This document provides guidance on principles and methods of drug administration for nurses. It discusses nursing responsibilities in medication administration including standard precautions, patient privacy and preparation, drug preparation, observing for adverse drug reactions, and documentation. It covers medication orders, controlled substances, types of orders, and the seven rights of administration. The document reviews various routes of administration including oral, enteral, percutaneous, parenteral, and important considerations for safe administration.

1. Principles and Methods of
Drug Administration

2. Medication Administration
Nursing Responsibilities
- Standard precautions
- Patient privacy
- Patient preparation
- Drug preparation

3. Nursing Implications Associated with
Drug Administration
Consult references/pharmacist
Observe for ADR’s
Report drug reactions
Record observations
Withhold drug if needed - notify
provider

4. Medication Orders
 The nurse must ensure the patient receives the
correct medication
 Orders should include the following:
 Name
Date/time
Drug name
Dose
Route
Time/frequency administration
Prescriber’s signature

5. Medication Orders
 Controlled substances
- Opioids, barbiturates, ect. double-locked
- Keys with charge nurse
- Log administration of drugs
- End-of-shift count
- Waste controlled substance with witness

6. Medication Orders
 Types of orders
- Standing orders
- pre-written, no call
- Verbal orders
- telephone to nurse
- repeat back to provider
- To be written and signed by the provider asap

7. The Seven Rights of Medication
Administration
 Right drug
 Right dose
 Right patient: name and birth date
 Right time
 Right route
 Right documentation
 Patient’s right to refuse

8. Medication Preparation
 Know the seven rights
 Drug reference available
 Know drug action, contraindications, usual
dosage, and side effects
 Check label 3 times
- removing drug from container or drawer
- on comparison with MAR
- before giving to patient (if unit dose)
- Before returning to drawer (if multi-use
container)

9. Important Considerations
Enlist the patients
Utilize the pharmacists
Prepare one patient’s medication at a
time
Minimize need for calculations or
compare answers with another nurse’s
Two licensed nurses must double check
high alert drugs before administration,
i.e. insulin, heparin

10. Important Considerations
Always report errors
Never give an unlabeled drug
Don’t confuse drug names
Date and initial (multiuse vials or
containers)
If you didn’t prep it, don’t give it

11. Important Considerations for
Medication Administration
 2 identifiers for safety: name and DOB
 If you gave it, chart it
 Do not chart for someone else or have
someone else chart for you
 Do not transport or accept a container that is
not labelled
 Do not put down an unlabeled syringe

12. Important Considerations for
Medication Administration
 Watch the patient take it and swallow it
 Assess patient’s response
 If a patient refuses a medication:
 do not force it, chart it
 If you elect to omit a dose based on your
nursing judgment, let another nurse help
make the decision. If medication is not
given, document, “dose omitted because…”
Report to the provider

13. Commonly Used Abbreviations
Joint Commission on Accreditation of
Healthcare Organization (JCAHO)
approved abbreviation list
institutional policy and list of used
abbreviations

14. Routes of Administration
Enteral
- Via the GI Tract
- Powders
- Pills
- Tablets
- Liquids or suspensions
- Suppositories

15. Routes of Administration
Percutaneous
- Through the skin or mucous
membranes
- Topical
- Instillation
- Inhalation

16. Routes of Administration
 Parenteral
- Methods other than the GI tract; needle
route
- Intramuscular (IM)
- Subcutaneous (SC)
- Intradermal
- Intravenous (IV)
- Ampules
- Vials

17. Enteral Administration
 Tablets, pills, capsules
- absorbed more slowly from GI tract into the
bloodstream
than via any other route - (PO) route
relatively safe
- Do not crush enteric coated or sustained
release pills
- Only divide scored pills
- Liquid medications: children and patients
who cannot swallow pills

18. Oral Medications
 Unit dosage system: most common
 Med stays in package until administration
 May place prepackaged medications in the
same cup until administered
 Involve the patient and include teaching
 Patient refusal: return unopened medication
to the drawer, document reason, notify
provider

19. Oral Medications
From multi-dose containers, pour pill
into the cap, drop into a medicine cup
Label cup with med name, dose
Do not touch meds with bare hands
Falls on floor? Toss it. Working on med
cart? Add clean field

20. Enteral Administration of Liquid Medications
 PO, or via a NG, gastrostomy, or jejunostomy
tube
 No liquids to unconscious patients:
aspiration
 Some liquid medications are not to be
followed by water; some may stain the teeth
 Use calibrated cup or syringe (but not IV
syringe)
 Measure liquids at bottom of meniscus

21. Enteral Administration of Tubal Medications
NG tubes: liquid meds to unconscious
patients, dysphasic patients, those too ill
to eat
Use liquid form or crush tablets and
open capsules if allowed – give separately
in warm water
Not all tablets are safe to use when
crushed and not all capsules are safe to
use when opened

22. Enteral Administration of Suppositories
Rectum or vagina
Dissolves at body temperature and
absorbed directly into the bloodstream
infants, patients intolerant of oral
preparations, N/V
Store in cool place

23. Administration of Vaginal Medications
Usually for yeast infections
Some products are used to induce labor
Use gloves
Provide privacy

24. Percutaneous Administration
skin /mucous membranes
Mostly local action; some act
systemically
topical applications (ointments, creams,
powders, lotions, and transdermal
patches), instillations, and inhalations
Absorption is rapid, short duration

25. Percutaneous Administration
 Ointments
- oil-based; semisolid; skin or mucous
membrane
 Creams
- Semisolid, non-greasy emulsions; external
application
 Lotions
- Aqueous, soothing: pruritus, protectant,
cleansing, astringent

26. Percutaneous Administration
 Transdermal Patches
Adhesive-backed, medicated patches
-sustained, continuous release of medication over
hours/days
 Eye drops and Eye Ointments
- Don’t touch the dropper or the tube to the eye (p 70
Fig 2-18)
 Eardrops
- ‘Otic’ solutions must be at room temperature when
applied
- Use only droppers supplied with medications for
administration

27. Percutaneous Administration
 Nose drops
- individual use only
 Nasal sprays
- absorbed quickly; less medication used,
wasted
 Inhalations
- mucous membranes ofrespiratory tract
- relatively limited effect or a systemic effect
- used by respiratory therapy and
anesthesiologists

28. Percutaneous Administration
 Sublingual medications
- under the tongue, rapidly absorbed
- tablet or a liquid squeezed from capsule
- Do not give water after as water reduces absorption
- tablet should dissolve (no swallowing)
 Buccal medications
- between the gum and the cheek, preferably above
the molar
- Follow same administration guidelines as SL

29. Parenteral Administration
 Intramuscular (IM)
 Subcutaneous
 Intradermal
 Intravenous (IV)
 Rationale for using these methods include:
- Absorption rate
- No oral route
- Emergencies
- Drug is destroyed in the GI tract

30. Parenteral Administration
 Equipment
- Syringes
- barrel, plunger, and tip
- calibrated in milliliters, minims, insulin or heparin units
- Types
- Tuberculin syringe (for allergy testing/treatments, TB
testing and small quantities)
- Insulin syringe
- One and three milliliter syringes
- Safety-Lok syringes

31. Parts of a Syringe
.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)

32. Tuberculin Syringe Calibration
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

33. Calibration of U100 Insulin Syringe
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

34. Reading the Calibrations of a 3-mL
Syringe

35. Safety-Glide Syringe

36. Parenteral Administration
 Equipment
- Needles
- Parts are the hub, shaft, and beveled tip
- Opening at the needle’s beveled tip is the
lumen
- Size of the diameter of the inside of the
needle’s shaft determines the gauge of the
needle; the smaller the gauge, the larger the
diameter
- Needle gauge selection is based on the
viscosity of the medication

37. Parts of a Needle
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

38. Parenteral Administration
 Equipment
- Needle length
- Selected based on the depth of the tissue
into which
the medication is to be injected
- Intradermal: 3/8 to 5/8 inch
- Subcutaneous: ½ to 5/8 inch
- Intramuscular: 1 to 1 ½ inch
- Intravenous needles
- Butterfly (scalp needle)
- Over the needle catheter

39. Needle Length and Gauge
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

40. Parenteral Administration
Equipment
- needleless devices
- sheath or guard
- IV caths: blunt-edged cannulas, valves,
or needle guards
- IV tubing: recessed and shielded needle
connectors to reduce needle sticks

41. Parenteral Administration
 Intramuscular (IM) injections
- Site selection
- Gluteal sites: ventrogluteal (gluteus medius)
- Vastus lateralis muscle (thigh)
- Rectus femoris muscle (thigh)
- Deltoid muscle (arm)
- Z-track method
- Used to inject irritating meds

42. Locating IM Injection for Ventrogluteal
Site
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)

43. Giving IM Injection in Vastus Lateralis
Site on an Adult
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)

44. Rectus Femoris Muscle
A. Child/Infant B. Adult
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

45. Giving IM Injection in Deltoid Site
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)

46. Figure 23-20
A, Z-track method. B, Using an air lock. C, Administering IM injection
by airlock technique.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

47. Parenteral Administration
 Intradermal injections
- serum, vaccine, or skin test agent
- Not aspirated
- Small volumes (0.1mL) injected to form a
small wheal just under the skin
- Used for allergy sensitivity tests, TB
screening, local anesthetics
- tuberculin syringe with 25-gauge, 3/8 to 5/8
inch needle

48. Figure 23-21
Angles of insertion for intramuscular (90°), subcutaneous (45°),
and intradermal (15°).
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

49. Parenteral Administration
 Subcutaneous injections
- loose connective tissue between the dermis and the
muscle layer (fatty layer)
- absorption slower than with IM injections
- Given at a 45-degree angle if the patient is thin or at
a 90-degree angle if the patient has ample
subcutaneous tissue
- Usual needle length is ½ to 5/8 inch and 25 gauge
- insulin and heparin

50. Subcutaneous Injection
Angle and
needle length
depend on the
thickness of
skin fold
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)

51. Parenteral Administration
Fluid and electrolytes will be also
covered again in systems classes
Starting of IV’s and management of
tubing and delivery devices will be
covered in skills lab

52. Parenteral Administration
 Intravenous (IV) therapy
- fluid and electrolyte maintenance,
restoration, replacement
- Give meds, nutritional feedings
- blood and blood products
- chemotherapy to cancer patients
- patient-controlled analgesics
- Keep a vein open (KVO)

53. Scope of Practice
 Know LPN SOP for practice state
 OSBN LPN IV policy prohibits LPN’s from
initiating the following items:
- Antineoplastic agents
- Blood and blood components
- Antiarrhythmics
- Antiseizures
- Ambulatory infusion devices
- Hypertensive agents

54. Parenteral Administration
Methods of intravenous administration
- IV push
- Intermittent venous access device
- Intermittent infusion (or piggyback)
- Continuous infusion
- Electronic pumps and controllers
- Patient-controlled analgesia
- Volumetric chambers

55. Parenteral Administration
 Nursing responsibilities
- Nurse ensures that correct fluid, amount
started and that the fluid is regulated to
infuse over the period ordered
- To find the drops per minute (the drip rate),
find drip factor on tubing package

56. Parenteral Administration
 Nursing Responsibilities
- Monitor Intravenous Therapy
- Check the infusion and the IV needle site
at least every hour
- Flow of fluid
- IV site: erythema, wetness, and edema
- Phlebitis: inflamed vein
- Infiltration: fluid passes into the tissues
- Assess for chills, fever, headache, nausea,
vomiting, anxiousness, and dyspnea

57. Parenteral Administration
Nursing Responsibilities
- Assess for Anaphylactic Shock
- Respiratory distress
- Skin reactions
- Signs of circulatory collapse
- GI signs and symptoms
- Change in mental status
- Requires immediate intervention

58. Parenteral Administration
Nursing responsibilities
- Record administration
- Record information
- Evaluate and record patient’s
response
- Observe for ADR’s

59. Patient and Family Teaching
 must be ready to learn
 Include family as allowed by patient
 teaching enables patient to care for self
 Patient should demonstrate self-care skills
 The patient should know about their illness or
diagnosis and treatment
 The patient should know names of all
medications, administration schedule,
common side effects, provider to call, where to
get prescriptions

60. Promoting Cooperation with Medication regimens
 Inadequate understanding of illness or disease
 Cost of the medication
 Development of adverse effects
 Forgetfulness
 Measures to foster cooperation include:
- Education
- Resources for drug payment
- Memory aids

61. The Nursing Process in Pharmacology
 Assessment
- Take med history
- Collect physical status data
- social networks, resources?
 Diagnosis and Planning
- Check nursing diagnoses
- Identify desired outcomes of nursing
interventions
- Know why the drug is needed, how it will be
given, and common side effects
 Implementation
- Prepare meds safely
 Evaluation