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 preferred by patients and are one of the most commonly used routes of medication administration by providers. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract. Oral medications are available in solid forms (e.g., tablets, capsules, caplets, and enteric-coated tablets) and liquid forms (e.g., syrups, elixirs, spirits, and suspensions). Most oral medications have a slower onset of action and, in the case of liquids and swallowed oral medications, may also have a more prolonged effect. Enteric-coated tablets are covered with material that prevents dissolution and absorption until the tablet reaches the small intestine. Additional oral medication routes (not shown in this video) include sublingual administration, in which the preparation is placed under the tongue to dissolve, and buccal administration, which involves placing the medication in the cheek area between the gums and mucus membranes to dissolve.
When preparing and administering oral tablets and liquid medications, the nurse must consider whether the medication is appropriate given the patient's medical conditions, medication allergies, and current clinical status, and whether previous doses of the medication have been administered. This step represents the Right Assessment. Patients with altered gastrointestinal function (e.g., vomiting and nausea) should not be given oral medications, since they would not be able to retain them. Oral medications are contraindicated in patients who are unconscious, uncooperative, or unable to swallow due to a medical problem. Medication administration also requires the nurse to be knowledgeable about the medication's purpose, adverse effects, and patient preferences. These aspects reflect the Right Education and support the patient’s Right to Refuse. This demonstration will present how to prepare and administer oral medications in both tablet and liquid forms (most common), including the Ten Rights, and will discuss medication documentation.
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.
This video demonstrated the verification and administration of oral medication, including tablets, capsules, and liquid forms. Because pharmacy dose formulations may be limited, nurses must ensure the correct dose is prepared, such as administering 1.5 tablets when a 30 mg dose is ordered and only 20 mg tablets are available. For medications requiring precise dosing, oral syringes are preferred over medication cups for accuracy. A common error in oral liquid administration is failing to measure at eye level or on a level...
Chapters in this video
0:00
Overview
0:50
Types of Oral Medications
1:48
Medication Preparation
7:48
Administration Protocol
10:28
Summary
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