Dispose of old patch as per agency policy (usually in a biohazard trash bag) by folding in half with sticky sides together and wrapping it in a glove, or cutting it before disposal.<\/td>\nThis prevents accidental exposure to the medication.<\/td>\n<\/tr>\n
    6. Use a felt tip or soft tip pen\u00a0to write the date, time, and your initials on the outside of the new patch. DO NOT use a ballpoint pen.<\/td>\nInitialling patch communicates application date and time to other health care providers.<\/p>\n
    \"Write<\/a>
    Write the date, time, and your initials on the transdermal patch<\/figcaption><\/figure>\n

    Ballpoint pen can damage patch and thus affect medication delivery.<\/td>\n<\/tr>\n

    7. Apply the new patch to a new site that is clear, dry, hairless, and free of skin irritations.<\/td>\nIf it is necessary to remove hair, clip the hair instead of shaving to avoid skin irritation.<\/p>\n

    A consistent surface ensures even medication distribution.<\/td>\n<\/tr>\n

    NOTE<\/strong>: It is usual to have a “patch-free period” of 10 to 12 hours when the patch is removed, because tolerance to the medication may develop if the patch is worn 24 hours\/day. Check doctor’s orders to determine if the patch should be removed overnight.<\/td>\n<\/tr>\n
    8. Carefully remove the backing from the patch, taking care to hold it at the edges and not touch the medication with your fingers.<\/td>\nThis prevents interference with medication and maintains stickiness of patch.<\/td>\n<\/tr>\n
    9. Apply patch by holding one hand firmly over the patch for 10 seconds, then press around the edges to make sure that the patch is securely attached to the skin.<\/td>\nThis prevents loss of patch and ensures effectiveness of medication delivery.<\/p>\n
    \"Apply<\/a>
    Apply new transdermal patch<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    10. Perform hand hygiene<\/a>.<\/td>\nThis prevents the transfer of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    NOTE:<\/strong><\/p>\n
      \n
    • Do not apply new patch to previously used sites for at least one week, so skin irritation is reduced.<\/li>\n
    • Never cut patch in half; a change in dose requires a new transdermal patch.<\/li>\n
    • Never apply a heating pad over the patch as it will affect the rate of absorption, with potentially serious adverse effects.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    11. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\nAccurate and timely documentation improves patient safety.<\/td>\n<\/tr>\n<\/tbody>\n
    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Checklist 54 lists the steps for applying topical medications as creams, lotions, and ointments.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 54: Applying Topical Creams, Lotions, and Ointments<\/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:<\/span><\/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

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

    4.\u00a0Apply non-sterile\u00a0gloves unless skin is broken; then apply sterile gloves.<\/td>\nUsing gloves protects health care provider from contact with medication.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n

    If skin is broken, sterile gloves will prevent the spread of microorganisms.<\/td>\n<\/tr>\n

    5. Wash, rinse, and dry the affected area with water and a clean cloth.<\/td>\nThis removes previous topical medications.<\/td>\n<\/tr>\n
    6. If skin is very dry and flaking, apply topical medication while skin is still damp.<\/td>\nApplying while skin is damp helps to retain moisture within skin layers.<\/td>\n<\/tr>\n
    7. Change gloves, performing hand hygiene in between.<\/td>\nUse sterile gloves for open skin lesions to prevent spread of microorganisms.<\/p>\n
    \"Apply<\/a>
    Apply sterile gloves if patient has open lesions<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    8. Place required amount of medication in palm of hands and soften by rubbing palms together.<\/td>\nSoftening makes topical medication easier to spread.<\/p>\n
    \"Rub<\/a>
    Rub medication in hands to soften and warm<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Let patient know that initial application may feel cold. Apply medication using long even strokes that follow the direction of the hair. Do not rub vigorously.<\/td>\nThis prevents irritation of hair follicles.<\/td>\n<\/tr>\n
    10. Let patient know that skin may feel greasy after application.<\/td>\nSome topical medications contain oils.<\/td>\n<\/tr>\n
    11. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\nAccurate and timely documentation improves patient safety.<\/td>\n<\/tr>\n
    12. Perform hand hygiene<\/a>.<\/td>\nThis step prevents the transfer of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<\/tbody>\n
    Data source: BCIT, 2015; Lilley et al., 2011; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Checklist 55 lists the steps for applying medicinal powder topically.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    \u00a0 \u00a0\u00a0<\/a>Checklist 55: Applying Topical Powder<\/h3>\n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:<\/span><\/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

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

    4. Ensure that skin is completely dry and clean before application.<\/td>\nThis minimizes potential for powder to cake and crust.<\/td>\n<\/tr>\n
    5. If application is near patient’s face, ask patient to turn away from powder or briefly cover face with a clean towel.<\/td>\nThis prevents patient from inhaling powder.<\/td>\n<\/tr>\n
    6. Dust skin with a light layer\u00a0of powder.<\/td>\nToo thick a layer of powder will congeal and crust.<\/td>\n<\/tr>\n
    7. If ordered, cover the affected site with the prescribed dressing.<\/td>\nCovering site prevents soiling of patient’s clothes and linens.<\/td>\n<\/tr>\n<\/tbody>\n
    8. Document as per agency policy, making sure to include site of administration on the MAR.<\/td>\nAccurate and timely documentation improves patient safety.<\/td>\n<\/tr>\n
    9. Perform hand hygiene<\/a>.<\/td>\nPrevents transfer of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\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
    \n
    \n

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

    \n
      \n
    1. Your patient\u2019s MAR states that their Nitro-Patch should be removed at night. Please explain why this is considered safe practice.<\/li>\n
    2. Discuss the steps you would take to administer a lotion for a patient with a rash that has several open lesions.<\/li>\n
    3. Discuss why it is necessary to ensure that your patient\u2019s skin is clean and dry prior to applying a prescribed topical powder.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3676","chapter","type-chapter","status-publish","hentry"],"part":2860,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3676","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\/3676\/revisions"}],"predecessor-version":[{"id":10214,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3676\/revisions\/10214"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/2860"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3676\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=3676"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=3676"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=3676"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=3676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}