Administering Oral Medications
PURPOSE
• To provide a medication that has systemic effects or local effects on the GI tract or both (see specific
drug action)
ASSESSMENT
Assess
• Allergies to medication(s)
• Client’s ability to swallow the medication
• Presence of vomiting or diarrhea that would interfere with the ability to absorb the medication
• Specific drug action, side effects, interactions, and adverse reactions
• Client’s knowledge of and learning needs about the medication
• Perform appropriate assessments (e.g., vital signs, laboratory results) specific to the medication.
Equipment
• Disposable medication cups: small paper or plastic cups for tablets and capsules, waxed or plastic
calibrated medication cups for liquids
•Medication Administration Record (MAR)
• Pill crusher or cutter
• Straws to administer medications that may discolor the teeth or to facilitate the ingestion of liquid
medication for certain clients
• Drinking glass and water or juice
Preparation
1. Know the reason why the client is receiving the medication, the drug classification, contraindications,
usual dosage range, side effects, and nursing considerations for administering and evaluating the
intended outcomes for the medication.
2. Check the MAR.
• Check for the drug name, dosage, frequency, route of administration, and expiration date for
administering the medication, if appropriate. Rationale: Orders for certain medications (e.g., controlled
substances, antibiotics) expire after a specified time frame and they need to be reordered by the
primary care provider.
• If the MAR is unclear or pertinent information is missing, compare the MAR with the prescriber’s most
recent written order.
• Report any discrepancies to the charge nurse or the primary care provider, as agency policy dictates.
3. Verify the client’s ability to take medication orally.
• Determine whether the client can swallow, is NPO, is nauseated or vomiting, has gastric suction, or has
diminished or absent bowel sounds.
4. Organize the supplies.
• Gather the MAR(s) for each client together so that medications can be prepared for one client at a
time. Rationale: Organization of supplies saves time and reduces the chance of error.
Performance
1. Perform hand hygiene and observe other appropriate infection prevention procedures.
2. Obtain the appropriate medication.
• Read the MAR and take the appropriate medication from the shelf, drawer, or refrigerator. The
medication may be dispensed in a bottle, box, or unit-dose package.
•Check the expiration date of the medication. Return expired medications to the pharmacy. Rationale:
Outdated medications are not safe to administer.
• Use only medications that have clear, legible labels. This ensures accuracy.
3. Prepare the medication.
• Calculate the medication dosage accurately.
• Prepare the correct amount of medication for the required dose, without contaminating the
medication. Rationale: Aseptic technique maintains drug cleanliness.
• While preparing the medication, recheck each prepared drug and container with the MAR again.
Rationale: This second safety check reduces the chance of error.
Liquid Medication
• Thoroughly mix the medication before pouring. Discard any medication that has changed color or
turned cloudy, the exception being oral suspensions.
• Remove the cap and place it upside down on the countertop. Rationale: This avoids contaminating the
inside of the cap.
• Hold the bottle so the label is next to your palm and pour the medication away from the label.
Rationale: This prevents the label from becoming soiled and illegible as a result of spilled liquids.
• Place the medication cup on a flat surface at eye level and fill it to the desired level, using the bottom
of the meniscus (crescent-shaped upper surface of a column of liquid) to align with the container scale.
❹ Rationale: This method ensures accuracy of measurement.
• Before capping the bottle, wipe the lip with a paper towel. Rationale: This prevents the cap from
sticking.
4. Check the room number against the MAR if agency policy does not allow the MAR to be removed
from the medication cart. Rationale: This is another safety measure to ensure that the nurse is entering
the correct client room.
5. Provide for client privacy.
6. Prepare the client
• Check the client’s identification band or Introduce self and verify the client’s identity using agency
protocol. Rationale: This ensures that the right client receives the medication.
• Assist the client to a sitting position or, if not possible, to a side-lying position. Rationale: These
positions facilitate swallowing and prevent aspiration.
• If not previously assessed, take the required assessment measures, such as pulse and respiratory rates
or blood pressure.
7. Explain the purpose of the medication and how it will help, using language that the client can
understand. Include relevant information about effects; Rationale: Information can facilitate acceptance
of and compliance with the therapy.
8. Administer the medication at the correct time.
• Take the medication to the client within the guidelines of the agency.
• Give the client sufficient water or preferred juice to swallow the medication. Before using juice, check
for any food and medication incompatibilities. Rationale: Fluids ease swallowing and facilitate
absorption from the GI tract.
• If the client is unable to hold the pill cup, use the pill cup to introduce the medication into the client’s
mouth, and give only one tablet or capsule at a time. Rationale: Putting the cup to the client’s mouth
maintains the cleanliness of the nurse’s hands. Giving one medication at a time eases swallowing.
• If an older child or adult has difficulty swallowing, ask the client to place the medication on the back of
the tongue before taking the water. Rationale: Stimulation of the back of the tongue produces the
swallowing reflex.
• If the medication has an objectionable taste, give the medication with juice, applesauce, or pudding if
there are no contraindications. Rationale: Juices, applesauce, or pudding may mask the taste of the
medication.
• If the client says that the medication you are about to give is different from what the client has been
receiving, do not give the medication without first checking the original order. Rationale: Most clients
are familiar with the appearance of medications taken previously. Unfamiliar medications may signal a
possible error.
• Stay with the client until all medications have been swallowed. Rationale: The nurse must see the
client swallow the medication before the drug administration can be recorded. The nurse may need to
check the client’s mouth to ensure that the medication was swallowed and not hidden inside the cheek.
9. Document each medication given.
• Record the medication given, dosage, time, any complaints or assessments of the client, and your
signature.
• If medication was refused or omitted, record this fact on the appropriate record; document the
reason, when possible, and the nurse’s actions according to agency policy.
10. Dispose of all supplies appropriately.
• Replenish stock (e.g., medication cups) and return the cart to the appropriate place.
• Discard used disposable supplies.
EVALUATION
• Return to the client when the medication is expected to take effect (usually 30 minutes) to evaluate
the effects of the medication on the client
