Medication administration

Medication Administration
Ahmad Thanin

Purpose of
Medication
• To identify any disease
Diagnostic
• To prevent the occurrence of disease.
eg:- heparin to prevent thrombosis or
antibiotics to prevent infection.
Prophylaxis
• To cure the disease.
Therapeutic

INTRODUCTION
The principles are:
Authority Competence safety
Three principles outline the expectations related to medication practices that promote public protection.
The Medication practice standard describes nurses’ accountabilities when engaging in medication
practices, such as administration, dispensing, medication storage, inventory management and disposal.

Authority
Nurses must have the necessary authority to perform
medication practices.
Registered Nurses and Registered Practical Nurses require
an order for a medication practice when:
• a controlled act is involved
• administering a prescription medication, or
• it is required by legislation that applies to a practice
Nurses accept orders that are:
• Clear
• Complete
• appropriate.

Competence
Nurses ensure that they have the knowledge, skill and
judgment needed to perform medication practices
safely.
Nurses:
• ensure their medication practices are evidence informed
• assess the appropriateness of the medication practice by
considering the client, the medication and the environment
• know the limits of their own knowledge, skill and judgment, and get
help as needed, and
• do not perform medication practices that they are not competent to
perform.

Safety
Nurses promote safe care and contribute to a culture of safety within
their practice environments, when involved in medication practices.
Nurses:
•seek information from the client about their medication, as needed
•provide education to the client regarding their medication
•collaborate with the client in making decisions about the plan of care in relation to
medication practices
•promote and/or implement the secure and appropriate storage, transportation and
disposal of medication
•promote and/or implement strategies to minimize the risk of misuse and drug
diversion
•take appropriate action to resolve or minimize the risk of harm to a client from a
medication error or adverse reaction
•report medication errors, near misses or adverse reactions in a timely manner, and
•collaborate in the development, implementation and evaluation of system approaches
that support safe medication practices within the health care team.

The "Ten Rights of
Medication
Administration" are
the right, or correct:
Medication
Right
Dose
Right
Time or frequency
Right
Patient
Right
Route
Right
Client education
Right
Documentation
Right
To refuse
Right
Assessment and
Right
Evaluation
Right

Right Medication
Beware of same and similar first and surnames
to prevent the error of administering one
person’s medication to another and vice versa.
Right Medication: before administering any
medicine,
Compare name on medication chart/medication
order with that on the medication at least 3
times-checking medication label when removing it
from storage unit,
Compare medication label with that on treatment
chart and medication label and name on
treatment chart with patient’s name tag.

Right Dose
This becomes very important when
medications at hand are in a larger volume or
strength than the prescribed order given or
when the unit of measurement in the order is
different from that supplied from the
pharmacy.
Careful and correct calculation is important to
prevent over or under dosage of the
medication.

Right Time or Frequency
drug timing is very especially with some drugs like antibiotics, antimalaria drugs etc. to achieve cure and
prevents resistance.
Some drugs must be given on empty stomach e.g. antituberculosis drugs;
some after meals e.g. NSAIDS-these must be noted and adhered to.
The interval of administration of drugs should also be adhered to because it is important for many drugs that
the blood concentration is not allowed to fall below a given level and for others two successive doses closer
than prescribed might increase blood concentration to a dangerous level that can harm the patient.

Right Patient
correct identification of the client
cannot be over emphasized.
This can be done by asking the
client to mention his/her full
name which should be compared
with that on the identification
bracelet or the patient’s folder
and medication/treatment chart
for confirmation.

Right Route
An acceptable medication order
must specify the route of
medication.
If this is unclear, the prescriber
should be contacted to clarify
or specify it.
The nurse should never decide on
a route without consulting the
prescriber.

Right Client
Education
The patient has the right to
know the drug he/she is
taking, desired and adverse
effects and all there is to know
about the medication.
The charter on patient’s right
made this clear.

Right
Documentation
Documentation should be done
after medication and not before

Right to Refuse
The patient has the right to
refuse any medication.
However, the nurse
is obliged to explain
to patients why the
drug is prescribed
and the
consequences
refusing medication.

Right Assessment
Some medications require specific assessment before
their administration e.g. checking of vital signs.
Before a medication like Digoxin is administered the
pulse must be checked.
Some medication orders may contain specific
assessments to be done prior to medication

Right Evaluation
Conduct assessment to ascertain drug action, both desired an side effect.

Patients Rights Related to Medication
Administration
To refuse medication
Right
To be educated
Right
To administration by knowledgeable, licensed person
Right
Not to receive experimental therapy without consent
Right

Administration Routes
•enteral route
•sublingual administration
•buccal administration
Oral Route
•Subcutaneous injection
•Intramuscular injection
•Intradermal injection
•Intravenous injection
•Intra-arterial injection
•Intracardial injection
•Intraperitoneal injection
•Intraspinal injection
•Intraosseous injection
•Intra-articular injection
Parenteral

Administration Routes
• Vaginal administration
• Rectal instillation
• Irrigation
• Skin application
Topical
• Nebulization
• Steam inhalation
• Inhaler
Pulmonary

• It is the powdered
medication
compressed into
hard disk or cylinder.
Tablet:
• Medication covered
in gelatin shell.
Capsule:
• A clear or translucent
semisolid that
liquefies when
applied to the skin.
Gel or jelly:
• A flat, round, or oval
preparation that
dissolves and
releases a drug when
held in the mouth.
Lozenge:
• Drug particles in a
solution for topical
use.
Lotion:
• containing a drug to
be applied externally.
Ointment:
Semisolid
preparation

•Single or mixture of
finely ground drugs.
Powder:
•A drug dissolved in
another substance.
Solution:
•Finely divided,
undissolved particles in
a liquid medium; should
be shaken before use.
Suspension:
•Medication combined in
a water and sugar
solution.
Syrup:
•An easily melted
medication preparation
in a firm base such as
gelatin that is inserted
into the body (rectum,
vagina, urethra).
Suppository:
•Unit dose of medication
applied directly to skin
for diffusion through
skin and absorption into
the bloodstream.
Transdermal
patch:

Age Specific Route, Form and Dosage
Considerations
• Use a syringe, dropper or nipple for oral liquid medications.
• use the vastus lateralis, rectus femoris and ventrogluteal muscle sites for intramuscular
injections and not the deltoid or the gluteus maximus muscles because these muscles have
not yet developed in the infant and dosages are based on the infant's weight in kilograms (kg).
infants:
• Liquid oral medications are given with a spoon or a cup
• the vastus lateralis, rectus femoris and ventrogluteal sites are used for intramuscular
injections,
• the gluteus maximus muscle can be used after the toddler has been walking for at least a year,
• flavors can be used to improve the taste of oral medications, and the dosages continue to be
based on kilograms of weight.
Toddlers:

Age Specific Route, Form and Dosage
Considerations
• These children are usually able to take capsules and tablets,
• the gluteus maximus muscle and the deltoid muscle can now be used
for intramuscular injections,
• in addition to the vastus lateralis, rectus femoris and ventrogluteal
intramuscular injection sites, and dosages continue to be based on
kilograms of weight.
Preschool and school age children:
• Adolescents get adult dosages, routes and forms of medications.
Adolescents:

Age Specific Route, Form
and Dosage Considerations
• Adult dosages may be decreased because the normal physiological changes of the
aging process make this age group more susceptible to side effects, adverse drug
reactions, and toxicity and over dosages.
• Renal function is decreased which can impair the elimination and clearance of
medications,
• the liver function can be decreased, absorption in the gastrointestinal tract may be
decrease, and the distribution of medications can be decreased because the elderly
client may have decreased serum albumin.
• All of these factors increase the elderly client's risk for side effects, adverse drug
reactions, and toxicity and over dosages.
The Elderly:

Mixing Medications From Two Vials When
Necessary
Medications can only be mixed when they are compatible with each
other.
Many diabetic clients who take two forms of insulin can mix these
medications from two vials so that they will only have to use one,
rather than two, subcutaneous injection sites.
• For example, a client who takes NPH insulin in the morning and takes regular insulin
prior to breakfast for the coverage of hyperglycemia can mix the NPH insulin and the
regular insulin in the same syringe.

The procedure for this mixing insulins
Prep the top of the longer acting insulin vial with an alcohol swab.
Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe.
• Do NOT withdraw the longer acting insulin yet.
Prep the top of the shorter acting insulin with an alcohol swab
Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin
syringe.
Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe.
And, then lastly, withdraw the ordered dosage of the longer acting insulin using the same insulin
syringe.

Administering Oral Medication
Gather equipment
Check medication
order
Know the drug
action
Wash your hands
Prepare for the
drug
Recheck each
medication
Identify the patient
carefully
Assist patient to an
upright position
Administer the
medication
Remain with
patient until the
medication is
swallowed
Wash hands
Document each
medication given
Check the patient
within 30 minutes
to verify response
to drug

Buccal and Sublingual Route
of Administration
Buccal medications are placed between the
teeth and the inner aspect of the client's cheek.
Sublingual medications are administered under
the back of the tongue:
• Don gloves.
• Place the buccal medication in the buccal pouch and the
sublingual medication under the client's tongue.
• Instruct the client to not chew or swallow the medication
but, instead, to leave the drug in its position until it is
completely dissolved.

Topical Route Administration
Some topical medications are only suitable on intact skin and others that
contain a medication are used for the treatment of broken skin or a wound.
• Open the tube or container.
• Place the top upside down on a tabletop to prevent contamination to the inner aspect of the
cap.
• Don gloves.
• Apply the topical medication onto the ordered area(s) using the gloved hand, a tongue
depressor, a cotton tipped applicator or sterile gauze.
• Apply the topical medication in long and even strokes following the direction of hair growth
when the ordered bodily area has hair.

Transdermal
Route
Administration
Transdermal medications are absorbed from the
surface of the skin.
The site should be without hair so it may be
necessary to shave the area and these
medications are applied on the client's upper arm
or chest.
Some transdermal medications are commercially
prepared with the ordered dosage and others
require the nurse to measure and apply the
ordered dosage on a transdermal patch.

Transdermal Route Administration
This procedure is described below.
• Remove the old transdermal patch if there is one.
• Wash the site with soap and water. Dry the site.
• Don gloves.
• Measure the ordered dose onto the patch or strip without letting the medication to touch your
own skin because this medication can also be absorbed by the nurse's skin.
• With the medication against the skin gently move the strip over a 3-inch area to spread it out. Do
not rub the medication into the skin.
• Secure the site with a plastic wrap or another semipermeable membrane specifically made for
this use.
• Tape the patch in place if it is not surrounded with an adhesive.
• Write the date, time and your initials on the dressing.

Ophthalmic Route Medication Administration
Ophthalmic eye medications are applied using sterile technique which is one of the few
routes that require more than medical asepsis or clean technique.
Don gloves.
Position the patient in a sitting position or in a supine position.
Have the patient tilt their head back and toward the eye getting the drops or ointment
in order to prevent the medication from entering and collecting in the client's tear duct.
Have the patient look up and away to prevent the tip of the tube or dropper from
touching the client's eye. .

Ophthalmic Route Medication Administration
Rest your hand against the client's forehead to steady it.
To administer drops, pull down the lower lid and instill the ordered number of drops into the
conjunctival space.
To administer an ointment, pull down the lower lid and squeeze the ointment into the
conjunctival space from the inner to the outer canthus of the eye without letting the tip of the
tube or dropper from touch the client's eye.
Instruct the client to close their eyes, roll their eyes and blink. Blinking will spread the drops
and rolling the closed eyes will spread the ointment over the eye.
Clean off any excess drops or ointment gently using a facial tissue from the inner to the outer
canthus of the client's eye(s).

Otic Route Administration
Warm the ear drops to body temperature.
Instruct the person to lie on their side so that the ear to receive the medication is upright.
Straighten out the ear canal by pulling the auricle up and back for the adult and down and back for the infant and
young child less than 3 years of age.
Administered the ordered number of drops against the side of the inner ear and hold the auricle in place until the
medication is no longer visible.
Release the auricle of the ear.
Instruct the client to remain in the side lying position with the treated ear up for at least 10 minutes so that the
medication gets a chance to enter the ear.

Inhalation Route Administration
•Shake the bottle and remove the cap.
•Instruct the client to exhale as fully as possible.
•Have the client then firmly place their lips around the mouthpiece immediately after the strong exhalation.
•Press the bottle against the mouthpiece to release the medication while the person is taking in a long, slow inhalation.
•Instruct the client to hold their breath for a couple of seconds and then slowly exhale.
•Have the client rinse their mouth with water and then spit it out to prevent a fungal infection of the mouth.
The procedure for using a metered dose inhaler is:
•Slide the sleeve away from the mouthpiece.
•Turn the mouthpiece counter-clockwise to open it.
•Place the colored part of the medication into the stem of the mouthpiece.
•Re screw the inhaler.
•Slide the sleeve all the way down to puncture the capsule.
•Instruct the client to fully exhale and then to deeply inhale and hold their breath for several seconds.
•Repeat inhalations until all of the medication has been used.
•The patient can then gargle and rinse their mouth
The procedure for using a turbo inhaler is:

Nasogastric Tube Route Bolus Administration
Using Gravity
Position the patient in a Fowler's position and up at least at a 30-degree angle.
Ensure proper tube placement by aspirating the residual and checking the pH of the
aspirate or by auscultating the epigastric area with the stethoscope to hear air sounds
when about 30 mLs of air are injected into the feeding tube.
• A pH > 6 indicates that the tube is improperly placed in the respiratory tract rather than the gastrointestinal
tract.
Prepare the medication(s) to be administered.

Nasogastric Tube Route Bolus Administration
Using Gravity
the syringe without the piston into the end of the nasogastric tube.
Insert
the medications into the syringe and allow them to flow with gravity.
Pour
the administration with about 30 to 50 ml of water for an adult and 15 to 30 ml for children
to clear the tube and to maintain its patency.
Follow
the person in a Fowler's position for at least 30 minutes after instillation.
• If the person cannot remain in a Fowler's position, place the patient on the right side with the head elevated.
Leave

Vaginal Route
Administration
Assist the client into the lithotomy position.
Drape the patient exposing only the perineum.
Remove the suppository from the wrapper and lubricate it with a
water-soluble jelly.
Don gloves.
Spread the labia and insert the suppository about 3 to 4 inches into the
vagina.
If an applicator was used, wash it or discard it if the applicator is for a
single use.

Rectal Route Suppository Administration
Position the patient on their left side
in the Sim's position.
Drape the patient exposing only the
buttocks.
Remove the suppository from the
wrapper and lubricate it with a
water-soluble jelly.
Don gloves.
Lift the person's upper buttock with
the nondominant hand and insert the
suppository with the tapered end
first into the rectum for about 3
inches beyond the rectal sphincter
while the patient is taking deep
breaths to relax the sphincter.
Instruct the person to lie still so the
suppository can be retained.
•If the person has the urge to defecate, place a
gauze pad over the rectum and gently press the
area until the urge to defecate passes.

Rectal
Ointment
Administration
Drape the patient exposing
only the buttocks.
Don gloves.
Place the ointment on a gauze
pad and apply to the rectum.

The sites for intramuscular medications are
Gluteus maximus,
Deltoid muscle,
Vastus lateralis,
Rectus femoris muscle, and
Ventrogluteal muscle.

How to administer an intramuscular injection
Wash your hands
•needle and syringe with medication
•alcohol pads
•gauze
•puncture-resistant container to discard the used needles and syringe — typically a red, plastic sharps container
•Bandages
Gather all needed supplies
•To isolate the muscle and target where you’ll place the injection, spread the skin at the injection site between two fingers.
•The person receiving the injection should get into a position that’s comfortable, provides easy access to the location, and
keeps the muscles relaxed.
Locate injection site
•Clean the site selected for injection with an alcohol swab and allow the skin to air dry.
Clean injection site

Prepare syringe with Medication
•If the vial or pen is multi-dose, take a note about when the vial was first opened.
•The rubber stopper should be cleaned with an alcohol swab.
Remove the cap.
•Draw back the plunger to fill the syringe with air up to the dose that you’ll be injecting.
•This is done because the vial is a vacuum, and you need to add an equal amount of air to regulate the pressure.
•This also makes it easier to draw the medication into the syringe.
•Don’t worry — if you forget this step, you can still get the medication out of the vial.
Draw air into the syringe.
•Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial.
•Inject all the air into the vial.
•Be careful to not touch the needle to keep it clean.
Insert air into the vial.

• Withdraw the medication.
• Turn the vial and syringe upside
down so the needle points upward
and pull back on the plunger to
withdraw the correct amount of
medication.

• Remove Air Bubbles.
• Tap the syringe to push any bubbles
to the top and gently depress the
plunger to push the air bubbles
out.

Self-injection with a
syringe
• Insert the needle.
• Hold the needle like a dart and
insert it into the muscle at a 90-
degree angle. You should insert the
needle in a quick, but controlled
manner.
• Do not push the plunger in.

Check
for
blood.
Using the hand that’s holding the skin at the injection site, pick up
your index finger and thumb to stabilize the needle.
Use your dominant hand — the one that did the injection — to pull
back on the plunger slightly, looking for blood in the syringe.
If you see blood going into the syringe, it means the tip of the
needle is in a blood vessel.
If this happens, withdraw the needle and begin again with a new
needle, syringe with medication, and injection site. It’s rare to have
this happen.
If you don’t see blood going into the syringe, the needle is in the
correct place and you can inject the medicine.

Inject the medication
• Push the plunger slowly to inject the medication into the muscle.
Remove the needle
• Withdraw the needle quickly and discard it into a puncture-resistant sharps container.
• Don’t recap the needle.
• A sharps container is a red container that you can purchase at any pharmacy.
• It’s used to collect medical waste, like needles and syringes.
• You shouldn’t put any of these materials into the regular garbage, as needles can be hazardous to
anyone who handles the trash.
Apply pressure to the injection site
• Use a piece of gauze to apply light pressure to the injection site.
• You can even massage the area to help the medicine be absorbed into the muscle.
• It’s normal to see slight bleeding. Use a bandage if necessary.

Tips for an
easier injection
To minimize
possible
discomfort
before
injection
Apply
• Apply ice or an over-the-counter topical
numbing cream to the injection site before
cleaning it with the alcohol pad.
Allow
• Allow the alcohol to dry completely before the
injection. Otherwise, it might cause stinging.
Warm
• Warm the vial of medication by rubbing it
between your hands prior to drawing the
medication into the syringe.

What are the complications of intramuscular
injections?
It’s normal to experience some discomfort after an
intramuscular injection. But certain symptoms may
be a sign of a more serious complication as following
severe pain at
the injection
site
tingling or
numbness
redness,
swelling, or
warmth at
the injection
site
drainage at
the injection
site
prolonged
bleeding
signs of an
allergic
reaction, such
as difficulty
breathing or
facial swelling

Z-Track Injections Overview
The Z-track method is a type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue
(underneath the skin).
During the procedure, skin and tissue are pulled and held firmly while a long needle is inserted into the muscle.
After the medication is injected, the skin and tissue are released.
When you insert a needle into the tissues, it leaves a very small hole, or track.
Small amounts of medication can sometimes leak backwards through this track and be absorbed into other tissues.
Pulling the skin and tissue before the injection causes the needle track to take the shape of the letter “Z,” which gives the procedure its name.
This zigzag track line is what prevents medication from leaking from the muscle into surrounding tissue.

Purpose of
Z-Track
Injection
The Z-track method is not often recommended
but can be particularly useful with medication
that must be absorbed by muscle to work.
It also helps to prevent medication from
seeping into the subcutaneous tissue and
ensures a full dosage.
Some medications are dark colored and can
cause staining of the skin.
• If this is a side effect of the medication you will be taking,
the doctor may recommend using this technique to
prevent injection site discoloration or lesions.

Z-Track Injection Sites
Z-track injections can be performed at any intramuscular injection location, though the thigh
and buttocks are the most common sites.
Thigh (vastus lateralis muscle):
• Divide the upper thigh in thirds. Use the middle third, on the outside or middle of the muscle for the injection.
Hip (ventrogluteal):
• Place the heel of your hand on the head of the greater trochanter (hip bone) with your thumb pointing toward the
abdomen.
• Extend your index finger up to the anterior superior iliac spine then spread your other fingers back along the iliac crest.
• Insert the needle in the “V” formed between your index and third fingers.

Preparing for Z-Track Injection
It is important that the correct size needle is used.
healthcare team will advise patient on which needle and syringe to use, taking pt weight, build, and
age into consideration.
Be sure to check if patient have a bleeding disorder.
In an adult, the most commonly used needles are one inch or one and a half inches long, and 22 to
25 gauge thick.
Smaller needles are typically used when injecting a child.

Administering a Z-Track Injection
Wash your hands with soap and warm water.
Gather the necessary supplies:
Clean the injection site.
• Get into a comfortable position so that your muscle is as relaxed as possible.
• This may be lying down on your stomach or bending over a chair or counter or sitting (if
self-injecting into your thigh).
Relax the muscle to be injected.

Prepare the syringe with medication.
Remove the cap.
• If the vial is multi-dose, take a note about when the vial was first opened.
• The rubber stopper should be cleaned with an alcohol swab.
• Draw back the plunger to fill the syringe with air up to the dose that you will be injecting.
• This is done because the vial is a vacuum, and you need to add an equal amount of air to regulate the pressure.
• This makes it easier to draw the medication into the syringe. Don’t worry; if you forget this step, you can still get the medication out of the vial.
• Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial.
• Inject all the air into the vial. Be careful to not touch the needle to keep it clean.
Withdraw the medication.
• Turn the vial and syringe upside down so the needle points upward.
• Then pull back on the plunger to withdraw the correct amount of medication.
Remove any air bubbles.
• Tap the syringe to push any bubbles to the top and gently depress the plunger to push the air bubbles out.

• Insert the needle.
• Use one hand to pull downward on
your skin and fatty tissue. Hold it
firmly about an inch away (2.54 cm)
from the muscle.
• In the other hand, hold the needle
at a 90-degree angle and insert it
quickly and deeply enough to
penetrate your muscle.

Inject the
medication.
• If there is no blood in the syringe, push on
the plunger to inject the medication slowly
into the muscle.
Create Z-
track.
• Keep the needle in place for about 10
seconds before taking it out.
• After you’ve removed the needle, release
your hold on the skin and tissue.
• This disrupts the hole that the needle left in
the tissues and prevents the medication
from leaking out of the muscle.

Apply pressure to the site.
Use gauze to apply gentle
pressure to the site for a
moment.
A small bandage may be
used if you are bleeding.
Note:
Never massage the site of
your Z-track injection. This
may cause the medication
to leak. It may also cause
irritation.

Risks and Side Effects
Z-track injection is generally considered a common and safe procedure.
• swelling,
• site pain, and
• bruising.
Mild side effects include
• formation of abscess
• infection – redness, swelling, warmth or drainage
• damage to tissues, nerves, blood vessels, or bones
• hemorrhage, especially in people with bleeding disorders
Less common, but more serious risks include:

Subcutaneous
Route
Injections
Subcutaneous injections can
be given in the abdomen,
upper arms and the front of
the thighs.
Subcutaneous injections are
used for the administration
of insulin, heparin and other
medications.

What Is a Subcutaneous Injection?
A subcutaneous injection is a method of administering medication.
• Subcutaneous means under the skin.
In this type of injection,
• a short needle is used to inject a drug into the tissue layer between the skin and the muscle.
• Medication given this way is usually absorbed more slowly than if injected into a vein, sometimes over a period of
24 hours.
This type of injection is used when other methods of administration might be less effective.
• For example, some medications can’t be given by mouth because acid and enzymes in the stomach would destroy
them.
Other methods, like intravenous injection, can be difficult and costly.
• For small amounts of delicate drugs, a subcutaneous injection can be a useful, safe, and convenient method of
getting a medication into your body.

Medications given using a subcutaneous
injection
Medications administered by subcutaneous injection include
• drugs that can be given in small volumes (usually less than 1 mL but up to 2 mL is safe).
• Insulin and some hormones are commonly administered as subcutaneous injections.
Other drugs that need to be given very quickly can also be administered via subcutaneous injection.
• Epinephrine comes in an automated injector form, called an EpiPen, that’s used to quickly treat severe allergic reactions.
• While it’s intended to be given intramuscularly, epinephrine will also work if given subcutaneously.
Some pain medications like morphine and hydromorphone (Dilaudid) can be given this way as well.
• Drugs that prevent nausea and vomiting like metoclopramide (Reglan) or dexamethasone (DexPak) can also be given via
subcutaneous injection.
Some vaccines and allergy shots are administered as a subcutaneous injection.
• Many other vaccines are administered as an intramuscular injection — into muscle tissue rather than under the skin.

Preparing for a
subcutaneous
injection
The location of injection is important for
subcutaneous injections.
The drug needs to be injected into the fatty
tissue just below the skin. Some areas of
the body have a more easily accessible
layer of tissue, where a needle injected
under the skin will not hit muscle, bone, or
blood vessels.

The most common
injection sites are:
• Abdomen:
• at or under the level of the belly
button, about two inches away
from the navel
• Arm:
• back or side of the upper arm
• Thigh:
• front of the thigh

Equipment
used for
subcutaneous
injections
includes:
• Vials of liquid medication can be single-use or multiuse.
• Vials can also be filled with a powder to which liquid needs to be
added.
Medication:
• The needles are short, at 5/8 inches long.
• The thickness of the needle is usually 25 or 27 gauge.
• There may be other options for doses more than 1 mL or for
children or people with visual impairments.
Syringes:
• Some medications are available in a “pen” with a short single-use
needle screwed onto the end of a pen-shaped, multiuse vial.
• The amount of medication needed is then dialed in at the end.
• As mentioned earlier, emergency medications like epinephrine
can also come in this form.
Auto-injector pen:

How to
administer a
subcutaneous
injection
Wash your hands
Gather the necessary supplies:
Clean the injection site.
• Before withdrawing medication from a vial and
injecting yourself or someone else, make sure
you’re using the correct medication, at the correct
dose, at the correct time, and in the right manner.
• Use a new needle and syringe with every injection.
Prepare the syringe with medication.

Preparing a syringe:
Remove
Remove the cap from the
vial.
•If the vial is multidose, make a
note about when the vial was
first opened.
•The rubber stopper should be
cleaned with an alcohol swab.
Draw
•Draw back the plunger to fill the
syringe with air up to the dose
that you’ll be injecting.
•This is done because the vial is a
vacuum, and you need to add an
equal amount of air to regulate
the pressure.
•This makes it easier to draw the
medication into the syringe.
Insert
•Remove the cap from the needle
and push the needle through the
rubber stopper at the top of the
vial.
•Inject all the air into the vial. Be
careful to not touch the needle
to keep it clean.

Withdraw the
medication
Turn the vial and
syringe upside down
so the needle points
upward.
Then pull back on
the plunger to
withdraw the
correct amount of
medication.

Remove any air
bubbles
Tap the syringe to
push any bubbles
to the top and
gently depress the
plunger to push
the air bubbles
out.

Preparing an Auto-Injector:
If you’re using a pen delivery system, attach the needle to
the pen.
The first time you use the pen, you’ll need to prime it to
push out extra air in the delivery system.
Dial a small dose (usually 2 units or 0.02 mL, or as
indicated by the package instructions) and push the
button to expel the primer.
Dial the correct dose and prepare for your injection.

Inject the medication
Pinch
your
skin.
• Take a big pinch of skin
between your thumb and
index finger and hold it.
(Your thumb and
forefinger should be
about an inch and a half
apart.)
• This pulls the fatty tissue
away from the muscle
and makes the injection
easier.

Inject the needle.
Inject the needle into
the pinched skin at a
90-degree angle.
You should do this
quickly, but without
great force.
If you have very little fat
on your body, you may
need to inject the
needle at a 45-degree
angle to the skin.

Insert the Medication
Slowly push
the plunger
to inject the
medication.
You should
inject the
entire
amount of
medication.

• Let go of the pinched skin and withdraw the
needle.
• Discard the used needle in a puncture-
resistant sharp’s container.
Withdraw the Needle.
• Use gauze to apply light pressure to the
injection site.
• If there’s any bleeding, it should be very minor.
• You may notice a little bruising later. This is
common and nothing to be concerned about.
Apply pressure to the site.

Complications of subcutaneous injection
If you’ll be doing this type of injection for more than one dose or for multiple days, you’ll need to rotate the
injection sites.
This means that you shouldn’t inject medicine into the same spot twice in a row.
•For example, if you injected medicine into your left thigh this morning, use your right thigh this afternoon.
•Using the same injection site over and over again can cause discomfort and even tissue damage.
As with any injection procedure, infection at the site of injection is a possibility.
Signs of infection at the injection site include:
•Severe pain
•Redness
•Swelling
•Warmth or Drainage

Intra Venouse Route Bolus Administration (IV Push)
•Select the largest vein suitable for the medication.
•Don gloves.
•Apply a tourniquet, locate the vein, prep the skin and insert the needle at a 30 degree angle with the bevel up.
•Lower the angle when you are in the vein.
•Check for blood backflow.
•Remove the tourniquet and slowly inject the medication at the ordered or recommended rate.
•Withdraw the needle, cover the site with a gauze pad and pressure for 3 minutes.
•Place a bandage over the site.
The procedure for IV push without an existing IV line is as follows:
•Make sure that the medication is compatible with the IV solution and any additives.
•Don gloves.
•Close the flow clamp on the IV tubing or pinch the tubing just above the injection port.
•Prep the injection port with alcohol.
•Inject the medication slowly over several minutes.
•Open the flow clamp and readjust the flow rate to the ordered rate.
The procedure for an IV push bolus with an existing IV line is as follows:

Intravenous Piggyback or
Secondary Line Administration
Make
• sure, that the medication is compatible with the IV
solution and any additives.
Hang
• the secondary IV set (piggyback).
Clean
• the injection port on the primary intravenous line with
alcohol.
Insert
• the secondary set needle or needless system into the
injection port of the primary IV tubing.

Intravenous Piggyback or Secondary Line
Administration
Lower the primary IV using an
extension hook to run only the
piggy back medication.
This allows the higher piggy back
to run until it is finished, after
which the primary intravenous
will automatically run at the
established rate.
If you want to run the primary
intravenous solution at the same
time as the piggy back, keep the
primary and the secondary
containers at the same height.
Remove the secondary set when
the medication is completely
administered.

Medication Error
Any medication error must be reported immediately to the physician
ordering the medication.
Vital signs must be taken and reported.
Issue must be reported to Head Nurse.
Error must be documented, and an incident form must be completed and
submitted to the Nursing Director.
Further physician order must be followed.

Administration of Narcotic
and Controlled Drugs
Only Registered Nurse/licensed physician can administer narcotic and controlled drugs.
Physician’s order must be checked carefully.
Always check the drug.
Nursing staff are NOT allowed to administer IV/Controlled drugs.
•They can administer orally and intra-muscular.
Empty ampoules must be returned in the pharmacy together with the narcotic
prescription.
Documentation must be completed (prescription distribution).

Counts can take place between 2 licensed nursing
personnel.
Each individual ampoule/ tablet should be checked
carefully for breakage , unusual appearance or
tampering.
If there is any discrepancy:
• Nursing director must be notified immediately.
• IR will be completed and pharmacy in charge should be notified.
• Disciplinary action will be taken according to the investigation
outcome and as per HMC violation policy.

Drug
Classification
Narcotic
• Pethidine
• Morphine
• Fentanyl
Controlled
• Tramal
• Dormicum
• Valium
• Chloral hydrate

Verbal /
Telephone
Order
If necessary, verbal order’s can be taken
from the known doctor in an emergency.
Verbal
Follow the rule Steps:
•Write down
•Read back
•Confirm
Follow

MEDICATION
CALCULATION PRACTICE
Converting
Metric Units
• 1 gram (g) = 1000
milligram (mg)
• 1 milligram
(mg)=1000
micrograms (mcg)
• 1 liter (L) = 1000
milliliters (ml)

CALCULATION
OF ORAL
MEDICATION
( TABLETS OR
CAPSULES)

CALCULATION OF PARENTAL MEDICATION

Quick Calculation of Drip rates
For sets that deliver 10 gtt/ml, divide the flow rate by 6.
With microdrip set (drip factor of 60 gtt/ml) simply remember that
the drip rate is the same as the flow rate.

GLOSSARY
• is a basic nursing function that involve skillful technique
and consideration of the patient’s development and
safety.
Medication administration
• is a substance administered for the diagnosis, cure,
treatment, or relief of a symptom or for prevention of
disease.
A medication
• is the study of the effect of drugs on living organisms.
Pharmacology
• The written direction for the preparation and
administration of a drug is called a
prescription.

GLOSSARY
• Adverse drug reaction as defined in the Food and Drug
Regulations is a noxious and unintended response to a drug,
which occurs at doses normally used or tested for the
diagnosis, treatment or prevention of a disease or the
modification of an organic function.
Adverse Drug Reaction:
• Adverse reaction as defined in the Natural Health Products
Regulations is a noxious and unintended response to a natural
health product that occurs at any dose used or tested for the
diagnosis, treatment or prevention of a disease or for
modifying an organic function.”
Adverse Reaction:
• An event, situation, or error that took place but was captured
before reaching the patient
Near Miss:

GLOSSARY
• Acts that could cause harm if performed by those
who do not have the knowledge, skill and judgment
to perform them.
Controlled Acts:
• To select, prepare and transfer stock medication for
one or more prescribed medication doses to a client
or the client’s representative for administration at a
later time
Dispensing:
• When controlled substances are intentionally
transferred from legitimate distribution and
dispensing channels.
Drug Diversion:

GLOSSARY
• Practice that is based on successful strategies that
improve client outcomes and are derived from a
combination of various sources of evidence, including
client perspective, research, national guidelines, policies,
consensus statements, expert opinion and quality
improvement data.
Evidence-Informed:
• Any preventable event that may cause or lead to
inappropriate medication use or patient harm while the
medication is in the control of the health care
professional, patient, or consumer.
• Such events may be related to professional practice,
health care products, procedures, and systems, including
prescribing; order communication; product labeling,
packaging, and nomenclature; compounding; dispensing;
distribution; administration; education; monitoring; and
use.
Medication Error:

Medication administration

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