04 Preparing and Administering Medications
Learn how to verify, prepare, administer, document, and monitor medications safely across common routes of administration.
Verify and prepare safely
requires accurate checks, patient assessment, the correct route-specific technique, infection prevention, timely documentation, and follow-up. Follow the , product instructions, local policy, and your scope of practice. If an order is unclear, incomplete, inconsistent with the patient’s condition, or appears unsafe, pause and clarify it with the prescriber or pharmacist before giving the medication.
Verify the patient and order
Identify the patient using the required identifiers and compare them with the medication record. Do not rely on a room number or recognition alone. Confirm the medication, dose, route, time, and any special instructions.
Review allergies and the recorded reaction. Check relevant assessment findings, precautions, and required parameters, such as a blood pressure or blood glucose reading when specified. An allergy, contraindication, unexpected finding, or mismatch between the order and the patient’s condition should prompt clarification before administration.
Prepare and explain
Perform hand hygiene and use a clean, well-lit workspace; avoid interruptions where possible. Read the label when selecting the medication, preparing it, and before giving it. Check the expiration date, packaging, appearance, and required storage. Calculate doses carefully and obtain an independent check when required by policy, especially for .
Tell the patient what the medication is for and how it will be given. Confirm that the patient can safely take the planned route; for example, assess swallowing ability before oral medication. Respect a refusal, document it, and notify the appropriate clinician.
These checks are safeguards, not a substitute for clinical judgment.
Use route-specific techniques
Use the prescribed route. Medications with similar names or forms may not be interchangeable, and technique and timing can vary by medication and device. Follow the product’s instructions.
Oral, sublingual, and buccal
For oral medication, confirm that the patient can swallow and is permitted to take oral intake. Give it with the ordered amount of fluid and in the position recommended by the care plan. Do not crush, split, or open a tablet or capsule unless the pharmacist or product instructions confirm it is safe; modified-release and enteric-coated products are common examples that may be damaged by alteration. Do not leave medication unattended unless policy allows it.
Place a sublingual medication under the tongue or a buccal medication between the cheek and gum as directed. Explain whether it must dissolve without chewing or swallowing, and avoid food or drink until the product instructions permit it.
Enteral tube, topical, and transdermal
For an enteral feeding tube, verify the correct tube and medication formulation. Check with a pharmacist before crushing or mixing medicines, and give medications separately when directed. Follow local instructions for pausing feeds and flushing the tube. Do not mix medication into feeding formula unless specifically directed.
For topical or transdermal medication, wear gloves when indicated, apply it to the correct site, and avoid broken or irritated skin unless specifically ordered. For patches, check for and remove an old patch before applying a new one, rotate sites as directed, and record the patch and application time. Do not cut patches unless the manufacturer specifically permits it. Wash hands after handling. Leaving an old patch in place can result in unintended duplicate dosing.
Eye, ear, and nasal
For ophthalmic medication, check the correct eye and medication. Keep the dropper tip from touching the eye, lashes, fingers, or other surfaces. If more than one eye medication is ordered, follow instructions for spacing drops or ointments.
For otic medication, check the correct ear and drops. Keep the dropper tip clean and prevent it from touching the ear. Position the patient with the treated ear facing upward for the time directed.
For nasal medication, use the prescribed device and dose. Keep the nozzle clean, aim as directed, and avoid sharing the device. Prime or clean the spray only as directed by its instructions.
Inhaled, rectal, vaginal, and injected medication
For inhaled medication, check the prescribed device and demonstrate or assist with correct technique. With a metered-dose inhaler, coordinate actuation with a slow inhalation or use a spacer if prescribed. Rinse and spit after an inhaled corticosteroid when directed. Keep devices clean and do not share them. If the patient cannot use an inhaler correctly, pause to coach, use an appropriate spacer if prescribed, or seek assistance.
For rectal or vaginal medication, provide privacy, explain the procedure, and use gloves. Position the patient appropriately, use lubrication if directed, and insert the medication as instructed. Follow product-specific guidance about remaining in position afterward.
For an injection or infusion, confirm the medication, concentration, dose, route, site, and required equipment. Use and the correct needle or device. Choose the route-specific site and technique according to training and policy. For IV medication, check the line and required rate, dilution, and compatibility; stop and seek guidance if any are uncertain. Dispose of sharps immediately in an approved container.
Prevent infection
Perform hand hygiene before preparing medication and after administration. Keep clean supplies separate from used equipment. Prepare injections in a designated clean area away from sinks and contaminated items, and use .
Disinfect vial access diaphragms before entry and allow the disinfectant to dry. Use a new sterile needle and syringe for every entry into a medication container and every injection; never reuse them, even for the same patient. Never use one syringe for more than one patient, even if the needle is changed.
Use single-dose vials, ampules, and IV bags or bottles for one patient only; do not save or pool leftovers. Dedicate multidose vials to one patient whenever possible, and follow product instructions and facility policy for storage and discard dates. Discard any item if its sterility is uncertain.
Document and monitor the response
After a medication is given, evaluate its expected effect and watch for adverse reactions. A new rash, swelling, breathing difficulty, sudden change in consciousness, or another serious or rapidly worsening symptom requires immediate action under emergency and facility protocols.
For an unexpected reaction, protect the patient, notify the appropriate clinician, document the findings and actions, and follow reporting procedures. Do not repeat a dose or compensate for a missed dose without an appropriate order or instruction.
Record the medication, dose, route, and time after it is given—not before. Document omitted or refused doses and the reason. Monitor and document the intended effect and any unexpected response.