Procedure for the safe administration of medicines

In April 2002 the Nursing and Midwifery Council (NMC 2000a) revised the guidelines for the administration of medicines, and these should be adhered to at all times. The following procedure is based on those guidelines and gives the rationale for each element. If ever in doubt remember ‘the six Rs’.

• Right drug
• Right dose
• Right route
• Right form
• Right time
• Right client

Also remember to become familiar with your local policies related to the administration of medicines before participating in this procedure (see below).

Procedure	Rationale
Wash and dry hands thoroughly	To reduce the risk of crossinfection
Collect prescription sheet and ensure that the client is available and willing to take any prescribed medications	To gain consent and avoid wastage
Ensure that the prescription is dated, legible and signed by a doctor	To fulfil legal requirements related to drug administration
Prior to administration ensure you are knowledgeable about the drug(s) to be administered. This should include: therapeutic use, normal dosage, routes/ forms (see Table 4.1), potential side effects, contra-indications	To ensure safety and wellbeing of client and to enable you to identify any errors in prescribing
Confirm identity of client verbally and with identification band against prescription, checking full name, home address, date of birth, age, identification number, RIGHT CLIENT and ensure that the drug has not already been given	To ensure that the correct drug is being administered to the correct client
Check the prescription carefully, ascertaining RIGHT DRUG, DOSE, ROUTE, FORM and TIME	To ensure client safety. If any errors of prescribing are noticed then withhold the drug and inform the medical officer
Check client understands the need for the drug and answer any questions he or she may have prior to administration	To ensure that consent is informed
Be familiar with the client’s care plan and past medical history	To ensure that only the medications currently required are administered. Knowledge of past medical history assists in identifying contra-indications specific to client
Select the appropriate medication and for a second time check the drug, route, dose, time, form and co-existing therapies prior to administration	To ensure safe administration of the medication
Check the expiry date of all medications to be administered	To protect the client from harm. Medicines that have expired can be dangerous, as products deteriorate over time. Expired medications should be returned to pharmacy for appropriate disposal
Check that the client is not allergic to the drug or any of its derivatives prior to administration	To protect the client from harm. If the client is allergic inform medical staff without delay to review prescription
Administer the medication in the appropriate form, by the prescribed route, at the correct dosage to the correct client and make sure that they have taken/ received it	To fulfil your responsibilities and prevent any untoward occurrences
Following administration of the medication ensure clear, accurate and immediate documentation. This includes refusal of medicines by client or any intentionally withheld drugs	Legal requirement to document treatment and safeguard client through effective communication. Student nurses or midwives must not administer any drug unsupervised and all signatures must be countersigned by a registered practitioner
Controlled drugs must be checked by two nurses/ midwives, one of whom must be registered, and the appropriate additional documentation completed	Legal requirement relating to Misuse of Drugs Regulations 1985 and the Misuse of Drugs (Safe Custody) Regulations 1973
Clear away all equipment and ensure safe storage of medications as per local policy	To adhere to health and safety regulations

If you are unsure about any aspect of the medicines prescribed it is advisable to contact the pharmacy staff, who will be only too happy to advise and guide you.

Table 4.1 Advantages and disadvantages of different routes
Route	Advantages	Disadvantages	Form(s)
Oral (O)/ Sublingual (S/L) (under the tongue) Buccal (Buc) (between lip and gum)	• Comfortable • Non-invasive • Easy to use • Inexpensive	Cannot use if client has: • Nausea or vomiting • Reduced gut motility, bowel disease or malabsorption • Difficulty swallowing • Impaired consciousness • OR if the client is to remain nil by mouth (NBM)	Tablet Capsule Elixir Gel
Intramuscular injection (I/M)	• Rapid and assured absorption • Effective if client unable to use oral medication • Can sometimes combine drugs into one injection	• More expensive • Client anxiety and discomfort on administration • Increased risk of side effects with rapid absorption • Risk of introducing infection • Risks involved with sharps usage • Slower absorption if client is cold	Single-use glass or plastic Vial Liquid solution or powder requiring reconstitution
Subcutaneous injection (S/C)	• Slow sustained absorption • Virtually pain free • Suitable for repeated injections or infusion	• Risk of ulceration, infection or atrophy of skin if injection site not rotated • More expensive • Client anxiety • Risks involved with sharps usage	Single- or multi-use vial of a drug or pre-filled syringe
Intravenous (IV) injection	• Very rapid and assured absorption therefore effective in critical care • Enables combined drug usage • Effective when unable to use oral routes	• Increased risks of side effects due to rapid absorption • Client anxiety and discomfort • Requires patent IV access via a cannula or central line • Increased risk of introducing infection • Risks involved with sharps usage • Can only be administered by an advanced nurse practitioner or doctor • Much less time to rectify adverse reactions	Single- or multi-use glass or plastic vial or pre-mixed infusion
Topical (Top)	• Painless • Inexpensive • Easy to use • Low risk of side effects • Local effect	• Cannot be used on broken skin • Difficult to use if client has reduced mobility • May stain skin or soil clothing	Cream Gel Paste
Mucous membranes which include: sublingual (see Oral) buccal eyes ears (Aural) nose (Nasal) vagina (PV) rectum (PR)	• Effective if client unable to use oral route • Rapid absorption due to systemic blood supply • Direct application to source, e.g. infection	• Risk of side effects • Client anxiety • Embarrassment and discomfort • Some routes cannot be used following surgery • Must have functional GI tract for rectal drugs • Underlying complications prevent use, e.g. ruptured eardrum	Tablet Capsule Cream Drops Drops Spray Cream Pessary Suppository Cream Enema
Inhalation i.e. Inhalers (Inh) and nebulizers (Neb)	• Rapid effect for relief of some respiratory symptoms • Sometimes used prophylactically presurgery	• Some side effects including sore mouth and throat (this can be reduced by using spacer device) • Client anxiety • Difficult to use with elderly or children • Support and teaching required for inhaler use • Expensive nebulizer equipment if used in chronic illness at home	Single-use plastic nebule or multidose inhaler (differing types)