1. MEDICATION ADMINISTRATION
By
MS.Rajathurai Jeya,RN

2. Administration of Medications
• Medicine may be defined as a substance used to
promote health , to prevent, to diagnose , to
alleviate or cure diseases.
• The safe and accurate administration of medication
is one of the major responsibility of a nurse.
• The nurse must have through knowledge of drugs
that is administered by her
“A FUNDAMENTAL RULE OF SAFE DRUG ADMINISTRATION IS:
“NEVER ADMINISTER AN UNFAMILIAR MEDICATION”
2

3. • Nurses must know generic and trade names of drugs
to be administered, classification, average dose, route
of administration, use, side and adverse effects,
contraindications, and nursing implications in
administration.
• Essential parts of Medication order.
• Abbreviations and symbols used in writing medication
order as per hospital policies.
• Preparation of solutions and fractional doses
• Storing of medicines
• Factors of safety in the administration of medicines
• Rules for the administration of medicines
• Ethical and legal aspects
• Nurse’s role in the administration of medicines.

4. Drug Knowledge
1.Names of Drugs:
All the drugs will have at least two names
1. Generic Name
2. Trade name
(e.g. )Ceftriaxone - Generic name
Mesporin, Samixon, Rocephin –Trade name
2.Classification of drugs:
Drugs are classified in several ways, according to their action,
composition , their purposes and uses etc.
(e.g.) Analgesics, antipyretics, etc.
3.Preparation of drugs:
Medications are available in different types of preparation.
The preparations may determine the method of
administration
(e.g.)Capsule , Ointment , Powder, Suppository etc.

5. 4.Dosage:
The dose is the amount of drug administered at one time.
Information about the dosage and route is crucial to protect
against medication error
5.Effects of drug on the body:
Therapeutic effects: It is the effect which is desired or the reason a
drug prescribed .
Local and systemic effects: Local effects of a drugs are expected
when they are applied topically to the skin or mucus membrane.
A drug used for systemic effect must be absorbed into the blood
stream to produce the desired effect in the various systems and parts
of the body.
Toxic effects: May develop after prolonged intake or when a
medicine accumulates in the blood because of impaired metabolism or
excretion, or excessive amount taken
•Toxic levels of opioids can cause respiratory depression
•Antidotes available to reverse effects

6. Side and Adverse Effects
Side effects are non-therapeutic reactions to a drug.
• Unintended secondary effects a medication predictably will
cause
• May be harmless or serious
• If side effects are serious enough to negate the beneficial effect
of meds therapeutic action, it may be discontinued
• People may stop taking medications because of the side effects
(An example of side effect is Drowsiness , Which
occurs with antihistamines)
• Adverse Drug Reaction: Any reaction to a drug that is
undesirable, unexpected, and occurs at doses normally used for
the prevention, diagnosis, or treatment of disease .
• All adverse medication reactions or suspected medication
reactions are reported to the Physician, Nurse Manager/Charge
Nurse and Pharmacist. An adverse reaction is reported to the
Pharmacy by filling out the Adverse Drug Reaction Notification
Form .

7. Pregnancy category

8. Nursing process in administering drugs:
• Assessment: The first step of nursing process is the
systematic organized collection of data about the
patient.
• Nursing diagnosis: Once the data have been collected,
the nurse must organize and analyze that information
to arrive at a nursing diagnosis.
• Intervention :The assessment and nursing diagnosis of
the patient’s situation will direct specific nursing
intervention.
• Evaluation: it is a part of continual process of patient
care that leads to changes in assessment, diagnosis,
intervention. The patient is continually evaluated for
therapeutic response.

9. Essentials of medication order
• The drug order, written by the physician, it has 7
essential parts for administration of drugs safely.
the nurse should know how to read a drug order.
• It should have the following components:
1- Patients full name.
2- Date and time.
3- Drug name.
4- Dosage.
5- Route of administration.
6- Time and frequency of administration.
7- Signature of physician.

10. Types of Medication Orders
• STAT order: needed immediately
• Single order: given only once
• PRN order: given as needed
• Routine orders: given within 2 hours of being
written and carried out on schedule
• Standing order: written in advance carried
out under specific circumstances.

11. TIME OF ABBREVIATION MEANINIG TIME
ac Before Meals 7:30am, 12:30pm, 7:30pm
pc After Meals 10am, 2pm, 10pm
tid –with meals Three times a daily with 8am, 1pm, 8pm
meals
bid Twice a day 8am,8pm(IV)- 10am, 10pm (oral)
tid Three times a day 10am,6pm,2am
q6h Every six hours (Four 6am, 12nn, 6pm, 12am
times a day)
6am, 10am,2pm,6pm,10pm,2am
q4h Every four hours (six
times a day)
q3h Every Three hours(8times 6am, 9am,12nn, 3pm, 6pm, 9pm, 12am, 3am
a day)
q2h Every two hours twelve 6am,8am,10am,12nn,2pm,4pm,6pm, 8pm,
times a day) 10pm, 12am, 2am,4am

12. Basic principles (Safety) in medication administration
3 checks and 7 Rights:
obtaining the container
removing the med
replacing the container
• Right patient
• Right dose
• Right drug
• Right route
• Right time
• Right Frequency
• Right Documentation

13. Right Drug
• Read the physician’s orders to study the
correct name of the drug
• If the order is not clear consult the physician
• Make sure the drug copied correctly on the
Medication chart, on the nurses record
• Select the right drug from the cupboard. Read
the label of the medicine container and the
name of the medicine in the medication chart
thrice
• Look for the colour, odour and consistency of
the drug . Unusual characteristics of the drug
should be questioned.
• Administer medicine only from a clearly
labeled container.
• Avoid conversations during preparation of
medicines.

14. Right Dose
• Read the physician’s orders to know the
correct dose.
• Consider the age and weight of the
patient. This may help to find an error in
physician’s orders.
• Know the minimum and maximum dose of
the medicine administered. Calculate the
fraction dosage correctly.
• Have the medicine card or written order
before you preparing drug.
• Know the abbreviations and symbols used
• Help the patient to take all the medicines
that is ordered for him.

15. Right patient
• An important step in administering
medication safely is being sure the
medication is given to the right client.
• Read the physician’s orders to make sure
for whom the medicine is ordered.
• To identify the client correctly:
• The nurse check the medication
administration Form against the client’s
identification bracelet and ask the client
to state his or her name to ensure the
client’s identification bracelet has the
correct information.

16. Right Route
• Read the Physician’s orders to determine the
route of administration
• Dilute the drug if indicated
• Know right method of giving drugs ,e.g. oral,
parenterally etc..
• Know the abbreviations used to designate
the route of administration e.g. I.V, IM. P.O,
etc.
• Review the available forms of drug to make
sure the drug can be given according to the
order.
• Make sure the patient is able to take the
drug by the route indicated or ordered.

17. Common routes
ORAL( P.O) •It is the most a. Inappropriate if
client cannot swallow
common route and if GIT has reduced
•Most motility
convenient b. Inappropriate for
client with nausea and
route vomiting
•The easiest and c. Drug may have
most desirable unpleasant taste
d. Drug may discolor
way to the teeth
administer e. Drug may irritate
medication the gastric mucosa
f. Drug may be
•Usually less aspirated by seriously
expensive ill patient.

18. Nurse's responsibility in administration of oral drugs
• Check the physician’s orders ,Check the
diagnosis and age of the patient
• Check the purpose of medication
• Check the nurses record for the time of last
dose given.
• Check for any contraindications present
(nausea ,Vomiting, delirium, unconsciousness,
etc)
• Check the form of drug available
• Break the tablets only if it is scored.
• Explain the procedure to the patient ,
discuss the need of medications.
• Assist the patient sitting position if possible
• Stay with the patient until swallow medicine

19. Sublingual •A drug that is placed •Same as oral
under the tongue, • Drug is rapidly
where it dissolves. absorbed in the
•When the medication bloodstream
is in capsule and Disadvantages
ordered sublingually, •If swallowed, drug
the fluid must be may be inactivated by
aspirated from the gastric juices.
capsule and placed • Drug must remain
under the tongue. under the tongue until
• A medication given dissolved and
by the sublingual absorbed
route should not be
swallowed, or desire
effects will not be
achieved

20. Buccal a. A medication is held in • Same as oral
the mouth against the
mucous membranes of • Drug can be
the cheek until the drug administered for
dissolves. local effect
b. The medication should
not be chewed, • Ensures greater
swallowed, or placed potency because
under the tongue (e.g drug directly
sustained release
nitroglycerine, opiates, enters the blood
antiemetic, tranquilizer, and bypass the
sedatives) liver
c. Client should be taught
to alternate the cheeks •If swallowed,
with each subsequent drug may be
dose to avoid mucosal inactivated by
irritation
gastric juice

21. Topical Administration
Skin applications Nasal Instillation Eye Instillation
•Use of gloves or •Drops, ointments, disks
•Assessment of •Assessment of eyes
applicators
•Preparation of skin nares •Asepsis
•Thickness of application •Client instruction •Positioning
and self-
administration
Ear Instillation Vaginal Instillation Rectal Instillation
•Suppositories
•Assessment of ear •Suppositories, •Use of gloves
canal foams, creams •Client positioning, comfort,
•Warming of solution •Use of gloves and and hygiene
•Straightening of applicator Inhalation
canal for children •Client positioning, The patient inhales the fumes
and adults comfort, and hygiene in to the lungs to have local
or systemic effects

22. Parenteral administration of medicine
• Parenteral tharapy means giving of therapeutic
agent including food outside the alimentary tract.
• Types of parenteral routes: Intra dermal,
subcutaneous, Intra Muscular, Intravenous, etc)
Purposes:
• To get rapid and systemic effect of the drug
• To provide needed effect when the patient
unconscious, unable to swallow due to
neurological or surgical alterations.
• To give nourishment when it cannot taken by
mouth

23. Intra DermalRoute
• Intra Dermal: Medicine when
introduced in the
dermis(under the epidermis)
• 10 – 15-degree angle
• 0.5 ml or less of medication
• injection into the Dermis
• form a bleb or wheal
• common site: forearm, upper
back, upper dorsal aspect of
the arm, and upper chest
• many nerves are in the dermis
– painful, burning sensation,
• TB and allergy testing most
common
• 27g needle most common
• Slowly inject medication until
wheal forms on skin
• Avoid scarred, blemished,
hairy areas

24. Subcutaneous
• Medicine introduced in to the
subcutaneous tissue
• 45-90degree angle
• adipose tissue
• tissue does not have as many
blood vessels as muscle so
medication is absorbed slower
• 1mL max.
• common sites: posterior arm,
abdomen and anterior
aspects of the thigh
• 23 – 25-gauge needles
• rotate injection sites
• “give slowly”

25. Intramuscular
Deltoid
• Expose upper arm and shoulder
• Relax arm, flex elbow to find triangle-shaped
deltoid muscle
• Injection site in center of triangle
• 1–2 inches below acromion process.

26. Intramuscular
Dorsogluteal, Ventrogluteal, Vastus Lateralis,
• Dorsogluteal: is composed of the thick gluteal
muscles of the buttocks.(Extreme caution: sciatic
nerve and major blood vessels
• Never used for kids less than 2 years old or small
children with small body mass/muscle
• Divide in fourths, upper/lateral divide in fourths
again, outside top edge
Position: The patient may be prone or side lying .

29. Intramuscular
• Vastus Lateralis: The vastus lateralis is the
major muscle in the anterolateral thigh and
is used most often for intramuscular
injections in infants. By school-age and
adolescence, this site may be more painful
than others because of the development of
the musculature.
• To administer: Locate the area between
the greater trochanter of the femur and
the knee. Divide this area into thirds. Give
the injection into the middle third,
grasping the thigh and compressing the
muscle as shown. The needle should be
directed on a front-to-back course.

30. Intramuscular
• Ventrogluteal Muscles: The ventrogluteal
muscles make up the other preferred site
for IM injections in infants, although this is
a useful site for other age-groups as well.
These muscles contain no important
nerves or vessels and are accessible when
the child is in a variety of positions.
• To administer: on the anterior superior
iliac spine and your middle finger at the
iliac crest. Inject the medication just below
the iliac crest using a 90˚ angle.

31. Intramuscular
• Gluteal Region: The gluteal muscles are very small
and poorly developed in the infant and young
toddler. It is not recommended as an injection site
until the child has been walking for at least one
year since locomotion helps to develop the gluteal
musculature.
• Place the child supine and encourage a “toe-
in” position as this position will help relax
the muscle. Palpate the posterior superior
iliac spine and the head of the greater
trochanter of the femur. Give the injection
superior and lateral to imaginary line
between these landmarks. Direct the needle
in a straight front-to-back course.

32. Nurses responsibility in administration of parenteral
medications
• Check the physician’s orders for the type of
injections , dosage, and the route of
administration
• Check the diagnosis and age of the patients
• Check the purpose of injections
• Check the necessity for giving test dose.
• Check the form of the medication available and
the correct method of administration.
• The nurse must have the knowledge of anatomy
and physiology of the body is essential and safe
administration of medication parenteral route.

33. Right Time & Right Frequency
• Administered the drug as per physician’s orders
• The nurse must know why a medication is
ordered for certain times of the day and whether
the time schedule can be altered
• Medication that must act at certain times are
given priority (e.g. insulin should be given at a
precise interval before a meal )
• Know the common approved abbreviation in
administering drugs as per intuitional policy.
• Give the medicine as ordered in relation to the
food intake (a.c(before meals), p.c( after meals))
• Give the medicines according to the action
expected . e.g. Sleeping pills are given at bed
time, the diuretics are given in the morning
hours .

34. Right Documentation
• Documentation is an important part of safe
medication administration
• The documentation for the medication should
clearly reflect the client’s name, the name of
the ordered medication, the time, dose, route
and frequency.
• Sign medication sheet immediately after
administration of the drug.
• Use the standard abbreviations in recording the
medications.
• Record only that medicine which you have
administered.
• Never record a medication before it is giving to
the patient.
• Record the effects observed.
• Record the medications that are vomited by the
patient, refused by the patient and those drugs
that are not administered to the patient and the
reason for not giving the medication.

35. Rules of administration of medication
While preparing the drugs:
• Read the physician’s orders before preparing the drug. No medicine
should be prepared without the doctors orders. Verbal orders are
carried out only in emergency.
• Check medicine card against the physician’s orders. Be sure the
medicine is copied correctly on the medicine card and in the nurse’s
record.
• Avoid conversation during the preparation of medicine.
• Calculate the drug dosage accurately if doubt consult other
Supervisor or physician.
• Give medication only from clearly labeled container.
• Read the label of the medicine and compare it with the medicine
card thrice:
- Before the medicine container taken from the shelf
- Before pouring the drugs
- Before replacing the container in shelf
- Check the expiry date of the drugs along with the 3 checks

36. Cont’d
• Make sure the medicine glasses are clean and dry before
the medicine is taken
• When taking tablets and capsules do not touch them with
hand. Drop the tablets from the container to its lid and
then in to the medicine cup to be taken to the bedside.
• Once the medicine is poured out of bottle , it should not
be poured back in the bottle to prevent contamination of
whole medicine.
• Do not use the medicine differ in colour , taste, odour and
consistency.
• Prepare the drug just before the time of administration of
medicine. Never leave the medicine tray without proper
identification.

37. Cont’d
During Administration:
• Observe the seven rights and three checks.
• Observe for the symptoms of over dosage of the drugs
before it is administered.
• Identify the patient correctly.
• Give the drugs one by one
• Stay with the patient until he has taken the medicine
completely
• Always give the medicine prepared by yourself.
• Do not leave the medicine with the patient.
• Medication errors must be reported according to the
policy of the hospital

38. Monitoring first dose of medication
Before administering the drugs:
• Ask if patient has taken medication before
• Ask for patient allergies
• Review concomitant medicines, herbs and foods
• Review concomitant disease states
• Review lab values
• Know right medications , dose, patient, route,
time, and reason
• Explain to patient, medication’s name , purpose
and potential adverse effects.

39. During & after administration
• Observe for changes in clinical status, adverse
reactions and allergic reactions.
• When present, involve the family in monitoring
the patient.
• Monitor for acute changes in clinical status,
patient’s subjective and objective response.
• Adverse reactions and allergic reactions
• If adverse reaction are present follow the hospital
policy and procedure of reporting adverse reaction
of drugs .

40. Ethical and legal aspects in drug administration
A moral as well as legal dimension is involved in the
administration of medications.
“Nurses are responsible for their actions”
• Under the law nurses are responsible for their own actions
regardless of a written order. It is expected to know all
nurses the minimum and the maximum dose of every
medicine that she administer.
If a nurse gives an Inj.pethadine 500mg to a patient instead
50mg , the nurse is responsible for the harm, she cannot
justify her deed spite of a written order for the same
dosage.
• The nurses responsibility includes to monitor medication
errors by observing seven rights of giving medication.
• The nurse must follow the own institutional policy(leaving
medicine in the bedside strictly prohibited)

41. CLIENT’S RIGHT RELATED TO MEDICATION
ADMINISTRATION
• The patient has the right to considerate and respectful
care, and the right to refuse the medication,
• To be informed of the medication’s name, purpose,
action, and potential undesired effects,
• To refuse a medication regardless of the consequences
• To have a qualified nurses or physicians assess medication
history, including allergies
• To be properly advised of the experimental nature of
medication therapy and to give written consent for its use
• To receive appropriate supportive therapy in relation to
medication therapy
• To not receive unnecessary medications

42. Medication safety guidelines
• Medications are not given without physician’s
written orders.
• Do not administer a drug about which any doubt
exists, check further with the physician.
• Labels must be clear if not return to pharmacy.
• A nurse not to pour medication to one bottle to
another, not to put a medicine back into bottle,
Nurses are not authorized to re-label medication
bottles, Medication which loses its label or which
lacks a legible label shall be return to the
pharmacy.

43. • Nurse who administer the medications are responsible
for their own action. Question any order that you
considered incorrect (may be unclear or inappropriate)
• Be knowledgeable about the medication that you
administer
• Keep the Narcotics in locked place.
• Use only medications that are in clearly labeled
containers.
• Return liquid that are cloudy in color to the pharmacy
• Before administering medication, identify the client
correctly
• The nurse who prepares the drug administers it.. Only the
nurse prepares the drug knows what the drug is. Do not
accept endorsement of medication.
• If the client vomits after taking the medication, report
this to the nurse in-charge or physician.

44. • Preoperative medications are usually discontinued
during the postoperative period unless ordered to
be continued.
• When a medication is omitted for any reason,
record the fact together with the reason.
• When the medication error is made, report it
immediately to the nurse in-charge or physician. To
implement necessary measures immediately. This
may prevent any adverse effects of the drug.
• Each nurse should know the common dose,
maximum dose, how to compute dosage if
necessary.

45. • Do not leave the
medication at the
bedside. Stay with
the client until he
takes the
medications.
• Prepare medications
for one patient at a
time.
• Do not label the
medicine by patient
room number or bed
number .

46. • Know and follow institutional policy and procedures
• Look up what you do not know
• Chart carefully
• Listen to the patient “I never took that before’’ and the like
• Check ,Double – check when a dose seems high
• The unit dose cart should be moved up to door of the patient
room with drawer side towards the room during administration .
• Narcotics are to be checked by every shift, and the narcotic
cabinet must be locked.
• Follow the universal safeguards in administration of medications.
• Always check patient ID before administering medications.
• Chart the medication after administration, if it is not charted , it
is not done.
• Chart if any nursing action done before administering( apical
heart rate, B.P, )
• Check for the expected effect(therapeutic) of the drug. Did side
effects or adverse effects occur perform indicated nursing actions .
Record observations.

47. Patient & Family Education
• Name dose and action of
the drug.
• Time of administration
• Special storage and
preparation of the drug
• Specific OTC drugs and
alternate
• Special comfort and safety
reasons
• Specific points about drug
toxicity
• Specific warning about drug
discontinuation.

48. Thank you
for
listening