Goal: The medication is delivered successfully into the eye.
1. Gather equipment. Check medication order against the original order in the medical record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3. Perform hand hygiene.
4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.
5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.
6. Prepare medications for one patient at a time.
7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.
8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.
9. When all medications for one patient have been prepared, recheck the label with the CMAR/MAR before taking them to the patient.
10. Lock the medication cart before leaving it.
11. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.
12. Ensure that the patient receives the medications at the correct time.
13. Perform hand hygiene and put on PPE, if indicated.
14. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the CMAR/MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.
15. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain the purpose and action of each medication to the patient.
16. Scan the patient’s bar code on the identification band, if required.
17. Put on gloves.
18. Offer tissue to patient.
19. Cleanse the eyelids and eyelashes of any drainage with a washcloth, cotton balls, or gauze squares moistened with normal saline solution. Use each area of the cleaning surface once, moving from the inner toward the outer canthus.
20. Tilt the patient’s head back slightly if sitting, or place the patient’s head over a pillow if lying down. The head may be turned slightly to the affected side to prevent solution or tears from flowing toward the opposite eye.
21. Remove the cap from the medication bottle, being careful not to touch the inner side of the cap. (See the Skill Variation in your skills book for administering ointment.)
22. Invert the monodrip plastic container that is commonly used to instill eye drops. Have patient look up and focus on something on the ceiling.
23. Place thumb or two fingers near margin of lower eyelid immediately below eyelashes, and exert pressure downward over bony prominence of cheek. Lower conjunctival sac is exposed as lower lid is pulled down.
24. Hold dropper close to eye, but avoid touching eyelids or lashes. Squeeze container and allow prescribed number of drops to fall in lower conjunctival sac.
25. Release lower lid after eye drops are instilled. Ask patient to close eyes gently.
26. Apply gentle pressure over inner canthus to prevent eye drops from flowing into tear duct.
27. Instruct patient not to rub affected eye.
28. Remove gloves. Assist patient to a comfortable position.
29. Remove additional PPE, if used. Perform hand hygiene.
30. Document the administration of the medication immediately after administration.
31. Evaluate the patient’s response to medication within appropriate time frame.
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