Preparing and Administering Oral Tablet and Liquid Medications
1. General medication administration considerations (review in the room, with the patient).
Upon first entering the patient's room, wash hands with soap and warm water, and apply vigorous friction for at least 20 seconds. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss their physical allergic responses and reactions.
At the bedside computer, pull up the Medication Administration Record (MAR).
Review the medications that are due to be administered, and clarify with the patient if they have a preference or concerns prior to acquiring and preparing the medication. Engaging the patient in this discussion aligns with the Right to Refuse and the Right Education.
Some patients may have difficulty swallowing whole tablets or capsules. This may require cutting the tablet into smaller doses or opening the capsule to release the powder or granules. Before splitting a tablet or opening a capsule, you must ensure that it is safe to do so. Enteric-coated medication and extended/sustained-release medications should never be broken.
There are many medications that can be given in liquid form if swallowing partial tablets or granules is still difficult. Consult with a pharmacist to determine liquid preparation availability. Leave the patient's room and wash hands as described above.
The nurse must now maintain a distraction/disruption-free environment while dispensing and administering medications to prevent medication errors. Acquire the oral tablet medication from the medication dispensing device, using the Ten Rights during the first safety check. These include the right patient, right medication, right dose, right time, right route, right documentation, right education, right to refuse, right assessment, and right evaluation.
2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and complete the first safety check using the Ten Rights of medication administration.
3. In the medication preparation area, prepare the oral medication according to the MAR, pharmacy instructions, nurse drug guide, patient preference, best practices, and institutional policies/procedures. Pre-packaged oral tablets or capsules that do not require preparation should remain in the original packaging.
Open oral medication packaging and prepare for medication preparation if difficulty swallowing, patient preference, or partial dosing requires it. Partial tablet administration may be required by the oral tablet medication dose or patient preference. Some prescribed doses require splitting a tablet to obtain the desired dose of the medication. Divide a large, scored tablet into two equal pieces by grasping both sides of the tablet and breaking at the scored line. For unscored tablets, place the tablet evenly into a pill cutter and quickly close the device to ensure that the tablet cuts evenly. Dispose of remaining partial doses according to institutional policy if partial dosing is required. If cutting and/or breaking tablets for patients with difficulty swallowing, place all medication pieces into a medication cup.
Oral capsule preparation for patients who are unable to swallow a capsule will require obtaining soft food from the nutrition room. To empty the contents of the oral capsule medication, grasp both ends of the capsule, twist and pull gently, and empty the contents into a medication cup. Be careful not to lose any of the medication. Carefully spoon 2–3 tablespoons of soft food into the medication cup containing the capsule contents. This will facilitate administration and will help to mask the taste of the medication.
Premixed liquid oral medications will require gentle shaking of the medication for a few seconds to ensure equal distribution of the medication within the liquid. Obtain an oral syringe and medication cup from the medication drawer in the medication preparation room. Intravenous syringes can easily be mistaken for oral syringes. Always use oral syringes when dispensing oral medications to avoid medication errors.
Calculate the appropriate volume to withdraw given the concentration provided on the liquid medication label. Place the medication cup on a level surface and crouch until you are at eye level with the volume measurement. Pour the medication into the cup until it reaches the correct volume. If the medication requires a precise measurement, an oral syringe should be used to withdraw it from the medication cup. Withdraw slightly more than the prescribed volume, then slowly expel air and excess liquid until the desired volume is reached. Ensure accuracy by aligning the plunger at eye level with the measurement. Dispose of any remaining medication per policy and return multi-dose containers to the dispensing system. Dispose of all packaging in an appropriate waste container.
4.All medications removed from their original packaging must be labeled with the medication name and dose prior to leaving the medication preparation room. This fulfills the Right Documentation.
5. In the preparation area, complete the second safety check using the Ten Rights of medication administration.
6. Gather necessary supplies including a cup of water, straw, non-sterile gloves, oral medication, and medication cups. Take these into the patient's room.
Administration
7. Upon re-entering the patient's room, place the medications on the counter and perform hand hygiene.
8. Complete the third and final medication safety check using the Ten Rights of medication administration. Verify the patient's identity by asking for their name and birthdate and checking against the name band to confirm the Right Patient.
9. Educate the patient about the medication—its name, indication, and action—fulfilling the Right Education. Discuss any potential side effects or adverse effects. Address concerns and ensure the patient's decision is informed. If the patient refuses the medication, ensure they understand the consequences, respecting the Right to Refuse.
10. Administer the oral medication. Confirm the patient can swallow by offering a sip of water. Open pre-packaged medications and place them in a medication cup. Administer according to patient preference and ability.
11. Document the administration in the MAR, including the medication name, dose, route, date, time, and your initials. Include any assessments performed beforehand. This step ensures the Right Documentation, Right Assessment, and supports the Right Evaluation.
12. Remind the patient of possible side effects to report.
13. Exit the patient's room and perform hand hygiene again.
Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Oral medications are the route most preferre…
1. General medication administration considerations (review in the room, with the patient).
Upon first entering the patient's room, wash hands with soap and warm water, and apply vigorous friction for at least 20 seconds. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss their physical allergic responses and reactions.
At the bedside computer, pull up the Medication Administration Record (MAR).
Review the medications that are due to be administered, and clarify with the patient if they have a preference or concerns prior to acquiring and preparing the medication. Engaging the patient in this discussion aligns with the Right to Refuse and the Right Education.
Some patients may have difficulty swallowing whole tablets or capsules. This may require cutting the tablet into smaller doses or opening the capsule to release the powder or granules. Before splitting a tablet or opening a capsule, you must ensure that it is safe to do so. Enteric-coated medication and extended/sustained-release medications should never be broken.
There are many medications that can be given in liquid form if swallowing partial tablets or granules is still difficult. Consult with a pharmacist to determine liquid preparation availability. Leave the patient's room and wash hands as described above.
The nurse must now maintain a distraction/disruption-free environment while dispensing and administering medications to prevent medication errors. Acquire the oral tablet medication from the medication dispensing device, using the Ten Rights during the first safety check. These include the right patient, right medication, right dose, right time, right route, right documentation, right education, right to refuse, right assessment, and right evaluation.
2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and complete the first safety check using the Ten Rights of medication administration.
3. In the medication preparation area, prepare the oral medication according to the MAR, pharmacy instructions, nurse drug guide, patient preference, best practices, and institutional policies/procedures. Pre-packaged oral tablets or capsules that do not require preparation should remain in the original packaging.
Open oral medication packaging and prepare for medication preparation if difficulty swallowing, patient preference, or partial dosing requires it. Partial tablet administration may be required by the oral tablet medication dose or patient preference. Some prescribed doses require splitting a tablet to obtain the desired dose of the medication. Divide a large, scored tablet into two equal pieces by grasping both sides of the tablet and breaking at the scored line. For unscored tablets, place the tablet evenly into a pill cutter and quickly close the device to ensure that the tablet cuts evenly. Dispose of remaining partial doses according to institutional policy if partial dosing is required. If cutting and/or breaking tablets for patients with difficulty swallowing, place all medication pieces into a medication cup.
Oral capsule preparation for patients who are unable to swallow a capsule will require obtaining soft food from the nutrition room. To empty the contents of the oral capsule medication, grasp both ends of the capsule, twist and pull gently, and empty the contents into a medication cup. Be careful not to lose any of the medication. Carefully spoon 2–3 tablespoons of soft food into the medication cup containing the capsule contents. This will facilitate administration and will help to mask the taste of the medication.
Premixed liquid oral medications will require gentle shaking of the medication for a few seconds to ensure equal distribution of the medication within the liquid. Obtain an oral syringe and medication cup from the medication drawer in the medication preparation room. Intravenous syringes can easily be mistaken for oral syringes. Always use oral syringes when dispensing oral medications to avoid medication errors.
Calculate the appropriate volume to withdraw given the concentration provided on the liquid medication label. Place the medication cup on a level surface and crouch until you are at eye level with the volume measurement. Pour the medication into the cup until it reaches the correct volume. If the medication requires a precise measurement, an oral syringe should be used to withdraw it from the medication cup. Withdraw slightly more than the prescribed volume, then slowly expel air and excess liquid until the desired volume is reached. Ensure accuracy by aligning the plunger at eye level with the measurement. Dispose of any remaining medication per policy and return multi-dose containers to the dispensing system. Dispose of all packaging in an appropriate waste container.
4.All medications removed from their original packaging must be labeled with the medication name and dose prior to leaving the medication preparation room. This fulfills the Right Documentation.
5. In the preparation area, complete the second safety check using the Ten Rights of medication administration.
6. Gather necessary supplies including a cup of water, straw, non-sterile gloves, oral medication, and medication cups. Take these into the patient's room.
Administration
7. Upon re-entering the patient's room, place the medications on the counter and perform hand hygiene.
8. Complete the third and final medication safety check using the Ten Rights of medication administration. Verify the patient's identity by asking for their name and birthdate and checking against the name band to confirm the Right Patient.
9. Educate the patient about the medication—its name, indication, and action—fulfilling the Right Education. Discuss any potential side effects or adverse effects. Address concerns and ensure the patient's decision is informed. If the patient refuses the medication, ensure they understand the consequences, respecting the Right to Refuse.
10. Administer the oral medication. Confirm the patient can swallow by offering a sip of water. Open pre-packaged medications and place them in a medication cup. Administer according to patient preference and ability.
11. Document the administration in the MAR, including the medication name, dose, route, date, time, and your initials. Include any assessments performed beforehand. This step ensures the Right Documentation, Right Assessment, and supports the Right Evaluation.
12. Remind the patient of possible side effects to report.
13. Exit the patient's room and perform hand hygiene again.
1. General medication administration considerations (review in the room, with the patient).
Upon first entering the patient's room, wash hands with soap and warm water, and apply vigorous friction for at least 20 seconds. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss their physical allergic responses and reactions.
At the bedside computer, pull up the Medication Administration Record (MAR).
Review the medications that are due to be administered, and clarify with the patient if they have a preference or concerns prior to acquiring and preparing the medication. Engaging the patient in this discussion aligns with the Right to Refuse and the Right Education.
Some patients may have difficulty swallowing whole tablets or capsules. This may require cutting the tablet into smaller doses or opening the capsule to release the powder or granules. Before splitting a tablet or opening a capsule, you must ensure that it is safe to do so. Enteric-coated medication and extended/sustained-release medications should never be broken.
There are many medications that can be given in liquid form if swallowing partial tablets or granules is still difficult. Consult with a pharmacist to determine liquid preparation availability. Leave the patient's room and wash hands as described above.
The nurse must now maintain a distraction/disruption-free environment while dispensing and administering medications to prevent medication errors. Acquire the oral tablet medication from the medication dispensing device, using the Ten Rights during the first safety check. These include the right patient, right medication, right dose, right time, right route, right documentation, right education, right to refuse, right assessment, and right evaluation.
2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and complete the first safety check using the Ten Rights of medication administration.
3. In the medication preparation area, prepare the oral medication according to the MAR, pharmacy instructions, nurse drug guide, patient preference, best practices, and institutional policies/procedures. Pre-packaged oral tablets or capsules that do not require preparation should remain in the original packaging.
Open oral medication packaging and prepare for medication preparation if difficulty swallowing, patient preference, or partial dosing requires it. Partial tablet administration may be required by the oral tablet medication dose or patient preference. Some prescribed doses require splitting a tablet to obtain the desired dose of the medication. Divide a large, scored tablet into two equal pieces by grasping both sides of the tablet and breaking at the scored line. For unscored tablets, place the tablet evenly into a pill cutter and quickly close the device to ensure that the tablet cuts evenly. Dispose of remaining partial doses according to institutional policy if partial dosing is required. If cutting and/or breaking tablets for patients with difficulty swallowing, place all medication pieces into a medication cup.
Oral capsule preparation for patients who are unable to swallow a capsule will require obtaining soft food from the nutrition room. To empty the contents of the oral capsule medication, grasp both ends of the capsule, twist and pull gently, and empty the contents into a medication cup. Be careful not to lose any of the medication. Carefully spoon 2–3 tablespoons of soft food into the medication cup containing the capsule contents. This will facilitate administration and will help to mask the taste of the medication.
Premixed liquid oral medications will require gentle shaking of the medication for a few seconds to ensure equal distribution of the medication within the liquid. Obtain an oral syringe and medication cup from the medication drawer in the medication preparation room. Intravenous syringes can easily be mistaken for oral syringes. Always use oral syringes when dispensing oral medications to avoid medication errors.
Calculate the appropriate volume to withdraw given the concentration provided on the liquid medication label. Place the medication cup on a level surface and crouch until you are at eye level with the volume measurement. Pour the medication into the cup until it reaches the correct volume. If the medication requires a precise measurement, an oral syringe should be used to withdraw it from the medication cup. Withdraw slightly more than the prescribed volume, then slowly expel air and excess liquid until the desired volume is reached. Ensure accuracy by aligning the plunger at eye level with the measurement. Dispose of any remaining medication per policy and return multi-dose containers to the dispensing system. Dispose of all packaging in an appropriate waste container.
4.All medications removed from their original packaging must be labeled with the medication name and dose prior to leaving the medication preparation room. This fulfills the Right Documentation.
5. In the preparation area, complete the second safety check using the Ten Rights of medication administration.
6. Gather necessary supplies including a cup of water, straw, non-sterile gloves, oral medication, and medication cups. Take these into the patient's room.
Administration
7. Upon re-entering the patient's room, place the medications on the counter and perform hand hygiene.
8. Complete the third and final medication safety check using the Ten Rights of medication administration. Verify the patient's identity by asking for their name and birthdate and checking against the name band to confirm the Right Patient.
9. Educate the patient about the medication—its name, indication, and action—fulfilling the Right Education. Discuss any potential side effects or adverse effects. Address concerns and ensure the patient's decision is informed. If the patient refuses the medication, ensure they understand the consequences, respecting the Right to Refuse.
10. Administer the oral medication. Confirm the patient can swallow by offering a sip of water. Open pre-packaged medications and place them in a medication cup. Administer according to patient preference and ability.
11. Document the administration in the MAR, including the medication name, dose, route, date, time, and your initials. Include any assessments performed beforehand. This step ensures the Right Documentation, Right Assessment, and supports the Right Evaluation.
12. Remind the patient of possible side effects to report.
13. Exit the patient's room and perform hand hygiene again.
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Q1: What are the different forms of oral medications available for patient administration?
Oral medications come in solid and liquid forms. Solid preparations include tablets, capsules, caplets, and enteric-coated tablets. Liquid forms include syrups, elixirs, spirits, and suspensions. Enteric-coated tablets have a special coating that prevents dissolution until the medication reaches the small intestine, protecting it from stomach acid.
Q2: Why are some patients contraindicated for oral medication administration?
Patients who are unconscious, uncooperative, or unable to swallow due to medical problems cannot safely receive oral medications. Additionally, patients with altered gastrointestinal function such as vomiting and nausea should not receive oral medications because they cannot retain them, making the medication ineffective.
Q3: What does the Right Assessment involve when preparing oral medications?
Right Assessment requires the nurse to evaluate whether the medication is appropriate for the patient's medical conditions, medication allergies, and current clinical status. The nurse must also verify whether previous doses have been administered. This assessment ensures safe and appropriate medication administration tailored to individual patient needs.
Q4: How do oral medications differ from other routes in terms of onset and duration?
Oral medications typically have a slower onset of action compared to other routes. Liquid oral medications and swallowed tablets may also have a more prolonged effect. This delayed absorption occurs because the medication must travel through the gastrointestinal tract before entering the bloodstream.
Q5: What knowledge must nurses possess to support the Right Education principle in medication administration?
Nurses must be knowledgeable about the medication's purpose, adverse effects, and patient preferences. This knowledge supports the Right Education principle and enables patients to make informed decisions about their treatment. Understanding these aspects also supports the patient's Right to Refuse medication if they choose.
Q6: What are sublingual and buccal routes of oral medication administration?
Sublingual administration involves placing medication under the tongue to dissolve directly into the bloodstream. Buccal administration places medication in the cheek area between the gums and mucus membranes to dissolve. Both routes bypass the gastrointestinal tract, allowing faster absorption than swallowed oral medications.
Q7: Why is oral medication administration the preferred route for most patients?
Oral medications are the most preferred route by patients and commonly used by providers because they are non-invasive, convenient, and generally safe. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract. This route offers patients greater comfort and independence compared to injectable or other invasive administration methods.
Chapters in this video
0:00
Overview
0:50
Types of Oral Medications
1:48
Medication Preparation
7:48
Administration Protocol
10:28
Summary