• Avoid distractions and interruptions when preparing and administering medications to prevent medication administration errors.^5,6
• Verify the practitioner’s order.^7,8,9,10
• Review the order to make sure that the prescribed medication dose, rate, and route of administration are appropriate for the patient’s age, condition and access device. Address concerns about the order with the practitioner, the pharmacist, or your supervisor, and, if needed, the risk management department or as directed by your facility.^7,11
• Gather and prepare the necessary equipment and supplies.
• Compare the medication label with the order in the patient’s medical record.^8,9,10,11,12
• Check the expiration date on the medication.¹¹ If the medication is expired, return it to the pharmacy and obtain a new medication.^8,9,10,12
• Check the patient’s medical record for an allergy or other contraindication to the prescribed medication. If an allergy or other contraindication exists, don’t administer the medication; notify the practitioner.^8,9,11,13
• Visually inspect the medication for discoloration or other indication of loss of integrity. Don’t administer the medication if its integrity is compromised.^8,9,10,11,12

NURSING ALERT Never use a medication that’s cloudy or discolored or that contains a precipitate unless the manufacturer’s instructions allow it. Remember the presence of drug particles is normal for some drugs (such as suspensions). If in doubt, check with the pharmacist.

• Discuss any unresolved concerns about the medication with the patient’s practitioner.^8,9,10,11
• Coordinate with the ordering practitioner and the radiography department to ensure that a chest X-ray is obtained before medication administration, if necessary, for use as a baseline to monitor the effect of medication.
• Perform hand hygiene.^{14,15,16,17,18,19}
• Confirm the patient’s identity using at least two patient identifiers.²⁰
• Provide privacy.^21,22,23,24
• Explain the procedure to the patient and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.²⁵
• If the patient is receiving the medication for the first time, teach the patient and family (as appropriate) about potential adverse effects and any other concerns related to the medication.^8,9,10,12,26
• Verify that the medication is being administered at the proper time, in the prescribed dose, and by the correct route to reduce the risk of medication errors.^8,9,12,13
• If your facility uses bar-code technology, use it as directed by your facility.¹¹

NURSING ALERT If required by your facility, before administering a medication by the intrapleural route, have another nurse or the practitioner perform an independent double-check to verify the patient’s identity and to make sure that you have the correct medication in the prescribed strength or concentration; the medication’s indication corresponds with the patient’s diagnosis; the dosage calculations are correct and the dosing formula used to derive the final dose is correct; the prescribed route of administration is safe and proper for the patient; the prescribed time and frequency of administration are safe and proper for the patient; and, if an infusion, the pump settings are correct and the infusion line is attached to the correct port.^27,28

• After comparing results of the independent double-check with the other nurse, administer the medication if there are no discrepancies. If discrepancies exist, rectify them before administering the medication.²⁷
• Have the patient lie supine in the bed with the head of the bed at a comfortable level.
• Raise the bed to waist level before providing care to prevent caregiver back strain.²⁹
• Perform hand hygiene.^{14,15,16,17,18,19}
• Put on clean gloves to comply with standard precautions.^30,31,32
• Obtain the patient’s vital signs, including auscultation of the lungs bilaterally, to serve as baselines for comparison.³³
• Screen for and assess the patient’s pain using a facility-approved pain assessment tool that’s consistent with the patient’s age, condition, and ability to understand.³⁴
• Treat the patient’s pain, as needed and ordered, using nonpharmacologic, pharmacologic, or a combination of approaches. Base the treatment plan on evidence-based practices and the patient’s clinical condition, past medical history, and pain management goals.³⁴
• Assess the integrity of the drainage system tubing and chest tube to ensure that the drainage system is intact, with no air leaks or kinks, and to help prevent clot formation.³⁵
• Note the character, consistency, and amount of drainage in the chest tube drainage collection unit chamber. Mark the drainage level by writing the time and date at the drainage level on the drainage collection chamber to accurately monitor output after medication administration.^36,37
• Remove and discard your gloves.^30,32
• Perform hand hygiene.^{14,15,16,17,18,19}
• Put on gloves to comply with standard precautions.^30,31,32
• Turn off the suction, if applicable.
• Position the patient with the affected side up to gain access to the injection port.
• Assist the practitioner with removing the dressing from the intrapleural catheter or chest tube, if indicated, and clamp the drainage tube if one is present.³⁶
• Discard the dressing in the appropriate receptacle.³⁰
• Remove and discard your gloves.³⁰
• Perform hand hygiene.^{14,15,16,17,18,19}
• Put on gloves to comply with standard precautions.^30,31,32
• Trace the tubing from the patient to its point of origin to make sure that the medication is being administered into the correct port.^38,39
• If a stopcock is in place, and if appropriate to the medication being administered, turn the lever to point to the chest tube drain to stop the flow from going into the drainage collection device.⁴⁰
• Disinfect the access port of the catheter or chest tube with an antiseptic-soaked gauze pad and then allow it to dry.
• Connect the prepared prescribed medication to the port and administer the medication as ordered following safe medication administration practices.^36,41
• Disinfect the access port of the catheter or chest tube with an antiseptic-soaked gauze pad and then allow it to dry.
• Flush the intrapleural chest tube or intrapleural catheter with sterile normal saline, as ordered, following safe medication administration practices.⁴¹
• If ordered, keep the chest tube or catheter clamped for the prescribed dwell time.^36,41,42
• Obtain the patient’s vital signs at a frequency determined by your facility, including auscultation of lungs bilaterally, and monitor the patient for signs of discomfort.^36,42
• Reassess the patient’s pain and assess for any adverse reactions or events from treatment. Notify the practitioner immediately if any such event occurs.³⁴
• Unclamp the chest tube after the ordered dwell time and turn the suction back on, if ordered and applicable.⁴¹
• Return the stopcock lever to the open position, if applicable, to allow drainage to collect in the drainage collection system.^36,42
• Observe the type, color, and amount of drainage in the drainage collection chamber. Immediately notify the practitioner of a sudden increase in drainage or frank bloody drainage.³⁷
• Return the bed to the lowest position to prevent falls and maintain patient safety.⁴³
• Discard used supplies in appropriate receptacles.³⁰
• Remove and discard your gloves.^31,41
• Perform hand hygiene.^{14,15,16,17,18,19}
• Clean and disinfect your stethoscope using a disinfectant pad.^44,45
• Perform hand hygiene.^{14,15,16,17,18,19}
• Document the procedure.^46,47,48,49