DRUG ADMINISTRATION

 

DRUG ADMINISTRATION

DRUG ADMINISTRATION: A Drug is any substance that alters physiologic function, with potential for affecting (positively or negatively). Medication is a drug administered for its therapeutic effects. Therefore, medications are drugs, but not all drugs are medications.

Medication can also be a substance other than food used to; 

 1.  Prevent diseases

 2.  Aid in diagnosis

 3. Treat or cure disease and

 4. Restore or maintain normal functioning of the body.

Any chemical compound that may be used on or administered to humans or animals as an aid in the diagnosis, treatment or preventing of disease or other abnormal condition for the relief of pain or suffering or to control or improve any physiological or pathological condition is classified as a drug.

To administer medications effectively and safely, nurses must possess a broad range of general and specific knowledge.

TERMINOLOGIES IN DRUG ADMINISTRATION 

1. Pharmacology

The study of drugs including their origin, chemical structure, preparation, administration, action, metabolism, and excretion.

2. Therapeutics

The application or action of drugs and other measures in the treatment of diseases.

3. Prophylaxis

The application of the action of drugs and other measures in the prevention of diseases (thus a treatment that prevent diseases or stop it from spreading e.g. Vaccination and SP for pregnant women

TYPES OF DRUGS

1. Tablets

A powdered drug compressed into a hard small disk. Some are readily broken along a score line for easy breaking. Eg. Paracetamol tablet.

2. Capsules

A gelatinous container containing a drug in powder, liquid or oily form. They are useful as a means of administering bitter drugs.

3. Syrups

They are medicine dissolved in sugar and water: thus, they are aqueous solution of sugar often used to disguise unpleasant tasting of drugs and to soothe irritation in the membrane. These drugs are often suitable in small dose for children.

4. Pills

This is one or more drugs mixed with cohesive material in oval, rounded or flattened shape. It is usually sugar coated

5. Emulsion

Drugs which is made of the mixture of oil and water. Example is liquid paraffin

6. Suspension and Mixture

They are solution or suspension of drugs in water together with flavouring agent which must be shaken before administration because it separates. They were once the most popular form of drugs presentation but have largely been replaced by tablets and capsules. E.g- milk of magnesia (MMT).

7. Lozenges (troche)

It is round, flat or oval in shape and these preparations mostly dissolves in the mouth for relief for local effects.

8. Elixirs

They are sweetened aromatic solution of alcohol which is most often in a syrup form. That is liquid preparation of medication with alcohol base.

9. Tincture

Potent solution of an alcoholic base derived from plants e.g. tincture of belladonna (Atropine from belladonna)

10. Linctus

This is a sweet syrup preparation of a drug used in the treatment of cough. E.g. linctus codeine.

11. Enema

Thịs is a solution form of drugs administered per rectum.

12. Suppository

This is a solid form of drugs administered per rectum.

13. injectable

They are drugs introduced into the body by routes other than the mouth, rectum or topical. Syringes and needles are mostly used to introduce these drugs. For instance, Intravenous (IV), Subcutaneous (SC), Intramuscular (IM).

CLASSIFICATION OF DRUGS

 

1. Analgesics

They are drugs that relieve pains e.g. Paracetamol, Diclofenac, Aspirin

2. Anti-inflammatory

Suppresses local inflammations, e.g. Diclofenac, Aspirin.

3. Antibiotics

They destroy or inhibit the growth of microorganisms. Example Augmentin, Flagyl, Penicillins, Tetracycline etc

4. Antihistamines

Used to treat allergic reactions, e.g. hydrocortisone, piriton

5. Anthelminthics

Drugs that are used in the treatment of worm infestation

6. Antacids

This neutralises and dilutes excessive acidity in the stomach. E.g. MMT

7. Anaesthetics

This eliminates sensations in the body. E.g. Ketamine, Propofol, Lidocaine

8. Diuretics

This increases urine production from the kidneys e.g. Lasix

9. Emollients

This soothes the skin and mucous membrane. E.g. Calamine lotion

10. Narcotics

Reduces pain sensation and promotes sleep. E.g. cocaine, heroin, pethidine, morphine. NB. Over dosage causes addiction and other psychiatric disorders.

11. Sedatives / Minor Tranquillizer

This relieves tension and induces sleep. E.g, Diazepam

12. Stimulants

Stimulates the CNS and causes increased energy of an organ. E.g. Coffee

13. Anti-emetics

Prevents nausea and vomiting. E.g. Promethazine (Phernegan)

14. Antihypertensives

This decreases blood pressure

15. Anti arrhythmias

Regulates heart rhythm

16. Anticoagulants

Decreases clot formation

17. Antipsychotics

Decreases psychotic symptoms (e.g. hallucination)

18. Antidepressants

Decreases depression

19.Cathartics (Laxatives / Purgatives)

They are drugs taken to soften the content of the GIT or promote free bowel movement.

PRESCRIPTION OF DRUG

A prescription is a legal order for the preparation and administration of a medication. Certain medications require medical supervision, often because of narrow margin of safety between a therapeutic and a toxic dose. Physicians, nurse practitioners, physician’s assistants, and dentists are the only health care professionals legally responsible for prescribing medications.

ROUTES FOR DRUG ADMINISTRATION

A route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is brought into contact with the body.

The method used to administer drug depend on

1.Type of drug

2.Nature of drug

3.Condition of patient

There are two (2) desired effects when a drug is applied or used;

1. Local

2. Systemic.

Local effects

The drug is applied on the site of infection, irritation, or pain. It is also known as topical effects. It is most applied on the skin or mucous membrane to have its desired or local effects.

Systemic effect

The drug is absorbed into the circulation into the body cells and it gives a general effects.

The routes of drug administration are;

1. Enteral /digestive tract route

     Rectal

     Oral

2. Parenteral route

3. Topical /local route

1. ENTERAL ROUTES

Drugs are given into the digestive tract either through the mouth (oral) or per rectum.

Oral entry

The patient swallows the drug weather liquid, pills, capsules, tablets etc through to mouth. It can also be put under the tongue as in Nifedipine (sublingual). Such drugs are not supposed to be swallowed.

Contra-indications for oral drug administration

a. In cases of nausea and vomiting

b. Unconscious patient

C. In case of oral surgery or patients labelled ‘nil per os’ for surgery

d. In cases where there is likelihood that medication would be destroyed by the action of digestive enzymes. E.g. insulin and adrenalin

Advantages of  oral drug administration

1. Painless

2. Safe with no injuries

3. It helps the nurse to assess the mental and emotional state of the patient.

4. Drug administered by oral route are not irritating.

5. It is easy to swalow.

6. It is a useful method when there is no qualified personnel to give the drug

7. No risk of infection, complications or collateral structural damage.

Disadvantages of oral drug administration

1. Some of the drugs stain the teeth e.g. FAC, Iron, Tetracycine.

2. Nauseated and vomiting patients cannot use this route.

3. The digestive enzyme may destroy the effectiveness of certain drugs.

4. Some patients may be uncooperative and may refuse to take the medication.

5. Unconscious patient may aspirate the medication into the lungs

6. If there is obstruction in the GIT especially the esophagus, the drugs cannot swallowed.

7. It cannot be used in emergency situations.

8. It is easy to take an overdose of the drug.

2. RECTAL ROUTE

It consists of instillation of liquid medication into the rectum as enema or insertion of solids medication as suppositories into the rectum.

Advantages of rectal route drug administration

1. lt can be used when the drug is offensive or bitter to be swallowed

2. It can be given to unconscious patients or small children who cannot swallow the drug.

3. The rectal route is given when digestive enzymes will interfere with oral drugs.

Disadvantages of rectal route drug administration

1. The patient may not be able to retain all or the whole amount of drugs, and if it is not put well and gets expelled, it cannot be effective.

2. Absorption in the rectum is very slow.

3. Drug administered this way is usually small amount

4. Rectal route of administration is embarrassing.

3.PARENTERAL ROUTE

This includes drug administration other than through the digestive tracts. The term parenteral is most commonly used to denote drugs given by injection. These medications must be soluble, absorbable, and sterile; and must not be irritating or able to cause injury to the tissues.

Administration by Injection/Parenteral Route

 intradermal (ID) Injection (15 degrees celsius)

This involves injecting a smal amount of drug just beneath the outer layer of the skin making a bump where it is absorbed slowly into general circulation. This method is used when testing for allergies.

Subcutaneous (SC) Injection (45 degrees Celsius ) / Hypo-dermal Injection

A small amount of drug is injected into the subcutaneous tissue at an angle of 45. This method is used for drugs that are soluble and non-irritating e.g. ATS (Anti Tetanus Serum), Insulin, Atropine, Adrenaline etc. This is done for drugs whose effect is expected to spread for along period of time

Intramuscular (IM) Injection (90°)

A drug is injected into the muscle beneath the subcutaneous tissue at an angle of 90 degrees Celsius. This method is used when giving irritating or large amount of drug or dose of drug at a point in time. Absorption is faster because muscle tissue has greater number of blood vessels.

Intravenous Injection (IV) and Infusion

A drug may be injected directly into the vein to obtain the rapid response needed or when it is impossible to inject the drug into other tissues. A large quantity of solutton is given by infusion, thus the solution flows into the patient’s vein with the aid of gravity. Drugs can be added to the infusion. Nutrients can also be given the same way. If blood is given, it is referred to as transfusion. Drugs and other things cannot be added to the transfusion.

Intrathecal or Intraspinal Injection

A doctor may choose to administer a drug by direct injection into the subarachnoid space in order to maximize the effect of the drug on the CNS.

Intracardiac Injection

In extreme emergency such as cardiac arrest, the doctor may inject a drug directly into the left ventricle of the heart. The heart then pumps the drug in the blood into general circulation when the heart contracts again.

Advantages of parenteral route of drug administration

1. Rapid in action but can be dangerous when errors are made.

Fast: 15-30 seconds for IV, 3-5 minutes for IM and subcutaneous

2. Drugs that may be altered by GIT enzymes can be given through this route.

3. Large amount of the drugs can be given by this route.

4. It is advantageous when an exact amount of drug is needed

5. It can also be beneficial in unconscious patients

Disadvantages of parenteral route of drug administration

1. Abscess formation through repeated insertion of needle and infection if

a. The correct site is not chosen

b. The correct needle is not used

c. Oily drugs are given in large quantities

d. Microorganisms are introduced into the body by syringe and needle.

e. The drug is expired.

2. Necrosis: Excessive damage to an area resulting in dead of tissue

3. Injury to the sciatic nerve will lead to paralysis

4. Prolonged pain may be due to damage to small nerve endings.

5. It cannot be given when there are no qualified personnel. Thus, patients are not typically able to self-administer onto themselves.

6. Onset of action is quick, hence more risk of addiction when it comes to injecting drugs of abuse.

7. Belonephobia, the fear of needles and injection.

8. If needles are shared, there is risk of HIV and other infectious diseases

9. It is the most dangerous route of administration: It bypasses most of the body’s natural defenses, exposing the user to health problems such as: Hepatitis, abscesses, infections, and addictions/ contaminants

ITEMS USED IN GIVING INJECTION.

Syringe and Needle

There are several kinds. The commonly used ones are the standard

Hypodermic syringes,

Insulin syringes and

Tuberculous syringes.

Most syringes used today are plastics and disposable. They are not packed and sterile as used to be in the olden days.

Parts of a syringe

All syringes have 3 parts:

       The tip or the nozzle of the syringe which connect the needle.

       Barrel or the outside of the syringe which have the scale.

       The plunger or piston for pushing the drug along.

Parts of needle

Bevel, Shaft, and Hub

Procedure of Giving an Intramuscular Injection.

Requirements

A Sterile tray or trolley depending on the number of people you are going to administer the injection to. The trolley or tray should contain the following:

1. A Sterile syringes and needles well packaged with their appropriate sizes

2. Sterile prescribed medications (which may be in vials or ampoules)

3. A galipot (sterile) containing sterile cotton wool with Methylated spirit (or a diluted antiseptic lotion)

4. A dry cotton wool swab to open the ampoule

5. Receiver for used swabs

6. Gloves (sterile)

7. Patient’s treatment sheet and a nurse’s notes

8 A file (in cases of opening a vial)

9. A sterile forceps in helping to open an ampoule (if needed)

Procedure / Steps

1. ldentify and check for the right patient, right drug, right route, right time and right dosage (which is the recommended 5Rs)

2. Explain procedure to patient and provide privacy by screening or curtaining

3. Prepare and take trolley to patient’s bedside.

4. Check details again and with patient’s treatment sheet

5. Wash and dry hands

6. Assemble syringe and needle using sterile techniques

7. File and break ampoules or remove metal cap of vial a clean swab, draw drug and discard the used needle.

8. Replace a new needle and expel the air

9. Clean site with a swab dipped

10. Insert the needle quickly firmly deep into the muscles at 90° or at a right angle.

11. Drawback to check whether the needle is not in a vein. (If blood comes out, then it means it is in a vein)

12. Push to release drug into the tissue if the needle is at the right place.

13. Withdraw the syringe and needle quickly and with a Swab, gently apply pressure to the point of injection.

14. Discard syringe and needle into a container

15. Make patient comfortable and thank patient for corporation

16. Remove screen and wash hands thoroughly

17. Document in the drug administration (treatment chart) and in the nurse’s notes.

Also in cases of abnomalities or anaphylacic shock, administer prescrbed allergic reaction drug after reporting to the nurse in-charge or the doctor in charge

Other Routes for injection

A. Inunctions:

Drugs are applied locally and externally on an area of the body e.g. application of ointment on the skin. The drug is applied on the affected part and its action is felt quickly on the part

Advantages of inunctions

It does not come directly in contact with general circulation.

Disadvantages inunctions

1. The drugs may be over used

2. It may be irritating

3. Its potency diminishes easily due to its exposure to the atmospheric conditions

B. Instillation: 

These drugs are in the form of drops and are instilled into nose, ear, eye, urinary bladder.

C. Insufflations: 

This is putting powdered drugs into a cavity or a wound.

D. Insertion: 

It’s when the drug is in suppository form. It is inserted into the vagina or rectum.

D. Radiation and ionization:

Radiation is applied to destroy cancerous cells, while ionization is where electric current is applied to relieve pains psychologically from tissues.

E. Inhalation:

The drug which is in the form of vapour or spray is inhaled into the respiratory tract. This soothes the mucous membrane lining the upper respiratory tract and also reduces inflammation. Example, Asthma drugs

STORAGE OF DRUGS

In our traditional set up; drugs are usually kept in common places e.g. cabinet or cupboard from which they are disposed or administered. In modern times, many hospitals store their medicines in locked movable trolleys. Medications of individuals are stored in the individual’s drawers in the trolley. This helps in preventing patients from receiving wrong medications. Wherever drugs are stored, they should be arranged in an orderly fashion. Some drugs may need refrigeration or brown bottles to preserve their chemical properties. Every drug should be clearly labeled. Drugs stored in cupboard are grouped: mixtures are kept in one place while capsules, pills, tablets etc are also kept in one place.

Meaning of Cupboard I

The cupboard is labeled for external use only. The drugs kept in cupboard I are lotions and preparations that are for external use. These are grouped under the poisonous drugs and include all disinfectants. All preparations that contain poison are kept in brown or green bottles with ridges on the surfaces. They are labeled in red block letter “poison” or “for external use only

Meaning of Cupboard II

For internal use only, this cupboard is used to store drugs such as capsules, tablets, pills, mixtures, syrups, injectables etc.

Meaning of Cupboard III

They are referred to as Dangerous Drug Act (D.D.A) drugs. This is a special cupboard for storing dangerous habit forming drugs. It can be a cupboard on its own or cupboard within cupboard. This cupboard is always under locked and the key kept with the nurse-manager or in-charge or the deputy.

DRUG ACTS

This is a law passed in parliament to control the use of certain drugs. Drugs that are used in Medicine for human use are grouped in schedule I to IV.

A. Poisonous Drug Act

In Ghana, this Act of Parliament was passed in 1935 to control the dispensing and the use of some drugs which when taken in excess can cause harm to the body. The law requires that:

1. These drugs can only be obtained by the public with a written medical prescription e.g. Antibiotics, Barbiturates e.g. phenobarbitone, sulphur drugs, Digitalis e.g. Digoxin.

2. They should be clearly and distinctively labeled.

3. They should be kept in locked cupboard subject to certain restrictions

B. Narcotic Dangerous Drug Act

This act of parliament came into force in 1919 to control the dispensing and used of addictive drugs, thus habit forming drugs e.g.

Opium and its derivatives

Morphine and its derivatives

Cocaine and its derivatives

Pethidine, sedatives and hypnotics

Very potent analgesics or pain relieving drugs are often considered as narcotics which are powerful pain relieving drugs and at the same time inducing sleep and include pethidine, methadone, morphine etc. Many countries have established code of administration for the control of the dangerous drugs.

 

These are for the protection of patients (clients) and staffs.

1. In the hospital, the use of these drugs is under strict control.

2. They are kept under lock and key in a special DDA cupboard

3. None of these drugs can be given without a written prescription by the doctor.

4. Each dose of drugs administered may be entered into a special register provided for the purpose. In the book, the following must be written

a. Date

b. Name of Drug and dosage

c. The name of the nurse

d. Time

e. Patient’s name

5. All bottles, ampoules, and tubes containing dangerous drugs should be clearly labeled.

6. Collection of supplies can also be obtained by the hand of the ward in charge. The supplies are then signed and checked by the nurse in-charge

7. The hospital pharmacists keep these records for at least 2yrs before filling it.

8. Between the times of the pharmacist check, the nurse in-charge also checks the content of the DDA cupboard. In many hospitals, these drugs are checked each time there is a change in staff shift. In this way, the nurse-in-charge of each shift takes over responsibilities of the content on the cupboard.

9. A registered nurse should check the drug before it is administered

LEGAL IMPLICATION IN DRUG ADMINISTRATION

Under the law, nurses are responsible for their own actions regardless of whether there is a written order or not. If a physician writes an incorrect order e.g. 200mg of Laxis instead of 20mg, the nurse who administer the incorrect dosage is responsible for the error. Therefore, nurses should question an order which appear unreasonable and ask for clarification or refuse to give the medication until the order is changed. It is an important responsibility to each nurse to be knowledgeable about all drugs given. There is no excuse for giving a drug without first knowing the appropriate dosage and the possible side effect.

The nurse should therefore keep herself abreast by reading the standard reference books on drugs.

PREPARATION TO ADMINISTER DRUGS

Rules to Consider during Administration of Drugs.

Since all drugs are potentially dangerous or poisonous, the nurse should take great care when administering it.

A nurse must read the prescription or the order form carefully and should ask for clarification from the doctor or nurse in-charge.

The nurse must concentrate on the task to avoid error while preparing and giving medication

The 10 rights will guide the nurse in preparing for drug administration;  Right Time, Right Drug, Right Route, Right Dose, Right Patient, Right Documentation, Right Assessment, Right Evaluation, Right of patient to refuse drug, Right Education.

 To prevent errors the nurse must read the label on the container 3 times •Before taking it from the shelf. •Before pouring it or taking it out, •Before giving it to the patient.

When preparing medication, do not use the following:

Medication from unmarked bottle or container with unreadable labels.

Liquid medication that are cloudy, and solid drug which colour has changed.

Medication that have sediment at the bottom unless that drugs require shaking

Suspension should be shake. Whether there is obvious sediment or not.

 Always pour the drug where there is a good light using a graduated glass.

Never return medication into its container or transfer medication from one container to another or use a drug that has been left out of a labeled container.

Provide the necessary nursing measures before administering a drug. For example, check the pulse before serving digitals like digoxin. If the pulse is below 60bpm, notify the nurse in-charge or doctor for further information. Always check patient’s b.p before given bp drugs

Never leave the medication at the bedside because you may not know if the patient takes it or not.

If a patient vomits after taking a drug. report to the nurse-in-charge and state the names of the drugs given. Sometimes the doctor may order the same drug but by different route of administration.

Remember to record appropriately any medication given.

Remember to observe any special procedure in administering dangerous drugs.

Check drug allergies and report any unusual reactions of the patients after serving the medication.

GIVING OTIC DRUGS OR EAR INSTILLATION

Otic drugs may be instilled to Treat infections and inflammation, soften cerumen (wax) for later removal, Produce local anaesthesia, Facilitate removal of foreign body and relieve pain.

It is more comfortable for the patient if the solution is warmed to approximately the body temperature. Drugs or irrigations are instilled into the auditory canal.

Methods giving otic drugs or ear instillation

1. Gather all the necessary equipment, including the prescribed eardrop, drug chart of patient, a penlight, swabs, emesis basin for warm water on a tray and send it to the patient’s bedside.

2. Explain procedure to patient and provide privacy.

3. Verify the order of the patient’s medication record and check the medication label against the patient’s medication record.

4. To avoid adverse effects (such as vertigo, nausea, and pain) from instiling ear drops that are too cold, warm the medication to body temperature in the basin of warm water.

5. Wash hands, confirm the patient’s identify and let the patient lie on the side so that the affected ear faces upwards.

6. Straighten the patient’s ear canal. For adults, pull the auricle of the ear up and back (near right). For intants or children under 3years, gently pull the auricle down and back (far right) because the ear canal is positioned differently in infants and toddlers.

7. Using the pen light examine the ear canal for drainage. If you find any, clean the canal with a tissue or cotton tipped applicator because drainage can reduce the medication’s effectiveness.

8. Straighten the patient’s ear canal again and instil the ordered number of drops with the dropper. To avoid patient’s discomfort, aim the dropper so that the drops fall against the sides of the ear canal.

9. Hold the ear canal in position until you see the medication disappear down the canal.

10. Instruct the patient to remain on the side for 5-10 minutes to allow the medication to travel down the ear canal.

11. If ordered, tuck a cotton ball loosely into the opening of the canal to contain the medication. NB: Avoid inserting it too deeply; to prevent secretions from draining and decrease pressure on the eardrum.

12. Clean and dry the outer ear and assist the patient into a comfortable position and wash your hands.

13. Report and record any abnormalities and procedure.

Precautions and contra-indications of giving otic drug

1. Don’t instill otic drugs into a patient with a perforated eardrum (although it may be permitted with certain medications and with sterile technique

2. Certain ear medications may be prohibited in other conditions because they may enhance the growth of pathogens. For instance, medications containing hydrocortisone in patients with Herpes Viral or fungal infections.

3. Some conditions make the normally sensitive ear canal quite tender, so be gentle when instilling ear drugs.

4. Also take special care not to injure the eardrum.

5. Never insert an object, such as a cotton-tipped applicator into the ear canal past the point where the tip can be seen.

6. If the patient has vertigo, keep the side rails of the bed up and assist him as necessary. Also, move slowly to avoid aggravating his vertigo.

GIVING OPTHALMIC DRUGS/EYE INSTILLATIONS

Ophthalmic drugs – in drops, ointment, lens form etc are diagnostic or therapeutic. Eye drops should be given to...

1. Anaesthetise the eye to facilitate examination

2. Dilate the pupil

3. Stain the cornea (to detect abrasions or scars) during an eye examination.

4. To lubricate the eye or/and its socket.

5. To protect the vision of the neonates and treat certain eye disorders e.g. Pilocarpine for glaucoma.

Method of giving opthalmic drugs or eye instillations

Gather the prescribed medication, drug chart, sterile cotton wool swabs, gloves, warm water, 0.9% NaCl solution, sterile gauze pads, an eye dressing may be required if necessary.

Check drug label and verify with patient’s medication order and make sure that medication is for ophthalmic use. Check also the expiry date of the medication. If the solution appears abnormal in any way, don’t use it.

If administering an ointment and the tip of the tube has crusted, wipe it with a sterile gauze pad to remove the crust.

Make sure that you know which eye to treat because different medications or dosages may be ordered for each eye.

Confirm the patient’s identity.

Explain the procedure to the patient and provide privacy.

Wash hands and put on gloves. If the patient has an eye dressing, remove it by gently pulling it down and away from the forehead.

Remove any discharge by cleaning around the eye with sterile cotton wool swabs or sterile gauze pads. Moist with warm water or 0.9% NaCl solution

Clean from the inner canthus to the outer canthus Using a fresh sterile cotton wool swab or sterile gauze pad for each stroke.

To remove crusted secretions around the eye, moisten a gauze pad with warm water or 0.9% NaCl solution. Have the patient close the eyes, then place the moist pad over it for 1-2 minutes.

Remove the pad and reapply new moist sterile gauze pads, as needed, until the secretion solution is enough to be removed without injuring the mucosa.

Have the patient tilt their head back and down on the side of the affected eye. This allows excess medication to flow away from the tear duct (to minimise systemic absorption).

Unless the medication and dropper are a closed unit, remove the dropper cap from the medication bottle and draw the medication into the dropper, taking care not to contaminate it.

Before instilling the eye drops, ask the patient to look up and away. This moves the cornea away from the lower lid and minimizes the risk of touching the cornea with the dropper if the patient blinks.

If you are instilling eye drops, steady the hand, holding the medication bottle against the patient’s forehead.

Use the other hand to gently pull down the lower eyelid and instill the drops in the conjunctival sac not directly on the eyeball.

Release the patient’s eyelid and have him blink to distribute the medication

If an eye ointment is to be instilled, squeeze a small ribbon of medication off the edge of the conjunctival sac from the inner to the outer canthus.

Avoid touching the tube to the patient’s eyes. Cut off the ribbon by turning the tube. Then release the eyelid and have the patient roll her eye behind closed lids to distribute the medication.

Use a clean tissue to remove any excess solution or ointment leaking from the eye. Use a fresh tissue for each eye to prevent cross contamination.

Apply a new eye dressing if indicated.

Precautions and Contra-Indications of giving opthalmic instillations

If you are opening the drug container for the first time remember to write the date on the label because an opened container should be used within 2 weeks to avoid contamination

To prevent contamination, never use a medication container for more than one patient.

Keep in mind that certain drugs may cause eye disorders or other serious consequences. For example, anti-cholinergic, which are commonly used during eye examinations, may precipitate acute glaucoma in a predisposed patient.