After completing the chapter, you will be able to accomplish the following:

1. Prepare medications for administration in a safe manner.
2. Administer oral medications.
3. Administer medications via a gastric tube.
4. Remove medication from an ampule.
5. Remove medication from a vial.
6. Mix medications from two vials in one syringe.
7. Identify appropriate needle size and angle of insertion for intradermal, subcutaneous, and intramuscular injections.
8. Locate appropriate sites for intradermal injection.
9. Administer an intradermal injection.
10. Locate appropriate sites for a subcutaneous injection.
11. Administer a subcutaneous injection.
12. Locate appropriate sites for an intramuscular injection.
13. Administer an intramuscular injection.
14. Administer a continuous subcutaneous infusion: Applying an insulin pump.
15. Administer medications by intravenous bolus or push through a continuous intravenous infusion.
16. Administer medications by intravenous bolus or push through a medication or drug-infusion lock.
17. Administer a piggyback, intermittent, intravenous infusion of medication.
18. Administer an intermittent intravenous infusion of medication via a mini-infusion pump.
19. Apply a transdermal patch.
20. Administer eye drops.
21. Administer eye irrigation.
22. Administer ear drops.
23. Administer ear irrigation.
24. Administer a nasal spray.
25. Administer a vaginal cream.
26. Administer a rectal suppository.
27. Administer medication via a metered-dose inhaler.
28. Administer medication via a dry-powder inhaler.
29. Administer medication via a small-volume nebulizer.

• Assessment
• Clinical decision making/clinical judgment
• Safety
• Teaching and learning/patient education

• adverse drug reactions
• ampule
• inhalation
• intradermal injections
• intramuscular injections
• intravenous (IV) route
• metered-dose inhaler (MDI)
• nebulizer
• subcutaneous injections
• suppository
• vial

Medication administration is a core nursing function that involves skillful technique and consideration of safety principles that consider the patient's developmental state, individual characteristics, and health status. The nurse administering medications needs to have knowledge of drugs, including drug names, preparations, classifications, adverse effects, and physiologic factors that affect drug action (Fundamentals Review 5-1).

Use of the three checks and the rights of medication administration when administering medications can assist with safe administration of medications. The use of technology, such as bar-code medication administration (BCMA) and medication dispensing systems, does not relieve the nurse of responsibility for ensuring safe medication administration. Check the label on the medication package or container three times during medication preparation and administration (Fundamentals Review 5-2).

The rights of medication administration (Fundamentals Review 5-3) can help to ensure accuracy when administering medications. However, the Institute for Safe Medication Practices (2007) reiterated a position taken in 1999 that the rights of medication administration “are merely broadly stated goals or desired outcomes of safe medication practices” (para. 1). The rights themselves do not ensure medication safety. The nurse assumes individual accountability for safe drug administration by collaborating with the patient and interprofessional team and engaging in behavior that follows standards of best practice and behaviors prescribed by the institution to achieve the goals of the rights (Frandsen & Pennington, 2021; Hanson & Haddad, 2020; Rohde & Domm, 2017). Suggested rights of administration vary slightly between references, spanning from the classic 5 rights (Rights 1 through 5 in Fundamentals Review 5-3) to up to 10 or 11 rights of medication administration identified in the evidence for practice (Frandsen & Pennington, 2021; Hanson & Haddad, 2020; McCuistion et al., 2021; Smeulers et al., 2015). The first five rights (Fundamentals Review 5-3) are included in most references to the rights of medication administration and are the ones verified at each of the three checks (Taylor et al., 2023). Nurses should integrate reliance on embedded, sometime rote, processes with intentional decision making grounded in clinical judgment (Taylor et al., 2023).

In addition, it is important to acknowledge that medication administration is a process with many interconnected players, including clinical nurses, physicians, advanced practice professionals, pharmacists, and patients. All involved in the process share the responsibility for a safe medication system (Hanson & Haddad, 2020). Education and training should focus on interprofessional roles and responsibilities, communication techniques, and other initiatives that foster the teamwork required to promote patient safety in medication administration processes (Bartlett & Kinsey, 2020).

When administering medication, consider factors that may affect drug action, such as age-related considerations. For example, physiologic changes associated with the aging process, including decreased gastric motility, muscle mass, acid production, and blood flow affect drug action (Rochon, 2020). Older adults may also be more susceptible to certain adverse drug reactions. Drug interactions in older adults are a very real and dangerous problem because older adults are more likely to take multiple drugs simultaneously and because of age-related declines in hepatic and renal function (Cahir et al., 2019).

Nursing responsibilities for drug administration are summarized in Fundamentals Review 5-4. This chapter covers skills that the nurse needs to administer medications safely via multiple routes. Proper use of equipment and proper technique are imperative. Fundamentals Review 5-5 and Figure 5-1 review important guidelines related to administering parenteral medications. Nurses should be aware of the higher risk of making an error when their workflow is disrupted from either a distraction or interruption; effective reduction and management of distractions and interruptions is critical to safe medication administration and increased patient safety (Bravo et al., 2016; Hanson & Haddad, 2020; Williams et al., 2014). Medication errors predominately occur during the phases of preparing and administering medications (Hanson & Haddad, 2020).

1. Discuss routines and rituals typically used at home with Cooper's mother. Incorporating these routines and rituals if they are safe and positive can provide a positive way to administer medication. Offer simple choices to Cooper, such as allowing him the choice of having the nurse or his mother administer the medication. A toddler may enjoy using an oral syringe to squirt the medicine into his own mouth. The nurse could also allow Cooper to act out medication administration with a favorite toy, pretending to administer liquid medication to the toy.
2. Explore Erika's feelings related to injections and assess her knowledge of the procedure. Allow patients who are fearful of injections to talk about their fears. Answer the patient's questions truthfully and explain the nature and purpose of the injection. Taking the time to offer support often allays fears and decreases discomfort. Explain to Erika how the injection will be given. Discuss possible injection sites and allow Erika to have a say in the location used for the injection, if possible. It is very important that the nurse selects the appropriate needle length and gauge for the medication and patient criteria, including site location, patient's body size, and age. The nurse must use the correct technique to administer the injection and minimize pain. The nurse should consider use of the Z-track technique to reduce pain and discomfort related to the injection.
3. Diabetes is a chronic illness that requires life-long self-management behaviors. However, it is important that, initially, Jonah learns the “survival skills.” “Survival skills” are basic information that patients must know to survive. Jonah should have a basic understanding of the definition of diabetes, normal blood glucose ranges and target levels; the effect of insulin and exercise; the effect of food and stress; basic treatment approaches; administration of prescribed medications, including subcutaneous insulin and oral antidiabetes medications; and meal planning. Jonah must also have an understanding of how to recognize, treat, and prevent hypoglycemia and hyperglycemia before discharge. The nurse should include information related to the importance of continued diabetes education, once the basic skills are mastered and information understood. Patient knowledge and engagement with treatment are crucial to preventing complications related to diabetes.