Download Administration of Medicines

Administration of Medicines
Ingrid Johnston
Consultant Pharmacist
LIQUIDS
Prepare
1. Identify the desired measurement on the medicine cup.
2. If indicated, shake the medication.
3. Pour the liquid into the cup to the desired level.
4. With the medication cup on a flat surface, check the medication
level by bringing your eye to the same level as the cup.
5. Pour any excess into a disposable cup.
6. Recheck the level
SHAKE WELL BEFORE
USE
Meniscus
Administer
1. Check medication chart and observe the “x” Rights of Medication
Administration
2. Observe resident take the medication
3. Add a small amount of water to the cup and swish around – have
resident drink this also
4. Offer a glass of water after the dose
5. Document medication administration
6. Clean and dry medicine cup
Practice points
• Order on drug chart must specify strength of liquid preparation
eg Epilim® 200mg/5mL
• Best practice for doses should be expressed in millilitres and
milligrams
Eg 12.5mLs = 500mg
• Avoid dripping medication on label
• Do not mix liquid medications together
• Do not mix with other drinks or food
Some extra tips…
Effervescent tablets
eg Chlorvescent®
- dissolve in at least 125mLs
water
- ensure FULLY dissolved
before administration
Sachets eg Movicol® or
Gastrolyte®
ensure packet directions
regarding volume for
mixing are followed
EYE MEDICATIONS
Medications for the eyes
• Types of medications for the eyes
– Drops
– Gels and ointments
– Sprays
• Used to treat conditions such as:
– Dry eyes, redness, allergies,
conjunctivitis, glaucoma
Sterility of eye preparations
• Eye medications are manufactured to be sterile
• Preventing contamination
– Do not touch any part of the eye with the tip of the
dropper/ointment tube
– Close cap tightly when finished using eye drops/ointments
– Ensure proper storage of eye drops/ointments
Storage
• Each eye medication may require different
storage
– All medications should be kept away from
humidity
– Most require storage at room temperature
– Some require storage in the refrigerator
– Never store medications in the freezer
• Most eye drops have a 30 day expiry
• Some lubricant preparations now have a 6
month expiry
• Single use products also available
Administration
• Easiest when resident is sitting or lying down
• Check expiry date on bottle
– Once eye drops are opened, they should be disposed of after 1
month unless otherwise indicated
• Wash hands with soap and water
• Remove lid
• Hold or place it down carefully so it does not become contaminated
• Hold bottle upside down in one hand between thumb and index
finger
• Using other hand, gently pull down lower eyelid to form a pouch
Administration
• Have resident tilt head back and look up
• Put tip of bottle close to lower eyelid
– Do not let it touch the eye
• Release one drop into the pouch by gently squeezing the bottle, or
squeeze in desired amount of ointment
• Instruct resident to close eyes and keep closed (do not blink or rub
eye)
• While eye is still closed, have resident place index finger against
inner corner of the eye and press against the nose for two minutes
• This stops the medicine from draining through tear duct to
nose/throat
Administration
•
•
•
•
Blot excess solution around the eye with a tissue
Seal lid of medication tightly
Wash hands again with soap and water
After use, wait at least 5 minutes before putting any other eye
drops in eye(s)
Practice points
• Only one drop should be used at a time
• A second drop may
– wash out the first or
– increase the possibility of systemic absorption and toxicity,
– it can also often end up on the skin of the eyelids and the
patient is then more likely to develop a contact allergy
– doubles the cost of the medication (there are 20 drops per ml)
• Patients who develop an allergy to the preservative may need to
use a formulation without a preservative
• Many eye drops are also available in single-use disposable
containers
Practice points
• If the resident is wearing contact lenses, they should be removed
before putting the drops in the eye.
• The resident should wait at least 15 minutes before replacing the
contact lenses.
• Be careful not to touch the dropper tip against the eye, eyelid or
anything else to avoid contaminating the eye drops.
• There are dose administration aids available for residents who self
administer eye drops but are having difficulty – speak to the
pharmacist
Eye Drop Aids
Eye sprays
1. Liposomes are sprayed onto the eyelid and gather in the corners
2. Liposomes mix with natural lipids
3. When the eyes open, the new lipid mixture covers the whole
tear film
More than one eye preparation?
1st:
Clear medicated drops
2nd:
Cloudy eye preparations (shaken)
Eg. Azopt®, FML®, Flarex®
3rd:
Lubricant eye drops
4th:
Eye gels as they are designed to stay in the eye longer
Last:
Ointments last as they repel other drops and will stay in the eye
the longest
Questions
1. Why do you need to block the tear duct after instilling eye
drops?
2. How long should you wait between instilling 2 drops
3. If a resident is prescribed Timolol eye drops and Refresh Plus
eye drops what order should they be instilled?
4. What is the expiry date of eye drops?
EAR PREPARATIONS
Ear medications
• Drops
• Ointments
Drops usually preferred as less
likely to cause blockage of the
ear canal and drops penetrate
further into the ear canal
Administration
• Remove anything in the ear (hearing aids)
• Clean and dry the external ear canal
thoroughly, making sure no trace of soap or
other cleanser remains.
• Lie the patient down with the affected ear
upwards.
• Warming the bottle in your hand can
reduce drop viscosity and increase
comfort
Administration
• Instil the prescribed number of
drops or small amount of
ointment into the ear canal
• Massage the cartilage flap over
the opening of the ear canal to
aid penetration into the ear
canal.
• Leave the patient in the prone
position for few minutes to allow
the preparation to ‘penetrate’.
Storage of ear medications
• Storage recommendations
are specific for each product
• All medications should be
stored away from humidity
• Most should be stored at
room temperature
• Some should be stored in
the refrigerator
– Kenacomb (Otocomb®) drops
• Should never be stored in
the freezer
DOSE ADMINISTRATION AIDS
Types of DAAs
•
•
•
•
•
•
Compartmentalised plastic boxes
Blister packs
Sachets
Automated devices
Unit dose pack
Multidose pack
What can be packed?
• Solid oral dose forms
• Some medication may require separate packing
– PRN medication
– cytotoxics
–
–
–
–
S8 medications
antibiotics
Short term medications
warfarin
Medication considerations
• Occupational health & safety risks for staff
• Space
– Interaction
– Checking
– Physical damage
• Stability
–
–
–
–
Temperature (heat/refrigeration)
Moisture
Light
Air
Not suitable for packing
Type of tablet
Examples
Effervescent/dispersible
Chlorvescent
Sublingual
Anginine
Chewable
Vitamin C
Hygroscopic
Sodium valproate (Epilim)
Light sensitive
Tamoxifen
Heat sensitive
Containing Al hydroxide/Mg trisilicate
Gaviscon, hiprex
Wafers
Risperidone
Manufacturer specified
Dabigatrin (Pradaxa®)
Expiry dates
• Manufacturer
– Removal from original packaging reduces or invalidates
expiry date indicated on the immediate packaging
Expiry dates
• The Pharmaceutical Society of Australia (PSA) recommends the
quantity packed should not exceed the quantity that reasonably
could be required during 8 weeks .
• Paracetamol tablets have evidence of stability in a Webster‐pak
stored for 12 months.
Expiry dates
• US FDA recommend
– an expiry date of 6 months from the date packed into a single
unit dose container
OR
– 25% of the remaining time of manufacturer's original expiry
date.
DAA labelling
Monitor the resident for outcomes and adverse
reactions to the medication.
Documentation
•
•
•
•
Recording of administration
Dropped or misplaced medication
Refused medications
Appropriate disposal
PEG ADMINISTRATION
OF MEDICATION
Enteral Feeding Tubes
May affect the
bioavailability of the
medicine
– Change in site of
delivery
– Nutrient
interactions
Issues to Consider
1.
2.
3.
4.
Is the medication still necessary?
Change to liquid forms of the medicine
Change to alternative routes of administration
Medicine must not be added directly to the enteral feed
a) May change physical characteristic of feed (clumping
or thickening)
b) Feed may have an effect on the medicine
c) Risk of microbial contamination of sterile pre-packed
feed
d) Changes in feed rates can increase risk of over or under
dosing
Special Considerations
• Medicines to be given on an empty stomach
• Give single daily dose during period where the feed is
stopped and the GIT is resting
• If enteral tube is in stomach
– Stop enteral feed for at least 2-hours before admin
– Wait at least 30 minutes after dosing before restarting feed.
• If enteral feed is in duodenum or jejunum
– Stop feed for 30-60 min before admin
– Wait for 30 min after dosing before restarting
Special Considerations
• If unable to stop the feed a dose adjustment may be needed
– consult pharmacist / drug info service
• If feed interruption is required
– consult with a dietician
• Consult individual medicine monographs
Special Considerations
Buccal or sublingual tablets should not be given via enteral
feed
– designed to be absorbed in mouth
Effervescent tabs dispersed in at least 50 ml of water in a
cup
– to allow gases to escape
Some antacids and sucralfate act locally in the stomach
– not suitable for duodenal or jejunal tubes
Some medicines may have increased bioavailability when
given via jejunal tube
References
• Appropriate use of dose administration aids Rohan A Elliott,
Australian Prescriber, vol.37 : no. 2 : April 2014
• Not Just Pills, Penny Kraemer
• Guidelines and Standards for Pharmacists – Dose Administration
Aids Service
• Guiding Principles for Medication Management in RACFs – October
2012 Aust Gov Dept of Health and Ageing
• Webster resources
• eMims March 2015